Evaluation of awareness, attitudes, and practices towards disaster preparedness among Saudi healthcare professionals: implications for enhancing emergency response and training

Introduction

The public health emergency management (PHEM) is a key element in the health systems because disasters are common in most countries and come in the form of natural and man-made disasters (Brencic et al., 2017; Rose et al., 2017). Lately, rampant urbanization and global population growth have led to an increase in natural and artificial disasters or calamities (He et al., 2021; UNDRR, 2019). The impact of the disaster can be abrupt and limited; however, it is very often extensive and could persist for longer durations. In addition, these challenges may prompt the suffering community or group to thrive under their own limited supplies, and thus may necessitate aid from outside, which possibly will involve immediate authorities, or even national and international government bodies (Dagnino, Qian & Beatrici, 2024; EM-DAT, 2024; Zeng et al., 2025). Emergency events database categorizes disasters or calamities into natural, which includes geological (tsunamis, volcanic eruptions, and earthquakes), meteorological (cyclones and storms), hydrological (floods), climatological (wildfires and droughts), disasters, and catastrophes triggered by human-driven activities like industrial (biochemical spill), transport, and miscellaneous accidents, for instance, detonation (EM-DAT, 2024; UNDRR, 2017).

Recognizing an outbreak depends on the government agencies’ ability to identify a significant rise in the cases of a specific disease, more than the number ordinarily expected. Epidemic prevention, preparedness, and response rely on a high level of technical expertise to implement the associated plans (Li et al., 2022). Healthcare professionals (HCPs) must be familiar with emergency management procedures, possess the skills to effectively integrate stakeholders, and meet the stress demands of their profession. Studies have shown that healthcare professionals’ attitudes towards disaster planning strongly influence their likelihood of engaging in preparedness training and following institutional procedures, as well as the overall implementation of emergency management plans (Kennedy et al., 2020; Li et al., 2022).

Disaster preparedness among HCPs can be defined as all the measures taken to ensure that the health care institution, its workers, and patients are ready for a given disaster, including training, drills, supply of essentials, and equipment, among others (UNDRR, 2017). A recent study of these practices provides insight into the real-world application of the intended preparedness efforts. It also records the discrepancies between proposed policies and implementations, which are crucial in modifying public health approaches and responses to disasters where they are needed most (Calonge, Brown & Downey, 2020). Literature review on the knowledge, attitude, and practice of disaster preparedness among the HCPs revealed that knowledge deficits, attitude towards disasters, and disaster preparedness can be improved, and practical disaster preparedness measures need to be improved (Alhamaid et al., 2024; Mohamed, Abdel-Aziz & Elsehrawy, 2023; Tassew et al., 2022). While there is some appreciation of disaster preparedness in Saudi Arabia, important areas that still require public health attention include training in disaster preparedness and the HCPs’ attitude towards it, as well as the lack of consistent enforcement of disaster preparedness practices (AlDulijand et al., 2024; Alhamaid et al., 2024; Almukhlifi et al., 2024). This has made it clear that proper disaster preparedness measures are necessary and important, especially in Saudi Arabia, due to the geographical and socio-political structure of the Middle East. Furthermore, plenty of natural calamities in Saudi Arabia could be possibly owing to the diverse geographical landscapes, such as gigantic mountains or valleys, and coastline sections, whereas other areas are tremendously arid (Alamri, 2011). Unlike most clinical conditions, disasters can occur unexpectedly without giving early warning signs. Therefore, preparation and education beforehand would certainly aid in the proper handling of these grave conditions along with their aftereffects.

It can be concluded that the rationale behind conducting this research is based on the recommendations of the literature review, existing knowledge gaps, and regional needs, as follows. To begin with, the applicability of the given study to the field of public health cannot be overemphasized because it is vital to know the preparedness and the attitudes of HCPs in this context (Alrowili et al., 2025; Skaff et al., 2024). Secondly, despite the increasing global recognition of disaster preparedness, Saudi evidence remains fragmented. Thirdly, much of the available evidence is confined to single institutions, specific professions (such as nurses or emergency medical technicians), or narrow aspects of preparedness, leaving critical gaps in understanding broader predictors across multiple cadres of HCPs (Al-Shammari et al., 2024; Alrowili et al., 2025). This limits the ability to design targeted, evidence-based training and preparedness strategies. Moreover, the Gassim region represents a significant context due to its diverse healthcare infrastructure and inclusion of both Saudi and expatriate professionals. By evaluating the predictors of awareness, attitudes, and practices among different cadres within the Gassim context, our study will provide not only context-specific but also relevant insights that can be applied by policymakers beyond the region to develop specific training and preparedness plans. Finally, an ongoing evaluation of the HCPs’ preparedness may provide policymakers with sufficient information to implement emergency response and training programs for the HCPs (Alrowili et al., 2025; Bajow et al., 2024). So that they will be prepared to handle any disaster efficiently and reduce short- and long-term public health impacts. Therefore, we performed this study to determine the HCPs’ knowledge, attitude, and practice towards disaster preparedness. The authors also determined the predictors related to these three domains.

Materials & Methods

Results

The research team approached 447 HCPs during the data collection period, of which 390 agreed to participate in the survey (response rate is 87.2%). Of the 390 HCPs, the majority were in the age group of 31 to 45 years, females (53.6%), married (48.2%), Saudi nationals (63.3%), and working in general hospitals (45.1%). Nearly 37% of the participants had a bachelor’s degree, and 58.7% of the HCPs participated in disaster management training (Table 1).

A majority of participants demonstrated awareness of key aspects of disaster preparedness, with over 60% affirming familiarity with programs, emergency risks, referral contacts, and evacuation protocols (Table 2).

Table S1 shows the participants’ responses regarding their attitude towards disaster preparedness. Nearly 41% of the participants were interested in educational classes on disaster medicine preparedness (strongly agree—21.3%, agree—19.5%). Furthermore, 43.6% of the respondents believed that disaster preparedness is important for healthcare professionals (strongly agree—21.0%, agree—22.6%). Thinking that the workplace adequately prioritizes disaster preparedness was reported by 43.7% of the participants (strongly agree—24.2%, agree—19.5%). In addition, 45.4% of the respondents (strongly agree—22.1%, agree—23.3%) indicated that they felt supported by the organization in terms of disaster preparedness initiatives.

Table S2 depicts the participants’ responses in the practice section. Nearly 44% of the participants feel comfortable while executing evacuation protocols in the event of a disaster (strongly agree—21.5%, agree—22.6%). Additionally, 46.9% of the respondents reported that they are ready to practice under a disaster, even though some basic medications may not be available (strongly agree—25.1%, agree—21.8%). Regularly reviewing and updating their knowledge of disaster preparedness measures was done by 45.1% of the participants (strongly agree—25.1%, agree—20.0%).

Figure 1 depicts that 41% of the participants had medium knowledge. Furthermore, low attitude and practice were shown among 45.9% and 49.2% of the participants, respectively.

Table 3 showed significant positive correlations between knowledge and attitude (rho = 0.649, p = 0.001), knowledge and practice (rho = 0.565, p = 0.001), and attitude and practice (rho = 0.708, p = 0.001).

Table 4 shows the predictors associated with the HCPs’ awareness. Significantly higher levels of awareness were observed among nurses (adjusted odds ratio (AOR) = 3.19, 95% confidence interval (CI) [1.36–7.44], p = 0.007), and those HCPs who attended training programs related to disaster preparedness (AOR = 3.14, 95% CI [1.95–4.86], p = 0.037). Lower levels of awareness were observed among participants with PhD/MD education (AOR = 0.46, 95% CI [0.23–0.94], p = 0.032) and those in the age group of 31 to 45 years (AOR = 0.43, 95% CI [0.20–1.07], p = 0.006).

Table 5 presents the predictors associated with the HCPs’ attitude. Healthcare professionals with work experience from 5 to 10 years (AOR = 0.411, 95% CI [0.18–0.96], p = 0.040), those with experience > 10 years (AOR = 0.38, 95% CI [0.17–0.53], p = 0.001), and those working in general hospitals (AOR = 0.44, 95% CI [0.25–0.79], p = 0.006) had significantly lower attitude scores. Similar to the awareness, significantly higher levels of awareness were observed among nurses (AOR = 4.56, 95% CI [1.87–11.27], p = 0.001), and those HCPs who attended training programs related to disaster preparedness (AOR = 2.77, 95% CI [1.43–3.80], p = 0.013).

Table 6 presents that the participants in the age group 31–45 years (AOR = 0.49, 95% CI = 0.28–0.71, p = 0.024), those with higher levels of qualification, such as master, PhD/MD/Saudi board (AOR = 0.25, 95% CI [0.13–0.50], p = 0.001 & AOR = 0.41, 95% CI [0.26–0.67], p = 0.006) had significantly lower practice scores. The significantly higher levels of practice were noted in non-Saudi nationals (AOR = 2.07, 95% CI [1.47–3.69], p = 0.031), nurses (AOR = 3.24, 95% CI [1.38–7.59], p = 0.007), and those who had training (AOR = 4.35, AOR = 2.53–6.31, p = 0.001).

Discussion

HCPs are considered the front-line staff in normal situations. However, their responsibilities increase several-fold during disasters and emergencies at hospital sites. Saving human lives and promoting their health in emergencies requires high efficiency and appropriate skills associated with realistic capabilities of healthcare professionals (Khirekar et al., 2023; National Academies of Sciences, Engineering, and Medicine, National Academy of Medicine & Committee on the Future of Nursing 2020–2030, 2021; Olorunfemi & Adesunloye, 2024). Many types of disasters are liable to occur in the Kingdom of Saudi Arabia, including Middle East respiratory syndrome (MERS), landslides, earthquakes, storms, floods, and human-made disasters (annual mass of pilgrims’ aggregations, accidents related to the oil industry) (World Bank Group, 2021; Al-Bassam, Zaidi & Hussein, 2014; Apostolopoulos et al., 2024; Palacios, Palacios-Rosas & Abdul-Aziz-Al-Mughanam, 2024; Rahman et al., 2017). Understanding the knowledge, attitude, and practice of healthcare professionals regarding disaster preparedness is essential in guiding policymakers to develop strategic plans that enhance disaster preparedness.

The present study revealed that most healthcare professionals considered their knowledge of disaster preparedness to be high, consistent with a study conducted in Saudi Arabia, which showed a satisfactory level of knowledge among the targeted population (Mohamed, Abdel-Aziz & Elsehrawy, 2023). In contrast, low levels of preparedness were observed by Khan et al. (2021). The variations across the studies indicate that region-specific policy-driven interventions are required. This study showed that nurses had significantly higher knowledge, attitude, and practice scores compared to physicians, pharmacists, and other healthcare professionals. Nurse professionals exhibit better preparedness knowledge, possibly due to different curricula, access to professional development, and more direct patient interaction, which nurses experience more often. The workforce requires specialized training to advance all healthcare professionals, including physicians, technicians, and allied medical staff, to achieve equal competencies in emergency preparedness and response. Furthermore, the association between marital status and knowledge scores should be interpreted with caution, as it may simply reflect underlying factors such as age or work experience rather than being an independent predictor.

Regarding HCPs’ attitude towards disaster preparedness, most respondents had a positive attitude toward disaster management, with 40% expressing interest in educational classes in disaster medicine, and 43.6% believed that disaster preparedness is essential for all healthcare professionals. Previous studies revealed that participants who had prior disaster education or participated in a disaster simulation exercise showed significantly increased levels of perceived disaster preparedness (Aslanoğlu et al., 2024; Lin et al., 2024). The present study confirmed the positive influences of disaster-specific education and simulation drills on disaster knowledge and individual perceptions of preparedness. In addition, more than one-third of the participants in this study reported that training is mandatory for all healthcare professionals. A study conducted by Ogedegbe et al. (2012) depicted the importance of training on disaster preparedness among healthcare professionals. This encouraging finding suggests that healthcare professional education requires immediate integration of disaster training, which must become mandatory for all HCPs. The potentially stronger nursing professional knowledge base can enhance emergency response capabilities by implementing interprofessional mentorship or collaborative exercises (Al Thobaity, 2024; Sultan et al., 2023). A study by Corrigan & Samrasinghe (2012) to assess disaster preparedness in an Australian urban trauma center showed that 59.3% of the respondents had previously received training to handle a disaster, 37.9% had attended a disaster simulation drill, and 12.9% had actually experienced a disaster. The study further demonstrated that these participants were more prepared to deal with such situations than those with no such disaster handling or simulation experience (Corrigan & Samrasinghe, 2012).

The practice-related findings of this study highlight areas of both strength and concern within the current state of disaster readiness among HCPs in central Saudi Arabia. For example, some items, including updating readiness by reviewing the guidelines and being comfortable with performing disaster management protocols, received positive responses from nearly half of the participants. However, we found a significant lack of preparedness for other items. The preparedness level among the HCPs differs across the studies (Gillani et al., 2022; Shanableh et al., 2023). The variation in findings is attributed to the study settings and their participants. For example, regarding the practice towards disaster preparedness, 44.1% of the participants feel comfortable executing evacuation protocols in the event of a disaster, a finding reinforced by Alhamaid et al. (2024) who reported that 48.54% of the participants approved the execution of disaster drills in the hospital. Furthermore, we observed that non-Saudi nationals had significantly higher levels of preparedness than Saudi nationals. This could be attributed to the overall trend of higher readiness levels among nurses to handle disasters. Interestingly, a recent study revealed a similar result (Thirunavukkarasu et al., 2022). Another important finding identified by the present study is the positive correlation across the domains. This finding suggests that the targeted training program must be holistic to improve the HCPs’ knowledge, beliefs, and practical competencies. Interestingly, knowledge and practice did not vary significantly by work setting (primary, general, or tertiary hospitals). This suggests that the higher preparedness scores observed among nurses may be attributed to their professional training and role in patient care, rather than to differences in clinical setting or specialty exposure.

The results emphasize the current requirement for established training systems that concentrate on disaster models for enhancing readiness capabilities. Healthcare facilities need to organize regular evacuation training as well as provide specific emergency protocol development and applied staff training to boost HCPs’ disaster and emergency preparedness levels. This can be done by numerous methods, such as simulation, artificial intelligence, etc (Bari et al., 2023; Doumi et al., 2024; Sa’d & Malak, 2025). In Saudi Arabia, despite the disasters that have already occurred, there is a lack of a multi-sectoral department that aims to facilitate effective disaster health management. Instead, Saudi Arabia continues to take a traditional health approach to their response to disasters and emergencies. The ICN Framework of disaster nursing competencies recommends comprehensive disaster management plans that can be used to meet the challenges associated with disasters ranging from the lowest to the highest level.

The present study consists of several strengths. Firstly, it is one of the few studies that aimed to evaluate the HCPs of all cadres from various settings, such as primary health centers and general and specialty hospitals. Secondly, we have utilized a standard and validated data collection tool, enabling policymakers to make informed, evidence-based decisions. Furthermore, the response rate (more than 80%) among the invited participants supports the validity of our findings. Finally, we performed this study in the region where data related to HCPs are least reported in previous studies. The limitation of the present study is its cross-sectional nature, which introduces subsequent recall bias and reduce temporal robustness. The absence of triangulated qualitative data constrains the ability to explore contextual and experiential dimensions of disaster preparedness in greater depth. Therefore, while the findings provide useful baseline insights, they should be interpreted with caution when extrapolated to a larger level. In addition, there is a lack of generalizability as this study is confined to HCPs in the central region of Saudi Arabia. Furthermore, the deeper and more subjective exploration of HCPs’ preparedness cannot be stated from this study (as our study relied on self-reported survey data), as it can only be conducted through a mixed-methods or qualitative study.

Conclusions

Participants of the present study had low knowledge (36.2%), attitude (45.9%), and practice (49.2%) towards disaster preparedness. This study revealed significant positive correlations among knowledge, attitude, and practice, as well as between knowledge and attitude. Nursing professionals had significantly higher knowledge, attitude, and practice scores. The present study recommends that HCPs should receive ongoing training and skill development to handle a variety of disaster events effectively. Healthcare facilities need to organize regular disaster training programs and provide specific emergency protocols to boost HCPs’ disaster and emergency preparedness levels. Building on the observed higher knowledge levels among nurses, future preparedness efforts could explore interprofessional mentorship or collaborative training approaches to strengthen preparedness across healthcare groups. Finally, we suggest exploring the qualitative component of HCPs’ disaster preparedness using the sequential mixed-methods surveys.

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