Assessing beliefs and preparedness for disasters among high school female students in Riyadh, Saudi Arabia

Abstract

Background/Aim

Disasters are becoming more frequent globally. In the past years, Saudi Arabia has been exposed to various disasters. Public awareness of disasters and disaster preparedness/response are deemed important to reduce risks, injury, or even death from disasters. This study was conducted to determine the level of knowledge, beliefs, and performance of female high school students in relation to disaster preparedness.

Method

From November to December 2016, a cross-sectional study was conducted among 579 female high school students enrolled in five public schools in Riyadh, Saudi Arabia. Participants were distributed a self-administered questionnaire on disaster experiences, knowledge of disaster, attitudes and beliefs, and health belief model components.

Results

The students’ level of knowledge was high (48.7%), while their level of performance in disaster preventive behaviours was average (28.5%). The students’ total preparedness for disasters was also average (30%). Their beliefs regarding the risk of catastrophe were low (45.1%).

Conclusion

The findings of this study reveal a significant gap between knowledge and action. The students’ disbelief in the occurrence of disasters and the importance of preparation has led to a lack of readiness. This underscores the critical need for increased education and emphasis on disaster response and preparedness among female high school students.

Introduction

A disaster is a serious functional disruption of a community involving widespread human, material, economic or environmental losses and impacts that exceed the ability of the affected community to cope using its own resources [1]. It is characterized by being unpredictable, unfamiliar, urgent, life-threatening and fast which leads to deaths, severe injuries, disease outbreaks, food shortage, mass displacement and economic loss [2]. While most references do not set a specific number for an incident to be called a disaster, the international disaster database (EM-DAT) recognizes an event as a disaster when ten or more people are reported dead [3]. The World Meteorological Organization mentioned that disasters due to weather and water, with around 8,835 disasters occurring between 1970 and 2012, caused 1.94 million deaths and $2.4 trillion of economic losses globally [4]. The EM-DAT has classified natural and technological disasters into two significant categories [5]. The frequency of artificial disasters in the 20th century has increased drastically since 1970; after the appearance of new industries, the primary sources were explosions and fires [6].

Saudi Arabia is a country that is not spared from exposure to natural and artificial disasters. Unfortunately, there is no official central database agency tracking disasters that hit Kingdom of Saudi Arabia(KSA) in the past years, other than little information from some sources such as local newspapers or the International Disaster Database (IDD). According to these sources, although disasters in KSA are relatively rare, the frequency of natural disasters has increased, killing 484 people and affecting 29,203 people with economic damage of $1,350,000 in the years 1980 to 2010 [7]. Furthermore, in the past years, KSA was exposed to floods, sand storms, earthquakes, and even volcanic eruptions [6,7,8,9,10]. In 2005, the number of fire incidents in KSA was reported to be around 30,000 incidents with 171 deaths and 941 injuries and economic loss of $18M [11]. The General Directorate of Civil Defense of Saudi Arabia reported that the number of fire incidents in educational facilities was 403, which was much higher than the 113 incidents reported in petroleum facilities in the year 2013 [12]. Schools are not exempted from such disasters and are vulnerable to disasters because of containment of hundreds of students and staff in one place, which increases the risk of death or injury due to stampede if not from the hazard itself [13].

The Emergency Management Accreditation Program (EMAP) in the United States has recognized the importance of public awareness in disaster response as part of disaster preparedness, and it has acknowledged the lack of public awareness in disaster response [14]. However, awareness of disaster response is not always enough. Instead, people have to be prepared in case such disaster occurs [15]. Disaster preparedness behaviour has been influenced by different factors and complex variables such as risk perception [16,17,18]. People respond to hazards according to their perception of the risks, thus it is an essential consideration in public health and risk management decision-making [19]. On the contrary, some studies showed that direct experience with disasters does not directly influence perception [20].

The health belief model (HBM) is a psychological model that aims to explain and predict health behaviours by focusing on individuals’ beliefs and attitudes [21]. If behaviour-related beliefs were changed through psychological persuasive methods resulting in behaviour change, this provides an evidence-based health education. Threat perception and behavioural evaluation are the two aspects of assessing individuals’ health behaviour. Two more elements were added, which are self-efficacy and cues to action to determine personality potential for preparedness [22, 23]. Schools serve as good places to assess beliefs and preparedness of the public and the best places to raise awareness and implement educational programs about the risk of disasters and ways to respond to them [24]. Thus, executing educational efforts on students has the probability of success in disaster preparedness information and plans, as they will transfer information to their families as an in-house response assistance and carry these benefits to the next generation [25].

This study was conducted to determine the level of information, beliefs and performance of female high school students about disaster preparedness.

Methods

This was a cross-sectional study in which female students were enrolled from five governmental schools in five different areas in Riyadh, KSA, between November and December 2016. The inclusion criteria were all actively enrolled female high school students at the time of the study. Stratified sampling was done by including 600 students, with 120 students from each school, 40 students from each level, and 20 students from each track (scientific and literacy) in the second and third levels of high school. Classes were chosen randomly, and 20 students from each class were chosen according to their willingness to participate.

A random choice of two classes in the first level and one class from each track from the second and third high school levels was made.

The study objectives, freedom to participate, and assurances of the participants’ anonymity were obtained from all the study participants.

Survey tool: [26,27,28]

The survey tool was a preformed self-administered questionnaire. The survey questionnaire consisted of five main sections. The first section has five questions about demographic characteristics, including their track (scientific and literacy) and the level of education of their parents. The second section was a question on the students’ previous disaster experiences. The third section consisted of nine questions that tested the students’ knowledge of disaster response, containing 3-Likert scale choices of yes, no, and I don’t know. The fourth section consisted of four questions on their actual performance in preventive behaviour. The fifth section consisted of five questions that assessed the students’ attitudes and beliefs regarding disaster response per the health belief model, including the health belief model, perceived susceptibility, perceived severity, perceived barriers, perceived benefits, and self-efficacy. The final perceived benefits question asked if the student believes that having in-school training on disaster response with yes and no choices is important.

Scoring

• 1. Student knowledge - The scoring and analysis of the questions were based on three levels of knowledge: good knowledge (mean score of 15 to 20), average knowledge (mean score of 9 to 14), and poor knowledge (mean score of 3 to 8).

• 2. Actual performance to behaviour—The scoring and analysis of the question were based on three levels of behavioural preparedness: poor level (mean score 0 to 26), average level (mean score 27 to 32), medium-high knowledge (mean score 33 to 39), and high knowledge (mean score 40 to 55).

• 3. Perceived benefits—The scoring and analysis of the question were based on two levels of beliefs: low level (mean score 0 to 12) and high level (mean score 13 to 24).

All data were entered into the Microsoft Excel database program, and the Statistical Package for Social Sciences (SPSS) version 21 software (SPSS Inc, Chicago, Illinois, USA) [29] was used for statistical tabulation and analyses. Descriptive statistics were reported as numbers, percentages (categorical variables), and means and standard deviation for continuous variables. T-tests and analysis of variance tests were conducted to compare means between group knowledge and attitudes. Pearson correlation test was used to test associations between knowledge and HBM attributes. P values of ≤ 0.05 were considered statistically significant.

Results

Demographic characteristics

Five hundred seventy-nine students participated in the survey; 193 (33.3%) of them were first years, 190 (32.8%) second years and 196 (32.8%) were third years. The percentage of students enrolled in the five different regions of Riyadh was around 20% of the 579 students from each region. Students in the second and third-year levels were specializing in either scientific (n = 201) or literacy (n = 186). Parents of these students were high school graduates (fathers = 36.2%, mothers = 35.7%), and bachelor degree holders (fathers = 33.3%, mothers = 26.3%). After categorizing the parental level of education, 51.3% were low (illiterate, intermediate, secondary and high school), and 65.5% were high (bachelor, master and PhD).

Previous disaster experience/s

The most common disasters encountered by the students were sandstorms (35%), epidemics (22%) and flash floods (19%). (Fig. 1) This was correlated positively with the belief of being susceptible and threatened by disasters (24%). (Fig. 2)

Fig. 1

High school female students’ previous experience with disasters

Fig. 2

Response time

Student knowledge of disaster and actual performance to preventive behaviour

The knowledge level of most students was high (48.7%). The student’s actual performance in preventive behaviours was average (28. 5%). The student’s total knowledge and behavioural preparedness were average (30%). (Fig. 3).

Fig. 3

Disaster’s response knowledge, performance of preventive behaviors, preparedness level and beliefs towards disaster risk of high school female students

The students’ knowledge about floods varied. Around 34.7% of students responded correctly to questions about the above-knee stream (60.4%). About 92% of students responded correctly regarding heavy rain and flood. In the case of huge fires, correct responses were high (76.3%). Around 73.7% of students responded that they would shut the main power in case of electricity-related fires. In the case of fire in a multi-story building, 95% of them will follow the emergency exit.

The student’s knowledge about the best response in sandstorms was moderately high. Only 46.4% agreed to apply petroleum jelly and cover their nose and mouth in case of sandstorms. Around 81.6% agreed that moving through the storm is not a good response during a sandstorm. Meanwhile, 89% agreed they would wait in a safe place until the storm ends. The student’s knowledge of response in case of a chemical spillage was high. Around 74.3% agreed to avoid going to chemical spill areas to offer help, 93.1% would exit the area as soon as possible, and 83.4% would not stay put. The students’ knowledge of the best response in case of being trapped under a collapsed building, which could happen during war or explosions, was high. About 62.3% agreed to cover their nose with a cloth, 70% agreed they should not move a lot, 70% agreed not to do anything and wait for help, and 54.5% agreed they knocked on walls and pipes to be heard. Finally, the knowledge of students’ response in case of an epidemic was average. About 95.7% agreed to wash their hands regularly with soap and water, 92.1% agreed they would avoid crowds, and 86.4% agreed they would not visit infected cases.

Student’s attitudes and beliefs about disaster response

The beliefs regarding the risk of disasters were low (45.1%). The students were asked whether they have one or more of the mentioned emergency plans, both in-home and in-school. In those in-home plans, 72.8% reported that they don’t have agreed-upon places to reunite with family members, 48.4% reported not having multiple exit routes, and 61.9% reported having an out-of-house contact in case of emergency. However, the school had better results, with 85.4% having agreed upon places to reunite with school members, 90.4% reported having and knowing about multiple routes, and 35 not having out-of-school contacts.88.2% have received in-school training for disaster response.

The students were also asked about their familiarity with emergency supplies at home and school. Available supplies at home were drinking water (87.1%), followed by masks (76.1%) and flashlights (69.5%). Instead, the supplies that were mostly available in school were fire extinguishers (94.7%); however, only around half of them knew how to operate them, followed by the first aid kit (62.1%).

Health belief model components

Students perceived susceptibility (54%) and severity (52.6%) about disasters were considered average, while their perceived self-efficacy (39.3%) and barriers (39.2%) were low. However, the perceived benefits were extremely high (96%). (Table 1) Most students agreed that lack of information was the greatest barrier to preparing for disasters (66%), followed by difficulty preparing for a disaster (51.3%). Some students perceived the lack of time (35.7%) and feeling of susceptibility (34.4%) as barriers to preparing for disasters. (Table 2) Students perceived benefits are considered very high, meaning that students value the importance of having in-school training on disaster response by around 95.7% (Fig. 2).

Table 1 Descriptive statistics of health belief model components

Correlations

In Table 3, assessing the preparedness level of students for disasters, there was a significant correlation between students’ beliefs and the area of the school (p-value 0.004), with mean scores of 12.5 for north and south schools and 11.5 for the rest areas. There was a significant difference between different high school levels regarding their preparedness level (p-value = 0.004). Scientific track students had a higher correlation with beliefs about the risk of disasters than literacy track students (p-value = 0.003). The fathers’ education level was correlated with beliefs (p-value = 0.048). In Table 4, the correlation between students’ performance of preventive behaviours with knowledge was significant (p-value < 0.001), beliefs (p value = 0.012) and HBM components except for perceived barriers (p-value = 0.244) and perceived severity (p-value = 0.496).

Table 2 Comparing mean score of knowledge, HBM (beliefs) and students’ performance (behaviors) and preparedness (knowledge + behaviors) in areas of Riyadh city, levels of high school

Table 3 Comparing mean score of knowledge, HBM (beliefs) and students’ performance (behaviors) and preparedness (knowledge + behaviors) between different parental educational levels

Table 4 Correlation between knowledge and HBM components with students’ performance behaviors towards disaster preparedness

Discussion

In our study, the percentage of knowledge about disaster response was high. Students have enough knowledge regarding disaster response compared to the study done in Iran, which assessed high school student’s knowledge regarding influenza. The Iranian study showed that most students (71%) had an average understanding of disaster response [30]. Another study showed low levels of knowledge about Avian influenza among high school students [31]. This explains that this study tested the general information of most probably encountered disasters. In contrast, other studies were more specific on certain disasters or epidemics, asking more profound and complex questions. No published study tested the students’ knowledge of most encountered disasters to compare with this study.

Floods, along with other disasters, were asked in the questionnaire. Flooding is one of the most significant disasters in KSA. Yet, out of two questions, flooding was only a third of the highest number of students experiencing the disasters, next to sandstorms and epidemics. This indicates that despite correct knowledge about disaster response, knowledge of the essential disasters that have happened most frequently and will probably occur in the future was average. This could mean that students had their knowledge by chance rather than an organized effort brought about by an increased awareness of disasters. Planning a disaster awareness program would address the most frequently encountered disasters, which requires educational programs focused on mostly encountered disasters. Moreover, the percentage of self-reported behavioural preparedness for disaster students was average; however, the rate of beliefs regarding the risk of disasters was low. This means more information on disaster response is needed to prepare for a disaster. That belief plays a vital role in affecting the preparedness behaviour of students.

Students’ perceived susceptibility and severity scored average in this study. This means that students were unaware that they were exposed to certain disasters and were not threatened by such disaster/s. Students’ perceived barriers and self-efficacy were low. Students have had an issue with their ability to prepare for disasters due to a lack of awareness. Therefore, targeting them via educational programs and school curriculum modifications will help increase disaster awareness. Students’ performance had the highest correlation with self-efficacy, which means that low self-efficacy will lessen the possibility of students getting prepared for disasters -which is the case in this study. Increasing self-efficacy will reinforce self-esteem and improve preparedness for disasters.

The parent’s education level did not affect students’ preparedness, knowledge, and behaviour. Only the fathers’ high education level was linked to the high level of students’ beliefs on disaster risks. People who are educated are more aware of their surroundings and are more perceptive of risks. Fathers generally serve as role models and sources of information to their children, which explains the higher beliefs of disaster risk.

The limitations of the study are as follows: First, the research was conducted in 2016, and males were excluded due to social and cultural reasons. Another limitation was that our sample population consisted solely of high school students enrolled in government schools, without including those from private schools. This may affect the generalizability of the study results to the broader population. Additionally, the lack of local and international studies on general disasters, as well as studies examining students’ awareness and beliefs about disasters, was a significant limitation. Such studies could have provided valuable comparisons regarding students’ knowledge, perceptions of benefits, attitudes, and beliefs related to disasters and disaster preparedness.

Conclusion

Knowledge doesn’t necessarily lead to behavioural change, and the belief in adopting the proper behaviour affects its conduct. Students’ belief that a disaster will not occur and the belief that there is no use in preparing for disasters despite having adequate information led to students needing to prepare enough for catastrophe. Information-awareness programs sometimes fail to fulfil their purpose of changing people’s behaviour due to their focus on information only, neglecting the importance of ensuring that people will adopt healthy behaviours and agree with the importance of it.