# Presentation: 046594

## National Prevention SummitEstablishing a Culture of Preparedness October 27, 2006

**Moving the Needle Toward Increased All-Hazards Preparedness: A Personal Behavior Change Model**

**Notes:**
With just a brief amount of time, I’m going to jump right in and share with you as much information as I can about the work we are doing with the Department of Homeland Security’s Office of Community Preparedness, to help move the needle toward increased all-hazards preparedness – and by all-hazards, I mean any natural disasters such as hurricanes, floods, earthquakes, as well as man-made threats like terrorist attacks, and also infectious disease threats, like pandemic flu.  I apologize in advance for speeding through some of the information, but I want to cover the major points, and then each of you can take a copy of the model and its narrative with you before you leave. 

## Current and Trend Data

- NCDP DATA:
- < 1/3 of Americans (31%) have a basic family emergency plan (two days supply of food and water, a flashlight, a portable radio, spare batteries, and emergency phone numbers and a meeting place)
- 66% feel personally unprepared
- In New York State and NYC, fewer people (26%) have a basic family preparedness plan compared to 31% nationally

**Notes:**
Several national surveys have revealed a relatively consistent insufficient level of preparedness among Americans.  

Data from the National Center for Disaster Preparedness at Columbia’s Mailman School of Public Health showed that in 2006:...

[1]	ORC Macro. (2003). ORC Macro research on U.S. households (Final report presented to Citizen Corps). Calverton, MD: Author. 
[2]	ORC Macro. (2005–06). Citizen preparedness review: Methodological considerations and key findings in preparedness research. Issues 1 and 2. Unpublished manuscript. 
So what did we find?  We found that fewer than half of the households have a disaster plan. 

## Current and Trend Data

- ORC MACRO DATA:
- Does your household have a disaster plan at home that includes instructions about where to go and what to do during a disaster situation?   Pre-Katrina: 58%;              Post-Katrina:   43%
- Have you discussed this disaster plan with others in your household, such as family or roommates?    39% (2005)
- Does your disaster plan include a specific meeting location for all members of the household to meet during or after a disaster?   37% (2005)

**Notes:**
ORC Macro also conducted national household surveys before Hurricane Katrina (2003) and after Katrina (2005) and found a decrease from pre- to post- from 58% to 43% who have a disaster plan that just includes where to go and what to do in a disaster situation. 

**Notes:**
So why is it that after terrorist attacks, hurricanes and flood disasters, earthquakes, and pan flu warnings, Americans are not sufficiently motivated to engage in basic preparedness activities? 

## Post-Katrina Findings—Barriers to Preparedness

| You indicated that you were not prepared, can you tell me why? | Don't know how to get prepared | 54.4% |
| --- | --- | --- |
|  | Don't have the money | 33.2% |
|  | Don't think its important | 22.1% |
| What is the main reason you do not have an emergency supply kit at home? | Don't think it's important | 25.4% |
|  | Haven't had time | 12.4% |
|  | Don't know how to put one together | 10.0% |
|  | Too expensive | 7.9% |

**ORC Macro, 2005**

**CEG/Red Cross**

| Have not thought about it | 52% |
| --- | --- |
| Nothing they do would really be effective | 45% |
| Don’t know what they should do | 44% |
| Cost | 37% |
| Time | 35% |

**Notes:**
Well, here are a few reasons people say they aren’t prepared, based on follow-up questions on the Council for Excellence in Government’s survey, and ORC Macro’s 2005 survey...

EXTRA:
The Council for Excellence in Government (CEG) – conducting pilot studies and focus groups in an effort to develop a short and reliable tool for measuring individual/household preparedness. 

## What will it take to move the needle toward greater personal preparedness?

- Our efforts to communicate to the public how and what they can do to increase their personal preparedness for disasters need to improve.
- FIRST STEP: Determine what motivates and deters Americans to engage in effective and sustained preparedness.

**Notes:**

Despite several recent well funded efforts, risk communication has failed to inform the American public about the essentials of preparedness.

				−NCDP (2006)

 to figure out what it takes to motivate the American public in effective and sustained preparedness. 

## Snapshot view: The Personal Behavior Change Model for Disaster Preparedness (PDP)

**Purpose**
- To describe the factors that influence people’s motivation for to engage in recommended preparedness behaviors and describe ways to target those factors through communication and outreach in an effort to increase personal preparedness.
**Theoretical Development**
- Extended Parallel Process Model (EPPM)
- Stages of Change/Transtheoretical Model
**Key Model Components**** **
- Individual factors
- Individual Threat/Efficacy Preparedness Profile
- Social marketing/outreach activities
- Social marketing/outreach outcomes
- Preparedness behavior outcomes
**Next Steps**
- Focus groups to test the model’s constructs
- Household survey will examine some of the model’s components

**Notes:**
So we were asked to develop a personal behavior change model for disaster preparedness – to help explain how and why people are or are not prepared, with the main goal being an increase in the effective design and implementation of preparedness promotion initiatives. 

## Theoretical Underpinnings

***Social Cognitive Theory***

***Health Belief Model***

***Protection Motivation Theory***

***Socio-Ecological Model***

***Stages of Change***

***Persuasive Health Message Framework***

**Notes:**
There are a number of theories and models that we explored from the social science fields, trying to build on and learn from the work that has already been conducted by behavioral scientists in fields such as injury prevention, chronic disease prevention, and mental health.  In effect, we began by thinking about the ways in which disaster preparedness is like other health promotion or disease prevention issues, and then focused on why disaster preparedness is unique.   So these are a few of the theories we considered. 

## Extended Parallel Processing Model (Witte, K. 1998)

**Efficacy **
**(Self- & Response-)**

**Threat **
**(Susceptibility & Severity)**

**Low Threat = No Response**

**Low**

**High**

**High**

**Notes:**
We decided on two, the first of which is – The Extended Parallel Processing Model designed by Kim Witte. 

This is a very basic description of the model, but it highlights the two major constructs of interest that influence a person’s behavior when faced with a threat – 

Threat (the y axis) = risk
Efficacy (the x axis) = belief that I can do it and it will make a difference. 

The main point is that if a person does not perceive that he is at risk for a particular disaster, then he will not engage in protective behaviors.

A person’s perception of threat is comprised of two components 1) threat severity (e.g., how severe will the effects of a disaster be?), and 2) threat susceptibility (e.g., how likely is it that the disaster will happen to me?)
A person’s assessment of the value of a recommended protective action are also comprised of two components 1) self-efficacy (e.g., Do I know how to develop a good emergency plan for my household), and 2) response efficacy (e.g., Will having an emergency plan for my household really be useful in the event of any disaster?) 

## Extended Parallel Processing Model

**Efficacy**
**(Self- & Response-)**

**Threat **
**(Susceptibility & Severity)**

**Low**

**High**

**High**

**High Threat + Low Efficacy =**
** ****Fear Control Response**

**Notes:**
If, on the other hand, a person has a high perception of threat, but has low perceived efficacy, the person will not engage in preparedness or protective actions; instead they may be in denial, rationalize the situation or ignore the situation. 

## Extended Parallel Processing Model

**High Threat + High Efficacy = Danger Control Response**

**Low**

**High**

**High**

**Efficacy**
**(Self- & Response-)**

**Threat **
**(Susceptibility & Severity)**

**Notes:**
When perceived threat is high AND perceived efficacy is high, a person engages in danger control response – which is another way of saying, they are motivated to protect themselves from the danger. 
Danger control focuses on a solution to the threat (e.g., preparedness or protection). For danger control to be selected, a person needs to believe that an effective response is available (response efficacy) and that he is capable of utilizing this response to reduce the risk (self efficacy).

Fear control is not solution-oriented and can be represented by denial, rationalization, and escapism.

## Stages of Change Model (Prochaska, J.O. & DiClemente, C.C. 1982)

**Precontemplation**

**Contemplation**

**Preparation**

**Action**

**Maintenance**

## Slide 13

**Notes:**
And here’s the model. 

## Individual Factors: Factors may influence motivation to engage in preparedness actions:

- Age
- Sex
- Race/ethnicity
- SES (education, income, etc.)
- Language and culture
- Trust in government
- Civic engagement experience
- Prior experience with disasters
- Religiosity
- Disability/ability
- Occupation and work environment
- Home structural characteristics
- Perceived community/social norms
- Modes of transportation
- Geographic location

**Notes:**
Various factors influence a person’s motivation to behave a certain way.  Individual, or personal, factors are listed in the far left box within the model.  The model includes factors that go beyond normal demographics and looks at other contextual and individual factors that may influence a persons threat/efficacy profile, such as “trust in government” and household or occupational characteristics that may impact a person’s real or perceived risk, his access or receptivity to information, and his ability to carry out preparedness actions. 

## Threat/Efficacy Profiles 

| 
Low Perceived Threat Profile
People who do not believe a threat is likely to occur (low susceptibility)
People who do not believe a threat will impact them significantly (low severity)
People do not believe that the threat is imminent (low urgency) |
| --- |

| Low Perceived Efficacy Profile
People who do not believe they can carry out the recommended behavior (because of lack of knowledge or skill; Self-Efficacy
People who do not believe the recommended strategy will be effective in helping him survive or manage a disaster (Response-Efficacy)
People who believe there is a barrier to successfully carrying out the recommended strategy (External Barriers) |
| --- |

**Notes:**
The Threat/Efficacy Profiles build on applying the EPPM model to disaster preparedness and describe three broad categories of awareness and motivation related to threats and efficacy of preparedness measures.  The Threat/Efficacy Profiles include: 1) Unaware or Dismissive of Threat Because of Perceived Low Susceptibility, Urgency and/or Severity; 2) Understands Susceptibility to, and Severity of, Threat Yet Is Unprepared; and 3) Understands Threat and has High Belief in Self- and Response- Efficacy. The model then identifies related messages to reduce barriers and increase motivation to take action. The focus and outcomes of the targeted outreach and social marketing approaches are color-coded on the model to match the designated profiles to which each applies. 

## Outreach and Social Marketing to Address Low Perceived Threat

**Notes:**
Remember these individuals perceive low susceptibility, severity, or urgency of threat.

If an individual’s perceived threat is low, it will be important to increase the individual’s understanding of actual threat susceptibility, severity or urgency.  Outreach and marketing efforts to motivate those with this profile should focus on risk-based preparedness messages.  Messages with this focus would educate individuals about the threats in their area, including the likelihood of the disaster occurring, the severity of the disaster’s consequences, and the likelihood of the disaster occurring in the near future.  These types of messages are intended specifically to increase people’s knowledge about the chances of the disaster happening and its potential impact on health, well-being and quality of life (knowledge change); change people’s attitudes so that they feel concerned and feel a sense of urgency and personal responsibility associated with protecting themselves (attitude change); and equip people with the skills they need to assess their own personal risk (skill change).  To avoid panic or anxiety, risk-based messages should be paired with messages describing actions that can be taken to mitigate the negative consequences of the threat (e.g., appropriate preparedness information and positive encouragement to take action).

## Outreach and Social Marketing to Address Low Perceived Efficacy 

**Notes:**
Social marketing and outreach efforts designed for those individuals who know they are at risk, but are still not engaging in preparedness activities must focus on increasing people’s knowledge of recommended preparedness actions, describing the simplicity of completing the actions (self-efficacy), and explaining why the recommended measures will make a difference in a disaster situation (response-efficacy). 
In addition, outreach and public information efforts should also address the external barriers that may affect self-efficacy or response-efficacy.  External barriers may be a genuine barrier to efficacy and may need to be removed through policy or structural changes. And when these external barriers are removed, public outreach is critical in order to educate and convince individuals that the barrier no longer exists. 

## Behavior Maintenance

**Notes:**
Behavior Maintenance Profile
Preparedness is not a one-time occurrence.  In fact, an integral characteristic of preparedness is its ongoing nature.  Just as batteries in a smoke detector need to be maintained in working order, personal disaster preparedness knowledge, skills, and supplies need to be revisited, revised and maintained.  
Outreach and Social Marketing to Support Behavior Maintenance
For those who understand the threats, have knowledge of preparedness actions, and believe in the efficacy of their actions and the measures themselves, social marketing messages should serve as reminders and cues to action that prompt people to re-assess and update their preparedness measures.  These maintenance messages also are required to create a true, sustained culture of preparedness throughout the country.  

## External Motivation

_**External Motivation**_: External factors that influence personal preparedness: Policies, school/workplace initiatives, incentives (e.g., tax-free purchases, insurance benefits)

**Notes:**
External Motivators
Factors that influence a person’s desire to perform a behavior, such as to obtain an incentive or reward or to avoid a punishment.  External motivators are generally unrelated to the perceived threat or perceived efficacy. 

## Preparedness Behavior Outcomes

**Individuals Receptive to Preparedness Messages/Contemplating Preparedness Behaviors**

**Individuals Engaging in Recommended Preparedness Behaviors**

- M
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- P
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- CONTEMPLATION/PREPARATION

- ACTION

**Notes:**
The preparedness behavior outcomes identified in the PDP are depicted in the vertical arrow on the far right of the model. The arrow shows a progressive movement through the stages of change to the ultimate outcome of increased numbers of individuals maintaining recommended preparedness behaviors. 

## ORC Macro Support of DHS Office of Community Preparedness: Citizen Corps

**Tracking and Analysis of Citizen Preparedness Research:  **
***Citizen Preparedness Reviews***** available at **_[http://](http://www.citizencorps.gov/ready/research.shtm)__[www.citizencorps.gov/ready/research.shtm](http://www.citizencorps.gov/ready/research.shtm)_
**Preparedness Behavior Change Model**
**Telephone Survey of U.S. Households**
- Tracking Preparedness Measures (Based on TCLs)
- Behavioral Measures (Based on Behavior Change Model)
**Media Framing Study**
- Triangulated analysis of how the media presents disaster preparedness information, research and communication campaigns  to consumers
**Research with the Responder Community**
- Research  with representatives from emergency management, emergency medical/public health, law enforcement, and fire service

**Notes:**

Citizen Preparedness Reviews will soon be available  and we would love it if they would let us know of the important research they are doing or might know of so that it too could be included and further develop our understanding.

By the way – remember TCL means Target Capabilities List based on the National Preparedness Plan

## Thank you for your attention.

**Carol Freeman**
- Principal
- ORC Macro
- 11785 Beltsville Drive
- Calverton, MD 20705
- 301-572-0581(tel.)
- 301-572-0999 (fax)
- Carol.S.Freeman@orcmacro.com

- Please send us your comments on the model as well as future preparedness surveys.

**Stephanie Kamin**
- Project Manager
- ORC Macro
- 3 Corporate Square Suite 370
- Atlanta, GA 30329
- 404-321-3211(tel.)
- 404-321-3688 (fax)
- Stephanie.L.Kamin@orcmacro.com

- ORC Macro Contacts:

**Notes:**
I’ve brought copies of the model as well as a comprehensive narrative that goes into more detail about the model and its various components.  Our next steps are to test the model through focus groups and continued survey analyses and work on specific message development and testing.  

If you have any feedback or comments on the model, on future preparedness surveys you or others are working on, please send them to us so that we can ensure the model’s utility.