Understanding preparedness for extreme weather events among adults with chronic diseases: the interplay of illness perceptions, threat appraisal, and weather-related worry.
Hamama-Raz Y & Shinan-Altman S • Frontiers in public health • 2026
More negative illness perceptions showed a significant serial indirect association with greater preparedness for extreme weather events through higher threat appraisal and greater weather-related worry among adults with chronic diseases.
Key Findings
Results
More negative illness perceptions were significantly associated with greater preparedness for extreme weather events through a serial indirect pathway involving higher threat appraisal and greater weather-related worry.
The study used a serial mediation model to test this indirect association
The indirect association was significant for both 'intuitive' and 'planned' preparedness behaviors
The association held across all three disease groups (respiratory disease, cancer, and cardiovascular disease)
The cross-sectional design means the ordering of variables should be interpreted as 'theoretically informed rather than as evidence of a temporal or causal pathway'
Results
The pattern of indirect associations in the serial mediation model was similar across respiratory disease, cancer, and cardiovascular disease groups.
Of nine interaction terms tested, only one was statistically significant
Disease group moderated the association between illness perceptions and weather-related worry
This moderation was significant among participants with respiratory disease, but not among those with cancer or cardiovascular disease
The authors described this moderating finding as 'exploratory' and recommended it be examined in future research
Methods
The study examined extreme weather preparedness in a cross-sectional sample of 450 Israeli adults aged 50 years or older with physician-diagnosed chronic diseases.
Sample size was 450 participants
Participants were aged 50 years or older
Inclusion required a physician-diagnosed respiratory disease, cancer, or cardiovascular disease
Participants completed self-report measures of illness perceptions, threat appraisal, weather-related worry, and preparedness for extreme weather events
The study was conducted in Israel
Results
Illness perceptions, threat appraisal, weather-related worry, and preparedness for extreme weather events were interrelated among adults with chronic diseases.
The study drew on illness self-regulation theory to frame the relationships among these variables
Both 'intuitive' and 'planned' preparedness behaviors were examined as outcomes
The theoretical framework proposed that illness perceptions influence preparedness indirectly through cognitive and emotional appraisal processes
Findings were described as contributing 'to research at the intersection of illness self-regulation and climate-health adaptation'
Conclusions
The findings may inform future longitudinal research and preparedness interventions for medically vulnerable populations facing extreme weather events.
The authors noted that the cross-sectional design limits causal inference
The study was identified as relevant to climate-health adaptation for medically vulnerable groups
The authors called for future longitudinal research to examine the proposed temporal ordering of variables
The results are positioned as potentially useful for designing preparedness interventions targeting adults with chronic diseases
What This Means
This research suggests that how people with chronic illnesses think and feel about their diseases is connected to how prepared they are for extreme weather events like heatwaves or storms. Specifically, adults who held more negative views about their illness — seeing it as serious, long-lasting, or hard to control — were more likely to perceive extreme weather as a threat and to worry about it, and this in turn was associated with greater preparedness. The study included 450 Israeli adults aged 50 and older who had been diagnosed by a doctor with respiratory disease, cancer, or cardiovascular disease.
This pattern of associations — from illness perceptions, through threat appraisal and worry, to preparedness — was similar across all three disease groups and applied to both spontaneous ('intuitive') and deliberate ('planned') preparedness behaviors. One notable exception was that the link between illness perceptions and weather-related worry was stronger among people with respiratory disease compared to those with cancer or cardiovascular disease, though the authors considered this a preliminary finding requiring further study.
Because this was a cross-sectional study (meaning all data were collected at one point in time), it is not possible to confirm that illness perceptions actually cause greater preparedness — only that these factors are statistically related. The authors suggest these findings could help inform the design of emergency preparedness programs that take into account how people with chronic conditions perceive and emotionally respond to health and climate threats, and they call for future studies that follow people over time to better understand these relationships.
Hamama-Raz Y, Shinan-Altman S. (2026). Understanding preparedness for extreme weather events among adults with chronic diseases: the interplay of illness perceptions, threat appraisal, and weather-related worry.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1852635