Application of Behavioral Theories to Disaster and Emergency Health Preparedness: A Systematic Review.
Application of Behavioral Theories to Disaster and Emergency Health Preparedness: A Systematic Review.
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DOI：
10.1371/currents.dis.31a8995ced321301466db400f1357829
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发表时间：
2015-07-01
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影响因子：
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通讯作者：
Paton, Douglas
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文献类型：
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作者：
Ejeta, Luche Tadesse;Ardalan, Ali;Paton, Douglas
背景技术背景：在个人、社区和组织各级对灾害和紧急情况的防备，可以成为减轻灾害风险（日益增加的发生率）和减轻其影响的更有效的工具。也就是说，在减少灾害风险（DRR）方面发挥更重要的作用。备灾工作的重点是改变人类行为，减少人们的风险，提高他们科普灾害后果的能力。虽然准备计划使用行为理论来促进DRR，但人们使用了许多理论，但人们对哪些行为理论更常用、在哪里使用以及为什么它们比替代行为理论更受欢迎知之甚少。鉴于理论在所使用的变量和变量之间的关系方面存在差异，系统分析是回答有关理论相对效用的问题并为减灾战略的备灾组成部分提供更有力的证据基础的重要第一步。本系统评价的目标是搜索和总结证据，通过评估的应用行为理论的灾难和紧急卫生preparationacross the world.METHODS：该协议的准备，其中的研究目标，问题，纳入和排除标准，和敏感的搜索策略的开发和试点测试在研究开始。使用选定的关键词，主要在PubMed、Scopus、Mosby索引（护理索引）和Safetylit数据库中检索文章。根据文章标题、摘要和全文对文章进行评估。结果：共检索到2040篇文章，450篇摘要和62篇全文，其中5篇为其他来源的文献，最终筛选出33篇。健康信念模型（HBM）、扩展平行过程模型（EPPM）、计划行为理论（TPB）和社会认知理论最常应用于流感（H1N1和H5 N1）、洪水和地震灾害。研究主要在美国进行（13项研究）。在亚洲，每年的灾害和受害者人数超过其他大陆，但只确定了三项研究。总体而言，HBM（感知易感性，严重性，利益和障碍），EPPM（更高的威胁和更高的效率），TPB（态度和主观规范）的主要结构，以及社会认知理论中使用的大多数结构与各种危险的准备有关。然而，尽管上述所有理论都描述了构成变量之间的关系，但除了对社会认知理论的研究之外，很少有其他理论和模型的研究使用路径分析来确定各个理论/模型中描述的结构之间的相互依赖关系。同样，很少有其他中介变量如何影响灾害和应急preparation.CONCLUSIONS：现有的证据上的应用行为理论和模型的灾害和应急准备主要是来自发达国家。这就提出了关于它们在各国，特别是在亚洲和中东的效用问题，这些国家的文化特征与西方国家的文化特征大不相同，而西方国家的理论已经得到发展和检验。这里讨论的理论和模型主要应用于疾病爆发和自然灾害，缺乏关于它们作为人为灾害防备指南的效用的信息。因此，未来的研究涉及行为理论和模型，解决准备需要针对发展中国家的灾害风险和随之而来的准备需要高。这项分析还指出，需要开展更多工作，说明变量和结构之间的关系，包括更明确地阐明中介效应的作用。
BACKGROUND: Preparedness for disasters and emergencies at individual, community and organizational levels could be more effective tools in mitigating (the growing incidence) of disaster risk and ameliorating their impacts. That is, to play more significant roles in disaster risk reduction (DRR). Preparedness efforts focus on changing human behaviors in ways that reduce people's risk and increase their ability to cope with hazard consequences. While preparedness initiatives have used behavioral theories to facilitate DRR, many theories have been used and little is known about which behavioral theories are more commonly used, where they have been used, and why they have been preferred over alternative behavioral theories. Given that theories differ with respect to the variables used and the relationship between them, a systematic analysis is an essential first stepto answering questions about the relative utility of theories and providing a more robust evidence base for preparedness components of DRR strategies. The goal of this systematic review was to search and summarize evidence by assessing the application of behavioral theories to disaster and emergency health preparedness across the world.METHODS: The protocol was prepared in which the study objectives, questions, inclusion and exclusion criteria, and sensitive search strategies were developed and pilot-tested at the beginning of the study. Using selected keywords, articles were searched mainly in PubMed, Scopus, Mosby's Index (Nursing Index) and Safetylit databases. Articles were assessed based on their titles, abstracts, and their full texts. The data were extracted from selected articles and results were presented using qualitative and quantitative methods.RESULTS: In total, 2040 titles, 450 abstracts and 62 full texts of articles were assessed for eligibility criteria, whilst five articles were archived from other sources, and then finally, 33 articles were selected. The Health Belief Model (HBM), Extended Parallel Process Model (EPPM), Theory of Planned Behavior (TPB) and Social Cognitive Theories were most commonly applied to influenza (H1N1 and H5N1), floods, and earthquake hazards. Studies were predominantly conducted in USA (13 studies). In Asia, where the annual number of disasters and victims exceeds those inother continents, only three studies were identified. Overall, the main constructs of HBM (perceived susceptibility, severity, benefits, and barriers), EPPM (higher threat and higher efficacy), TPB (attitude and subjective norm), and the majority of the constructs utilized inSocial Cognitive Theories were associated with preparedness for diverse hazards. However, while all the theories described above describe the relationships between constituent variables, with the exception of research on Social Cognitive Theories, few studies of other theories and models used path analysis to identify the interdependence relationships between the constructs described in the respective theories/models. Similarly, few identified how other mediating variables could influence disaster and emergency preparedness.CONCLUSIONS: The existing evidence on the application of behavioral theories and models to disaster and emergency preparedness is chiefly from developed countries. This raises issues regarding their utility in countries, particularly in Asisa and the Middle East, where cultural characteristics are very different to those prevailing in the Western countries in which theories have been developed and tested. The theories and models discussed here have been applied predominantly to disease outbreaks and natural hazards, and information on their utility as guides to preparedness for man-made hazards is lacking. Hence, future studies related to behavioral theories and models addressing preparedness need to target developing countries where disaster risk and the consequent need for preparedness is high. A need for additional work on demonstrating the relationships of variables and constructs, including more clearly articulating roles for mediating effects was also identified in this analysis.