Esmat Rezabeigi Davarani1
Mahmood Nekoei-Moghadam1*
Narges Khanjani2Abedin Iranpour3Mohammadreza Chashmyazdan4
Hojjat Farahmandnia1- 1Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- 2Environmental Health Engineering Research Center, Kerman University of Medical Sciences, Kerman, Iran
- 3HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- 4Department of Medical Librarianship and Information Science, Kerman University of Medical Sciences, Kerman, Iran
Background: Earthquakes cause many casualties worldwide. Taking preventive measures and improving community preparedness is critical to reducing earthquake damage. The social cognitive theory explains how individual and environmental factors cause behavior. This review was conducted to identify the social cognitive theory structures, in research on the preparedness of households against earthquakes.
Materials and methods: This systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted from January 1, 2000, to October 30, 2021 in Web of Science, Scopus, PubMed, and Google Scholar. Studies were selected based on inclusion and exclusion criteria. The initial search yielded 9,225 articles, and finally, 18 articles were selected. Articles were assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.
Results: Eighteen articles about disaster preparedness behaviors based on the socio-cognitive constructs were identified and reviewed. The essential constructs used in the reviewed studies included self-efficacy, collective efficacy, knowledge, outcome expectations, social support, and normative beliefs.
Conclusion: By identifying the dominant structures that have been used in studies related to the preparedness of households against earthquakes, researchers can implement appropriate and more cost-effective interventions by focusing on improving suitable structures.
Introduction
The 21st century has witnessed an upward trend in natural hazards, increased casualties, and high economic loss (1, 2). Among natural disasters, earthquakes are important due to their unique characteristics, such as unpredictability, high destructive power, and high human casualties (3). Globally, 142.9 million people are at risk of earthquakes (4). The World Health Organization (WHO) reported that over the past century, 1,150 fatal earthquakes have occurred in 75 countries worldwide (5). Earthquakes yearly cause more than 10,000 deaths, most of which occur in developing countries (6).
The most efficient way to reduce earthquake losses is to design durable buildings (7). However, even in the safest structures, there is a potential for death and injury if non-structural vulnerability mitigation measures are not applied (8–10). Damage after an earthquake due to the interruption of essential services can be widespread and can negatively affect people's lives, work, and regular social processes (9, 11). Therefore, preventive measures and improving community preparedness are crucial to reducing earthquake damage (12).
Preparedness means activities and actions to ensure an effective response to hazards to minimize human and property damage (13–16). Essential measures in the preparation phase include acquiring knowledge and skills, planning to reduce the effects of hazards, providing emergency equipment and supplies, and emergency protective measures (17–20). Based on several studies conducted in Iran (21, 22), China (23), Australia, and New Zealand (24), most households were not prepared to deal with hazards.
Preparedness is affected by various demographic, behavioral, environmental, social, cognitive, economic, physical, and cultural factors (17, 21, 25, 26). Behavioral and social science theories provide a platform to understand why people engage in high-risk or protective behaviors (27). Behavior change theories and models have also been used in research on disaster risk management (12, 21, 22, 28–32).
Social cognitive theory is one of the most influential theories used in predicting behavior. This theory attempts to explain human behavior based on three pillars that are related to each other (1). Personal cognitive factors (self-efficacy, collective efficiency, outcome expectations, and knowledge), (2) socio-environmental factors (observational learning, normative beliefs, social support, barriers, and opportunities), (3) and behavioral factors (behavioral skills, intentions, reinforcement, and punishment) (33).
Since social cognitive theory has many structures, it is often not possible to study all of these structures at once. The diversity of constructs has caused researchers to choose a specific construct for evaluation, based on the type of behavior under study (34).
Considering that the current research is part of a sequential exploratory study, it was necessary to identify the structures used in related studies to design interview questions for future research. By identifying the structures that have received more attention in studies related to the preparedness of households against earthquakes, it is possible to design more appropriate tools and implement more cost-effective interventions.
Therefore, this systematic review was conducted to identify the constructs of the social cognitive theory in research related to household preparedness against earthquakes.
Materials and methods
This systematic review was a part of a consecutive exploratory study, to design and validate a tool (interview questions) to measure the factors affecting the preparedness of households against earthquakes based on the social cognitive theory. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. A search was conducted from January 1, 2000, to October 30, 2021, on Web of Science, Scopus, PubMed, and Google Scholar.
Search strategy
The search strategy was developed based on keywords related to the research topic. A set of keywords was selected based on previous studies and Medical Subject Headings (MeSH). We used four groups of keywords: (a) social-cognitive theory, social cognitive model, and cognitive-social theory constructs, (b) risk, disaster, emergency, hazard, catastrophe, crisis, and earthquakes, (c) preparedness, readiness, mitigation, behavior, protective action, and preventive behaviors (d) household, family, citizen, population, resident, inhabitant, and public. These keywords were combined using the operators of the mentioned databases. The search strategy and key terms were as follows: (“social-cognitive theory” OR “social cognitive model” OR self-efficacy OR “collective efficacy” OR “outcome expectations” OR “observational learning” OR “normative beliefs” OR “social support” OR “barriers and opportunities” OR “behavioral skills” OR “reinforcement and punishment”) AND (risk* OR disaster* OR emergenc* OR hazard* OR catastroph* OR crisis OR earthquake*) AND (prepar* OR readiness OR mitigation OR behavior* “protective action” OR “preventive behavior”) AND (household* OR family OR citizen* OR population OR resident* OR inhabitant* OR public). These searches were performed in abstracts, keywords, and titles. Furthermore, the reference list of published studies was also searched for relevant articles. Only English articles were included.
Data collection
The articles from the initial search were imported into EndNote software. After removing duplicate and unrelated titles, the remaining titles, abstracts, and the full text of the articles were screened by the first author (ER) and the second author (HS). Discussions about article selection were resolved through discussion, and the relevant articles were selected. The selection process for this review is shown in Figure 1.
Figure 1. Flow diagram showing a selection of articles reviewed.
The initial search yielded 9,225 articles, of which 4,730 duplicate titles and 2,508 unrelated titles were deleted. The abstracts of the remaining 1,987 titles were reviewed, and 83 related articles were selected. In the next step, 65 articles were excluded. The reasons for exclusion were that these articles used other health behavior change theories, did not examine household preparedness for earthquakes and did it for other organizations and groups, or examined household preparedness for other natural hazards. Eventually, 17 articles remained. Later one study was added through a search of the reference lists of the retrieved articles (Figure 1). The data of the selected articles were extracted based on a pre-designed form by the first and second authors.
Inclusion and exclusion criteria
Inclusion criteria were original quantitative articles about social-cognitive theory constructs related to earthquake preparedness of households. Articles in which the title was about disaster preparedness, but inside the article, the focus was on earthquakes were selected. However, articles that focused on other natural hazards, such as floods, climate change, etc., were excluded. Review studies, abstracts of papers presented at conferences, letters to the editor, editorials, and dissertations were not included.
Quality assessment
The quality of the included literature was assessed independently by two reviewers (ER and MN–M). For qualification assessment of the articles, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was applied (26). The checklist consisted of 22 questions. A “yes” answer would receive 1 point, and a “no, or unspecified” would receive 0 points.
Results
Eighteen articles on disaster preparedness behaviors based on socio-cognitive theory constructs were identified and reviewed. The essential constructs used in the reviewed studies included self-efficacy, collective efficacy, knowledge, outcome expectations, social support, and normative beliefs.
The constructs of the social-cognitive theory, including self-efficacy, collective efficacy, knowledge, outcome expectations, social support, and normative beliefs in studies, had been mentioned in respectively 9, 5, 5, 4, 3, and 1 articles. None of the articles used all of the constructs together.
In two articles, the study group was vulnerable households (elderly and disabled). In one article, the study examined the staff's household preparedness level. In 15 articles, an adult or head of household participated in the study. The characteristics of each of the selected studies are presented in Table 1.
Table 1. Summary of studies related to earthquake preparedness behaviors of households based on the structures of the social-cognitive theory.
The quality of the articles varied from 15 to 22 (Table 2).
Table 2. Quality of the final extracted articles using strengthening the reporting of observational studies in epidemiology (STROBE).
Discussion
The essential constructs used in the reviewed studies included self-efficacy, outcome expectations, social support, collective efficacy, normative beliefs, and knowledge.
Self-efficacy
In the reviewed articles, self-efficacy was one of the most important structures used in research on earthquake preparedness. Bandura considers self-efficacy to be a person's judgment of his or her ability to perform a particular action (27). Studies showed that the higher a person's self-efficacy, the more intention there is for preventive measures and disaster preparedness (23, 35, 38, 39, 41–43, 45, 46, 49). People are more likely to take precautionary measures and disaster preparedness behaviors when they believe they can do it. In studies based on other theories and behavior change models, people with higher self-efficacy performed more preventive actions and disaster preparedness behaviors (22, 31, 41, 50–52). According to a study by Newnham in Hong Kong (53), people with higher self-efficacy had fewer evacuation barriers during disasters. The results of Cong et al. from the United States (54) showed that lack of self-efficacy was one of the barriers to disaster preparedness behavior. In Janis et al.'s study in the Philippines (55), people with higher self-efficacy were more prepared for typhoons.
People are more likely to engage in disaster-prevention behaviors if they are confident in their ability to engage in disaster-prevention behaviors. In order to increase disaster preparedness, intentions, and behaviors, it is necessary to increase people's belief in their abilities.
Outcome expectations
Another construct of the social-cognitive theory used in the reviewed studies was outcome expectations. Outcome expectations anticipate possible outcomes that will result from preparedness measures (33). According to the studies, the higher the positive outcome expectations in people, the more the intention and behavior of disaster preparedness, and the higher the negative outcome expectations, the less the intention and behavior of preparedness (24, 47–49, 56). Also, the results of the reviewed studies showed that collective efficiency (47) and self-efficacy (49) were higher in societies where positive outcome expectations were reported in more people. If people are confident that their actions will have positive consequences, they will take preventive measures and improve disaster preparedness. However, if they find their efforts futile and feel helpless in the face of disasters, they will not take action to prepare themselves for disasters.
Social support
Social support is another construct of the social-cognitive theory used in studies of disaster preparedness behaviors. According to the results of studies, people with higher levels of formal and informal social support and more connections with the community and organizations were more prepared for disaster-related emergencies (37, 38, 44, 45). According to a study by Babcicky and Seebauer (57), people who received more social support in flood-prone areas in Austria had more self-efficacy. In a study conducted by Mideksa et al. (58) in the Philippines, students receiving higher social support from family, peers, and school were better prepared for disasters. In Permana's study in Indonesia (59), higher social support increased community self-efficacy in coping with the tsunamis.
But, contrary to the findings of the mentioned studies, the study conducted by Han et al. (36) in China showed that individuals who reported more social support had lower preparedness. In a study by Yu et al. (60) in earthquake-prone villages in China, the more informal social support was received, the less preparedness was reported.
According to Bandura (61), individuals, as social beings, tend to rely on other members of society to resolve issues and improve their wellbeing. Households receiving more support from relatives and authorities may feel more empowered to take preventative measures to reduce the risk of disasters. On the other hand, a strong sense of belonging to a community and receiving more social support may reduce the feeling of concern about natural hazards and mitigation.
Collective efficacy
Another construct used in these studies was collective efficacy. According to the social-cognitive theory, collective efficacy is the assurance of individuals that their joint efforts will bring social change (62). Compared to self-efficacy, collective efficacy beliefs are related to group tasks, group members' shared efforts and thoughts, and group progress (33). According to the results of the studies, in societies where higher collective efficacy and greater community participation were reported, the intentions and behaviors of disaster preparedness were higher (25, 31, 40, 41, 47). Studies have shown that people participating in more social events were more prepared for disasters (24, 40). In Florida, a study by Mash et al. (63) showed that the higher the collective efficacy, the more people were prepared after the hurricane. According to the study conducted by Fay-Ramirez et al. (64), respondents who were most affected by storms and floods, reported lower levels of collective efficiency before the disaster. In the study of Martins et al. (65), in New York City households that were politically active or were integrated into community networks were more likely to engage in all types of preparedness efforts.
The more extensive the social network before a disaster and the greater the social connections in the community, the less the adverse effects of a disaster. In communities where disaster risk reduction behaviors are compatible with the local community's culture, disasters cause minor damage, so planners must empower the community and involve people in social activities.
According to the results of the reviewed studies, the higher the social trust and trust in the government and authorities, the more disaster preparedness behavior was reported (25, 36, 37, 39–41, 47). While, in the study of Armaş et al. (42), those who felt less prepared were more likely to trust various institutions (government, NGOs, fire departments, media, etc.). Excessive trust in responsible authorities and organizations may make people feel less responsible, and a false sense of security may prevent them from taking precautionary measures and preparedness behaviors. On the other hand, high trust will likely improve communication between local authorities and residents and increase disaster preparedness.
Normative beliefs
One of the constructs of the social-cognitive theory is normative beliefs. According to the results of the reviewed studies, in McIver and Patton's (48) study, people with positive subjective norms had more intentions for disaster preparedness measures. The studies based on other theories also showed that people with higher subjective norms had more prepared intentions and behavior against disasters (21, 30, 31, 66). According to Nurjana's study in Indonesia (67), the higher the subjective norms, the greater the attitude toward preparedness and preparedness behaviors against disasters increased as well. In Ong et al.'s study in the Philippines (68), subjective norm was one of the key factors that increased people's intention to prepare for an earthquake. These studies show that if there is more interpersonal and social communication and people are influenced by relatives and other important people in the community, the intention and behavior of preparedness will increase. Recognition of these beliefs may assist policymakers and executives in developing a better understanding of the origins of preparedness behaviors.
Knowledge
According to the results of the studies, people with a higher level of knowledge had stronger beliefs, intentions, and preparedness behavior; and lack of awareness and knowledge was mentioned as one of the most important reasons for poor preparedness for emergencies (23, 43, 45, 46). Heinkel et al.'s study in Myanmar (69) shows that increasing household knowledge can improve preparedness. Wu et al. 's study in China (70) concluded that the more substantial the disaster knowledge, the better the disaster preparedness.
In Wu et al.'s (70) study, based on survey data of residents in the affected areas of Wenchuan and Lushan, residents had strong knowledge about disasters. But the residents' knowledge was weak before the earthquake.
Based on the results of reviewed studies, people who participated in the training programs or other family members had greater self-efficacy, knowledge, and preparedness (23, 24, 42). Amini et al., in Iran (12) showed that educational interventions improve the preparedness behavior of households against earthquakes.
Therefore, to improve the preparedness behavior of households against earthquakes, it is necessary to design and implement appropriate training programs based on structures that are strong predictors of intention and behavior.
Preparedness
Studies have shown that despite global efforts to reduce disaster risk, global preparedness intentions and behaviors are unsatisfactory despite the experience of natural hazards in these populations (35, 36, 40, 45, 46). However, in most studies that reported the level of preparedness of the population under study, most households were not sufficiently prepared for disasters or did not intend to take measures related to preparedness (23–25, 35, 36, 40, 42, 44, 46, 71). Chen et al.'s study in China (72) shows that only 9.9% of households were well prepared for emergencies, 53.6% did not know what to do and 31.6% did not want to think about it. Results of a study by Martins et al. (65), indicate that the levels of household preparedness in New York City at the time of the storm were modest. The reason for the difference in the level of preparedness of households against disasters in different regions may be due to the difference in the socio-economic level of households, the experience of a destructive hazards, the perception of risk, as well as the efforts and planning of the government to improve the level of people's preparedness and reduce the risk of disasters.
In a post-Taiwan earthquake study, people had high intentions to engage in earthquake preparedness behavior, but still lacked preparedness measures (51). It is likely that after experiencing a dangerous hazard, residents' awareness and risk perception will increase, and people will be more willing to prepare for potential future hazards. Failure to prepare for disaster may be due to a lack of knowledge and skills in that population despite high intentions.
Demographic factors
Based on the results of the studies, in several studies, older people (24, 35, 43, 45, 46) and in some studies, younger people (39, 42) had more reasonable beliefs, intentions, and disaster preparedness behaviors. Older people may report more preparedness and intentions due to more experience, better risk perception, religious beliefs, and responsibility toward younger people. However, limited mobility and disability at older ages can negatively affect appropriate behavior when hazards occur, or the feeling of being close to the end of life can reduce their motivation for disaster preparedness. Younger people are more likely to have better beliefs, intentions, and preparedness behaviors than older people, because of their higher levels of education and better economic, social, and physical status.
In most studies, men reported better belief, intent, and behavior in the face of disasters (24, 35, 36, 39, 42, 45), and in some articles, women reported better intent and preparedness (43, 46). Differences in the findings of different studies can be due to cultural, social, and economic differences in different regions. Another reason may be that the head of the household has more responsibility than other family members.
People with higher levels of education (35, 39, 42, 45) and incomes (24, 35, 42–46) were more prepared for disasters.
According to the results of the reviewed studies, people with physical disabilities and their families (38), and ethnic, racial, and political minority groups (36, 43) had lower beliefs, intentions, knowledge, and disaster preparedness behaviors.
Limitations
This article only reviewed studies published in English, and may therefore be subject to language bias.
Conclusion
The constructs of self-efficacy, collective efficacy, knowledge, outcome expectations, social support, and normative beliefs were used more frequently in studies related to earthquake preparedness behaviors of households. Designing and implementing interventions focusing on these structures can improve preventive behaviors and the preparedness of households against earthquakes.
Data availability statement
The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.
Author contributions
ER conceived the concept and design of the study. AI conducted the survey. HF and MC were involved in data analysis and manuscript writing. MN-M and NK supervised the study and critically reviewed the manuscript. All authors read reviewed the final manuscript.
Acknowledgments
The authors would like to express their gratitude to the officials in the Health in Disasters and Emergencies Research Center of Kerman University of Medical Sciences for supporting this project.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
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Keywords: earthquake, preparedness, family, households, social-cognitive theory
Citation: Rezabeigi Davarani E, Nekoei-Moghadam M, Khanjani N, Iranpour A, Chashmyazdan M and Farahmandnia H (2023) Factors related to earthquake preparedness of households based on social-cognitive theory constructs: A systematic review. Front. Public Health 11:987418. doi: 10.3389/fpubh.2023.987418
Received: 06 July 2022; Accepted: 25 January 2023;
Published: 16 February 2023.
Edited by:
Ali Asgary, York University, CanadaReviewed by:
Simon Grima, University of Malta, MaltaJavad Yoosefi Lebni, Lorestan University of Medical Sciences, Iran
Mikel Vicente Pascual, University Hospital Arnau de Vilanova, Spain
Negar Pourvakhshoori, Gilan University of Medical Sciences, Iran
Copyright © 2023 Rezabeigi Davarani, Nekoei-Moghadam, Khanjani, Iranpour, Chashmyazdan and Farahmandnia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Mahmood Nekoei-Moghadam, 
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