Date of Award


Degree Name

Doctor of Philosophy


Interdisciplinary Health Sciences

First Advisor

Dr. Amy B. Curtis

Second Advisor

Dr. Marie Gates

Third Advisor

Dr. Laura Morlock


This dissertation examines disaster preparedness in the U.S. and explores the relationships between risk perception, funding from the Health Resources and Services Administration (HRSA), and preparedness. Secondary data analysis was conducted using the National Study of Rural Hospitals from Johns Hopkins University. The study, based on a random sample of rural hospitals, consisted of a mail questionnaire and a follow-up phone interview with the hospital's Chief Executive Officer (n = 134).

A model of disaster preparedness was utilized to examine seven elements of preparedness. Risk perception was examined by seven risk threats, and HRSA funding was examined as a continuous and categorical variable.

The results indicated that rural hospitals were moderately prepared overall (78% prepared on average), with high preparedness in education/training (89%) and isolation/decontamination (91%); moderate preparedness in administration/planning (80%), communication/notification (83%), staffing/support (66%), and supplies/pharmaceuticals/laboratory support (70%); and low preparedness in surge capacity (64%).

The respondents reported greater risk perception from natural disasters (79% reported moderate to high risk) and vehicular accidents (77%) than from manmade disasters (23%). Eighty-nine percent of the hospitals had received HRSA funding, ranging from $1,000 to $526,555.

Results obtained from logistic regression models indicated that there was no statistically significant difference in the odds of a hospital being prepared overall when comparing high versus low risk perception (OR = .61; 95% CI, .26-1.44) or high versus low HRSA funding (OR = 1.09; 95% CI, .50-2.39), and no interaction was found between HRSA funding and risk perception on preparedness. Positive associations were identified between risk perception and the subcategory of education/training (OR = 1.24; 95% CI, 1.05-1.27) and between HRSA funding and isolation/decontamination (OR = 1.26; 95% CI, 1.08-1.83). Additionally, positive associations were found between system affiliation and staffing/support, and supplies/pharmaceuticals/laboratory support; and between Joint Commission accreditation and administration/planning, education/training, and supplies/pharmaceuticals/laboratory support.

Rural hospitals reported being moderately prepared overall in the event of a disaster. Further research should be conducted to identify predictors of preparedness in rural hospitals in order to optimize readiness for potential disaster events.

Access Setting

Dissertation-Open Access

Included in

Public Health Commons