Open Access Open Access  Restricted Access Subscription or Fee Access

Disaster-related communication preferences of homeless and nonhomeless VA patients

Alicia R. Gable, MPH, Claudia Der-Martirosian, PhD, Laura N. Pinnock, MSPH, PMP, Aram Dobalian, PhD, JD, MPH


Objective: To identify the communication preferences of homeless (H) and nonhomeless (NH) Veterans Affairs (VA) patients for receiving information about the impact of natural disasters on VA healthcare services.

Design: Probability-based sampling design stratified on age categories, urban/rural, coastal/noncoastal, and homelessness. Setting: Northeast United States.

Participants: Eligible NH and H participants included those who lived in and had at least one healthcare visit to a VA medical center/clinic in the region in the previous 24 months. Homeless participants included those receiving VA homeless services or having ICD9-CM V60.0 (Lack of Housing). 2,264/6,088 NH and 383/2,000 H completed the survey.

Intervention: Cross-sectional, mixed-mode survey administered August-November 2015.

Main Outcome Measures: Helpfulness of ten communication modes for receiving information about the impact of natural disasters on VA healthcare services.

Results: Despite sociodemographic and health status differences, the top five communication modes rated extremely/very helpful were the same for both groups: telephone (76 percent H; 81 percent NH), TV (63 percent H; 60 percent NH), text (62 percent H; 50 percent NH), e-mail (56 percent H; 58 percent NH), radio (54 percent H; 47 percent NH). Newspaper and online modes (VA/other Web sites, Twitter, Facebook, MyHealtheVet) were rated substantially lower.

Conclusions: H and NH patients prefer similar communication modes for receiving updates about the impact of natural disasters on VA healthcare services. Findings suggest that a multimodal communication strategy that incorporates phone, TV, text, e-mail, and radio will help Veterans Affairs (VA) reach its diverse patient population during natural disasters. Dissemination of messages via online modes, while rated less helpful, may augment the number of patients reached.


disasters, communication, Veterans, Homeless

Full Text:



Schultz CH, Koenig KL, Lewis RJ: Implications of hospital evacuation after the Northridge, California, earthquake. N Engl J Med. 2003; 348: 1349-1355.

Druss BG, Henderson KL, Rosenheck RA: Swept away: Use of general medical and mental health services among veterans displaced by Hurricane Katrina. Am J Psychiatry. 2007; 164: 154-156.

U.S. Department of Veterans Affairs: Restoration of outpatient services underway at Manhattan VA. April 1, 2013. Available at Accessed June 1, 2017.

U.S. Department of Veterans Affairs: Through hurricanes, VA continues efforts to care for Veterans. October 3, 2017. Available at Accessed October 30, 2017.

Dobalian A, Claver M, Fickel JJ: Hurricanes Katrina and Rita and the Department of Veterans Affairs: A conceptual model for understanding the evacuation of nursing homes. Gerontology. 2010; 56: 581-588.

Dobalian A, Stein JA, Heslin KC, et al.: Impact of the Northridge earthquake on the mental health of veterans: Results from a panel study. Disaster Med Public Health Prep. 2011; 5(Suppl 2): S220-S226.

Agha Z, Lofgren RP, VanRuiswyk JV, et al.: Are patients at Veterans Affairs medical centers sicker? A comparative analysis of health status and medical resource use. Arch Intern Med. 2000; 160: 3252-3257.

Nelson KM, Starkebaum GA, Reiber GE: Veterans using and uninsured veterans not using Veterans Affairs (VA) health care. Public Health Rep. 2007; 122: 93-100.

Randall M, Kilpatrick KE, Pendergast JF, et al.: Differences in patient characteristics between Veterans Administration and community hospitals: Implications for VA planning. Med Care. 1987; 25: 1099-1104.

U.S. Department of Housing and Urban Development: 2016 Point-in-time estimate of homeless veterans by state. Available at Accessed April 1, 2017.

O'Toole TP, Conde-Martel A, Gibbon JL, et al.: Health care of homeless veterans. J Gen Intern Med. 2003; 18: 929-933.

Tsai J, Doran KM, Rosenheck RA: When health insurance is not a factor: National comparison of homeless and nonhomeless US veterans who use Veterans Affairs Emergency Departments. Am J Public Health. 2013; 103(Suppl 2): S225-S231.

Hwang SW: Mortality among men using homeless shelters in Toronto, Ontario. JAMA. 2000; 283: 2152-2157.

LePage JP, Bradshaw LD, Cipher DJ, et al.: The effects of homelessness on Veterans' health care service use: An evaluation of independence from comorbidities. Public Health. 2014; 128: 985-992.

Leaning J, Guha-Sapir D: Natural disasters, armed conflict, and public health. N Engl J Med. 2014; 370: 783-784.

Cascardo D: Learning to live with volatility: Preparing for business continuity and recovery following a disaster. J Med Pract Manage. 2013; 28: 282-285.

Gin JL, Kranke D, Saia R, et al.: Disaster preparedness in homeless residential organizations in Los Angeles county: Identifying needs, assessing gaps. Nat Hazards Rev. 2015; 17: 04015022.

Burger J, Gochfeld M, Jeitner C, et al.: Trusted information sources used during and after Superstorm Sandy: TV and radio were used more often than social media. J Toxicol Environ Health A. 2013; 76: 1138-1150.

Buttke D, Vagi S, Bayleyegn T, et al.: Communication, information seeking, and evacuation plans for a disaster using Community Assessment for Public Health Emergency Response in the Gulf Coast counties of Alabama and Mississippi, 2011. J Emerg Manag. 2013; 11: 213-223.

Cretikos M, Eastwood K, Dalton C, et al.: Household disaster preparedness and information sources: Rapid cluster survey after a storm in New South Wales, Australia. BMC Public Health. 2008; 8: 195.

Ng KH, Lean ML: The Fukushima nuclear crisis reemphasizes the need for improved risk communication and better use of social media. Health Phys. 2012; 103: 307-310.

David CC, Ong JC, Legara EF: Tweeting Supertyphoon Haiyan: Evolving functions of twitter during and after a disaster event. PLoS One. 2016; 11: e0150190.

Stokes C, Senkbeil JC: Facebook and Twitter, communication and shelter, and the 2011 Tuscaloosa tornado. Disasters. 2017; 41(1): 194-2008.

Simon T, Goldberg A, Adini B: Socializing in emergencies—A review of the use of social media in emergency situations. Int J Inf Tech. 2015; 35: 609-619.

Merchant RM, Elmer S, Lurie N: Integrating social media into emergency-preparedness efforts. N Engl J Med. 2011; 365: 289-291.

Tsai J, Rosenheck RA: Use of the internet and an online personal health record system by US veterans: Comparison of Veterans Affairs mental health service users and other veterans nationally. J Am Med Inform Assoc. 2012; 19: 1089-1094.

Klee A, Stacy M, Rosenheck R, et al.: Interest in technology-based therapies hampered by access: A survey of veterans with serious mental illnesses. Psychiatr Rehabil J. 2016; 39: 173-179.

Kampmeijer R, Pavlova M, Tambor M, et al.: The use of e-health and m-health tools in health promotion and primary prevention among older adults: A systematic literature review. BMC Health Serv Res. 2016; 16(Suppl 5): 290.

Shimada SL, Brandt CA, Feng H, et al.: Personal health record reach in the Veterans Health Administration: A cross-sectional analysis. J Med Internet Res. 2014; 16: e272.

McInnes DK, Sawh L, Petrakis BA, et al.: The potential for health-related uses of mobile phones and internet with homeless veterans: Results from a multisite survey. Telemed J E Health. 2014; 20: 801-809.

Eyrich-Garg KM: Mobile phone technology: A new paradigm for the prevention, treatment, and research of the non-sheltered “street” homeless? J Urban Health. 2010; 87: 365-380.

McInnes DK, Fix GM, Solomon JL, et al.: Preliminary needs assessment of mobile technology use for healthcare among homeless veterans. PeerJ. 2015; 3: e1096.

McInnes DK, Li AE, Hogan TP: Opportunities for engaging low-income, vulnerable populations in health care: A systematic review of homeless persons' access to and use of information technologies. Am J Public Health. 2013;103(Suppl 2): e11-e24.

McInnes DK, Petrakis BA, Gifford AL, et al.: Retaining homeless veterans in outpatient care: A pilot study of mobile phone text message appointment reminders. Am J Public Health. 2014; 104(Suppl 4): S588-S594.

Gabrielian S, Yuan AH, Andersen RM, et al.: VA health service utilization for homeless and low-income Veterans: A spotlight on the VA Supportive Housing (VASH) program in greater Los Angeles. Med Care. 2014; 52: 454-461.

Tsai J, Edens EL, Rosenheck RA: Nicotine dependence and its risk factors among users of veterans health services, 2008-2009. Prev Chronic Dis. 2011; 8: A127.

Wright SM, Craig T, Campbell S, et al.: Patient satisfaction of female and male users of Veterans Health Administration services. J Gen Intern Med. 2006; 21(Suppl 3): S26-S32.

Edgington S: Disaster planning for people experiencing homelessness. Nashville, TN: National Healthcare for the Homeless Council, 2009. Available at Accessed June 20, 2017.

Chou W-yS, Hunt YM, Beckjord EB, et al.: Social media use in the United States: Implications for health communication. J Med Internet Res. 2009; 11(4): e48.

Medford-Davis LN, Kapur GB: Preparing for effective communications during disasters: Lessons from a World Health Organization quality improvement project. Int J Emerg Med. 2014; 7: 15.

Taylor-Clark KA, Viswanath K, Blendon RJ: Communication inequalities during public health disasters: Katrina's wake. Health Commun. 2010; 25(3): 221-229.

Lin L, Savoia E, Agboola F, et al.: What have we learned about communication inequalities during the H1N1 pandemic: A systematic review of the literature. BMC Public Health. 2014; 14: 484.



  • There are currently no refbacks.

Copyright (c) 2018 Journal of Emergency Management