■家庭应急准备干预措施对社区住宅的有效性,非制度化的人在很大程度上是未知的。
■为了确定关于社会支持的科学状况,教育,和行为改变干预措施,以提高所有危险家庭的备灾能力。
■系统评价和荟萃分析。
■数据库,审判登记册,reports,网站被搜索,引用跟踪使用可复制的方法。个人,群集,以及非制度化的交叉随机对照试验,社区居住人群和非随机对照试验,控制前后,并纳入项目评估研究。至少有两名综述作者独立筛选了每项潜在相关研究,提取的数据,并评估了偏差的风险。使用Cochrane的RoB2工具进行随机研究,使用ROBINS-I工具进行非随机研究,评估偏倚风险。采用随机效应模型进行Meta分析。在没有进行荟萃分析的地方,使用干预效果估计的汇总统计和基于效果方向的投票计数来综合结果。证据使用等级进行评级。
■17项研究被纳入了大量的方法学和临床多样性。对于备灾用品(OR=6.12,95%0.13至284.37)或知识(SMD=0.96,95%CI-0.15至2.08)结果未观察到干预效果。对准备行为观察到小的积极影响(SMD=0.53,95%CI0.16至0.91),证据的确定性很低。没有研究报告干预措施的不良反应。
■研究设计阐明了实际但复杂和多方面的社会支持的功效,教育,和行为改变干预措施带来了实质性的方法学挑战,其中严格的研究设计元素可能无法匹配上下文公共卫生优先需求和提供干预措施的资源。虽然证据的总体强度被评估为低到非常低,我们承认所纳入研究的宝贵和翔实的工作。该研究代表了该领域的开创性工作,并为家庭应急准备干预有效性和功效的科学状态提供了重要基础。这些发现与备灾实践和研究有关,我们鼓励研究人员继续这项研究,使用这些研究和这篇综述来告知研究设计的持续改进.
The efficacy of household emergency preparedness interventions for community-dwelling, non-institutionalized people is largely unknown.
To ascertain the state of the science on social support, educational, and behavioral modification interventions to improve all-hazard household disaster preparedness.
Systematic
review and meta-analysis.
Databases, trial registers, reports, and websites were searched, and citation trails followed utilizing replicable methods. Individual, cluster, and cross-over randomized controlled trials of non-institutionalized, community-dwelling populations and non-randomized controlled trials, controlled before-after, and program evaluation studies were included. At least two
review authors independently screened each potentially relevant study for inclusion, extracted data, and assessed the risk of bias. Risk of bias was assessed using Cochrane\'s RoB2 tool for randomized studies and ROBINS-I tool for nonrandomized studies. Meta-analyses were applied using a random-effects model. Where meta-analysis was not indicated, results were synthesized using summary statistics of intervention effect estimates and vote counting based on effect direction. The evidence was rated using GRADE.
17 studies were included with substantial methodological and clinical diversity. No intervention effect was observed for preparedness supplies (OR = 6.12, 95% 0.13 to 284.37) or knowledge (SMD = 0.96, 95% CI -0.15 to 2.08) outcomes. A small positive effect (SMD = 0.53, 95% CI 0.16 to 0.91) was observed for preparedness behaviors, with very low certainty of evidence. No studies reported adverse effects from the interventions.
Research designs elucidating the efficacy of practical yet complex and multi- faceted social support, educational, and behavioral modification interventions present substantial methodological challenges where rigorous study design elements may not match the contextual public health priority needs and resources where interventions were delivered. While the overall strength of the evidence was evaluated as low to very low, we acknowledge the valuable and informative work of the included studies. The research represents the seminal work in this field and provides an important foundation for the state of the science of household emergency preparedness intervention effectiveness and efficacy. The findings are relevant to disaster preparedness practice and research, and we encourage researchers to continue this line of research, using these studies and this
review to inform ongoing improvements in study designs.