Lessons From Federally Qualified Health Centers in the US Territories on Managing Non-Communicable Diseases in the Setting of Disasters: A Qualitative Study Using the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework.

Abstract

This study examines disaster preparedness and response in Federally Qualified Health Centers (FQHCs), which serve vulnerable populations, including individuals with non-communicable diseases (NCDs). Hurricanes Irma and Maria revealed gaps in chronic disease management, contributing to significant mortality. Climate change will likely exacerbate these challenges, necessitating a deeper understanding of preparedness factors. Using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, we conducted a qualitative study of 2 FQHCs in Puerto Rico and the U.S. Virgin Islands, analyzing inner (leadership, organizational culture, and staff dynamics) and outer (funding, networks, and policies) contextual factors. Twenty-four semi-structured interviews were analyzed thematically utilizing the EPIS framework. Interviews with 24 staff members highlighted strong leadership valuing both employees and patients, prior disaster experience, and a culture of continuous improvement as essential for preparedness. Personal support systems improved staff engagement, while external collaborations with relief organizations enhanced response efforts. Flexible policies allowing access to medication and healthcare services beyond insurance coverage were critical for NCD patients during disasters. The EPIS framework successfully contextualized chronic disease management in extreme weather events, identifying strategies to mitigate climate-related health disparities. Strengthening inter-organizational networks and policy adaptability can enhance FQHC resilience, ensuring continued care for at-risk populations during disasters.