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

描述（由申请人提供）：根据PA-11-265要求对灾害中老年人的社会和行为进行研究，我们提出了R21探索性研究，以确定行为和社会因素对特别脆弱的老年人群体即家庭护理接受者的备灾作用。正如最近的超级风暴“桑迪”所强调的那样，这一数量庞大且增长迅速的社区成员可能面临着与灾害相关的发病率和死亡率增加的风险。我们最近进行了一项试点研究，涉及253名主要是老年人和残疾人的社区成员，研究数据表明应急准备计划不够理想。在7项准备量表上，平均量表得分为2.32 （SD = 2.74，范围0- 7）。只有不到50%的参与者拥有最基本的准备计划，只有26%的参与者报告了在灾难事件中获得个人援助的备用计划。在新的备灾社会认知理论的指导下，将收集和分析与备灾有关的广泛的社会和行为因素的定性数据。总共100名参与者将从两个高风险地区——纽约和旧金山招募。每个城市主要依靠非常不同的家庭护理援助模式；在纽约，正规的家庭护理是通过认证或有执照的机构提供的，而在旧金山，由旧金山公共当局提供监督的接受者主导的护理是常态。因此，我们将有一个独特的机会来评估这些数据交付模型对可能预测准备计划的心理-社会结构的影响。这些构念包括：风险感知、结果预期、反应自我效能、感知责任、社区意识、个人赋权和信任等。使用新开发的“准备、意愿和能力”准备框架，还将从参与者的家庭护理机构（纽约市）、旧金山公共当局以及纽约市和旧金山的当地响应机构（例如，应急管理办公室、卫生部、老龄部等）收集信息，以确定他们对家庭护理接受者的准备计划和响应能力。这些多种来源的数据将使我们能够识别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。这项研究的信息将为重要的政策战略提供信息，从而减少这一弱势群体遭受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.