Background
Earthquakes are one of the most dangerous natural hazards that occur suddenly and uncontrollably. They cause physical, psychological, and social damages in human societies [
1]. Over the past two decades, 800 million people have been injured by natural disasters. Besides, natural disasters have caused 42 million deaths in the world [
2]. Iran is always at risk of earthquakes due to its geographical location on the Alpine-Himalayan orogenic belt [
3,
4]. More than 70% of the major cities in Iran are vulnerable to substantial damages. The earthquakes of recent decades have not only caused the deaths of thousands but also have caused massive economic damage and destroyed many cities and villages in the world [
5,
6]. Iran has only 1 % of the world’s population, but the percentage of its earthquake-related deaths is absolutely higher [
7]. The disaster management cycle has four phases including mitigation, preparedness, response, and recovery. Preparedness is the most important phase in the disaster management cycle. Previous research in Iran has shown that the role of people as the most important and largest group has often been neglected in disaster preparedness program planning [
8].
The Health Belief Model (HBM) describes the decision-making process that individuals use to adopt healthy behavior. It can be an effective framework for developing health promotion strategies [
9]. Theoretically, in the HBM, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy (the beliefs of individuals in their ability to prepare for disaster) predict behavior [
1,
9,
10].
There are some studies on earthquake preparedness that have assessed the readiness of individuals based on their knowledge and skills [
11‐
15]. Some studies have also considered structural and non-structural safety in some cities [
16] and some studies have investigated students’ readiness [
17,
18]. There are a few studies that have used behavioral change models in the disaster area [
5]. The Haraoka and Inal used the Health Belief Model to develop a questionnaire for earthquake preparedness [
1,
11].
Previous studies in Iran showed that most households did not have enough readiness and had a relatively high vulnerability to possible earthquake hazards [
19,
20]. Also, one study showed that improving the socio-economic status was correlated with improving the attitude of people about disaster preparedness [
13]. In DeYoung et al.ʼs study, earthquake readiness was positively correlated with risk perception, self-efficacy, and trust in information about hazards through media [
21].
To the best of the authors’ knowledge, this is the first study in Iran that examines earthquake preparedness of households, using a behavior change model. Considering the importance of earthquake preparedness of households, this study aims to asses the level of earthquake preparedness of households and its predictors based on HBM.
Results
In this study, 933 questionnaires were analyzed (response rate: 93.3%). The mean age of participants was 38.24 ± 12.85 years. Besides, 228 (24.44%) participants were male and 656 (70.31%) were female. About 80% of the participants did not have an academic education and had a diploma degree or less than a diploma degree. Also, 573 (61.41%) participants were homeowners (Table
1).
Table 1Basic and demographic characteristics of participants of earthquake preparedness study
Age | | 38.24 | 12.85 |
Family size | | 3.74 | 1.29 |
Residential years | | 13.09 | 12.58 |
Variables | | Number | Percent |
Sex | Man | 228 | 24.44 |
Woman | 656 | 70.31 |
Education | Uneducated | 86 | 9.22 |
Primary | 216 | 23.15 |
Secondary | 187 | 20.04 |
High school | 77 | 8.25 |
Diploma | 179 | 19.19 |
University | 186 | 19.94 |
Economic statue | Very good | 22 | 2.36 |
Good | 43 | 4.61 |
Moderate | 387 | 41.48 |
Poor | 243 | 26.05 |
Very poor | 205 | 21.97 |
Owner of the house | Yes | 573 | 61.41 |
No | 313 | 33.55 |
Marriage statue | Married | 812 | 87.03 |
Unmarried | 121 | 12.07 |
Earthquake experience | Yes | 744 | 79.74 |
No | 136 | 136 |
Damaging earthquake experience | Yes | 66 | 7.07 |
No | 822 | 88.10 |
Does anyone over 60 years old live at your home? | Yes | 253 | 27.12 |
No | 680 | 72.88 |
Does anyone under 16 years old live at your home? | Yes | 597 | 63.99 |
No | 336 | 36.01 |
Does anyone live with a disease that needs medication at your home? | Yes | 194 | 20.79 |
No | 736 | 78.89 |
The earthquake preparedness of the participants was low. The household preparedness score was 7.5 out of 25. In other words, the average earthquake preparedness of households was approximately 30%. Besides, the self-efficacy score was 60.79 ± 0.55 and the score of cues to action was 66.57 ± 0.45 (Table
2).
Table 2The mean scores (in percentage) of earthquake preparedness, constructs of Health Belief Model, and earthquake performance awareness of participants
Earthquake Preparedness | 30.03 (0.65) | 28.31–31.31 |
Perceived susceptibility | 68.67 (0.55) | 67.59–69.75 |
Perceived severity | 73.16 (0.77) | 71.65–74.61 |
Perceived benefits | 77.51 (0.69) | 76.15–78.87 |
Perceived barriers | 50.55 (0.52) | 49.53–51.57 |
Cues to action | 66.57 (0.45) | 46.46–65.67 |
Self-Efficacy | 60.79 (0.55) | 59.71–61.87 |
Earthquake performance awareness | 57.61 (0.71) | 56.21–59.02 |
The participants’ preparedness for the earthquake had a significant relationship with gender (
P < 0.001), homeownership (
P < 0.001), marital status (
P < 0.001), and previous experience of a destructive earthquake (
P < 0.001). Also, the mean score of earthquake preparedness was higher in those who reported moderate or good economic status. The mean difference was statistically significant by the Scheffe test (
P < 0.001). Furthermore, the one-way ANOVA/Scheffe’s test showed that there was a significant difference between illiterate people and those who had either university education or diploma degree and similarly, a significant difference in earthquake preparedness was observed between primary education and those who had either academic education or diploma degree (
P < 0.001) (Table
3).
Table 3The relationship between earthquake preparedness and demographic variables of participants by Independent T-Test and Analysis of Variance
Sex | female | 30.560 | 0.781 | 0.001> |
Male | 29.004 | 1.281 | |
Homeowner | Yes | 31.05 | 0.827 | 0.001> |
No | 27.961 | 1.084 | |
Marriage statue | Married | 30.182 | 0.693 | 0.001> |
Unmarried | 28.740 | 1.903 | |
Earthquake experience | Yes | 30.951 | 0.715 | 0.001 > |
No | 25.825 | 1.686 | |
Destructive earthquake experience | Yes | 35.151 | 2.461 | 0.001 > |
No | 29.888 | 0.685 | |
Age | 20> | 30.511 | 3.252 | 0.216 |
21–30 | 30.971 | 1.246 | |
31–40 | 31.265 | 1.103 | |
41–50 | 29.541 | 1.446 | |
50< | 26.834 | 1.705 | |
Educational level | illiterate | 25.116 | 1.194 | 0.001 > |
Elementary | 27.574 | 1.300 | |
Secondary school | 27.336 | 1.396 | |
High school | 29.368 | 1.172 | |
Diploma | 33.810 | 1.509 | |
Academic | 34.774 | 1.436 | |
Economic statue | Very poor | 26.595 | 1.224 | 0.001> |
Poor | 25.272 | 1.239 | |
Moderate | 33.385 | 1.008 | |
Good | 40.093 | 3.212 | |
Very good | 32.909 | 4.700 | |
Residential type | With yard | 30.668 | 0.813 | |
Apartment | 32.699 | 1.568 | 0.058 |
Leased | 26.173 | 1.473 | |
Mortgage | 31.076 | 5.586 | |
Governmental | 31 | 8.22 | |
The crude regression analysis showed that all constructs of the HBM except perceived severity were significant predictors of earthquake preparedness (P < 0.001) but after using stepwise regression, only perceived benefits (
P < 0.006), cues to action (
P < 0.001), and self-efficacy (
P < 0.001), significantly predicted the earthquake preparedness (Table
4).
Table 4The relationship between earthquake preparedness and study variables, using Stepwise Linear Regression
Perceived susceptibility | 0.005 | 0.931 | -0.106 | 0.116 |
Perceived severity | -0.020 | 0.554 | -0.087 | 0.046 |
Perceived benefits | -0.125 | 0.006 | -0.214 | -0.036 |
Perceived barriers | 0.060 | 0.267 | -0.047 | 0.169 |
Cues to action | 0.318 | 0.001 | 0.197 | 0.439 |
Self-efficacy | 0.253 | 0.001 | 0.137 | 0.369 |
Awareness | 0.048 | 0.146 | -0.016 | 0.113 |
Education | 1.793 | 0.001 | 0.854 | 2.733 |
Earthquake experience | 2.561 | 0.198 | -1.337 | 6.459 |
Economic statue | 1.580 | 0.053 | -0.22 | 3.182 |
Residential type | -2.467 | 0.004 | -4.151 | -0.783 |
Household size | -1.365 | 0.016 | -2.479 | -0.251 |
Destructive earthquake experience | 7.855 | 0.004 | 2.466 | 12.843 |
Discussion
In this study, we determined the level of earthquake preparedness of households and its predictors based on HBM. The earthquake preparedness of the participants was low. The participants’ preparedness for the earthquake had a significant relationship with homeownership, education, and previous experience of a destructive earthquake. Also, perceived benefits, cues to action, and self-efficacy significantly predicted the earthquake preparedness.
Despite the strong emphasis on earthquake preparedness to prevent its damaging effects, the findings of this study showed that most people had low preparedness for earthquakes which is similar to the findings of previous studies [
18,
23‐
25]. This can be very dangerous in areas that are vulnerable to earthquakes. Earthquake preparedness is related to the previous experience of destructive earthquakes and their damaging consequences. Households that had previously experienced destructive earthquakes were more prepared than those who had not previously experienced this event, which is similar to previous finding [
26,
27]. People who live in earthquakes zones and understand the potential losses from earthquakes are more likely to be prepared in comparison to people living in other areas [
18]. This could be due to recalling previous injuries as well as the fear of recurrence of similar injuries in future earthquakes. This goes back to the culture of societies that their members don’t believe that they are at risk of the occurrence of hazards and their consequences until they experience these hazards. Regarding the high frequency of earthquakes in the Hamadan province, most of the participants in this study had previous earthquake experience but they were not prepared for earthquakes. Perhaps this is because most of the recent earthquakes in Hamadan did not result in deaths and as a result, these households do not take the risk of earthquakes seriously and do not find it essential to hold earthquake preparedness [
28].
Besides, education was significantly correlated with households’ earthquake preparedness, which is similar to the results of the studies by Russell et al. and Ghadiri & Nasabi [
29,
30]. One explanation can be that people with higher education are more knowledgeable, more aware of earthquakes danger, and more inclined to acquire new skills [
28,
31].
In this study, we found that the preparedness of participants has a significant relationship with homeownership. Two previous studies showed homeowners were more prepared for earthquakes than renters [
32,
33], whereas a study in Ethiopia in 2014 showed that homeownership had no relationship with disaster preparedness [
28]. One of the explanations is that owners can make the necessary changes despite preparedness costs due to place attachment, but more studies are required to confirm the role of homeownership.
We adjusted for multiple possibly confounding factors in our analysis. After adjusting the model, perceived benefit, cues to action, and self-efficacy had significant predictors of earthquake preparedness. It is more possible that people’s earthquake preparedness increases when they are aware of the benefits of earthquake preparedness. Furthermore, people with high self-efficacy feel they can prepare for earthquakes [
34]. On the other hand, people may find the earthquake hazardous but if they feel enough confident to reduce damages of earthquakes, they will engage in preparedness. If people perceive the benefits of a healthy behavior higher than the barriers of it, they will engage in that healthy behavior. Therefore, people may perceive earthquakes as a high threat but it can be expected that higher perceived benefits and self-efficacy among them result in higher preparedness. One possible explanation is that the perceived benefits motivate people to perform a specific behavior and adopt an action [
10]. Besides, the significant association of self-efficacy with preparedness at the household level for earthquakes could be explained by the positive and strong association of cues to actions with earthquake preparedness at the household level. Self-efficacy can be improved by observational learning, role modeling, and encouragement. Self-efficacy affects one’s efforts to change risk behavior and causes the continuation of one’s safe behavior despite obstacles that may decrease motivation [
10]. Moreover, cues to action associated with earthquake preparedness [
1]. Cues to action mention to influences of the social environment such as family, friends, and mass media. Mass media can play a vital role in educating the public about earthquake preparedness.
This study has several limitations. Firstly, using a self-reporting approach for data gathering, and secondly, due to the low number of relevant studies on earthquake preparedness based on behavioral change models, it was less possible to compare different studies with the findings of this study. Third, it should be noted that the results of this study can be generalized in the study population and setting, but for other settings it should be done with caution. Despite these limitations, this study had some strengths, we use a theoretical framework for identifying factors that influence earthquake preparedness with a large sample size. Also, the findings of this study are useful for emergency service providers, health authorities, and policymakers in designing and implementing earthquake preparedness programs. This research is also useful for researchers as it can be used as a basis for future researches. It is recommended to design and implement interventions to improve household preparedness for an earthquake based on self-efficacy, perceived benefits, and cues to action.
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