Disaster preparedness frequently does not address populations less able to prepare for disaster such as those with chronic illness. Individuals with chronic illnesses are at particular risk of poor outcomes, including death. The purpose of the study was to develop a theoretical framework that describes how individuals with chronic illnesses who have experienced a disaster managed health-related challenges during the disaster. Theory about the five phases of disaster response (non-disaster, pre-disaster, impact, emergency, and reconstruction) and the individual, local, state, and federal level model served as conceptual frameworks.
Purposive sampling was used to recruit the sample. Thirty individuals with chronic illnesses who have experienced disaster and 10 lay caregivers were recruited from Florida and New Orleans This study used grounded theory methods from the qualitative tradition. Three data sources were used: interviews with individuals with chronic illnesses and caregivers who have experienced disasters, and media data. Combined interviews from the perspectives of those who have experienced disaster (individuals with chronic illness and caregivers) with media reports added contextual description of circumstances surrounding the disaster. Constant comparative analysis techniques were used to build the theoretical framework. Trustworthiness was addressed by member checks, audit trail, and data triangulation.
Analysis of the transcripts suggested that participants shifted the priorities of their illness to deal with the challenges of the disaster. There were four ways in which participants used the process of backburnering their chronic illness, which we named prudent, impromptu, deliberate, and unforeseen. Each way of backburnering related to five factors: media impact, evacuation, preparation, attention, and recovery. If participants were evacuated for longer than one week or returned to no or minimal damage to their home, many recovered from the disaster events enough to address at least some health-related concerns from afar. Those remaining home were more apt to ignore health-related concerns longer to deal with home and family issues. The study provided in-depth insight into how a vulnerable population manages health-related concerns specifically in the context of disaster response which can be used to guide future research and interventions.