International Journal of
Environmental Research and Public Health Article
Residents’ Disaster Preparedness after the Meinong Taiwan Earthquake: A Test of Protection Motivation Theory Jing-Shia Tang 1,2 and Jui-Ying Feng 3,4, * 1 2 3 4
*
Department of Nursing, Chung Hwa University of Medical Technology, No. 89, Wenhua 1st St., Rende Dist., Tainan 71703, Taiwan;
[email protected] International Doctoral Program in Nursing, College of Medicine, National Cheng Kung University, No. 1, University Rd., Tainan 70101, Taiwan Department of Nursing and Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan Department of Nursing, National Cheng Kung University Hospital, No. 1, University Rd., Tainan 70101, Taiwan Correspondence:
[email protected]; Tel.: 886-6-235-3535 (ext. 5851)
Received: 8 June 2018; Accepted: 6 July 2018; Published: 7 July 2018
Abstract: Because effective preparations are required to mitigate disaster impacts before implementing effective interventions, it is important to understand why people do or do not act on disaster preparedness. This study explores factors influencing residents’ intentions and actual behaviors following the 2016 Kaohsiung Meinong earthquake in southern Taiwan. Protection Motivation Theory was used to develop a hypothesized model to test hypotheses regarding residents’ disaster preparedness, and structural equation modeling (SEM) was used to test the model. Data were comprised of 286 valid responses from seven major administration areas in Tainan, Taiwan. Self-efficacy, response-efficacy, and obstacles were significantly correlated with behavioral intentions and actual disaster preparedness behaviors. SEM results revealed that (a) the model fit the data well, (b) the relationship between risk perception and response-efficacy was fully mediated by behavioral intention, and (c) self-efficacy and obstacles were partially mediated by behavioral intention. Behavioral intent and actual disaster preparedness behavior are related but not equal. The main factors affecting actual disaster preparedness behavior are self-efficacy and obstacles. Therefore, strategies like drills or workshops can improve disaster-preparedness knowledge and capabilities and reduce difficulties of implementing disaster preparedness. To improve health and well-being, healthcare providers should promote disaster preparedness by interventions to increase self-efficacy during disasters. Keywords: disaster preparedness; protection motivation theory; earthquake; Taiwan
1. Introduction Only effective disaster preparedness can mitigate the impacts future disasters are likely to have on human lives, health, and property [1,2]. Enhancing preparedness for hazardous events is mainly concerned with mitigating damage and addressing potential threats [3,4]. Earthquakes are among the most powerful natural forces in the world and differ from other destructive phenomena such as typhoons, tornadoes, and floods that are precipitated by extreme climates. Although earthquakes occur less frequently than other natural disasters, because of their unpredictability, people need to prepare for them before they occur.
Int. J. Environ. Res. Public Health 2018, 15, 1434; doi:10.3390/ijerph15071434
www.mdpi.com/journal/ijerph
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Taiwan is located in an active seismic region, and the epicenter of the Meinong earthquake occurred in Kaohsiung City, Taiwan, at 3:57 a.m. on 6 February 2016. The depth of the source that generated these seismic waves was 14.6 km, and the event measured 6.6 on the Richter magnitude scale. The earthquake caused the deaths of 117 people and injured 510 people in Tainan City, which is about 50 km from Kaohsiung City. Eight houses were completely destroyed, and five houses partially collapsed [5]. The participants in this study are residents who experienced this earthquake. Some had taken preparedness actions, while others had not. Preparedness is not only a form of disaster management, but also a dynamic form of health promotion [6]. Therefore, healthcare providers have a responsibility to promote disaster preparedness among individuals, households, and communities [7] to improve people’s health and well-being. To increase disaster preparedness behavior among residents, it is necessary to explore factors related to disaster preparedness motivations and behaviors prior to the implementation of appropriate disaster preparedness strategies. Protection Motivation Theory (PMT)—a health promotion model—states that some form of risk information can provide the impetus for an individual to determine the degree of risk severity, their vulnerability, and their ability to reduce that risk. PMT was first proposed by Rogers [8] in 1975 (and revised in 1985) to describe the mechanisms people use to adopt protective behaviors and reduce perceived threats. It explains that a cognitive process informs the efforts taken to protect oneself from harm and can be used to analyze both maladaptive behavior and adaptive response. For example, maladaptive responses are those that place an individual at health risk by either engaging in a health behavior risk (e.g., smoking) or not adopting a protective behavior or adaptive responses (e.g., getting vaccinated). PMT posits that health protection behaviors and disaster preparedness intentions are motivated by the same principles. Therefore, Grothmann and Patt [9] suggest that PMT can be used to explore disaster preparedness behavior. Thus, PMT has become one of the most widely applied disaster prevention decision-making models [10]. Related studies have explored threat appraisals among people that considered (1) the severity of the threat (individuals’ estimates of likely harmful consequences and severity) and (2) the probability that the threat would come to pass (the probability that individuals would incur damage from a particular threat). When people appraise a threat, they come to realize the existence of certain risks. Therefore, threat appraisal is also referred to as risk perception [11]. Self-efficacy and response-efficacy are essential components of an effective coping strategy [12] and refer to the existing levels of individuals’ abilities in relation to the recommended level of disaster preparedness and its effectiveness [13]. Furthermore, behavioral intentions may be influenced by both an individuals’ appraisal of a threat and their ability to cope. How people respond to disasters depends on their assessment of the damage likely to be inflicted on their environment and them. Similar to preventive medicine, one preventive measure that can be taken to mitigate the damage inflicted by a disaster includes improving people’s disaster preparedness. Although many people are fearful of the severe damage a natural disaster can cause them, their families, and society, they lack the motivation needed to engage in disaster preparedness [14]. In Taiwan, earthquake preparedness is mostly considered from the perspective of building structures [15–18] and is limited to considering factors that may influence residents to initiate behaviors that could protect them in the event of a disaster. Thus, when their disaster preparedness includes implementing effective prevention and mitigation measures, people develop abilities that will enable them to cope with various situations. People’s attitudes towards disaster preparedness are influenced by their personal characteristics, family circumstances [19,20], belief-related variables such as hazard beliefs, and how they assess their self-efficacy and outcome efficacy [13]. Lindell et al. [19] found that people with higher levels of disaster preparedness include families with vulnerable family members (e.g., elderly, children, and the disabled). Previous studies also found that other predictors of disaster preparedness behavior include high educational levels [13], home ownership, length of residence at their current address [21], perceived vulnerability [22], and previous disaster exposure [23,24]. In particular, perceived efficacy
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137 (47.9)
According to Hoyle [30] and Loehlin [31], because structural equation modeling (SEM) relies on tests that are sensitive to sample size, the sample size should be at least 100, preferably 200. A total of 305 responses were retrieved. However, nine responses were invalid due to missing data and thus Int. J. Environ. Res. from Public Health 2018, 15,analyses. 1434 3 of 12 were excluded subsequent The response rate was 94%, and 286 valid responses were analyzed. All participants had been living in their administrative areas from the day of the Meinong Taiwan 2016 in until the survey was conducted between October 2016 andhave July also 2017.been plays a earthquake critical role in [25,26] predicting disaster preparedness. Inconsistent results
found with regard to people’s risk perceptions. For example, Lindell and Perry [27] analyzed 23 studies 2.2. Questionnaire and concluded that higher risk perceptions tended to result in actual disaster preparedness behaviors. self-developed was based the modified PMT (Figure The SomeAstudies, however,questionnaire do not support thedesigned proposition thaton higher risk perceptions result in1).actual self-reported included 88 items that were used to in measure preparedness in preparations questionnaire being made [13,28]. A study of 885 residents living France,disaster for example, found that relation to six subscales: risk perception, response-efficacy, higher perceptions of risk positively influencedself-efficacy, people’s intentions to implementobstacle, preventivebehavioral measures intention, actual behavior. Specific assessments [29]. were also made with regard to whether they but did notand significantly influence their preparedness had aResearch stock of on emergency and had completed family emergency plan and a behavior home safety the socialsupplies cognitive perspective that a aperson’s disaster preparedness can assessment. being the the disaster preparedness questionnaire wasItreviewed be explainedBefore is limited in finalized, Taiwan, and purpose of this study is to address(DPQ) this gap. analyzes and evaluated by fivepreparedness experts (the chief executive officer of thethe Emergency Operations Center, an the levels of disaster that were evident following earthquake in southern Taiwan assistant professor of public health, aPMT lecturer of psychiatry nursing, an emergency nurse, and in 2016, and it draws on a modified to explore what factors motivated some room residents to take asteps structural engineer), and four were deleted a lower score. The final to prepare themselves foritems a disaster. We alsobecause test thatthey the had obstacles canmean directly motivate or questionnaire comprised 84 items. Respondents were asked to model rank each item on a 5-point Likert restrain intention and preparedness actions. We propose a path of preparedness (as shown in scale from 1 (“strongly disagree” or “not at all,” depending on the question)and to obstacles) 5 (“strongly Figure 1) that includes four domains (risk serious perception, self-efficacy, response-efficacy, as agree” or “very serious”). were expected to be intention) able to complete the questionnaire in 20 independent variables andParticipants one latent variable (behavioral as a mediator of how disaster minutes. The psychometric properties of This the DPQ were acceptable, with content of preparedness influenced actual behavior. model hypothesizes that theaeffects of validity the four index domains 0.95, Cronbach’s alphas test-retest reliabilities on preparedness actionsfrom may 0.78–0.95, actually beand indirect effects mediated of by0.44–0.79. behavioral intentions.
Figure Figure 1. 1. Behavioral Behavioral intention intentionfactors factorsaffecting affecting actual actual disaster disasterpreparedness preparedness behavior behavior (Modified (Modified from from the Protection Protection Motivation Theory [12]). the
2.3. Data Analysis Premised on the modified PMT, specific hypotheses were formulated and tested. Three of these hypotheses were aswas follows: Data analysis conducted using SPSS 22.0 (SPSS Inc., Chicago, IL, USA), and the significance level was set at α < 0.05. t-tests were used to test for significant differences between the groups. Hypothesis 1 (H1). Disaster preparedness in terms of risk perception, self-efficacy, response-efficacy, and obstacles is dependent on personal characteristics.
Hypothesis 1 (H2). Residents’ risk perceptions, self-efficacy, response-efficacy, and obstacles can be associated with behavioral intentions and actual behavior in regard to disaster preparedness. Hypothesis 1 (H3). Behavioral intention mediates the relationship between risk perception, self-efficacy, response-efficacy, obstacles, and actual behavior with regard to disaster preparedness.
2. Materials and Methods 2.1. Design and Participants This study was based on a two-step, descriptive, cross-sectional design. The first step involved conducting a preliminary study to develop a questionnaire and recruiting 30 Tainan residents as
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participants for a test-retest. During the second step, which represented the main part of the study, data were obtained from seven administrative areas in Tainan. Participants had to be between 20 and 80 years of age, registered and living in Tainan City, have no mental illness, and be able to read and write Mandarin. Residents who were registered but did not live in Tainan or were not in Tainan during the Meinong Taiwan earthquake were excluded. The participants’ average age was 38.1 ± 10.95 years, with a range between 20 and 79 years. Most were women (65.7%) and had a college degree or higher (75.9%). Married and single persons each accounted for nearly half of all participants (49.3% vs. 48.3%, respectively). Those who lived with elderly family members accounted for 27.6% of the participants, and people with children under 18 years old accounted for 43.0% of the participants. Most had a religious affiliation, a job, and owned a house (Table 1). Table 1. Participants’ demographic characteristics (n = 286). Variables Mean age Gender (F) Education
Number (%) 38.1 (±10.95) Range 20–79 years
n = 268
College or higher
187 (65.6) 217 (75.9)
Marital status
Married Single Divorced
141 (49.3) 138 (48.3) 7 (2.4)
Living with families
>65 years 65 years and
