Extended Parallel Process Model (EPPM)

EPPM has been used/tested in various public health settings considering many health-related behaviors.4

Recommended by the Citizen Corps of the Federal Emergency Management Agency (FEMA) to understand disaster preparedness behaviors.5

Identifies the factors that influence how individuals respond to a message about potential threats (Fig. 1)

Successful programs should provide information to achieve appropriate levels of risk perception (increase awareness, motivation) and information to address efficacy (e.g., ways to develop personal and communication plans).6

Danger Control: When sufficient levels of motivation and efficacy perceptions are achieved, individuals are likely to take the recommended actions to avert risks.

Fear Control: If individuals perceive high levels of risks but low levels of efficacy, they may avert distress by avoiding the topic.

Background

• During disasters, older adults are vulnerable to adverse health consequences due to: medical regiment needs, limited knowledge, reduced preparedness, and limited support availability.1

• Older adults often report difficulty preparing due to associated expense, complicated preparation processes, and lack of support.2

• Rurality poses additional challenges: Older adults in rural areas are socially isolated3

Limited services and resources

Improving preparedness among older residents and building strong social support networks

is especially important in rural areas

Mitigate negative impacts, Ensure survival/well-being

Translating Intervention: PrepKids PrepWise

• The PrepKids program guides families of children with special healthcare needs to develop individualized disaster plans prior to an emergency.

• There is a focus on developing self-protective skills, enhancing disaster response self-efficacy and building resiliency of family networks. These factors are particularly relevant to older

adults living in rural areas.2

• Due to the similarities in medical and social needs, the contents of PrepKids were translated to fit the needs of older adults to develop PrepWise.

Main Objectives

(1) Develop an emergency preparedness tool for older adults through theory-guided formative research.

(2) Pilot test and obtain qualitative feedback from community residents (applicability, acceptability, implementation strategies) to further refine the program.

Using Extended Parallel Process Model to Guide the Development of a Tool to Assist Community-Dwelling Older Adults in Rural Areas Prepare for Disasters

1University of Iowa College of Public Health, Department of Community and Behavioral Health, 2 University of Iowa Aging Mind and Brain Initiative,

3University of Iowa School of Social Work, 4University of Iowa College of Public Health, Department of Occupational and Environmental Health

Sato Ashida, PhD1,2, Erin L. Robinson, MPH, MSW1,3, Ellen Schafer, MPH, MCHES1, Elizabeth Rook, MPH1, Marizen Ramirez, PhD, MPH4

Introduction

References:1. Li, R. (2009). Meeting Report: Advancing Behavioral and Social Research on

the Elderly in Disasters. Washington, DC: National Academies, National Institutes of Health.

2. Heller, K., Alexander, D., Gatz, M., Knight, B.G., & Rose, T. (2005). Social and personal factors as predictors of earthquake preparation: The role of support provision, network discussion, negative affect, age, and education. Journal of Applied Social Psychology, 35(2), 399-422.

3. Baernholdt, M., Yan, G., Hinton, I., Rose, K., & Mattos, M. (2012). Quality of life in rural and urban adults 65 years and older: findings from the national health and nutrition examination survey. The Journal of Rural Health, 28(4), 339-347.

4. Witte, K., Meyer, G., & Martell, D. P. (2001). Effective health risk messages: A step-by-step guide. Thousand Oaks, CA: Sage Publications.

5. Belle, S. H., Burgio, L., Burns, R., Coon, D., Czaja, S. J., Gallagher-Thompson, D., ... Zhang, S. (2006). Enhancing the quality of life of dementia caregivers from different ethnic or racial groups: A randomized, controlled trial. Annals of Internal Medicine, 145(10), 727-738.

6. Witte, K., & Allen, M. (2000). A meta-analysis of fear appeals: Implications for effective public health campaigns. Health Education & Behavior, 27(5), 591-615.

7. Eriksen, E. (1950). Childhood and Society. New York: W. W. Norton & Company.

Theoretical Framework

Intervention Goal: To guide individuals to engage in Danger Control Processes by: Eliciting appropriate levels of risk perceptions (susceptibility and severity) Emphasizing the benefits of being prepared (response efficacy) Developing self-protective and communication skills (self-efficacy) to facilitate preparedness

Methods Implications

Step 1: Comprehensive Review

• Content analysis results of preparedness resources were compared to the original PrepKids program.• Original program contained topics on: 1) packed go kit; 2) packed stay kit; 3) evacuation; 4) shelter in

place; 5) pets, service animals; 6) receiving disaster information; 7) interpersonal communication; 8) assistive devices; 8) practice evacuation; and 9) types of disaster.

• Five new topics and two types of disasters that were not included in the original program were added.

Steps 2 and 3: Individual Interviews and Focus Groups

Service Providers• Perceived threat: Older adults in our community are at high risk for adverse outcomes.• Response efficacy: Older adults following the PrepWise recommendations can help improve outcomes.• Self-Efficacy: It will be difficult for older adults to follow some of the recommended actions.

Older Adults• Perceived threat: High perceived severity, but lower susceptibility levels. “I’ve never been through one

and I’ve lived here 20 years”; “That’s not gonna happen to me. It’s gonna happen down the street.”• Response efficacy: Excited that steps recommended would help them prepare better (e.g., how to

develop support network, keeping 3 to 7 days of medication and medical supplies)• Self-Efficacy: Some indicated high (“I don’t think they’ll be that hard to do”; “It’s fairly simple”) and others

indicated low levels (“Being on my disability, I just paid my rent, so don’t have a lot of money”).

Results

Message Components

• Self-Efficacy: Personal ability to follow through with the recommended actions

• Response Efficacy: Taking the recommended actions can successfully reduce the negative consequences

• Susceptibility: Likelihood of experiencing a disaster or emergency

• Severity: Consequences of the disaster or emergency

External Stimuli

Perceived Efficacy

• Self-Efficacy• Response Efficacy

Perceived Threat• Susceptibility• Severity

Fear

Defensive Motivation

Message Rejection

Message Acceptance

Protection Motivation

Change in Perceptions Outcomes

Danger Control

Process

Fear Control

No threat perceived (no response)

Figure 1.

Figure 2.

Discussion

To assist older adults in taking Danger Control Processes:• May need to increase susceptibility perceptions among those who have never experienced disasters.• Some may benefit from increasing the response efficacy of recommended actions success stories.• Many efforts should focus on increasing self-efficacy.

Suggestions from Participants: Increasing Self-Efficacy

• Assist older adults in preparing for disasters in addition to the recovery of disasters.• Educator or health professional should walk through the PrepWise tool with older adults.• Provide detailed instructions:

• Where to obtain items and equipment introduced in the program• What questions to ask health professionals: medications and medical regimen during disaster• Who to contact: list of local resources• How to talk to family and neighbors; what should be discussed

Future Directions

• Some changes have been implemented and more are expected based on further analyses.• Test different methods of delivery: group training, home visit, or web-based.

Acknowledgements: This research was funded in part by grant # 1R49CE002108-01 of the National Center for Injury Prevention and Control/CDC.

We would like to thank the participants of this study for sharing their stories and thoughts, as well as the community based organizations that helped make this research possible. We also would like to thank graduate research assistants Lauren Slagel and Audrey Schroer for their assistance on this project.

Topic added New section1. How to prepare: medication “Ask your doctor, pharmacist, and service providers”2. Assisting others “Assisting those with dementia”3. Post disaster coping “Everyone is affected by disasters-it’s OK to ask for help”4. Scams “Financial exploitation and scams”5. Role of Older Adults “Seniors play an important role in the community” Disaster type (2) “Severe winter storm,” “biological threat (e.g., influenza)”

Danger Control Processes

• “I should go home and do it”: “Well, it makes me think that I should act on this information after the presentation. I shouldn't just go home and file this.”

• Will talk to family and friends about this: “I’d like to get another one of these for my daughter.”

Fear Control Processes

• “I don’t want to think about it”: “Same reason I haven’t got my final passage papers written up for when I die. I just don’t wanna think about it!”

• “Whatever’s gonna happen is gonna happen”: “If we’re too old, we don’t give a darn”

Empowering Older Adults to Engage in Preparedness Behaviors

Older adults desire to contribute to the community and future generations (Theory of Generativity7)

“Seniors play an important role in the community during disasters” Older adults are often valuable resources in the community. Being prepared will help you help others.

Comprehensive Review

• Content analysis of preparedness publications for older adults: CDC, DHHS, AoA, FEMA, Red Cross, The Hartford Geriatric Education Center

Individual Interviews

• Staff from Aging Network Service Agency (N=5): Director, case manager, meals coordinator, nutrition specialist, volunteer coordinator

• Adults ages 60+ residing in the local community (N=5)

Pilot Testing

• Group preparedness training sessions(N=5 groups):A pre-training survey and one-month post survey administered.

• Focus groups after the training session (N=30 individuals): Feedback on materials and training implementation gathered.

Version 1

Version 2

Step 1

Version 3

Step 2

Step 3