Authors
- . Maryam Kiarsi 1
- . Mohammadreza Amiresmaili 2
- . Mohammad R. Mahmoodi 3
- . Hojjat Farahmandnia 2
- . Nouzar Nakhaee 4
- . Armin Zareiyan 5
- . Hamidreza Aghababaeian 2
1 Department of Medical Emergencies, School of Nursing and Midwifery, Dezful University of Medical Sciences, Dezful, Iran, Center for Climate Change and Health Research (CCCHR), Dezful University of Medical Sciences, Dezful, Iran, Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
2 Department of Medical Emergencies, School of Nursing and Midwifery, Dezful University of Medical Sciences, Dezful, Iran, Center for Climate Change and Health Research (CCCHR), Dezful University of Medical Sciences, Dezful, Iran
3 Department of Health in Emergencies and Disasters, School of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran, Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran, Department of Nutrition, Faculty of Public Health, Kerman University of Medical Sciences, Kerman, Iran
4 Department of Medical Emergencies, School of Nursing and Midwifery, Dezful University of Medical Sciences, Dezful, IranHealth Services Management Research Center, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Iran
5 Public Health Department, Health in Emergencies and Disasters Department, Nursing Faculty, AJA University of Medical Sciences, Tehran, Iran
Abstract
BACKGROUND: Heat wave adaptation is a new concept related to experiencing heat. The present
study aims at investigating a conceptual definition, that is, the mental framework of heat wave
adaptation and its strategies.
MATERIALS AND METHODS: A phenomenological study was performed to explain the mental
concept. At the same time with the data collection process, data analysis was also performed using
Colaizzi method. Semi‑structured interview method and purposeful sampling with maximum variety
were used. Interviews were conducted with 23 different subjects in the community. The accuracy of
the data was guaranteed using Lincoln & Guba scientific accuracy criteria.
RESULTS: The two main themes of the adaptation paradigm as well as its strategies were divided
into the main categories of theoretical and operational concepts, as well as personal care measures
and government measures. Under the category of individual measures, we obtained “clothing,
nutrition, building, place of residence and lifestyle,” and under the category of governance actions,
the “managerial, research, health, organizational” subcategories were obtained.
CONCLUSION: According to the results of the conceptual‑operational definition, heat wave adaptation
is an active process and an effort to reduce the adverse effects of heat waves on individual and
social life, and striking a balance that will not only result in individual awareness and actions that
will lead to lifestyle changes, but also mostly requires integrated and comprehensive planning in the
community. On the one hand, heat waves could not only be regarded as a threat or danger, but can
also become an opportunity for the development of a community through identification and smart
measures, and for adaptation, the community must take it as a risk. The community should have a
plan in advance, apply the necessary rules and training, and use the new facilities and rules where
necessary. This practical concept definition includes the main features of heat wave adaptation.
Keywords
Poursadeqiyan M. Migration health crisis associated with climate
change: A systematic review. J Educ Health Promot 2020;9:97.
2. McGregor GR, Bessmoulin P, Ebi K, Menne B. Heatwaves and
Health: Guidance on Warning‑System Development. WMOP;
2015.
3. Lee JY, Kim E, Lee W‑S, Chae Y, Kim H. Projection of future
mortality due to temperature and population changes under
representative concentration pathways and shared socioeconomic
pathways Int J Environ Res Public Health 2018;15:822. doi:
10.3390/ijerph15040822.
4. Park J, Chae Y, Choi SH. Analysis of mortality change rate from
temperature in summer by age, occupation, household type, and
chronic diseases in 229 Korean municipalities from 2007–2016.
Int J Environ Res Public Health 2019;16:1561. doi: 10.3390/
ijerph16091561.
5. Lopez‑Bueno JA, Díaz J, Sánchez‑Guevara C, Sánchez‑Martínez G,
Franco M, Gullón P, et al. The impact of heat waves on daily
mortality in districts in Madrid: The effect of sociodemographic
factors. Environ Res 2020;190:109993. doi: 10.1016/j.envres.
2020.109993.
6. ChaeY, Park J. Analysis on effectiveness of impact based heatwave
warning considering severity and likelihood of health impacts in
Seoul, Korea Int J Environ Res Public Health 2021;18:2380. doi:
10.3390/ijerph18052380.
7. Abadie L, Polanco‑Martínez J. Sensitivities of heat‑wave mortality
projections: Moving towards stochastic model assumptions.
Environ Res 2021;20:111895. doi: 10.1016/j.envres.2021.111895.
8. Rizvi SH, Alam K, Iqbal MJ. Spatio‑temporal variations in urban
heat island and its interaction with heat wave. J Atmos Sol Terr
Phys 2019;185:50‑7.
9. Tong S, Wang XY, Guo Y. Assessing the short‑term effects of
heatwaves on mortality and morbidity in Brisbane, Australia:
Comparison of case‑crossover and time series analyses PloS One
2012;7:e37500. doi: 10.1371/journal.pone.0037500.
10. Khan N, Shahid S, bin Ismail T, Wang XJ. Spatial distribution of
unidirectional trends in temperature and temperature extremes
in Pakistan. Theor Appl Climatol 2019;136:899‑913.
11. Cheng J, Xu Z, Bambrick H, Prescott V, Wang N, Zhang Y, et al.
Cardiorespiratory effects of heatwaves: A systematic review and
meta‑analysis of global epidemiological evidence. Environ Res
2019;177:108610. doi: 10.1016/j.envres.2019.108610.
12. Liss A, Naumova EN. Heatwaves and hospitalizations due to
hyperthermia in defined climate regions in the conterminous
USA. Environ Monit Assess 2019;191:1‑16. doi: 10.1007/
s10661‑019‑7412‑5.
13. Onozuka D, Hagihara A. All‑cause and cause‑specific risk of
emergency transport attributable to temperature: A nationwide
study. Medicine (Baltimore) 2015;94:e2259. doi: 10.1097/
MD.0000000000002259.
14. Cheng Y‑T, Lung S‑CC, Hwang JS. New approach to identifying
proper thresholds for a heat warning system using health risk
increments. Environ Res 2019;170:282‑92.
15. Thompson R, HornigoldR, Page L, Waite T. Associations between
high ambient temperatures and heat waves with mental health
outcomes: A systematic review. Public Health 2018;161:171‑91.
16. Zhang Y, Yu C, Wang L. Temperature exposure during
pregnancy and birth outcomes: An updated systematic review
of epidemiological evidence. Environ Pollut 2017;225:700‑12.
17. Dang TN, Honda Y, Van Do D, Pham ALT, Chu C, Huang C, et al.
Effects of extreme temperatures on mortality and hospitalization
in Ho Chi Minh City, Vietnam. Int J Environ Res Public Health
2019;16:432. doi: 10.3390/ijerph16030432.
18. XuZ, FitzGeraldG, GuoY, JalaludinB, Tong S. Impact of heatwave
on mortality under different heatwave definitions: A systematic
review and meta‑analysis. Environ Int 2016;89:193‑203.
19. Åström DO, Schifano P, Asta F, Lallo A, Michelozzi P,
Rocklöv J, et al. The effect of heat waves on mortality in
susceptible groups: A cohort study of a mediterranean and
a northern European City. Environ Health 2015;14:1‑8. doi:
10.1186/s12940‑015‑0012‑0.
20. Sheffield PE, Herrera MT, Kinnee EJ, Clougherty JE. Not so little
differences: Variation in hot weather risk to young children in
New York city. Public Health 2018;161:119‑26.
21. Adopted IP. Climate change 2014 synthesis report. IPCC: Geneva:
Szwitzerland; 2014.
22. Wondmagegn BY, Xiang J, Dear K, Williams S, Hansen A,
Pisaniello D, et al. Impact of heatwave intensity using excess
heat factor on emergency department presentations and related
healthcare costs in Adelaide, South Australia. Sci Total Environ
2021;781:146815. doi: 10.1016/j.scitotenv.2021.146815.
23. Banwell N, Rutherford S, Mackey B, Chu C. Towards improved
linkage of disaster risk reduction and climate change adaptation
in health: A review. Int J Environ Res Public Health 2018;15:793.
doi: 10.3390/ijerph15040793.
24. Pershing AJ, Mills KE, Dayton AM, Franklin BS, Kennedy BT.
Evidence for adaptation from the 2016 marine heatwave in the
Northwest Atlantic Ocean. Oceanography 2018;31:152‑61.
25. Rauf S, Bakhsh K, Abbas A, Hassan S, Ali A, Kächele HJEs, et al.
How hard they hit? Perception, adaptation and public health
implications of heat waves in urban and peri‑urban Pakistan.
Environ Sci Pollut Res Int 2017;24:10630‑9.26. Marshall TM. Risk perception and safety culture: Tools for
improving the implementation of disaster risk reduction
strategies. Int J Disaster Risk Reduction 2020;47:101557. doi:
10.1016/j.ijdrr.2020.101557.
27. Nikbakht A, Sabet FP, Bastami M, Gomarverdi S. Quality of life
in hemodialysis patients: A phenomenological study. Iran J Nurs
Res 2019;13:38‑44.
28. KR P. Application of Colaizzi’s method of data analysis
in phenomenological research. Medico‑Legal Update
2021;21:914‑8.
29. Elo S, Kääriäinen M, Kanste O, Pölkki T, Utriainen K, Kyngäs H.
Qualitative content analysis: A focus on trustworthiness. SAGE
Open 2014;4:2158244014522633. doi: 10.1177/2158244014522633.
30. Hota P, Behera BJIJoEE, Statistics. Understanding the household
perceptions of and adaptations to heat wave: A case study. Int J
Ecol Econ Stat 2014;33:98‑117.
31. Keith L, Meerow S, Wagner T. Planning for extreme heat:
A review. J Extreme Events 2019;6:2050003.
32. Salehi S, Ardalan A, Ostadtaghizadeh A, Garmaroudi G,
Zareiyan A, Rahimiforoushani A, et al. Conceptual definition
and framework of climate change and dust storm adaptation:
A qualitative study. J Environ Health Sci Eng 2019;17:797‑810.
33. Meerow S, Keith LJJotAPA. Planning for extreme heat:
A national survey of US planners. J Am Plan Assoc 2021:1‑16.
doi: 10.1080/01944363.2021.1977682.
34. Ostadtaghizadeh A, Ardalan A, Paton D, Khankeh H, Jabbari H.
Community disaster resilience: A qualitative study on Iranian
concepts and indicators. Nat Hazards 2016;83:1843‑61.
35. Huang C, Barnett AG, Xu Z, Chu C, Wang X, Turner LR, et al.
Managing the health effects of temperature in response to
climate change: Challenges ahead. Environ Health Perspect
2013;121:415‑9.
36. van Valkengoed AM, Steg LJNCC. Meta‑analyses of factors
motivating climate change adaptation behaviour. Nat Clim Chang
2019;9:158‑63.
37. Qu Y, Zhang W, Ryan I, Deng X, Dong G, Liu X, et al. Ambient
extreme heat exposure in summer and transitional months and
emergency department visits and hospital admissions due to
pregnancy complications. Sci Total Environ 2021;777:146134. doi:
10.1016/j.scitotenv.2021.146134.
38. Pisello A, Rosso F, Castaldo V, Piselli C, Fabiani C, Cotana FJE,
et al. The role of building occupants’ education in their resilience
to climate‑change related events. Energy Build 2017;154:217‑31.
39. Mehiriz K, Gosselin P, Tardif I, Lemieux M‑A. The effect of
an automated phone warning and health advisory system on
adaptation to high heat episodes and health services use in
vulnerable groups—evidence from a randomized controlled
study. Int J Environ Res Public Health 2018;15:1581. doi: 10.3390/
ijerph15081581.
40. Ashraf SA, Faruk M. Children’s perspective on adaptation to heat
waves and heavy precipitation in Dhaka, Bangladesh. Procedia
Eng 2018;212:768‑75.
41. Valois P, Talbot D, Caron M, Carrier M‑P, Morin AJ, Renaud J‑S,
et al. Development and validation of a behavioural index for
adaptation to high summer temperatures among urban dwellers.
Int J Environ Res Public Health 2017;14:820. doi: 10.3390/
ijerph14070820.
42. McCallT, BeckmannS, KaweC, AbelF, HornbergC. Climate change
adaptation and mitigation–a hitherto neglected gender‑sensitive
public health perspective. Clim Dev 2019;11:735‑44.
43. Folkerts MA, Bröde P, Botzen WJ, Martinius ML, Gerrett N,
Harmsen CN, et al. Long term adaptation to heat stress: Shifts in
the minimum mortality temperature in the Netherlands. Front
Physiol 2020;11:225. doi: 10.3389/fphys.2020.00225.
44. Hatvani‑Kovacs G, Belusko M, Skinner N, Pockett J, Boland J.
Heat stress risk and resilience in the urban environment. Sustain
Cities Soc 2016;26:278‑88.
45. Lee H, Mayer H, Kuttler WJUF, Greening U. Impact of the spacing
between tree crowns on the mitigation of daytime heat stress
for pedestrians inside EW urban street canyons under Central
European conditions. Urban For Urban Greening 2020;48:126558.
doi: 10.1016/j.ufug.2019.126558.
46. Loughnan M, Carroll M, Tapper NJ. The relationship between
housing and heat wave resilience in older people. Int J Biometeorol
2015;59:1291‑8.
47. Zhang Y, Ayyub BM. Projecting heat waves temporally and
spatially for local adaptations in a changing climate: Washington
DC as a case study. Nat Hazards 2020;103:731‑50.
48. Taylor J, Symonds P, Wilkinson P, Heaviside C, Macintyre H,
Davies M, et al. Estimating the influence of housing energy
efficiency and overheating adaptations on heat‑related mortality
in the West Midlands, UK. Atmosphere 2018;9:190.
49. Taylor J, Wilkinson P, Picetti R, Symonds P, Heaviside C,
Macintyre HL, et al. Comparison of built environment adaptations
to heat exposure and mortality during hot weather, West
Midlands region, UK. Environ Int 2018;111:287‑94.
50. Tewari M, Yang J, Kusaka H, Salamanca F, Watson C, Treinish L.
Interaction of urban heat islands and heat waves under current
and future climate conditions and their mitigation using green
and cool roofs in New York City and Phoenix, Arizona. Environ
Res Lett 2019;14:034002. doi: 10.1088/1748‑9326/aaf431.
51. Viguié V, Lemonsu A, Hallegatte S, Beaulant A‑L, Marchadier C,
Masson V, et al. Early adaptation to heat waves and future
reduction of air‑conditioning energy use in Paris. Environ Res
Lett 2020;15:075006. doi: 10.1088/1748‑9326/ab6a24.
52. Porritt S, Shao L, Cropper P, Goodier C. Adapting dwellings for
heat waves. Sustain Cities Soc 2011;1:81‑90.
53. Akompab DA, Bi P, Williams S, Saniotis A, Walker IA,
Augoustinos MJM, et al. Engaging stakeholders in an adaptation
process: Governance and institutional arrangements in heat‑health
policy development in Adelaide, Australia. Mitig Adapt Strateg
Glob Chang 2013;18:1001‑18.
54. Nordgren J, Stults M, Meerow S. Supporting local climate change
adaptation: Where we are and where we need to go. Environ Sci
Policy 2016;66:344‑52.
55. Hatuka T, Saaroni H. The need for advocating regional human
comfort design codes for public spaces: A case study of a
Mediterranean urban park. Landscape Res 2014;39:287‑304.
56. Dhalluin A, Bozonnet E. Urban heat islands and sensitive building
design–A study in some French cities’ context. Sustain Cities Soc
2015;19:292‑9.
57. Middel A, Turner VK, Schneider FA, Zhang Y, Stiller M. Solar
reflective pavements—A policy panacea to heat mitigation?
Environ Res Lett 2020;15:064016.
58. Stone Jr B, Mallen E, Rajput M, Broadbent A, Krayenhoff ES,
Augenbroe G, et al. Climate change and infrastructure risk: Indoor
heat exposure during a concurrent heat wave and blackout event
in Phoenix, Arizona. Urban Clim 2021;36:100787. doi: 10.1016/j.
uclim.2021.100787.
59. Gubernot DM, Anderson GB, Hunting KL. Characterizing
occupational heat-related mortality in the United States, 2000–
2010: An analysis using the census of fatal occupational injuries
database. Am J Ind Med 2015;58:203‑11.
60. Ioannou LG, Mantzios K, Tsoutsoubi L, PanagiotakiZ, KapniaAK,
Ciuha U, et al. Effect of a simulated heat wave on physiological
strain and labour productivity. Int J Environ Res Public Health
2021;18:3011. doi: 10.3390/ijerph18063011.
61. Gubernot DM, Anderson GB, Hunting KL. The epidemiology of
occupational heat‑related morbidity and mortality in the united
states: A review of the literature and assessment of research needs
in a changing climate. Int J Biometeorol 2014;58:1779‑88.
62. Gao C, Kuklane K, Östergren P‑O, Kjellstrom T. Occupational
heat stress assessment and protective strategies in the context of
climate change. Int J Biometeorol 2018;62:359‑71.63. Adam‑Poupart A, Smargiassi A, Busque M‑A, Duguay P,
Fournier M, Zayed J, et al. Summer outdoor temperature and
occupational heat‑related illnesses in Quebec (Canada) Environ
Res 2014;134:339‑44.
64. Matzarakis A, Laschewski G, Muthers S. The heat health warning
system in Germany—Application and warnings for 2005 to 2019.
Atmosphere 2020;11:170.
65. Price K, Benmarhnia T, Gaudet J, Kaiser D, Sadoine ML,
Perron S, et al. The montreal heat response plan: Evaluation of its
implementation towards healthcare professionals and vulnerable
populations. Can J Public Health 2018;109:108‑16.
66. Yuan F, Yao R, Sadrizadeh S, Li B, Cao G, Zhang S, et al. Thermal
comfort in hospital buildings–A literature review. J Build Eng
2022;45:103463. doi: 10.1016/j.jobe.2021.103463.
67. World Health Organization. Operational Framework for Building
Climate Resilient Health Systems. World Health Organization.
Geneva, Switzerland; 2015.
68. Ardalan A, Kandi Keleh M, Saberinia A, Khorasani‑Zavareh D,
Khankeh H, Miadfar J, et al. 2015 estimation of hospitals safety
from disasters in IR Iran: The results from the assessment of 421
hospitals. PloS One 2016;11:e0161542. doi: 10.1371/journal.pone.
0161542.
69. Jahangiri K, Izadkhah YO, Lari A. Hospital safety index (HSI)
analysis in confronting disasters: A case study from Iran.
International Journal of Health System and Disaster Management
2014;2:44.
70. Djalali A, Ardalan A, Ohlen G, Ingrassia PL, Della Corte F,
Castren M, et al. Nonstructural safety of hospitals for disasters:
A comparison between two capital cities. Disaster Med Public
Health Prep 2014;8:179‑84.
71. Fallah-Aliabadi S, Ostadtaghizadeh A, Ardalan A, Fatemi F,
Khazai B, Mirjalili MR. Towards developing a model for the
evaluation of hospital disaster resilience: A systematic review.
BMC health services research 2020;20:1-1.
72. Paterson J, Berry P, Ebi K, Varangu L. Health care facilities
resilient to climate change impacts. Int J Environ Res Public Health
2014;11:13097‑116.
73. Moradi S, Nekoei‑MoghadamM, AbbasnejadA, Hasheminejad N.
Risk analysis and safety assessment of hospitals against disasters:
A systematic review. J Educ Health Promot 2021;10:412.
74. Zaidi RZ, Pelling MJUS. Institutionally configured risk: Assessing
urban resilience and disaster risk reduction to heat wave risk in
London. Urban Stud 2015;52:1218‑33.
75. Hamstead Z, Coseo P, AlKhaled S, Boamah EF, Hondula DM,
Middel A, et al. Thermally resilient communities: Creating a
socio‑technical collaborative response to extreme temperatures.
Build Cities 2020;1:218‑32.
76. Hahrestanaki Y, Khankeh H, Masoumi G, Hosseini M.
What structural factors influencing emergency and disaster
medical response teams? A comparative review study. J Educ
Health Promot 2019;8:110.
77. Diniz FR, Gonçalves FLT, Sheridan S. Heat wave and elderly
mortality: Historical analysis and future projection for
metropolitan region of São Paulo, Brazil. Atmosphere 2020;11:933.
78. Cheng J, Xu Z, Bambrick H, Su H, Tong S, Hu W. Heatwave and
elderly mortality: An evaluation of death burden and health
costs considering short‑term mortality displacement. Environ
Int 2018;115:334‑42.
79. Dalip J, Phillips GA, Jelinek GA, Weiland TJ. Can the elderly
handle the heat? A retrospective case‑control study of the
impact of heat waves on older patients attending an inner city
Australian emergency department. Asia Pacific J Public Health
2012;27:NP1837‑NP46.
80. Yin Q, Wang J. The association between consecutive days’ heat
wave and cardiovascular disease mortality in Beijing, China. BMC
Public Health 2017;17:1‑9. doi: 10.1186/s12889‑017‑4129‑7.
81. Figgs LW. Increased pulmonary circulatory disease diagnosis risk
associated with heatwave. J Clim Change Health 2022;5:100100.
doi: 10.1016/j.joclim.2021.100100.
82. de Moraes SL, Almendra R, Barrozo LV. Impact of heat waves
and cold spells on cause‑specific mortality in the city of São Paulo,
Brazil. Int J Hyg Environ Health 2022;239:113861. doi: 10.1016/j.
ijheh. 2021.113861.
83. Liu X, Liu H, Fan H, Liu Y, Ding G. Influence of heat waves
on daily hospital visits for mental illness in Jinan, China—A
case‑crossover study. Int J Environ Res Public Health 2019;16:87.
doi: 10.3390/ijerph16010087.
84. Xu Z, Tong S, Cheng J, Crooks JL, Xiang H, Li X, et al. Heatwaves
and diabetes in Brisbane, Australia: A population‑based
retrospective cohort study. Int J Epidemiol 2019;48:1091‑100.
85. Budhathoki NK, Zander KK. Socio‑economic impact of and
adaptation to extreme heat and cold of farmers in the food bowl of
Nepal. Int J Environ Res Public Health 2019;16:1578. doi: 10.3390/
ijerph16091578.
86. Mangus CW, Canares TL. Heat‑related illness in children in an
era of extreme temperatures. Pediatr Rev 2019;40:97‑107.
87. Gifford RM, Todisco T, Stacey M, Fujisawa T, Allerhand M,
WoodsD, et al. Risk of heat illness in men and women: Asystematic
review and meta‑analysis. Environ Res 2019;171:24‑35.
88. van Steen Y, Ntarladima A‑M, Grobbee R, Karssenberg D,
Vaartjes I. Sex differences in mortality after heat waves: Are
elderly women at higher risk? Int Arch Occup Environ Health
2019;92:37‑48.
89. Varghese BM, Barnett AG, Hansen AL, Bi P, Nairn J, Rowett S,
et al. Characterising the impact of heatwaves on work‑related
injuries and illnesses in three Australian cities using a standard
heatwave definition‑excess heat factor (EHF). J Expo Sci Environ
Epidemiol 2019;29:821‑30.
90. Schwarz L, Castillo EM, Chan TC, Brennan JJ, Sbiroli ES,
Carrasco‑Escobar G, et al. Heat waves and emergency department
visits among the homeless, San Diego, 2012–2019. Am J Public
Health 2022;112:98‑106.
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