Ejeta Luche Tadesse, Ardalan Ali, Paton Douglas
Department of Disaster & Emergency Health, School of Public Health, Tehran University of Medical Sciences-International Campus, Tehran, Iran; Private Consultant, Addis Ababa, Ethiopia.
Department of Disaster Public Health, School of Public Health, Tehran University of Medical Science, Tehran, Iran; Department of Disaster and Emergency Health, National Institute of Health Research, Tehran University of Medical Science, Tehran, Iran; Harvard Humanitarian Initiative, Harvard University, Cambridge, USA.
PLoS Curr. 2015 Jul 1;7:ecurrents.dis.31a8995ced321301466db400f1357829. doi: 10.1371/currents.dis.31a8995ced321301466db400f1357829.
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 step to 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.
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.
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 in other 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 in Social 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.
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.
个人、社区和组织层面的灾害与应急准备工作，可能是减轻灾害风险（不断上升的发生率）及其影响的更有效工具。也就是说，在减少灾害风险（DRR）方面发挥更重要的作用。准备工作侧重于改变人类行为，以降低人们面临的风险，并增强他们应对灾害后果的能力。虽然准备工作倡议利用行为理论来促进减少灾害风险，但已使用了许多理论，对于哪些行为理论更常用、在何处使用以及为何比其他行为理论更受青睐，人们却知之甚少。鉴于不同理论在使用的变量及其相互关系方面存在差异，系统分析是回答有关理论相对效用问题并为减少灾害风险战略的准备工作提供更有力证据基础的关键第一步。本系统评价的目的是通过评估行为理论在全球灾害与应急卫生准备中的应用来搜索和总结证据。
制定了研究方案，在研究开始时确定了研究目标、问题、纳入和排除标准以及敏感的搜索策略，并进行了预试验。使用选定的关键词，主要在PubMed、Scopus、Mosby索引（护理索引）和Safetylit数据库中搜索文章。根据文章的标题、摘要和全文进行评估。从选定的文章中提取数据，并使用定性和定量方法呈现结果。
总共评估了2040篇文章的标题、450篇摘要和62篇全文是否符合纳入标准，同时从其他来源存档了5篇文章，最终选定了33篇文章。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用于流感（H1N1和H5N1）、洪水和地震灾害。研究主要在美国进行（13项研究）。在亚洲，每年的灾害和受灾人数超过其他各大洲，但仅确定了3项研究。总体而言，HBM的主要构成要素（感知易感性、严重性、益处和障碍）、EPPM（更高的威胁和更高的效能）、TPB（态度和主观规范）以及社会认知理论中使用的大多数构成要素都与应对各种灾害的准备工作相关。然而，虽然上述所有理论都描述了构成变量之间的关系，但除了社会认知理论的研究外，很少有其他理论和模型的研究使用路径分析来确定各自理论/模型中所描述的构成要素之间的相互依存关系。同样，很少有研究确定其他中介变量如何影响灾害与应急准备工作。
关于行为理论和模型在灾害与应急准备中的应用的现有证据主要来自发达国家。这引发了关于它们在其他国家，特别是在亚洲和中东国家的效用问题，在这些国家，文化特征与理论已得到发展和检验的西方国家大不相同。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准备指南的效用的信息。因此，未来与行为理论和模型相关的应对准备工作的研究需要针对灾害风险高且因此对应对准备有需求的发展中国家。本分析还确定需要开展更多工作来证明变量和构成要素之间的关系，包括更清晰地阐明中介效应的作用。
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