Journal of Preventive Medicine

Introduction
Iran is the fourth country in Asia and the 10th country in the world in terms of being prone to natural disasters. Iran is one of the earthquake-prone regions of the world; although the mountainous regions and the Zagros region in Iran are at greater risk of earthquakes, due to the earthquakes of Bam and Tabas in the last few years, no region of Iran is immune from the danger of earthquakes. Universities of medical sciences are one of the intervening and influential organizations in Iran during natural disasters, including earthquakes. Since the damages caused by natural disasters such as earthquakes is high, the limited resources of these medical universities will not be sufficient for all victims. Therefore, it is necessary to organize the capacity of resources such as community-oriented medical and paramedical manpower, medical equipment, and health workers in universities of medical sciences. This study aims to develop a community-oriented readiness model (CRM) for the universities of medical sciences in Iran in providing health services to earthquake victims.
Methods
This is a qualitative (grounded theory) study using structural equations modelling (SEM). It was conducted at two phases: (1) Designing a CRM for Iranian medical universities in providing healthcare services to earthquake victims (Qualitative approach), (2) Fitting and assessing the CRM (Quantitative approach). In the qualitative phase, a panel of experts including university professors in crisis management, senior managers of medical universities, and consultants in the field of crisis management were considered as the study population. In this phase, a purposive sampling method was used and sampling continued until theoretical saturation was reached. In the quantitative phase, the study population consisted of senior, middle-level and operational managers of 50 medical universities (n=500). Using Krejcie and Morgan’s table, 217 were selected as samples by a cluster sampling method. The data collection tool in the quantitative phase was a researcher-made questionnaire consisting of 40 items, which was distributed and collected online. In the quantitative phase, test the hypotheses were analyzed in LISREL software using SEM.
Results
Eleven interviews were conducted in this study. After analyzing the interviews, coding (open, axial, selective) was done. Then, by putting the concepts together and removing duplicate concepts, 59 final concepts were identified. With deep attention to the identified concepts and recognition of their similarities and differences with each other, they were categorized into 21 groups. In the next step, the identified categories were placed in the paradigm model and led to the creation of the CRM of medical universities (Figure 1). To check the fit of structural models, several criteria are used. The main criterion is the t-values which should be >1.96 or <1.96 in order to confirm the correctness of the relationship between constructs and research hypotheses at 95% confidence interval. The fitted model of the study (quantitative phase) in standard conditions and in case of a significant relationship between constructs are shown in Figures 2 and 3. In the quantitative phase, it was found that causal conditions had a positive and significant effect on the necessity of community-oriented readiness of medical universities in providing healthcare services at the time of earthquakes (t=0.46). The necessity of community-oriented readiness of universities of medical sciences had a positive and significant effect on the implementation of strategies in providing healthcare services at the time of earthquakes (t=0.61). Environmental conditions had a positive and significant effect on the implementation of strategies in providing healthcare services at the time of earthquakes (t=0.20). Moreover, the implementation of community-oriented strategies by medical universities had a positive and significant effect on reducing costs (t=0.55) and casualties (t=0.68), and on social capital capability (t=0.74).
Discussion
The results showed that individual, social and organizational variables had a significant effect on the community-oriented readiness of medical universities Iran for providing healthcare services to earthquake victims. Based on these factors, in the community-oriented readiness process, the way medical universities interact with people and create capacities for public participation is very important. The presented CRM has a good fit and, therefore, can be suitable for evaluating the community-oriented readiness of medical universities in Iran for providing healthcare services to the earthquake victims.

Ethical Considerations
Compliance with ethical guidelines
In the non-medical fields of the Ministry of Science, there is no need to write a code of ethics thesis.

Funding
All authors contributed equally in preparing all parts of the research.

Authors' contributions
Writing, preparation of the questionnaire, method of collecting information, method of analysis, editing: Mehdi Kazemi; How to extract the scientific content of thesis chapters from scientific databases, how to analyze and introduce authoritative scientific journals: Ali Mollahosseini; Preparation of the questionnaire, writing, data collection, analysis and analysis: Ali Azarpikan.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The participants in the research: crisis management experts, university professors, middle and operational crisis managers of universities of medical sciences and representatives of Semanah are appreciated and thanked.
 

References

1. Lee YI, Lu X, Jin Y. Uncertainty management in organizational crisis communication: The impact of crisis responsibility uncertainty and attribution-based emotions on publics’ further crisis information seeking. J Commun Manag. 2021. [DOI:10.1108/JCOM-02-2021-0018]
2. Vafaee A, Alamdari Sh, Hatamabadi H. [Design patterns in the crisis management Shohada hospital. (Persian)]. J Rescue Relief. 2011; 3(2-1):67-79. [Link]
3. Eskandari M, Nateghi Elahi F. [Planning for crisis management (earthquake) of a hospital” (Case Study) (Persian)]. Paper presented at: 3^th National Conference on Metropolis Management with Approach to Safety, health and environment. 28 -29 December 2017; Tehran: Iran. [Link]
4. Noorullahi B. [The role of public participation in crisis management (Looking at Tehran’s urban management approach in attracting public participation (Persian)]. Paper presented at: 5^th International Conference on Comprehensive Natural Disaster Management (INDM). 23 February 2014; Tehran: Iran. [Link]
5. Veisi F. [Comperhensive disaster management by commuity with a community-oriented and futuristic approach (Persian)]. Commercial Publishing Company: Tehran; 2019. [Link]
6. Jannat F, Alipour S, Ardalan A. [Examining how to participate people in dealing with natural disasters (Persian)]. Paper presented at: International Conference on Comprehensive Management of Natural Disasters, Permanent Secretariat of Conference. 2013; Tehran, Iran. [Link]
7. Rezaei MR, Nouri M. [Comparative analysis of citizens’ different performancein response to earthquake crisis with emphasis on the importance of preparedness in the crisis management cycle (case study: Kerman city) (Persian)]. Paper presented at: 2^nd National Conference on Applied Research in Civil Engineering (Structural Engineering and ConstructionManagement). 10 March 2018; Tehran, Iran. [Link]
8. Liu BF, Fowler BM, Roberts HA, Herovic E. Keeping hospitals operating during disasters through crisis communication preparedness. Public Relat Rev. 2018; 44(4):585-97. [DOI10.1016/j.pubrev.2018.06.002]
9. Ayoubi R, Danaeinia A. [The role of public participation in reducing the damage caused by earthquakes in historical contexts (Persian)]. J Maremat & Me’mari-e Iran. 2011; 1(2):53-62. [Link]
10. Bazrgar R, Khankeh H, Ahmadi Sh, Hosseini M, Rahgozar M, Moradian M. [Reviwing the effect of application of coordination-based crisis management model on hospital preparedness in Shiraz Shahid Rajaei Hospital (Persian)]. J Nurs Res Iran. 2013; 8(29):10-8. [Link]
11. Amouzad Khalili S, Rashidi A, Pirdashti H. [Investigating the role of public participation in improving the performance of urban environment crisis management and the effective factors on according to the Rogers’ publicparticipation theory in Behshahr city (Persian)]. Disaster Prev Manag-Know. 2018; 8(3):255-68. [Link]
12. Arvin M, Faraji A, Bazrafkan Sh. [Reviewing the effect of social capital on earthquake risk management with emphasis on resiliency” (case study: Tehran’s district 9) (Persian)]. Soc Capital Manag. 2018; 5(1):1-24. [DOI:10.22059/JSCM.2018.245715.1490]
13. Achour N, Miyajima M, Pascale F, Price AD. Hospital resilience to natural hazards: Classification and performance of utilities. Disaster Prev Manag. 2014; 23(1):40-52. [DOI:10.1108/DPM-03-2013-0057]
14. Hosseini Shokouh SM, Anjomshoa M, Mousavi SM, Sadeghifar J, Armoun B, Rezapour A, et al. Prerequisites of preparedness against earthquake in hospital system: A survey from Iran. Glob J Health Sci. 2014; 6(2):237-45. [DOI:10.5539/gjhs.v6n2p237] [PMID] [PMCID]
15. Charney RL, Rebmann T, Flood RG. Hospital employee willingness to work during earthquakes versus pandemics. J Emerg Med. 2015; 49(5):665-74. [DOI:10.1016/j.jemermed.2015.07.030] [PMID]
16. Qaedi H, Nasiripour A, Tabibi SJ. [Hospital preparedness in radiation crisis in selected countries and developing a conceptual model for Iran (Persian)]. Iran South Med J 2018; 21(5):393-408. [Link]