The RAND team conducted interviews with 50 individuals via site visits in four states/regions across the country.
Criteria for choosing sites. We initially screened states using the criterion that they were exemplars with respect to PHEP planning. We based this criterion on other ongoing RAND work in emergency preparedness and prioritized exemplary sites based on the size of the population and their distribution of at-risk populations, using statistics from the United States 2000 Census. We chose sites that represented disparate regions of the United States and had varied concentrations of urban or rural areas. We avoided sites that were over-studied (e.g., Louisiana) to reduce the research burden on potential informants and sites that would not be generalizable to the other sites (e.g., New York, given its extreme mix of urban and rural areas and its exposure to terrorism).
Although the initial site screening was based on exemplary work in PHEP, it was unclear if any state had yet emerged as exemplary in risk communication within emergency preparedness, especially as it related to risk communication with at-risk populations. We made many attempts to garner such information through informal conversations with emergency preparedness experts, emergency preparedness conference attendees, and Internet searches. We learned that although no state has yet been identified as exemplary in risk communication based on empirical evidence or consensus from public health informants, states that are leading innovative efforts in PHEP may have developed promising risk communication strategies for at-risk populations.
|TABLE 1. Sites Selected, Disaster Types, and At-Risk Populations|
|Site (Region)||Disaster Types||At-Risk Populations and Considerations|
|California (West)||Earthquakes, fires, floods, and landslides; terrorist threats to the Golden Gate Bridge and shipping ports||Diverse cultures (26% foreign-born) and non-English speakers (20% speak English “less than very well”); the vast majority (94%) of the 35 million residents live in urban areas in which commuting during disasters is a concern|
|Florida (South)||Hurricanes and flooding; receives evacuees from other states due to natural disasters||Senior citizens (17%); disabled (22%); and diverse cultures (17% foreign-born); and non-English speakers (10% speak English “less than very well”)|
|Metropolitan Washington Area (Montgomery County, MD, and Washington, DC) (East)||Hurricanes, winter storms and flooding; domestic terrorism; as the nation’s capital, this area remains a high-risk target for terrorism||Disabled (22%) and living below the federal poverty limit (>18%); relatively high percentage using the transportation system, which could make a large proportion of the population at-risk during a disaster, and a high proportion of African Americans (60%)|
|Oklahoma (Midwest)||Tornadoes, floods, and severe winter storms; domestic terrorism||Less populated state (3.5 million persons) with a relatively high number of rural persons living below the poverty limit (14%), disabled persons (22%), and diverse cultures (38 federally recognized Native American tribes)|
|SOURCES: Federal Emergency Management Agency Declared Disasters by Year or State, available at http://www.fema.gov/news/disaster_totals_annual.fema; U.S. Census Bureau, 2000.|
Given this context, we chose sites for our study that: use innovative public health emergency practices or are considered “exemplars” in this field, have experienced a range of potential public health emergencies that other states would experience, represent the at-risk populations of interest, and are geographically diverse.
Sites selected for study. The sites selected for our study were California, Florida, the Metropolitan Washington Area, and Oklahoma (see Table 1). In the Metropolitan Washington Area, we focused on two jurisdictions: (1) Washington, DC; and (2) Montgomery County, Maryland. These sites are geographically diverse. Cumulatively, these areas experience a variety of natural disasters (i.e., earthquakes, fires, floods, landslides, ice storms, hurricanes, and tornadoes) as well as other emergencies and include areas at higher risk for terrorism. The sites are also areas with a greater than normal proportion of at-risk populations (e.g., senior citizens in Florida, non-English speaking populations in California).
Interview sample. We interviewed a total of 50 individuals working in emergency preparedness and risk communication with at-risk populations between May and July 2008. We used semi-structured interviews conducted in person or by phone, each lasting approximately 45 minutes to two hours long. Interviewees were a convenience sample based on referrals, cold calls, and contacts we made or had in the four sites.3 The distribution of interviewees by site was as follows: California (n=11), Metropolitan Washington Area (n=9), Florida (n=14), and Oklahoma (n=15). Interviews were conducted primarily with individuals from community-based organizations (CBOs), state and local departments of public health, and other state and local government agencies (e.g., Departments of Rehabilitation, Aging, or Social/Human Services) (see Table 2).
The CBOs that our informants belonged to overwhelmingly addressed issues of PWD (including older adults with disabilities) followed by organizations that served senior citizens. Two organizations addressed issues of pregnant women, children, non-English speaking populations, and those from diverse cultures.
|TABLE 2. Interview Sample by Organizational Type (N = 50)|
|Departments of Public Healtha||13||26|
|Departments/Offices of Emergency Managementa||4||8|
Interview content. We developed an interview guide to elicit information about current risk communication practices (both that they were undertaking and other practices they are aware of in their area) with at-risk populations as they pertained to the broader study goals. Human subject protections and data safeguarding procedures were approved by RAND’s Human Subject Protection Committee. The protocol covered six domains:
Emergency plans for risk communication (e.g., What plans are currently in place? Who is responsible for message formulation and delivery?).
Risk communication for at-risk populations (e.g., Are at-risk populations specifically addressed in risk communication plans. Which at-risk populations are your focus? Are representatives from at-risk populations involved in the development and execution of plans/strategies?).
Current risk communication practices for at-risk populations (e.g., How were strategies developed? What other organizations were involved? What modes of communication are you using?).
Evaluation of risk communication strategies (e.g., Have you evaluated the impact of existing risk communication activities for at-risk populations? What have you learned?).
Challenges/barriers to risk communication in at-risk populations.
Data analysis. A team of five RAND staff took notes at each interview and compiled and analyzed the notes at the site. Site visit summaries were merged and compared across sites. We based our analyses on the six domains of the protocol and organized common themes across sites.
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