Public Health Nursing Vol. 32 No. 6, pp. 654–661 0737-1209/© 2015 Wiley Periodicals, Inc. doi: 10.1111/phn.12201
POPULATIONS
AT
RISK ACROSS
THE
LIFESPAN: POPULATION STUDIES
Identifying Residents’ Health Issues Six Weeks after the Great East Japan Earthquake Chie Teramoto, PHN, RN, MS,1 Satoko Nagata, PhD, PHN, RN,1 Reiko Okamoto, PhD, PHN, RN,2 Ruriko Suzuki, PHN, RN, MS,3 Emiko Kishi, PhD, PHN, RN,4 Michie Nomura, DSN, PHN, RN,5 Noriko Jojima, PHN, RN, MS,6 Masumi Nishida, PhD, PHN, RN,2 Keiko Koide, PhD, PHN, RN,2 Emiko Kusano, PhD, PHN, RN,7 Saori Iwamoto, PhD, PHN, RN,8 and Sachiyo Murashima, PhD, PHN, RN,9 1
Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; 2Graduate School of Health Sciences, Okayama University, Okayama, Japan; 3Iwate College of Nursing, Iwate, Japan; 4Graduate School of Nursing, Toho University, Tokyo, Japan; 5Ehime Prefectural University of Health Sciences, Ehime, Japan; 6Nara Medical University, Nara, Japan; 7Faculty of Nursing, Osaka Medical College, Osaka, Japan; 8Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan; and 9Oita University of Nursing and Health Sciences, Oita, Japan Correspondence to: Chie Teramoto, Department of Community Health Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. E-mail: [email protected]
ABSTRACT Objective: The aim of this study was to identify the characteristics and health issues of residents in need of assistance in a town affected by the Great East Japan Earthquake, six weeks after the disaster, through an outreach initiative. Design and Sample: A cross-sectional qualitative design was used. Public health nurses conducted comprehensive semi-structured interviews during home visits with residents. A total of 5,082 residents from the affected town. Measures: These included demographic information, public records of the extent of the damages, and qualitative interview data to determine the urgency of the necessary interventions. Results: A total of 281 residents needed some kind of assistance and were identified as requiring early intervention (within two weeks) or requiring assistance (within 12 weeks). The most common health issue requiring early intervention was interruption of treatment (25.0%), followed by need for mental care. The most frequent health issue requiring assistance within 12 weeks was the need for mental health care (39.7%), followed by interruption of treatment, and need for nursing care. Conclusions: During a disaster, it is imperative to identify cases requiring early intervention. Home-visit interviews were necessary to identify existing health concerns to prevent the development of more serious health problems. Key words: disasters, earthquakes, prevention and control, public health nurses, symptom assessment, tsunamis.
Background On March 11, 2011, a 9.0-magnitude earthquake, the Great East Japan Earthquake, occurred off the Pacific coast of the Tohoku region in northeast Japan, generating a massive tsunami that affected the lives of thousands of people. Because of the
654
disaster, 15,891 people were killed, 2,584 people were listed as missing, 6,152 were injured, and 127,830 homes were completely destroyed (National Police Agency, 2015). While natural disasters affect people and their health, both directly and indirectly, the actual
Teramoto et al.: Earthquake-Affected Residents’ Health Issues impact on the various aspects of their lives depends on the type and scale of the disaster. Earthquakes that occur in combination with tsunamis often result in more extensive destruction than earthquakes alone, affecting a larger section of the population, and destroying the country’s infrastructure in a short period. To provide the best possible assistance to disaster victims, it is important to understand how tsunamis impact the health of affected people and the characteristics of high-risk individuals who require immediate assistance in its aftermath. There has been little research on how the Great East Japan Earthquake’s tsunami-affected victims required immediate assistance. Previous studies have shown that disasters such as earthquakes and tsunamis affect the wellbeing of afflicted individuals, including those presenting with posttraumatic stress disorder (PTSD; Xu & Song, 2011), depression (Zhang, Shi, Wang, & Liu, 2011), and other forms of psychological distress (Oyama, Nakamura, Suda, & Someya, 2012; Toyabe et al., 2006), as well as contributing to a poorer quality of life (Tsai et al., 2007; Wang et al., 2000) and difficulties with activities of daily living (ADL; Setoh et al., 1996). However, these studies obtained data more than three months after the disaster and only a few were conducted 1–2 months postdisaster. Among the victims of the Sumatra tsunami in Thailand, elevated rates for symptoms of PTSD, anxiety, and depression were found eight weeks after the disaster (van Griensven et al., 2006). Previous studies on tsunamis have been conducted in less developed countries like Indonesia (Frankenberg et al., 2008) and Thailand (van Griensven et al., 2006). However, the Great East Japan Earthquake was unprecedented in that it struck a developed country with a large aged population. Furthermore, the first months after the disaster were considered the “honeymoon phase” in terms of community phases of disaster (U.S. Department of Health and Human Services, 2000). Four community phases are commonly recognized: (1) heroic, (2) honeymoon, (3) disillusionment, and (4) reconstruction (U.S. Department of Health and Human Services, 2000). In the honeymoon phase, victims may be rejoicing because their lives and the lives of loved ones have been spared (U.S. Department of Health and Human Services, 2000). We conducted this
655
study six weeks after the disaster—a time when many people were still living in evacuation centers before moving to temporary housing—making it imperative that victims at high risk of health complications be identified immediately after the disaster. Public health nurses (PHNs) in Japan work for community health and welfare. PHNs regarded support at both the individual/family and population/ community levels as important in terms of public health nursing activities (Hirano, Saeki, Kawaharada, & Ueda, 2011). Public nursing activities are necessary to promote the role of safety nets for protecting citizens’ health (Hirano et al., 2011). Therefore, we focused on PHNs’ activity after the disaster.
Study purpose This study examined cases requiring early intervention (within two weeks of the disaster) or assistance (within 12 weeks) following the Great East Japan Earthquake based on the results of a comprehensive home-visit health survey conducted by PHNs 6–8 weeks after the disaster.
Methods Design and sample The study employed a cross-sectional, qualitative design. Semi-structured interviews were conducted with 5,082 participants by PHNs. The town in which the study took place is located on the Sanriku coast in Iwate Prefecture; in 2011, the town had a population of 15,276 with 5,689 households (Ministry of Internal Affairs and Communications, Japan, 2011a); age distributions were as follows: 0–14 (11.4%), 15–64 (56.2%), and 65 or over (32.4%) (Ministry of Internal Affairs and Communications, Japan, 2011b). As of March 11, 2015, a total of 853 people were killed and 426 were listed as missing from Town A (8.4% of the predisaster population) (Disaster Prevention Iwate, 2015). This rate is greater than any other town in Iwate (National Police Agency, 2015). The town hall, hospital, health clinics, train station, and food and department stores were all destroyed. Government officers were killed and all health-related documents were lost.
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Measures The PHNs prepared individual data sheets recording the residents’ pre- and postearthquake addresses and family members. In each household, the PHNs measured residents’ blood pressure and conducted health interviews (e.g., “How was your health after the disaster?”, “Do you have symptoms after the disaster?”, “Do you have a medical history before the disaster and how was that after the disaster?”). We measured residents’ blood pressure only at the start of the interview and let the residents talk in their own words. Data were obtained for gender, age, extent of the damage to the predisaster residence, urgency of the assistance needed, and health problems requiring assistance. Age. Information about date of birth from the list of residents was used to identify participants’ ages as of May 8, 2011. Data were categorized into six age brackets: 0–14, 15–39, 40–64, 65–74, 75–84, and 85 years or over. Damage to the predisaster residence. Predisaster residences were classified into three groups according to the extent of the tsunami damage to the surrounding area: (1) completely destroyed (i.e., most of the houses were swept away completely), (2) partially destroyed or inundated (located within the reach of the tsunami), and (3) unaffected. The “partially destroyed or inundated area” classification was based on the assignment of “inundated areas” indicated by the Inundated Area Map (Geospatial Information Authority of Japan, 2015) and “(within) reach of the tsunami,” as shown in the Map of Tsunami-Affected Areas (Architects, Regional Planners and Associates, Kyoto [ARPAK], 2015). Residences within an “area where many residential buildings were swept away” according to ARPAK were allocated to the “completely destroyed area.” Residential areas excluded from these classifications were deemed to fall within the unaffected areas. Urgency of assistance. Judging from the overall conditions (e.g., health, mental health, housing condition, and shortage of medicine), the interviewing PHNs classified the respondents into three categories: (1) requiring early intervention, meaning the residents required medical intervention within
November/December 2015
two weeks; (2) requiring assistance, which included those residents who the PHNs anticipated would need medical intervention within 12 weeks; and (3) requiring no assistance at present. The PHNs and survey managers held meetings about people requiring early intervention or requiring assistance, and the survey manager immediately reported these cases to the PHNs working in Town A to request early intervention. In this study, residents in the first two categories were considered participants with health issues. Health issues requiring assistance. For participants within the “requiring early intervention” and “requiring assistance” categories, evidence was extracted from the health data sheet from the self-reports and PHNs’ reports to determine which health issues needed attention. If a participant had multiple problems, two or more researchers identified the most urgent health issue; in the case of disagreements, the issues were discussed until consensus was reached. Health issues were organized into eight categories: 1. Interruption of treatment: residents under treatment or taking medication for chronic disease (e.g., hypertension, diabetes) whose medical supervision was interrupted due to the earthquake; 2. Need for medical consultation: residents with a new symptom of any disease or in need of medical consultation due to the deterioration of symptoms for preexisting conditions; 3. Need for nursing care: residents in long-term care whose symptoms deteriorated postearthquake, and residents wishing to return home after living with family members or receiving care elsewhere; 4. Aggravation of dementia: residents presenting symptoms of incoherent or disordered speech after the earthquake; 5. Mental health concerns: residents requiring assistance for psychological problems, or aggravation of preexisting symptoms postearthquake;
Teramoto et al.: Earthquake-Affected Residents’ Health Issues
6. Drinking concerns: residents presenting with daytime drinking or greater frequency/quantity of drinking postearthquake; 7. Maternal and child-related concerns: residents with children who appeared violent, or expecting mothers requiring postdelivery assistance; 8. Other issues: residents who could not be classified into any of the above categories but who presented with substantial threats to well-being, including social problems, familial problems, or disabilities.
Data collection procedures PHNs visited all households and evacuation centers from April 23 to May 8, 2011 (43–58 days postearthquake), guided by house maps and a list of residents generated on March 1, 2011. Where there was more than one person in the household, we asked all family members’ status (e.g., living, deceased, living in another location postdisaster) and about their health problems. We invited other family members to participate and interviewed them. We regarded participants as all people who we met or who talked about their family’s health. Ethical considerations As previously noted, all cases identified as “requiring early intervention” or “requiring assistance” were reported immediately to the PHNs working in the town, and a copy of the completed data sheet was provided to them. Health survey data sheets were returned to the municipality office of Town A upon completion of the survey. The authors received a request from Town A under the order of the Chief Project Manager to analyze the survey results; therefore, data sheets were obtained that concealed the identities of the residents. Approval for this study was obtained from the Domestic Ethics Committee of the University Graduate School of Health Sciences. Analytic strategy Demographic data were analyzed using frequency analyses. Descriptive data were expressed in means (SD) for continuous variables and n (%) for categorical variables. Comparisons among the
657
three groups (“requiring early intervention,” “requiring assistance,” and “requiring no assistance at present”) were undertaken via one-way ANOVAs and Kruskal-Wallis tests. Fisher’s exact tests were used to compare the health problems of the three residential damage categories in relation to the two groups of residents requiring assistance (“requiring early intervention” and “requiring assistance”).
Results Home visits and comprehensive interviews were conducted with 5,082 residents. Participants’ characteristics are outlined in Table 1. A total of 281 (5.5%) needed some kind of assistance, 52 (men 51.9%, women: 48.1%) required early intervention, and 229 (men: 41.5%; women: 58.5%) required assistance. The mean age of residents requiring early intervention was 71.2 (SD = 14.1), with the majority (55.7%) aged 75 or over. Among those requiring assistance, 91 (39.7%) were aged 75 or over, and the mean age was 64.9 (SD = 18.9). In both cases, the mean age was significantly higher than that of the total sample, 59.6 (SD = 18.7, p < .001). Former residents of the completely destroyed or partially destroyed/inundated area accounted for 88.4% of those requiring early intervention and 77.3% of those requiring assistance. These figures were significantly higher than the total number of participants who did not require assistance (66.1%, p < .001).
Comparison of health issues and urgency of assistance The comparison of health issues across the two urgency groups is described in Table 2. Among those requiring early intervention, “interruption of treatment” was the most frequent health issue, affecting 19 people (36.5%), which is a significantly greater number than those requiring assistance (p < .001). This was followed by 13 (25.0%) participants requiring early intervention for “mental health concerns” and 9 (17.3%) for “need for nursing care.” “Mental health concerns” was the most prevalent health issue for participants requiring assistance, affecting 91 persons (39.7%); the second-most prevalent health issue was “interruption of treatment,”
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TABLE 1. Participant Characteristics Residents covered by this survey (n = 5,082)
Age Mean SD 0–14 15–39 40–64 65–74 75–84 85 or over Gender Male Female Damage of the area living before the disaster Completely destroyed area Partially destroyed/inundated area Unaffected area
Requiring no Preearthquake Total households assistance population of Town visited (n = 4,801) p-value A (n = 15,276) (n = 5,082)
Requiring early intervention (n = 52)
Requiring assistance (n = 229)
71.2 14.1 0 (0.0) 2 (3.8) 15 (28.8) 6 (11.5) 23 (44.2) 6 (11.5)
64.9 18.9 7 (3.1) 19 (8.3) 69 (30.1) 43 (18.8) 72 (31.4) 19 (8.3)
59.3 18.6 143 (3.0) 567 (11.8) 2,006 (41.8) 1,030 (21.5) 822 (17.1) 233 (4.9)
POPULATIONS
AT
RISK ACROSS
THE
LIFESPAN: POPULATION STUDIES
Identifying Residents’ Health Issues Six Weeks after the Great East Japan Earthquake Chie Teramoto, PHN, RN, MS,1 Satoko Nagata, PhD, PHN, RN,1 Reiko Okamoto, PhD, PHN, RN,2 Ruriko Suzuki, PHN, RN, MS,3 Emiko Kishi, PhD, PHN, RN,4 Michie Nomura, DSN, PHN, RN,5 Noriko Jojima, PHN, RN, MS,6 Masumi Nishida, PhD, PHN, RN,2 Keiko Koide, PhD, PHN, RN,2 Emiko Kusano, PhD, PHN, RN,7 Saori Iwamoto, PhD, PHN, RN,8 and Sachiyo Murashima, PhD, PHN, RN,9 1
Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; 2Graduate School of Health Sciences, Okayama University, Okayama, Japan; 3Iwate College of Nursing, Iwate, Japan; 4Graduate School of Nursing, Toho University, Tokyo, Japan; 5Ehime Prefectural University of Health Sciences, Ehime, Japan; 6Nara Medical University, Nara, Japan; 7Faculty of Nursing, Osaka Medical College, Osaka, Japan; 8Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan; and 9Oita University of Nursing and Health Sciences, Oita, Japan Correspondence to: Chie Teramoto, Department of Community Health Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. E-mail: [email protected]
ABSTRACT Objective: The aim of this study was to identify the characteristics and health issues of residents in need of assistance in a town affected by the Great East Japan Earthquake, six weeks after the disaster, through an outreach initiative. Design and Sample: A cross-sectional qualitative design was used. Public health nurses conducted comprehensive semi-structured interviews during home visits with residents. A total of 5,082 residents from the affected town. Measures: These included demographic information, public records of the extent of the damages, and qualitative interview data to determine the urgency of the necessary interventions. Results: A total of 281 residents needed some kind of assistance and were identified as requiring early intervention (within two weeks) or requiring assistance (within 12 weeks). The most common health issue requiring early intervention was interruption of treatment (25.0%), followed by need for mental care. The most frequent health issue requiring assistance within 12 weeks was the need for mental health care (39.7%), followed by interruption of treatment, and need for nursing care. Conclusions: During a disaster, it is imperative to identify cases requiring early intervention. Home-visit interviews were necessary to identify existing health concerns to prevent the development of more serious health problems. Key words: disasters, earthquakes, prevention and control, public health nurses, symptom assessment, tsunamis.
Background On March 11, 2011, a 9.0-magnitude earthquake, the Great East Japan Earthquake, occurred off the Pacific coast of the Tohoku region in northeast Japan, generating a massive tsunami that affected the lives of thousands of people. Because of the
654
disaster, 15,891 people were killed, 2,584 people were listed as missing, 6,152 were injured, and 127,830 homes were completely destroyed (National Police Agency, 2015). While natural disasters affect people and their health, both directly and indirectly, the actual
Teramoto et al.: Earthquake-Affected Residents’ Health Issues impact on the various aspects of their lives depends on the type and scale of the disaster. Earthquakes that occur in combination with tsunamis often result in more extensive destruction than earthquakes alone, affecting a larger section of the population, and destroying the country’s infrastructure in a short period. To provide the best possible assistance to disaster victims, it is important to understand how tsunamis impact the health of affected people and the characteristics of high-risk individuals who require immediate assistance in its aftermath. There has been little research on how the Great East Japan Earthquake’s tsunami-affected victims required immediate assistance. Previous studies have shown that disasters such as earthquakes and tsunamis affect the wellbeing of afflicted individuals, including those presenting with posttraumatic stress disorder (PTSD; Xu & Song, 2011), depression (Zhang, Shi, Wang, & Liu, 2011), and other forms of psychological distress (Oyama, Nakamura, Suda, & Someya, 2012; Toyabe et al., 2006), as well as contributing to a poorer quality of life (Tsai et al., 2007; Wang et al., 2000) and difficulties with activities of daily living (ADL; Setoh et al., 1996). However, these studies obtained data more than three months after the disaster and only a few were conducted 1–2 months postdisaster. Among the victims of the Sumatra tsunami in Thailand, elevated rates for symptoms of PTSD, anxiety, and depression were found eight weeks after the disaster (van Griensven et al., 2006). Previous studies on tsunamis have been conducted in less developed countries like Indonesia (Frankenberg et al., 2008) and Thailand (van Griensven et al., 2006). However, the Great East Japan Earthquake was unprecedented in that it struck a developed country with a large aged population. Furthermore, the first months after the disaster were considered the “honeymoon phase” in terms of community phases of disaster (U.S. Department of Health and Human Services, 2000). Four community phases are commonly recognized: (1) heroic, (2) honeymoon, (3) disillusionment, and (4) reconstruction (U.S. Department of Health and Human Services, 2000). In the honeymoon phase, victims may be rejoicing because their lives and the lives of loved ones have been spared (U.S. Department of Health and Human Services, 2000). We conducted this
655
study six weeks after the disaster—a time when many people were still living in evacuation centers before moving to temporary housing—making it imperative that victims at high risk of health complications be identified immediately after the disaster. Public health nurses (PHNs) in Japan work for community health and welfare. PHNs regarded support at both the individual/family and population/ community levels as important in terms of public health nursing activities (Hirano, Saeki, Kawaharada, & Ueda, 2011). Public nursing activities are necessary to promote the role of safety nets for protecting citizens’ health (Hirano et al., 2011). Therefore, we focused on PHNs’ activity after the disaster.
Study purpose This study examined cases requiring early intervention (within two weeks of the disaster) or assistance (within 12 weeks) following the Great East Japan Earthquake based on the results of a comprehensive home-visit health survey conducted by PHNs 6–8 weeks after the disaster.
Methods Design and sample The study employed a cross-sectional, qualitative design. Semi-structured interviews were conducted with 5,082 participants by PHNs. The town in which the study took place is located on the Sanriku coast in Iwate Prefecture; in 2011, the town had a population of 15,276 with 5,689 households (Ministry of Internal Affairs and Communications, Japan, 2011a); age distributions were as follows: 0–14 (11.4%), 15–64 (56.2%), and 65 or over (32.4%) (Ministry of Internal Affairs and Communications, Japan, 2011b). As of March 11, 2015, a total of 853 people were killed and 426 were listed as missing from Town A (8.4% of the predisaster population) (Disaster Prevention Iwate, 2015). This rate is greater than any other town in Iwate (National Police Agency, 2015). The town hall, hospital, health clinics, train station, and food and department stores were all destroyed. Government officers were killed and all health-related documents were lost.
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Number 6
Measures The PHNs prepared individual data sheets recording the residents’ pre- and postearthquake addresses and family members. In each household, the PHNs measured residents’ blood pressure and conducted health interviews (e.g., “How was your health after the disaster?”, “Do you have symptoms after the disaster?”, “Do you have a medical history before the disaster and how was that after the disaster?”). We measured residents’ blood pressure only at the start of the interview and let the residents talk in their own words. Data were obtained for gender, age, extent of the damage to the predisaster residence, urgency of the assistance needed, and health problems requiring assistance. Age. Information about date of birth from the list of residents was used to identify participants’ ages as of May 8, 2011. Data were categorized into six age brackets: 0–14, 15–39, 40–64, 65–74, 75–84, and 85 years or over. Damage to the predisaster residence. Predisaster residences were classified into three groups according to the extent of the tsunami damage to the surrounding area: (1) completely destroyed (i.e., most of the houses were swept away completely), (2) partially destroyed or inundated (located within the reach of the tsunami), and (3) unaffected. The “partially destroyed or inundated area” classification was based on the assignment of “inundated areas” indicated by the Inundated Area Map (Geospatial Information Authority of Japan, 2015) and “(within) reach of the tsunami,” as shown in the Map of Tsunami-Affected Areas (Architects, Regional Planners and Associates, Kyoto [ARPAK], 2015). Residences within an “area where many residential buildings were swept away” according to ARPAK were allocated to the “completely destroyed area.” Residential areas excluded from these classifications were deemed to fall within the unaffected areas. Urgency of assistance. Judging from the overall conditions (e.g., health, mental health, housing condition, and shortage of medicine), the interviewing PHNs classified the respondents into three categories: (1) requiring early intervention, meaning the residents required medical intervention within
November/December 2015
two weeks; (2) requiring assistance, which included those residents who the PHNs anticipated would need medical intervention within 12 weeks; and (3) requiring no assistance at present. The PHNs and survey managers held meetings about people requiring early intervention or requiring assistance, and the survey manager immediately reported these cases to the PHNs working in Town A to request early intervention. In this study, residents in the first two categories were considered participants with health issues. Health issues requiring assistance. For participants within the “requiring early intervention” and “requiring assistance” categories, evidence was extracted from the health data sheet from the self-reports and PHNs’ reports to determine which health issues needed attention. If a participant had multiple problems, two or more researchers identified the most urgent health issue; in the case of disagreements, the issues were discussed until consensus was reached. Health issues were organized into eight categories: 1. Interruption of treatment: residents under treatment or taking medication for chronic disease (e.g., hypertension, diabetes) whose medical supervision was interrupted due to the earthquake; 2. Need for medical consultation: residents with a new symptom of any disease or in need of medical consultation due to the deterioration of symptoms for preexisting conditions; 3. Need for nursing care: residents in long-term care whose symptoms deteriorated postearthquake, and residents wishing to return home after living with family members or receiving care elsewhere; 4. Aggravation of dementia: residents presenting symptoms of incoherent or disordered speech after the earthquake; 5. Mental health concerns: residents requiring assistance for psychological problems, or aggravation of preexisting symptoms postearthquake;
Teramoto et al.: Earthquake-Affected Residents’ Health Issues
6. Drinking concerns: residents presenting with daytime drinking or greater frequency/quantity of drinking postearthquake; 7. Maternal and child-related concerns: residents with children who appeared violent, or expecting mothers requiring postdelivery assistance; 8. Other issues: residents who could not be classified into any of the above categories but who presented with substantial threats to well-being, including social problems, familial problems, or disabilities.
Data collection procedures PHNs visited all households and evacuation centers from April 23 to May 8, 2011 (43–58 days postearthquake), guided by house maps and a list of residents generated on March 1, 2011. Where there was more than one person in the household, we asked all family members’ status (e.g., living, deceased, living in another location postdisaster) and about their health problems. We invited other family members to participate and interviewed them. We regarded participants as all people who we met or who talked about their family’s health. Ethical considerations As previously noted, all cases identified as “requiring early intervention” or “requiring assistance” were reported immediately to the PHNs working in the town, and a copy of the completed data sheet was provided to them. Health survey data sheets were returned to the municipality office of Town A upon completion of the survey. The authors received a request from Town A under the order of the Chief Project Manager to analyze the survey results; therefore, data sheets were obtained that concealed the identities of the residents. Approval for this study was obtained from the Domestic Ethics Committee of the University Graduate School of Health Sciences. Analytic strategy Demographic data were analyzed using frequency analyses. Descriptive data were expressed in means (SD) for continuous variables and n (%) for categorical variables. Comparisons among the
657
three groups (“requiring early intervention,” “requiring assistance,” and “requiring no assistance at present”) were undertaken via one-way ANOVAs and Kruskal-Wallis tests. Fisher’s exact tests were used to compare the health problems of the three residential damage categories in relation to the two groups of residents requiring assistance (“requiring early intervention” and “requiring assistance”).
Results Home visits and comprehensive interviews were conducted with 5,082 residents. Participants’ characteristics are outlined in Table 1. A total of 281 (5.5%) needed some kind of assistance, 52 (men 51.9%, women: 48.1%) required early intervention, and 229 (men: 41.5%; women: 58.5%) required assistance. The mean age of residents requiring early intervention was 71.2 (SD = 14.1), with the majority (55.7%) aged 75 or over. Among those requiring assistance, 91 (39.7%) were aged 75 or over, and the mean age was 64.9 (SD = 18.9). In both cases, the mean age was significantly higher than that of the total sample, 59.6 (SD = 18.7, p < .001). Former residents of the completely destroyed or partially destroyed/inundated area accounted for 88.4% of those requiring early intervention and 77.3% of those requiring assistance. These figures were significantly higher than the total number of participants who did not require assistance (66.1%, p < .001).
Comparison of health issues and urgency of assistance The comparison of health issues across the two urgency groups is described in Table 2. Among those requiring early intervention, “interruption of treatment” was the most frequent health issue, affecting 19 people (36.5%), which is a significantly greater number than those requiring assistance (p < .001). This was followed by 13 (25.0%) participants requiring early intervention for “mental health concerns” and 9 (17.3%) for “need for nursing care.” “Mental health concerns” was the most prevalent health issue for participants requiring assistance, affecting 91 persons (39.7%); the second-most prevalent health issue was “interruption of treatment,”
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Public Health Nursing
Volume 32
Number 6
November/December 2015
TABLE 1. Participant Characteristics Residents covered by this survey (n = 5,082)
Age Mean SD 0–14 15–39 40–64 65–74 75–84 85 or over Gender Male Female Damage of the area living before the disaster Completely destroyed area Partially destroyed/inundated area Unaffected area
Requiring no Preearthquake Total households assistance population of Town visited (n = 4,801) p-value A (n = 15,276) (n = 5,082)
Requiring early intervention (n = 52)
Requiring assistance (n = 229)
71.2 14.1 0 (0.0) 2 (3.8) 15 (28.8) 6 (11.5) 23 (44.2) 6 (11.5)
64.9 18.9 7 (3.1) 19 (8.3) 69 (30.1) 43 (18.8) 72 (31.4) 19 (8.3)
59.3 18.6 143 (3.0) 567 (11.8) 2,006 (41.8) 1,030 (21.5) 822 (17.1) 233 (4.9)
