A survey and cause analysis of community resilience in a Chinese city from the perspective of nursing

The survey tool consists of two parts. The first part captures basic community information, such as the community’s name, geographical location, establishment year, population and community area. The second part is the CRES-EN, which was developed for this study (Supplementary File 1 and Supplementary File 2). It includes the individual resilience questionnaire (4 dimensions and 17 items, with content validity 0.94 and Cronbach’s α 0.944), family resilience questionnaire (4 dimensions and 14 items with content validity 0.93 and Cronbach’s α 0.894), health care resilience questionnaire (4 dimensions and 17 items with content validity 0.95 and Cronbach’s α 0.906) and environment resilience questionnaire (3 dimensions and 23 items with content validity 0.93 and Cronbach’s α 0.875).

The family resilience questionnaire was completed by a family member who was familiar with the family situation, and then each family member completed an individual resilience questionnaire. Hospital managers and medical staff completed the health care resilience questionnaire. The community environmental resilience questionnaire was completed by government staff responsible for community matters. Our team members also interviewed some community office workers and residents to gain insight into the causes of the current state of community resilience. The questions included mainly what the community, medical institutions, families or individuals had done to prepare and respond to disasters, exploring what the advantages were of these efforts in promoting resilience and what problems still exist. The data reported here are part of a much larger mixed-methods study that also included 47 qualitative interviews. These data will be reported in another article.

SPSS Statistics for Windows, Version 19.0 (SPSS Inc.; Armonk, NY: IBM Corp.) was used for the data analysis. The frequency/component ratio was used to describe the count data, while the measurement data were described with the item mean ± SD. According to the above calculation formula for community resilience, the item mean was multiplied by the corresponding weight, and the sum was the current level of community resilience, which was expressed as the mean ± SD.

In the face of disaster events, a resilient individual should have a healthy body, a tough character, good social adaptability and a strong disaster response ability. Most current studies take objective data, such as the incidence of chronic diseases, population composition, income and psychological status, as indicators of community population resilience. However, these data may be updated slowly and fail to reflect the actual problems [3, 6, 7, 11, 12]. Community residents know their individual condition best. In this study, existing health data on the community and residents’ self-evaluation are combined to comprehensively describe the individual resilience of community residents to better reflect the actual level of resilience. Among the types of individual resilience investigated in this study, health status, psychological resilience and social adaptability were good, but earthquake disaster response ability was poor. Generally, people who have experienced disaster events can improve their psychological resilience and social adaptability to a certain extent, which is consistent with existing studies [13‐15].

The state of physical health is mainly related to the extent of the disaster, the level of local economic development, postdisaster recovery and the characteristics of the population [16‐18]. In this study, due to the damage of the Wenchuan earthquake to the urban area of Dujiangyan city, the government demarcated different postdisaster reconstruction communities for housing resettlement according to the characteristics of local residents. To encourage the integration of residents, many communities have organized appealing activities, such as kite festivals, dam feasts, and festival parties. These activities not only enrich daily life but also improve individual resilience in terms of physiology, psychology and adaptability and can therefore serve as a reference for interventions aimed at improving individual resilience.

Although Ye believed that residents’ self-rescue and mutual rescue abilities were an indispensable part of emergency rescue [15], in this study, on-site rescue ability had the lowest score. This ability refers mainly to the rescue of buried people, the treatment of wounds, freehand cardiopulmonary resuscitation and basic handling methods. Many residents said that these skills were too professional to be well mastered. This statement suggests that we should encourage and support nursing professionals in improving the on-site rescue ability of community residents by teaching rescue knowledge and conducting skills training that will aid in preparation for an earthquake disaster.

Family relationships are the cornerstone of family resilience, and good family cohesion enables family members to work better together in response to crises [19]. A positive attitude with regard to overcoming difficulties is the core of family resilience [20]. In this study, family relationships and family beliefs scored high. Many residents had experienced the earthquake or had personally participated in the process of postdisaster reconstruction, so their intentions to provide mutual support and encourage optimistic attitudes were relatively strong.

In the later interview, we found that residents with higher education generally had more stable families and careers than residents with less education, and their higher knowledge level and greater experience helped them to be independent and able to accept new challenges with a more tenacious attitude; this could allow them to more actively respond in a crisis [21]. As a supportive resource, social support could help families flexibly cope with various life events [22]. Professional community support is an important aspect of family resilience [20]. However, in this study, residents’ recognition of the support provided by the community was not high. On the one hand, this result may be due to cultural background, as Chinese people have always advocated self-reliance; they are embarrassed to solicit help from government agencies and try their best to solve their own affairs. On the other hand, some communities cannot put their daily work into practice. This suggests that community workers should strengthen contact with residents and put in place comprehensive community strategies. The family crisis response dimension had the lowest score. Lindsey et al. believed that the economic foundation is an important source of support for family resilience [19]. Earthquakes can cause damage to homes, property and so on. Additionally, following an earthquake, the battered local economy will offer fewer opportunities for residents to obtain jobs [23, 24]. Households with reduced incomes did not have extra money to spend on emergency food or medicine stocks, so disaster response capacity was lower. In a later investigation, we also found that many families were not very active in dealing with earthquake disasters and were not confident in their own abilities related to disaster prevention and mitigation.

In terms of health care resilience, the medical resource dimension had the highest score. After the Wenchuan earthquake, medical institutions in Dujiangyan city were severely damaged. Most of the community hospitals were built with assistance from Shanghai city, and because of Shanghai city’s resource advantages, the software and hardware resources of the community hospitals were good. The medical consortium policy promoted by the state has been widely implemented in China. All community hospitals had tertiary or secondary hospitals in the same region as consortium hospitals or two-way referral hospitals that could provide support or assistance in terms of referrals, technical support, staff training and so on. In terms of emergency resources, most hospital emergency supplies were distributed through cooperation agreements with suppliers. Community hospitals, as primary medical institutions, mainly play a role in the transitional stage before external relief arrives; community hospitals have limited funds, so having a large reserve of emergency resources is impractical for these institutions. Therefore, having a small amount of material reserves and cooperation agreements with suppliers is a practical approach.

Medical staff disaster management capacity had the lowest score among four dimensions. Ranked in descending order by score, these were communication ability, on-site emergency handling ability, disaster mitigation and preparedness ability, disaster assessment ability, and postdisaster disposal ability. This ranking is consistent with the results of Yang Yana [25]. Community health care workers have to engage with a variety of community residents and often go to residents’ homes to provide health education, so health care workers must have good communication skills. Most of the training in hospitals involved on-site emergency treatment capacity, such as cardiopulmonary resuscitation, hemostasis, and dressing, but there was little training related to disaster reduction and preparedness, disaster assessment and postdisaster disposal methods. This suggests that community medical institutions should not limit training to on-site first aid but should offer training related to disaster assessment and management and postdisaster reconstruction.

The dimensions of community environment resilience included three aspects: disaster preparedness and response management, infrastructure, and economic capital. Ainuddin et al. believed that a strong economy can not only enable communities to recover quickly from the impact of disasters but also reduce the risk of future disasters [6]. Dujiangyan city was hit hard by the Wenchuan earthquake in 2008, resulting in a slow economic recovery. However, the local government attaches great importance to earthquake emergency management, so the resilience of the disaster preparedness management system was good, and this was mainly reflected in the emergency command team, emergency planning, material reserves, and residents’ participation.

Infrastructure is an important aspect of community environmental resilience. Good infrastructure can withstand the consequences of earthquake disasters, keep basic functions intact, provide effective guarantees for reducing the number of residents’ lives lost, reduce property losses, and promote postdisaster recovery [11, 26, 27]. In this study, the infrastructure resilience was medium, but the scores for water supply, power supply and housing were low. A field survey showed that the housing quality of communities is uneven. On the one hand, half of the communities were rebuilt after the Wenchuan earthquake, and seismic performance was emphasized at the beginning of reconstruction. Therefore, the seismic resilience of the water supply, power supply and housing in these communities were good. On the other hand, due to the limitations of the local economy, other houses that were not seriously damaged were reinforced rather than reconstructed. This resulted in severe aging of the water and power supply facilities, and the seismic performance of these buildings was poor. In addition, some managers did not pay enough attention to infrastructure resilience, so the scores were low, which was consistent with existing research [28]. This suggests that the economy, management and infrastructure mutually reinforce and influence each other [29, 30]. A reduction in the resilience of one of these aspects will affect the other two, thereby reducing the overall environmental resilience of the community. Managers should pay attention to these three aspects and endeavor to balance their development to achieve an overall improvement in community environmental resilience.