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

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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.