Thomas Tracy N, Sobelson Robyn K, Wigington Corinne J, Davis Alyson L, Harp Victoria H, Leander-Griffith Michelle, Cioffi Joan P
Office of the Director, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia (Ms Thomas, Davis, Harp, and Leander-Griffith, and Dr Cioffi); and Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Sobelson, and Ms Wigington).
J Public Health Manag Pract. 2018 Jan/Feb;24(1):e16-e25. doi: 10.1097/PHH.0000000000000511.
Interventions and media campaigns promoting household disaster preparedness have produced mixed results in affecting behaviors. In large part, this is due to the limited application of instructional design strategies and behavior theory, such as the Transtheoretical Model (TTM). This study describes the development and evaluation of Ready CDC, an intervention designed to increase household disaster preparedness among the Centers for Disease Control and Prevention (CDC) workforce.
(1) Describe the instructional design strategies employed in the development of Ready CDC and (2) evaluate the intervention's impact on behavior change and factors influencing stage progression for household disaster preparedness behavior.
Ready CDC was adapted from the Federal Emergency Management Agency's (FEMA's) Ready campaign. Offered to CDC staff September 2013-November 2015, it consisted of a preassessment of preparedness attitudes and behaviors, an in-person training, behavioral reinforcement communications, and a 3-month follow-up postassessment.
Ready CDC employed well-accepted design strategies, including presenting stimulus material and enhancing transfer of desired behavior. Excluding those in the TTM "maintenance" stage at baseline, this study determined 44% of 208 participants progressed at least 1 stage for developing a written disaster plan. Moreover, assessment of progression by stage found among participants in the "precontemplation" (n = 16), "contemplation" (n = 15), and "preparation" (n = 125) stages at baseline for assembling an emergency kit, 25%, 27%, and 43% moved beyond the "preparation" stage, respectively. Factors influencing stage movement included knowledge, attitudes, and community resiliency but varied depending on baseline stage of change.
Employing instructional strategies and behavioral theories in preparedness interventions optimizes the potential for individuals to adopt preparedness behaviors. Study findings suggest that stage movement toward household preparedness was not spurious but rather associated with the intervention. Therefore, Ready CDC was successful in moving staff along the continuous process of adopting household disaster preparedness behaviors, thus providing a model for future interventions. The TTM suggests factors such as knowledge, beliefs, and self-efficacy will differ by stage and may differentially predict progression towards behavior adoption. Thus, tailoring interventions based on an individual's stage of change optimizes the potential for individuals to adopt desired behaviors.
旨在促进家庭备灾的干预措施和媒体宣传活动在影响行为方面取得了喜忧参半的结果。在很大程度上，这是由于教学设计策略和行为理论（如跨理论模型（TTM））的应用有限。本研究描述了“疾控中心备灾就绪计划”（Ready CDC）的开发与评估，该干预措施旨在提高疾病控制与预防中心（CDC）工作人员的家庭备灾能力。
（1）描述“疾控中心备灾就绪计划”开发过程中采用的教学设计策略，以及（2）评估该干预措施对行为改变的影响，以及影响家庭备灾行为阶段进展的因素。
“疾控中心备灾就绪计划”改编自联邦紧急事务管理局（FEMA）的“备灾就绪”活动。于2013年9月至2015年11月向疾控中心工作人员提供，包括对备灾态度和行为的预评估、面对面培训、行为强化沟通以及3个月后的随访后评估。
“疾控中心备灾就绪计划”采用了广受认可的设计策略，包括呈现刺激材料和增强期望行为的迁移。排除基线时处于TTM“维持”阶段的人员，本研究确定208名参与者中有44%在制定书面灾难计划方面至少前进了1个阶段。此外，按阶段对进展情况进行评估发现，在基线时处于“未考虑准备”（n = 16）、“考虑准备”（n = 15）和“准备”（n = 125）阶段以组装应急包的参与者中，分别有25%、27%和43%超越了“准备”阶段。影响阶段进展的因素包括知识、态度和社区复原力，但因基线变化阶段而异。
在备灾干预措施中运用教学设计策略和行为理论可优化个人采取备灾行为的可能性。研究结果表明，向家庭备灾的阶段进展并非虚假现象而是与干预措施相关。因此，“疾控中心备灾就绪计划”成功地推动工作人员在持续过程中采取家庭备灾行为，从而为未来的干预措施提供了一个模型。跨理论模型表明，知识、信念和自我效能等因素会因阶段而异，并且可能对行为采纳的进展有不同的预测作用。因此，根据个人的改变阶段量身定制干预措施可优化个人采取期望行为的可能性。
