Flood Preparedness Literacy of Older Adults and the Factors Related to Flood Preparedness Literacy

In this study, most of the subjects, or 82.8%, possessed adequate flood preparedness literacy regarding each aspect and overall flood preparedness literacy. The aspect with the highest mean was the decision-making aspect, at 74.7%. This was perhaps because Tambon Hua Weing has suffered flood disasters on a yearly basis and most of the subjects, or 79.1%, had lived in this area for a very long time. They gained more experience in dealing with flood disasters every year, which occurred in the same pattern. All of them intended to stay at home rather than evacuating themselves, so they had to maximize their own ability to defend themselves against floods. Additionally, this area could access help and resources from many authorities during the time of a flood, and this could promote flood preparedness literacy among the subjects in this study.

The factors related to the flood preparedness literacy of older adults with a statistical significance were marital status, social support, hearing ability, and the ability to carry out daily living activities, which can be explained as follows. Older adults that are living with their spouse will support each other in preparing for floods. Previous studies yielded similar findings.^{Reference Kingkaew and Prasertsri13,Reference Kaewthong, Termsirikulchai and Leerapan14} However, the finding of this study was different from some studies that reported that marital status was not seen to be related to health literacy.^{Reference Nilnate15,Reference Al-Rousan, Rubenstein and Wallace16} This may be due to the different context of the study, which is an urban community.^{Reference Nilnate15} Additionally, most of the subjects lived in an extended family, so they were able to receive support from their family members.^{Reference Nilnate15} With regard to social support, the communities in Tambon Hua Weing, Sena District, Phra Nakhon Sri Ayutthaya Province are rural communities where community dwellers take care of and help one another just as in other rural communities.^{Reference Preutikarnkij17} This is similar to the findings reported in previous studies.^{Reference Kaewthong, Termsirikulchai and Leerapan14,Reference Nontakaew and Suksa-ard18}

Hearing ability was found to be related to flood preparedness literacy. It could be explained that clarity and voice quality during communication had an effect on the communication about disaster management.^{Reference Mace and Doyle9} In this study, almost all of the subjects followed news on the flood through hearing; they listened to weather forecasts and flood warning announcements. If they had hearing loss, this could have affected their flood preparedness and evacuation. However, no studies were found related to hearing perception or disaster preparedness in the literature review.

The ability to carry out advanced daily living activities was one of the factors related to flood preparedness literacy in this study. Older adults that lack the ability to take care of themselves might be less prepared for flood disaster.^{Reference Mace and Doyle9} In fact, the ability to do advanced daily living activities is necessary for individuals to further develop their literacy. This finding is consistent with previous reports.^{Reference Kobayashi, Wardle and Wolf19–Reference Bostock and Steptoe21}

These factors were not related to flood preparedness literacy: gender, age, educational level, occupation, family income, visual ability, and comorbidity. Most of the subjects in this study were female with the mean age of 70.54 y, and most of them (84.3%) had completed an elementary education. A plausible explanation is that both the male and female subjects in this study had been living in Tambon Hua Weing for many years, and all of them had experienced flood disasters before. Thus, the flood preparedness literacy was not different between the females and males. This is consistent with a study of disaster preparedness among elders in Hong Kong,^{Reference Loke, Lai and Fung22} where it was found that age and educational level were not correlated with flood preparedness literacy. The subjects in this study learned how to adapt their lifestyles during the flood disaster on a yearly basis rather than learning about it in school. Such findings lend support to the findings of previous studies, where it was indicated that education level was not related to health literacy or disaster preparedness.^{Reference Kingkaew and Prasertsri13,Reference Nilnate15,Reference Loke, Lai and Fung22}

The context of Tambon Hua Weing is similar to that of other rural communities, that is, the people that live in the same neighborhood tend to have similar ways of living.^{Reference Preutikarnkij17} Therefore, whether they are employed or not, older adults are able to similarly access information about flood preparedness. Furthermore, they receive support from local government agencies that enable them to prepare for flood disasters. This is similar to the results of previous studies in Thailand, which indicated that occupation was not related to health literacy or disaster preparedness.^{Reference Kingkaew and Prasertsri13,Reference Nontakaew and Suksa-ard18} Likewise, family income was not seen to be related to flood preparedness literacy. This is not consistent with previous studies, which found that household income was related to health literacy and flood preparedness.^{Reference Nontakaew and Suksa-ard18,Reference Liu, Wang and Liang23} It can be explained that older adults in this study received materials, boats, barriers, and financial support from several agencies so they were able to prepare for floods without their own financial support.

Visual ability has been found to be related to health literacy.^{Reference McKee, Paasche-Orlow and Winters24–Reference Mullen, Curtis and O’Conor26} However, it was not related to visual ability or flood preparedness literacy in this study. Older adults with visual impairment might have some barriers in terms of obtaining information, including news on the disaster and warning for evacuation; however, they could receive news and information by listening to the radio, television, and public announcements in the community. Accordingly, they might be less affected by a visual impairment in terms of their preparedness literacy. Finally, it was found that comorbidity was not related to flood preparedness literacy. This is consistent with a study that reported that the number of underlying diseases was not related to health literacy.^{Reference Park and June27} In this study, it was possible that the older adults with or without a comorbidity might also be prone to experiencing a large affect from a flood so they prepare themselves to minimize the risks. Therefore, flood preparedness literacy was not seen to be different, whether the person had a low or high comorbidity.

Flood Preparedness Behaviors of Older Adults and Their Relationship With Flood Preparedness Literacy

The findings showed that the subjects’ behavior regarding follow-up news on floods and planning for evacuation was at a low level (50%). It is possible that the subjects were able to adjust themselves to living with floods by using lesson in the past. One explanation why the subjects’ mean score for knowledge about floods and flood management was lowest (20.0%) was that the subjects were older adults and their ability to learn was limited due to their age.^{Reference Somes and Stephens Donatelli28}

It was found that the older adults’ flood preparedness literacy was related to flood preparedness behaviors with a statistical significance (r = 0.281; P < 0.01), which was in compliance with the disaster literacy model that was adapted from the concept of health literacy, proposing health literacy as an outcome of health promotion that can change the determinants of health.^{Reference Nutbeam4} Accordingly, the disaster literacy model includes 4 levels of literacy by which people are increasingly enabled to exert greater control and have personal responsibility, along with increased awareness of the factors that shape their efforts to respond to disasters effectively.^{Reference Brown, Haun and Peterson3} Flood preparedness literacy in older adults should be assessed and promoted so as to enhance their disaster preparedness behavior and lessen the impacts from flood disasters.