The Role of Social and Behavioral Factors on Disaster Planning in Home Care

描述(申请人提供)：为了响应PA-11-265，呼吁对灾难中的老年人进行社会和行为研究，我们提出了这项R21探索性研究，以确定行为和社会因素在老年人特别脆弱的子集，即家庭护理接受者中对灾难准备的作用。正如最近的超级风暴桑迪所强调的那样，这一庞大且迅速增长的社区成员可能面临与灾害有关的发病率和死亡率增加的风险。我们最近进行的一项试点研究的数据记录了次优的应急准备规划，该研究涉及253名主要是老年人和残疾人的社区成员。在7个项目的准备量表上，平均得分为2.32(SD=2.74，范围0-7)。只有不到50%的参与者甚至拥有备灾计划的最基本要素，只有26%的参与者报告了在灾难事件期间获得个人援助的后备计划。在一种新的备灾社会认知理论的指导下，将收集和分析与备灾相关的各种社会和行为因素的定性数据。共有100名参与者将从纽约市和旧金山这两个高危地理区域招募。每个城市主要依赖非常不同的家庭护理援助模式；在纽约市，正式的家庭护理是通过经过认证或许可的机构提供的，而在旧金山，由受助者主导、由旧金山公共当局提供监督的护理是常态。因此，我们将有一个独特的机会来评估这些数据传递模型对可能预测准备计划的心理-社会结构的影响。这些结构包括：风险感知、结果预期、应对自我效能、感知责任感、社区意识、个人赋权和信任等。利用新开发的“准备好、愿意和能够”的准备框架，还将从参与者的家庭护理机构(在纽约市)、旧金山公共当局以及从纽约和旧金山的当地反应机构(如紧急情况管理办公室、卫生部、老年部等)收集信息。以确定其为家庭护理受助者制定的准备计划和应对能力。这些多个数据来源将使我们能够确定家庭护理患者的期望与家庭护理和反应机构能力之间的差距，以及社会和行为因素与这些差距的关联。这项研究提供的信息将有助于制定重要的政策战略，从而减少这一弱势群体中与灾害有关的不利后果的风险。

DESCRIPTION (provided by applicant): In response to PA-11-265, which calls for social and behavioral research on the elderly in disasters, we propose this R21 exploratory study to determine the role of behavioral and social factors on disaster preparedness in a particularly vulnerable subset of elderly people, namely home care recipients. As the recent super-storm Sandy underscored, this very large and rapidly growing population of community members may be at increased risk for disaster-related morbidity and mortality. Data from a pilot study we recently conducted, involving 253 mainly elderly and disabled community members, documented sub-optimal emergency preparedness planning. On a 7-item preparedness scale, the mean scale score was 2.32 (SD = 2.74, range 0- 7). Less than 50% of participants had even the most rudimentary elements of a preparedness plan, with only 26% of participants reporting back-up plans for obtaining personal assistance during a disaster event. Guided by a new social-cognition theory of preparedness, qualitative data on a wide range of social and behavioral factors associated with disaster preparedness will be collected and analyzed. A total of 100 participants will be recruited from two high risk geographic locales -- New York City and San Francisco. Each city relies primarily on very different models of home care assistance; in NYC formal home care is delivered through certified or licensed agencies, whereas in San Francisco, recipient-driven care, with oversight provided by the San Francisco Public Authority, is the norm. Thus we will have a unique opportunity to assess the influence of these data delivery models on psycho-social constructs that may predict preparedness planning. These constructs include: risk perception, outcomes expectancy, response self-efficacy, perceived responsibility, sense of community, personal empowerment, and trust, among others. Using the newly developed, "Ready, Willing and Able," preparedness framework, information will also be collected from the participants' home care agencies (in NYC), the San Francisco Public Authority, and from local response agencies in NYC and San Francisco (e.g., the Office of Emergency Management, Department of Health, Department on Aging, etc.) to determine their preparedness planning and response capabilities for home care recipients. These multiple sources of data will allow us to identify gaps between home care patients' expectations and home care and response agency capabilities, and the association of social and behavioral factors with these gaps. Information from this study will serve to inform important policy strategies that will lead to a reduction in risk of adverse disaster-related outcomes in this vulnerable population.