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Disaster Impact on Impoverished Area of US: An Inter-Professional Mixed Method Study

  • Linda H. Banks (a1), Lisa A. Davenport (a1), Meghan H. Hayes (a1), Moriah A. McArthur (a1), Stacey N. Toro (a1), Cameron E. King (a1) and Hazel M. Vazirani (a1)...



In the foothills of the Cumberland Mountains, in central Appalachia (a region that spans 13 states in the US), sits an economically distressed and rural community of the United States. Once a thriving coal-mining area, this region now is reported as one of the hardest places to live in the US. Southeastern Kentucky, located in a remote, rocky, mountainous area surrounded by rivers and valleys and prone to flooding, experienced a major flood in Spring 2013 causing significant damage to homes and critical infrastructure.


Aims of the study were to: (1) identify and better understand the contextual variables compounding the impact of a disaster event that occurred in Spring 2013; (2) identify ways participants managed antecedent circumstances, risk, and protective factors to cope with disaster up to 12 months post-event; and (3) further determine implications for community-focused interventions that may enhance recovery for vulnerable populations to promote greater outcomes of adaptation, wellness, and readiness.


Using an ethnographic mixed-methods approach, an inter-collaborative team conducted face-to-face interviews with (N=12) Appalachian residents about their disaster experience, documented observations and visual assessment of need on an observation tool, and used photography depicting structural and environmental conditions. A Health and Emergency Preparedness Assessment Survey Tool was used to collect demographic, health, housing, environment, and disaster readiness assessment data. Community stakeholders facilitated purposeful sampling through coordination of scheduled home visits.


Triangulation of all data sources provided evidence that the community had unique coping strategies related to faith and spirituality, cultural values and heritage, and social support to manage antecedent circumstances, risk, and protective factors during times of adversity that, in turn, enhanced resilience up to 12 months post-disaster. The community was found to have an innate capacity to persevere and utilize resources to manage and transcend adversity and restore equilibrium, which reflected components of resilience that deserve greater recognition and appreciation.


Resilience is a foundational concept for disaster science. A model of resilience for the rural Appalachia community was developed to visually depict the encompassing element of community-based interventions that may enhance coping strategies, mitigate risk factors, integrate protective factors, and strengthen access. Community-based interventions are recommended to strengthen resilience, yielding improved outcomes of adaptation, health and wellness, and disaster readiness.

Banks LH , Davenport LA , Hayes MH , McArthur MA , Toro SN , King CE , Vazirani HM . Disaster Impact on Impoverished Area of US: An Inter-Professional Mixed Method Study. Prehosp Disaster Med. 2016;31(6):583592.


Corresponding author

Correspondence: Lisa A. Davenport, PhD, RN, CEN University of Tennessee College of Nursing 1200 Volunteer Blvd. Knoxville, Tennessee 37996 USA E-mail:


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1. Lowrey, A. What’s the matter with Eastern Kentucky? The New York Times. Published June 29, 2014. Accessed June 15, 2015.
2. Pollard, K, Jacobsen, L. The Appalachian Region: a data overview from the 2009-2013 American Community Survey. Appalachian Regional Commission Web site. Accessed June 15, 2015.
3. County Health Rankings 2015. Robert Wood Johnson Foundation Web site. Accessed June 15, 2015.
4. Castleden, M, McKee, M, Murray, V, Leonardi, G. Resilience thinking in health protection. J Public Health (Oxf). 2011;33(3):369-377.
5. Haase, J. “Resilience.” In: Peterson SJ, Bredow TS (eds). Middle Range Theories: Application to Nursing Research. Philadelphia, Pennsylvania USA: Wolters Kluwer/Lippincott Williams & Wilkins; 2009: 326-362.
6. Pfefferbaum, RL, Pfefferbaum, B, Van Horn, RL, Neas, BR, Houston, JB. Building community resilience to disasters through a community-based intervention: CART applications. J Emerg Manag. 2013;11(2):151-159.
7. Tugade, MM, Fredrickson, BL, Feldman Barrett, L. Psychological resilience and positive emotional granularity: examining the benefits of positive emotions on coping and health. J Pers. 2004;72(6):1161-1190.
8. Plough, A, Fielding, JE, Chandra, A, et al. Building community disaster resilience: perspectives from a large urban county department of public health. Am J Public Health. 2013;103(7):1190-1197.
9. Norris, FH, Stevens, SP, Pfefferbaum, B, Wyche, KF, Pfefferbaum, RL. Community resilience as a metaphor, theory, set of capacities, and strategy for disaster readiness. Am J Community Psychol. 2008;41(1/2):127-150.
10. Keim, ME. Building human resilience: the role of public health preparedness and response as an adaptation to climate change. Am J Prev Med. 2008;35(5):508-516.
11. National Research Council (NRC). Disaster Resilience: A National Imperative. Washington, DC USA: The National Academies Press; 2012.
12. Ostadtaghizadeh, A, Ardalan, A, Paton, D, Jabbari, H, Khankeh, HR. Community disaster resilience: a systematic review on assessment models and tools. PLoS Curr. 2015;7.
13. Levac, J, Toal-Sullivan, D, O’Sullivan, T. Household emergency preparedness: a literature review. J Community Health. 2012;37(3):725-733.
14. National Research Council. Facing Hazards and Disasters: Understanding Human Dimensions. Washington, DC USA: National Academies Press; 2006: 19-20.
15. Homeland Security Presidential Directive/HSPD -21. Accessed June 15, 2015.
16. Morton, MJ, Lurie, N. Community resilience and public health practice. Am J Public Health. 2013;103(7):1158-1160.
17. “Holler.” American Heritage Dictionary of the English Language. Fifth Edition. Boston, Massachusetts USA: Houghton Mifflin Harcourt Publishing Company; 2001.
18. Centers for Disease Control and Prevention (CDC). Community Assessment for Public Health Emergency Response (CASPER) Toolkit. Second edition. Atlanta, Georgia USA: CDC; 2012.


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Disaster Impact on Impoverished Area of US: An Inter-Professional Mixed Method Study

  • Linda H. Banks (a1), Lisa A. Davenport (a1), Meghan H. Hayes (a1), Moriah A. McArthur (a1), Stacey N. Toro (a1), Cameron E. King (a1) and Hazel M. Vazirani (a1)...


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