Theory-Based Flood Disaster Education Enhances Disaster Preparedness Among Adolescents in Selangor, Malaysia: A Cluster Randomized Controlled Study

Theory-Based Flood Disaster Education Enhances Disaster Preparedness Among Adolescents in Selangor, Malaysia: A Cluster Randomized Controlled Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Theory-Based Flood Disaster Education Enhances Disaster Preparedness Among Adolescents in Selangor, Malaysia: A Cluster Randomized Controlled Study Khairunnisa Makmon, Fattah Azman, Rosliza Abdul Manaf, Mohd Rafee Baharudin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4766357/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Jun, 2026 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract Flood disasters are prevalent and severely impact humans and the environment, with adolescents being particularly vulnerable. This study evaluated the "Get-Ready DEM," a tailored disaster educational module based on the Extended Parallel Pathway Model (EPPM), to enhance flood disaster preparedness among adolescents in Selangor, Malaysia. A two-arm, single-blinded, cluster-randomised controlled trial involved 287 adolescents from eight secondary schools, divided into intervention (140 participants) and control (147 participants) groups. The intervention group received the "Get-Ready DEM" once after the baseline assessment, while the control group was on the waitlist. Preparedness was measured using the Flood Disaster Preparedness Index (FDPI) scores at baseline, immediate post-intervention, and three months post-intervention. Data were analysed using a generalised estimation equation. Results showed a significant increase in FDPI scores for the intervention group immediately post-intervention (β = 2.15; 95% CI = 1.64, 2.65; p < 0.001) and at the three-month follow-up (β = 1.53; 95% CI = 0.96, 2.10; p < 0.001) compared to the control group. These findings underscore the EPPM framework's efficacy in designing effective flood disaster education. Implementing modules like "Get-Ready DEM" can significantly enhance adolescents' resilience and preparedness, suggesting a promising approach for disaster preparedness programs. This study was registered under Thai Clinical Trial Registry TCTR20240426001 on 26th April 2024 and obtained ethical approval by the Ethics Committee of Human Research University Putra Malaysia (JKEUPM-2022-858) and the Ministry of Education, Malaysia (KPM.600-3/2/3-eras (15189). Earth and environmental sciences/Environmental social sciences Earth and environmental sciences/Natural hazards Extended Parallel Pathway Model (EPPM) Flood disaster preparedness disaster preparedness disaster education adolescent Introduction Preparedness is crucial for mitigating the severe impacts of floods, among the most destructive natural disasters globally. According to the Centre for Research on the Epidemiology of Disasters (CRED), in 2021, floods accounted for 52% of global disasters and 41% of disaster-related deaths in 2020 1 . Despite being outside the Pacific Ring of Fire, Malaysia is highly susceptible to floods, pollution, and landslides, with floods representing 74% of natural disasters from 1998 to August 2018 2 . From July 2012 to January 2019, Malaysia reported the highest number of individuals affected by floods in the ASEAN region 3 . The late 2021 and early 2022 floods caused extensive damage across various sectors, with losses estimated at RM6.1 billion, or approximately 0.40% of Malaysia's nominal GDP 4 . Adolescents, particularly vulnerable due to their developmental stage, suffer disproportionately from floods, impacting their physical, mental, socioeconomic, and educational well-being 5 . Adolescents, defined by the World Health Organization as individuals aged 10 to 19 6 and comprising nearly 11% of Malaysia's population, are at a critical developmental juncture 7 . This phase presents both opportunities for capacity development and significant vulnerabilities 8,9 . Educating this demographic about flood risks and appropriate responses is essential for their safety and fostering community resilience 10,11 . Their involvement is crucial in promoting effective behaviours in disaster risk reduction, as outlined in the Sendai Framework for Disaster Risk Reduction 2015-2030 12 . It aligns with the global sustainable development agenda, particularly the SDG 2030 education target 4.7, aiming to equip youth with skills to promote sustainable development and resilience against climate challenges, including Target 13.3 13 . Both formal and informal disaster education are vital from an early age 14 . Advocates highlight the importance of initiating education and awareness efforts in childhood to lay a foundation for a culture of preparedness and resilience 15,16 . Although studies have shown that educating adolescents about disasters prepares them to handle such calamities, a systematic review of school-based disaster education programs in 27 countries revealed discrepancies between increased awareness and preparedness among adolescents 17 . It indicates a need for innovative strategies to enhance the effectiveness of school-based disaster education programs 11,17 . Furthermore, age 17–19 , gender 18,20,21 , personal disaster experience 20,22,23 , perceived risk or threat 19,24,25 , perceived efficacy 26,27 , disaster knowledge 11,28 , and socioeconomic status 29 influence adolescent flood disaster preparedness. In Malaysia, research on disaster education among adolescents has been promising, yet there is a shortage of disaster education modules specifically targeting this group. This research crafted a flood disaster preparedness educational module for adolescents based on the Extended Parallel Process Model (EPPM), a prominent framework in health communication 30,31 . The EPPM incorporates cognitive (efficacy) and emotional (threat) components to predict behavioural responses. By influencing how individuals perceive flood disasters and enhancing their ability to manage such situations, this model aims to encourage proactive behaviour. By systematically amplifying perceived threats and efficacy, the module seeks to mould adolescents' perceptions of flood risks and enhance their capability to implement protective measures 31 . EPPM is particularly suited for this purpose due to its proven effectiveness in previous studies on preparedness for various natural disasters, pandemics, and outbreaks 32–35 . Therefore, by utilising the EPPM, this study aims to tailor a flood disaster education module for adolescents and evaluate its impact on their flood disaster preparedness. Materials and Methods Research Objectives. This study aims to develop, implement, and assess the effects of a flood disaster education module based on the Extended Parallel Pathway Model on flood disaster preparedness among secondary school students in Selangor, Malaysia. Study Design Two-armed, parallel, single-blinded, cluster-randomised control trial. Secondary schools designated as temporary shelters constitute this study's cluster. The clusters were divided into intervention and control groups. Both groups received follow-up during the trial. The intervention group received a 'Get-Ready DEM' flood disaster education program. The control group received no intervention and was put on the waiting list if the intervention group demonstrated a positive effect. The design and reporting of this study were performed in accordance to the CONSORT (Consolidated Standards of Reporting Trials) guidelines 2010, ensuring comprehensive and transparent documentation of the trial. Location of the study The research was carried out in Selangor, Malaysia. Selangor is one of 13 Malaysian states on the west coast of the Peninsular. Selangor has 6.99 million people, the most in Malaysia (21.6%), with approximately 674 people per square kilometres and 95.8% urban population 36 . The study was conducted in Selangor's four flood-prone districts: Klang, Hulu Langat, Gombak, and Sepang 37 , 38 . Study population and respondent selection Randomisation was performed at the cluster level (school). Eight schools were selected based on the list of secondary schools provided by the Selangor State Education Department. The selected schools were randomly allocated into the control and intervention groups using a 1:1 ratio. The allocation concealment was done using the subsequentially numbered, opaque, sealed envelope (SNOSE) technique. The eight schools were labelled by randomly assigning them to names (A, B, C, D, E, F, G and H). Then, it was concealed in eight identical black opaque envelopes size 2-inch by 2-inch, containing different colour-coded cards by the other third party. The white and red cards were labelled as control and intervention groups, respectively. Envelopes were opened only after it was time to allocate the intervention by research assistant. It should be noted that the allocation codes were masked from the investigator during this step. The intervention allocation was masked to the school and participants only. The sampling population consisted of adolescents between 13 and 15 years old who attended the selected secondary school during the study period. Study participants were recruited upon approval of the school principal. The recruitment of the participants was based on the selected class from Form 1 to Form 3 based on the selection by the random application of the computer generator. Population-sample The sample size (N) for this study was calculated by comparing the population of two groups using Lemeshow and Lwanga's formula 39 . The sample size was calculated by considering the intra-cluster correlation coefficient, the number of clusters, the expected effect, and the power of study (80%). This cluster randomised controlled study assumed an intracluster correlation (ρ) of 0.1, with a fixed number of clusters (k = 8), cluster size (m) and considering design effect, 1 + (ρ(m-1), given the small cluster size and rare outcome 40 . The final sample size was estimated to be 230 for both the intervention and control groups after adjusting for the 20% attrition rate of approximately 25 students per cluster. In secondary school in Selangor, there were approximately 25 to 40 students per classroom. Thus, based on the sample size calculation and the current local setting of classrooms, only eight clusters or schools were required to enrol in this study to fulfil the minimum sample size requirement. The process of recruiting schools and participants is presented in Fig. 1 in the supplementary. Study Instrument Flood Disaster Education Module for Intervention Group The flood disaster education module, "Get-Ready DEM," was meticulously developed based on the Extended Parallel Process Model (EPPM), effectively integrating the concepts of perceived threat and perceived efficacy. The module comprised three comprehensive sessions, which lasted approximately three hours and conducted at school during the school period. The initial session aimed to increase awareness of flood risks, thereby enhancing the participants' perception of the threat. The subsequent sessions were dedicated to improving flood disaster preparedness and disaster risk communication, focusing on boosting perceived efficacy. The intervention was implemented once following the initial baseline assessments of the participants. To facilitate active engagement and practical learning, various pedagogical tools were utilized. These tools included audio-visual aids, interactive group activities, and educational games, all designed to enhance participants' disaster awareness, knowledge, and preparedness skills. Among the key activities, participants were instructed on the essential steps to assemble an emergency bag and to devise an effective emergency evacuation plan through structured group activities. Furthermore, to aid in the retention of critical information, participants were provided with handouts in the form of stickers, along with models of emergency bags, first aid kits, and whistles. These stickers listed the essential items for an emergency bag and included vital emergency contact numbers, serving as a handy and accessible reference that reinforced the learning outcomes and preparedness for flood disasters. Additionally, each school received a model emergency bag and a poster detailing key flood disaster preparedness tips, which could be displayed in classrooms to promote and reinforce the message of flood disaster preparedness. The development of the "Get-Ready DEM" modules was guided by a dynamic instructional design framework, ensuring a systematic and structured approach to creating educational content for the flood disaster 41 . The modules were crafted in Malay and English to accommodate the linguistic preferences of the participants, thereby enhancing accessibility and understanding. A comprehensive validation process was undertaken to ensure the relevance and appropriateness of the module content for the local context and the intended audience. It involved a panel of four expert committees consisting of two public health specialists, a disaster and risk management expert, and an educator. Prior to the full-scale implementation, a pilot study was conducted to assess the content validity and face validity of the modules. This preliminary phase was crucial in refining the modules based on expert feedback and ensuring their suitability for effectively conveying essential disaster preparedness education. Self-reported Questionnaires This study used 24 items of the self-reported questionnaire that were mostly adapted from the pre-existing instrument and translated into the Malay language via forward and backward methods. A copy of the English version of the questionnaire is provided in the supplementary section. Flood Disaster Preparedness Index Tools (14 items) In this study, flood disaster preparedness is referred to as the knowledge and capacities of individuals, communities, institutions, or governments to efficiently anticipate, effectively respond to, and recover from disasters. The instrument used to measure flood disaster preparedness encompasses 14 items adopted from the Disaster Preparedness Index score, demonstrating a high Cronbach alpha reliability of 0.91 in a prior study in Chennai involving 445 participants 42 . It evaluates the adoption of essential precautions or measures necessary to safeguard life and property during and after a major natural disaster. For this study, the items were adapted to reflect the local context, and the study population showed satisfactory internal consistency of Cronbach's alpha 0.7, providing insights into the participants' perspectives on flood disaster preparedness practices at both individual and family levels 43 . The items in the questionnaire cover three main factors: indoor safety measures, document preparation, and collective efficacy and escape plans. For instance, items A1, A2, and A3 focus on evacuation plans, while items A4 to A6 and A9 address collective efficacy. Document preparation is assessed through items A7, A8, and A14, and indoor safety measures are captured by items A10 to A13 Adaptations included modifications like replacing the item from 'Acquired a fire extinguisher and learned how to operate' to 'Stored clean water supply for every household' and from 'Acquire an all-hazards alert radio' to 'Download applications or devices that help get related disaster information' to suit local needs. A copy of the questionnaire is enclosed in the supplementary. The response format is binary (Yes/No), with 'Yes' responses scored as one point and 'No' or 'Not Sure' as zero, summing up to a total score that categorises flood disaster preparedness into three levels: poorly prepared (0–5 points), moderately prepared (6–9 points), and well-prepared (10–14 points). Detailed Participant's Background questionnaires (10 items) This section asked about the participant's sociodemographic background (age,gender, parent’s educational background and family monthly income), disaster experience and severity, and exposure to disaster education. This question was requested once during the baseline or preliminary stage. Data collection method The data collection point was taken face-to-face at three-time points for both intervention and control groups. Prior to the intervention, T0 data were collected. Second, a similar questionnaire was used for the immediate post-intervention evaluation (T1) after the disaster education intervention, except the sociodemographic section was skipped. Post-intervention assessment (T3) was done three months following the disaster education intervention using the same self-reported questionnaire as T2. It is estimated that each survey will take approximately 15–20 minutes to complete. Data Analysis Data were analysed with SPSS 27.0. The Kolmogorov, Skewness and histogram tests were used to test continuous data normality. Continuous variable median, interquartile range, and mean rank were reported. An Independent T-test parametric test was used to determine any significant difference in baseline scores for the flood disaster preparedness score in the control and intervention groups. For categorical data (gender, parent's education, and monthly income), frequency and percentages were applied. The Chi-square test determined the significant difference in baseline categorical variable distribution between the intervention and control groups. This study established the alpha level for statistical significance at 0.05 across all tests conducted. Accordingly, p-values equal to or below 0.05 were deemed to reflect statistically significant results. This threshold, conventionally employed in empirical research, implies a 5% risk of committing a Type I error—erroneously rejecting the null hypothesis. Adopting this standard minimises the probability that the observed effects are due to random variation. The effect of Get-Ready DEM intervention on flood disaster preparedness was measured by comparing scores within and across groups using a generalised estimation equation (GEE). The GEE assessed mean population average flood disaster preparedness and preferred robustness in predicting accurate outcomes or models. Ethical Consideration Approval was obtained by the Ethics Committee of Human Research University Putra Malaysia (JKEUPM-2022-858) and the Ministry of Education, Malaysia (KPM.600-3/2/3-eras (15189). The study was registered under the Thailand Clinical Trial Registry: TCTR 2024040426001). Participants in the study were selected based on voluntary participation, and no personal identifiable information was gathered. Participants and their parents or guardians provided informed consent before the study. Participants have the option to withdraw from the study at any point. Inclusion criteria for schools and participants The selected schools were the public government secondary schools designated as temporary shelters in the districts of Klang, Gombak, Hulu Langat, or Sepang. These schools are coeducational and enroll students aged 13 to 15 years. Participants needed to be Malaysian citizens attending one of the selected schools, willing to participate in the study, and have parental or guardian consent. Additionally, participants were required to be proficient in either Malay or English. Exclusion criteria for schools and participants Any school and the participant who wished to withdraw from the study at any point in time. Expected benefits of the study This study is expected to significantly enhance the participants' knowledge of flood disaster preparedness through a targeted educational module, thereby contributing to the scientific foundation in public health and augmenting the existing literature. By integrating into national disaster preparedness programs, the study aims to bolster the capabilities of key agencies such as the National Disaster Management Agency of Malaysia (NADMA) and the Ministry of Health Malaysia (MOH) in equipping communities to handle flood disasters better. Additionally, aligning with Malaysia’s commitment to the Sendai Framework 2015–2030, the research supports global efforts to strengthen disaster resilience. Focused specifically on adolescent education regarding flood disaster preparedness, this initiative not only empowers a vulnerable demographic but also cultivates a resilient community capable of effectively withstanding and recovering from catastrophic events. Start and End Dates of the Study and Estimated Duration The data collection phase of the study was conducted between May 2023 to January 2024. Results Sociodemographic Background of Participants The study included 287 participants with a median age of 14 (± 1 year). Female participants constituted 54.7% of the sample, while males accounted for 45.3%. Most participants came from families with educational backgrounds up to the secondary school level (69%) and a monthly family income of less than RM4850 (64.8%). Notably, 68.1% of participants reported no prior experience with flood disasters. Conversely, 31.9% had experienced flood disasters, with 33% describing their experiences as moderately severe. Additionally, 60.2% of respondents indicated that their family or friends had encountered flood disasters, with 41.2% characterizing these experiences as moderately severe. Significant proportions of participants (82.9%) had not received any disaster education before the study, while 17.1% had some form of disaster education. Detailed sociodemographic and disaster experience data are presented in Table 1 in the supplementary section. Participation Rate The study achieved high response rates, with 97.2% immediately post-intervention and 96.5% at the three-month follow-up. Missing data were analysed using Little's MCAR test, indicating that the missingness was completely at random (p > 0.05). Given that only 4.9% of the data was missing, primarily from the sociodemographic section, no imputation was performed as it was unlikely to impact the outcomes significantly. Data analyses were conducted using the Generalized Estimating Equation (GEE) model on non-missing observations. Baseline study of flood disaster preparedness score At the baseline of the study, the flood disaster preparedness (FDP) scores, as assessed by the Independent T-test, revealed no statistically significant difference between the control group (Mean (SD) = 7.442 (2.95)) and the intervention group (Mean (SD) = 7.40 (2.42)). The t-value was 0.133 with a p-value of 0.894, indicating a mean difference of only 0.042 (95% CI: -0.59, 0.67). However, significant covariates were identified at baseline between the intervention and control groups concerning age (p < 0.001), perceived efficacy (p = 0.002), perceived threat (p = 0.018), individual disaster experience (p-value < 0.001) and disaster severity (p-value = 0.005), and family or friends' disaster experiences (p-value = 0.019) and disaster severity (p-value = 0.023). Effect of 'Get-Ready DEM' on flood disaster preparedness score on intervention group after adjusting the significant covariates. The study employed a robust multivariable analysis using the Generalized Estimating Equation (GEE) to assess the impact of the "Get-Ready DEM" module, after accounting for significant covariates such as age, perceived efficacy, perceived threat, individual disaster experience and severity, as well as the severity of family or friends' disaster experiences. The findings indicated that the intervention group experienced a significant increase in flood disaster preparedness scores by an average of 0.89 units (β = 0.89, 95% C: 0.21,1.58; p-value:0.011) compared with the control group. At three distinct evaluation timelines, only the immediate post-intervention assessment showed significant changes in FDP scores for both groups (β = -0.76,95% CI = 9.21, 1.58; p-value = 0.001). However, further interaction analysis between the timeline and trial groups revealed marked improvements in the intervention group's FDP scores. Specifically, there was a significant increase of 2.15 units in the intervention group's scores immediately post-intervention (β = 2.15; 95%CI = 1.64, 2.65 p-value < 0.001), and a 1.53 unit increase at the three-month follow-up (β = 1.53; 95% CI = 0.96, 2.10, p-value < 0.001), compared to baseline. Figure 2 at the supplementary section illustrates the total mean score of flood disaster preparedness score between trial groups at three different time points. Discussion This study demonstrated a significant enhancement in flood disaster preparedness scores among adolescents in the intervention group compared to the control group, immediately post-intervention and at the three-month follow-up. These results underscore the effectiveness of the 'Get-Ready DEM' module, which is consistent with similar studies conducted in Malaysia 44 – 46 , Indonesia 47 , 48 , Iran 49 , Pakistan 50 , Vietnam, 51 and Nepal 52 , all affirming the positive impact of disaster education on adolescent preparedness. The notable improvement in preparedness scores can be attributed to the comprehensive design of the 'Get-Ready DEM' module, which integrates theory-based (EPPM) with interactive and practical learning approaches 11 . These include game-based activities and audio-video lectures, which have proven effective in enhancing understanding and retention of disaster preparedness concepts 46 , 48 , 53 , 54 . Such interactive strategies have been shown to keep participants engaged and facilitate the translation of learned behaviours into actual preparedness measures 11 , 48 . However, the study also observed a decline in preparedness scores at the three-month follow-up, suggesting that a single educational intervention may not be sufficient for long-term preparedness 52 . This finding indicates the need for continuous education, periodic drills, and regular reinforcement to maintain and enhance disaster preparedness behaviours 55 . Implementing visual aids like banners and models of emergency kits within educational settings also played a crucial role in reinforcing learning and promoting a culture of preparedness 48 , 56 . Furthermore, the study highlighted several covariates, such as age, perceived efficacy, and personal and family disaster experiences that significantly influenced the outcomes. Older adolescents often display a better understanding and are more responsive to disaster preparedness measures due to advanced cognitive and emotional development 8 , 57 . Conversely, younger adolescents may require more tailored educational interventions that cater to their developmental stage 58 . Additionally, personal experience with disasters significantly impacted flood disaster preparedness actions, as those who have previously experienced floods are more likely to engage in proactive measures 57 , 59 . The severity of past experiences also enhances the perception of risk, prompting more robust preparedness efforts 23 . EPPM-based flood disaster education programs have proven to be a powerful tool for enhancing adolescent preparedness, affirming the value of incorporating such targeted educational strategies within broader disaster risk reduction (DRR) initiatives. This approach is consistent with findings from other regions, reinforcing the broader literature's perspective that structured disaster education not only raises awareness but also arms adolescents with the crucial skills and knowledge necessary for effective response to disasters 11 , 17 , 55 , 60 . The 'Get-Ready DEM' program, developed through systematic integration of effective communication theories and the strategic delivery of information via interactive practical sessions and audio-visual media, has effectively engaged participants. Situated within the school environment as the base for the program, it has significantly enhanced the learning process and successfully achieved the study’s objectives 17 . Therefore, school-based disaster education programs incorporating comprehensive disaster risk reduction (DRR) activities foster a safety culture and proactive disaster management among students 61 , 62 . These programs are particularly effective in environments with a strong synergy between community and school initiatives, underscoring the importance of collaborative strategies that include educators, community leaders, and policymakers. 63 . Schools play a pivotal role in preparing a generation that is aware of natural disaster risks and adept at mitigating these risks 28 , 51 . This is achieved by integrating DRR education into standard curricula and complementing it with community-based preparedness strategies, ensuring active participation of adolescents and providing a sustainable avenue for delivering disaster education. This study encountered several limitations, including the reliance on participants' self-reported knowledge and awareness of flood disaster preparedness, which may introduce information bias and not necessarily reflect actual behaviours. The brief assessment period, devoid of actual flood events, further limits the reflection of true proactive behaviours. Additionally, the limited sample size restricts the generalizability of the findings across different populations and geographical areas with varying flood vulnerabilities and socio-economic conditions. Future research should broaden the study's scope to include diverse geographical areas and cultural backgrounds to enhance generalizability and understanding of flood disaster preparedness. Investigating dissemination mechanisms for disaster risk reduction education and the roles of educators, volunteers, and guardians are crucial, along with fostering community involvement to build resilient partnerships. Furthermore, addressing the psychological impact of flood disasters on adolescents is essential, with future studies focusing on timely assessments and interventions to reduce anxiety, promote effective coping strategies, and enhance social support to improve disaster preparedness. Conclusion This study underscores the positive impact of the 'Get-Ready DEM' module in enhancing flood disaster preparedness among adolescents, affirming the need for ongoing educational initiatives and tailored interventions to sustain and elevate these behaviours. The findings align with an extensive body of research supporting the effectiveness of well-designed educational programs in bolstering disaster preparedness, especially when these initiatives are attuned to the developmental needs of their audience. The methodological rigour employed in this study, including the control of significant covariates, lends robust credibility to the outcomes, suggesting that similar educational approaches could benefit various disaster-prone regions and diverse populations. Hence, investing in disaster education is critical as it forms a cornerstone of sustainable disaster risk reduction strategies, emphasizing the development of future generations' resilience. Declarations Author contribution statement Conception and design: K.M Acquisition, analysis or interpretation of data: K.M Drafting the work or revising: K.M, AZFA, RAM, MRB Final approval of the manuscript: KM, AZFA Conflicts of Interest No potential conflicts of interest relevant to this article were reported. Author Contribution Conception and design: K.MAcquisition, analysis or interpretation of data: K.MDrafting the work or revising: K.M, AZFA, RAM, MRBFinal Approval of the manuscript: KM, AZFA Acknowledgement The authors extend their profound gratitude to the Ministry of Education and the participating schools for their invaluable cooperation and support, which were pivotal in facilitating the execution of this study. Additionally, heartfelt thanks are directed to the Universiti Putra Malaysia (UPM) for the financial support provided through the grant (6302015-14001) that ensured the seamless progression of this research. This collaboration and funding were essential in achieving the study's objectives and are deeply appreciated. Data Availability The datasets generated during and/or analysed during the current study are not publicly available as it require permission from the Ministry of Education for data sharing. The original questionnaire, educational materials, and datasets used or analyzed during the current study are available from the corresponding author only at a reasonable request to protect the participants' privacy, as the dataset has some identifying variables. References UNDRR Centre for Research on the Epidemiology of Disasters (CRED), I. Ucl. Disaster Year in Review 2020: Global Trends and Perspectives . Cred vol. May https://www.cred.be/index.php?q=work-with-us (2021). CFE-DM. Malaysia Disaster Management Reference Handbook . Center for Excellence in Disaster & Humanitarian Assistance (CFE-DM) (2019). Center for Excellence in Disaster Management & Humanitarian Assistance (CFE-DM) Organization. Malaysia:Disaster Management Reference Handbook . (2022). Department of Statistic Malaysia. Special Report on Flood Impact Assessments in Malaysia 2021 . https://www.dosm.gov.my (2022). Al Hussaini, M. H., Naseem Kausar & Indriani, F. Disasters and Their Effects on Child Development. International Journal of Learning Reformation in Elementary Education 1, 70–79 (2022). WHO. Adolescent Health. Department of Statistic Malaysia. Population Table: States | OpenDOSM. https://open.dosm.gov.my . Blakemore, S. J. & Choudhury, S. Development of the adolescent brain: Implications for executive function and social cognition. Journal of Child Psychology and Psychiatry and Allied Disciplines vol. 47 296–312 Preprint at https://doi.org/10.1111/j.1469-7610.2006.01611.x (2006). Sawyer, S. M., Azzopardi, P. S., Wickremarathne, D. & Patton, G. C. The age of adolescence. Lancet Child Adolesc Health 2, 223–228 (2018). Kurniawan, E., Suharini, E. & Dafip, M. How far disaster management implemented toward flood preparedness: A lesson learn from youth participation assessment in Indonesia. International Journal of Safety and Security Engineering 11, 175–183 (2021). Subarno, A. & Dewi, A. S. A systematic review of the shape of disaster education. IOP Conf Ser Earth Environ Sci 986, (2022). Asian Disaster Reduction Center. Sendai Framework for Disaster Risk Reduction 2015–2030 . (2015). Nation, U. Sustainable Development Goal. https://www.un.org/sustainabledevelopment/ . Kitagawa, K. Conceptualising ‘disaster education’. Educ Sci (Basel) 11, (2021). Shaw, R., Sakurai, A. & Oikawa, Y. New Realization of Disaster Risk Reduction Education in the Context of a Global Pandemic: Lessons from Japan. International Journal of Disaster Risk Science 12, 568–580 (2021). How, V., Azmi, E. S., Abdul Rahman, H. & Othman, K. The Way Forward: Opportunities and Challenges of Sustainable School Disaster Education in Malaysia. International Journal of Academic Research in Business and Social Sciences 10, (2020). Seddighi, H. et al. School-Based Education Programs for Preparing Children for Natural Hazards: A Systematic Review. Disaster Medicine and Public Health Preparedness 1–13 Preprint at https://doi.org/10.1017/dmp.2020.479 (2021). Mohammad, L. R. High school students seismic risk perception and preparedness in Savar, Dhaka. Educational Research and Reviews 14, 168–177 (2019). Codreanu, T. A. A multinational study of behavioural and practical disaster preparedness of final year high-school students. (The University of Western Australia, 2018). Wei, B., Su, G. & Li, Y. Evaluating the cognition and response of middle/high school students to earthquake—a case study from the 2013 Mw6.6 Lushan earthquake-hit area, China. International Journal of Disaster Risk Reduction 51, (2020). Peleg, K., Bodas, M., Shenhar, G. & Adini, B. Wisdom of (using) the crowds: Enhancing disasters preparedness through public training in Light Search and Rescue. International Journal of Disaster Risk Reduction 31, 750–757 (2018). Promsri, C. Exploring Flood Disaster Preparedness Awareness Factors through Historical Flood Victims in Bangkok Metropolitan and Vicinity by Using Factor Analysis. International Journal of Academic Research in Business and Social Sciences 7, (2017). Fitriani, D. R., Rizal, A. A. F., Milkhatun, M. & Astiningsih, N. W. W. Analysis of Factors Related To Adolescents Preparedness in The Disaster-Prone Areas In Lempake Village, Samarinda. STRADA Jurnal Ilmiah Kesehatan 9, 1434–1444 (2020). Qi, Y. et al. Flood Disaster Risk Perception and Urban Households’ Flood Disaster Preparedness: The Case of Accra Metropolis in Ghana. Water (Basel) (2021) doi: 10.3390/w13172328 . Ng, S. L. Effects of Risk Perception on Disaster Preparedness Toward Typhoons: An Application of the Extended Theory of Planned Behavior. International Journal of Disaster Risk Science Preprint at https://doi.org/10.1007/s13753-022-00398-2 (2022). Mhd Noor, M. T. et al. Facing flood disaster: A cluster randomized trial assessing communities’ knowledge, skills and preparedness utilizing a health model intervention. PLoS One 17, e0271258 (2022). Rao, S., Doherty, F. C. & Teixeira, S. Are you prepared? Efficacy, contextual vulnerability, and disaster readiness. International Journal of Disaster Risk Reduction 77, 103072 (2022). Nakano, G. & Yamori, K. Disaster risk reduction education that enhances the proactive attitudes of learners: A bridge between knowledge and behavior. International Journal of Disaster Risk Reduction 66, 102620 (2021). Gong, R. & Alrehaili, N. R. Flood Preparedness in United Kingdom and China: A Comparison Study Focusing on Social and Economic Factors. International Journal of Disaster Management 5, 181–192 (2023). Popova, L. The Extended Parallel Process Model: Illuminating the Gaps in Research. Health Education and Behavior 39, 455–473 (2012). Witte, K. & Allen, M. A Meta-Analysis of Fear Appeals: Implications for Effective Public Health Campaigns. Health Education & Behavior Preprint at https://doi.org/10.1177/109019810002700506 (2000). Hyejung Yoon, Myoungsoon You & Changwoo Shon. An application of the extended parallel process model to protective behaviors against COVID-19 in South Korea. PLoS One 17, (22AD). Salita, C., Tiongco, R. E. & Kawano, R. Assessment of school teachers’ disaster preparedness using the extended parallel process model: a cross-sectional study in Angeles City, Philippines. Journal of Public Health (Germany) 29, 1275–1282 (2021). Weber, M. C., Schulenberg, S. E. & Lair, E. C. University employees’ preparedness for natural hazards and incidents of mass violence: An application of the extended parallel process model. International Journal of Disaster Risk Reduction 31, 1082–1091 (2018). Zhao, S. & Wu, X. From Information Exposure to Protective Behaviors: Investigating the Underlying Mechanism in COVID-19 Outbreak Using Social Amplification Theory and Extended Parallel Process Model. Front Psychol 12, (2021). Jabatan Perangkaan Malaysia. Poket Stats Negeri Selangor ST3 2020 . Jabatan Perangkaan Malaysia (Putrajaya, 2020). Drainage and Irrigation Department (DID). Annual Flood Report 2020 . Department of Irrigation and Drainage Malaysia (2020). Drainage and Irrigation Department (DID), M. Annual Flood Report 2021 . (2021). Lemeshow, S., Hosmer Jr, D. W., Klar, J., Lwanga, S. K. & WHO, W. H. O. Adequacy of Sample Size in Health Studies . (1990). Hemming, K., Girling, A. J., Sitch, A. J., Marsh, J. & Lilford, R. J. Sample size calculations for cluster randomised controlled trials with a fixed number of clusters. BMC Med Res Methodol 11, (2011). Rita C. Richey & James D.Klein. Design and Development Research . (Lawrence Erlbaum Associates, Inc., Publishers, New Jersey, United States of America, 2007). Rohith, V. R., Kolathayar, S., Priyatham, K., Karan Kumar, V. & Nikil, S. Disaster Preparedness Index: A Valid and Reliable Tool to Comprehend Disaster Preparedness in India. in Urbanization Challenges in Emerging Economies: Resilience and Sustainability of Infrastructure - Selected Papers from the ASCE India Conference 2017 156–163 (American Society of Civil Engineers (ASCE), 2018). doi: 10.1061/9780784482032.017 . Yusoff, M. S. B. ABC of Content Validation and Content Validity Index Calculation. Education in Medicine Journal 11, 49–54 (2019). Azmi, E. S., How, V. & Rahman, H. A. Effect of health belief model on flood-risk educational approach among elementary school children in Malaysia. Jamba: Journal of Disaster Risk Studies 13, 1–6 (2021). don, N. F. S., don, H. S. S., Alias, R. A. & Nakanishi, H. Flood Preparedness Module for Malaysian Higher Education Students via Metaverse Environment. IOP Conf Ser Earth Environ Sci (2023) doi: 10.1088/1755-1315/1144/1/012011 . Chong, K. L., Nifa, F. A. A., Abbas, S. R. & Zahir, N. M. Disaster education using board games technique: A case of SK Felda Bukit Tangga. in American Institute of Physics Conference Series vol. 2644 30017 (AIP, 2022). Amri, I. et al. Effectiveness of an educational intervention for disaster preparedness for elementary school students in Central Sulawesi. Enferm Clin 31, S779–S782 (2021). Siswi, D., Setioputro, B. & Wantiyah. The Effectiveness of Audiovisual Media Health Education on Flood Disaster Preparedness in Elementary School Children. Jurnal Kegawatdaruratan Medis Indonesia 2, 26–42 (2023). Moradian, M. J. & Mehraein Nazdik, Z. Game versus Lecture-Based Learning in Disaster Risk Education; An Experience on Shiraz High School Students. Bull Emerg Trauma 7, 112–117 (2019). Shah, A. A. et al. Schools’ Flood Emergency Preparedness in Khyber Pakhtunkhwa Province, Pakistan. International Journal of Disaster Risk Science (2018) doi: 10.1007/s13753-018-0175-8 . Thi, T. & Shaw, R. School-based disaster risk reduction education in primary schools in Da Nang City, Central Vietnam. Environmental Hazards 15, 356–373 (2016). Nakano, G., Suwa, S., Gautama, A. & Yamori, K. Long-term evaluation of proactive attitudes toward disaster education in Nepal. International Journal of Disaster Risk Reduction 50, (2020). Rismayani, Paliling, A., Nurhidayani, A. & Pineng, M. Fundamental Design of Flood Management Educational Games Using Virtual Reality Technology. International journal of online and biomedical engineering 18, 19–32 (2022). How, V., Azmi, E. S. B., Mohd Zaki, N. F. B. & Othman, K. Bin. Integrating Flood Education Miniature and Interactive E-Learning in a Prototype of Flood Learning Kit for Knowledge Resilience Among School Children. in 355–368 (Springer Singapore, 2020). doi: 10.1007/978-981-32-9527-8_20 . Oktari, R. S. & Kumala, I. D. Improving Student Internalization of Disaster Knowledge by Participating in Learning Package Development. Jurnal Pengabdian kepada Masyarakat (Indonesian Journal of Community Engagement) 6, (2020). Pickering, C. J. et al. The Promotion of ‘Grab Bags’ as a Disaster Risk Reduction Strategy. PLoS Curr (2018) doi: 10.1371/currents.dis.223ac4322834aa0bb0d6824ee424e7f8 . de Milliano, C. W. J. Luctor et emergo, exploring contextual variance in factors that enable adolescent resilience to flooding. International Journal of Disaster Risk Reduction 14, 168–178 (2015). Ronan, K. R., Johnston, D. M. & Daly, M. School Children’s Risk Perceptions and Preparedness: A Hazards Education Survey The Australasian Journal of Disaster and Trauma Studies School Children’s Risk Perceptions and Preparedness: A Hazards Education Survey. The Australian Journal of Disaster and Trauma Studies (2005). Siddique Akbar, M. A Phenomenological Study Of Lived Experiences Of 2022 Flood Survivors In Rajan Pur District-South Punjab-Pakistan. Pakistan Journal of Social Research vol. 4 (2022). Dewi, R. P. et al. Improving natural disater understanding of junior high school students. IOP Conf Ser Earth Environ Sci 986, 012010 (2022). Wang, Z., Han, Z. & Li, Y. The Interplay between School Preparedness and Student’s Individual Protective Actions: The Mediating Role of Disaster Education. Sustainability 15, 14888 (2023). Masini, A. et al. Evaluation of school-based interventions of active breaks in primary schools: A systematic review and meta-analysis. J Sci Med Sport 23, 377–384 (2020). Ismail, N. et al. Malaysian Experiences: Public-Private Partnership Involvement in Disaster Risk Reduction in Community Resilience in Malaysia. AIP Conf Proc 105, 169–173 (2018). Additional Declarations No competing interests reported. Supplementary Files Supplementarykhairunnisanature.docx Cite Share Download PDF Status: Published Journal Publication published 16 Jun, 2026 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 12 Sep, 2024 Reviews received at journal 10 Sep, 2024 Reviewers agreed at journal 27 Aug, 2024 Reviews received at journal 19 Aug, 2024 Reviewers agreed at journal 13 Aug, 2024 Reviewers invited by journal 12 Aug, 2024 Editor assigned by journal 12 Aug, 2024 Editor invited by journal 30 Jul, 2024 Submission checks completed at journal 30 Jul, 2024 First submitted to journal 19 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4766357","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":344107532,"identity":"c9b720de-8d94-43e3-b249-b6838599852d","order_by":0,"name":"Khairunnisa Makmon","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Khairunnisa","middleName":"","lastName":"Makmon","suffix":""},{"id":344107533,"identity":"49f5a8e5-de6e-4def-8118-3db29d535a02","order_by":1,"name":"Fattah Azman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAs0lEQVRIiWNgGAWjYFACxgcMHyAsA2K1MBswziBZCzMPSVr4+w8zfrZtuxPNwN68TYIx5zBhLRIHDjNL57Y9y23gOVYmwbiNCC0MB/sPALUczm2QyDEjTov8YWbm35YgLfJviNRicIyZTZoRbAsPkVoMzzCzWface5bbxpNWbJG4LZ2wFrnzh5lv/Ci7k9vPfnjjjY/brAlrgYIDDGwgKoGhmQQtUFBHtJZRMApGwSgYOQAAIFw5Fqd+ZhoAAAAASUVORK5CYII=","orcid":"","institution":"Universiti Putra Malaysia","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Fattah","middleName":"","lastName":"Azman","suffix":""},{"id":344107534,"identity":"862773be-4642-4408-b8df-6c756a854c43","order_by":2,"name":"Rosliza Abdul Manaf","email":"","orcid":"","institution":"Universiti Putra Malaysia","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rosliza","middleName":"Abdul","lastName":"Manaf","suffix":""},{"id":344107535,"identity":"00b59857-ffe9-425b-85c6-35d7e1e4414f","order_by":3,"name":"Mohd Rafee Baharudin","email":"","orcid":"","institution":"Universiti Putra Malaysia","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mohd","middleName":"Rafee","lastName":"Baharudin","suffix":""}],"badges":[],"createdAt":"2024-07-19 05:41:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4766357/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4766357/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-026-56110-7","type":"published","date":"2026-06-16T16:01:48+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":112746373,"identity":"6caa0a83-79c3-4460-8d39-a51feaf517fa","added_by":"auto","created_at":"2026-06-22 16:16:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":211488,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4766357/v1/9fa1db53-8845-4573-b902-eb701b378cec.pdf"},{"id":63246794,"identity":"2a64b1e1-9819-47ef-b085-69e72a8b30e0","added_by":"auto","created_at":"2024-08-26 06:01:58","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":284748,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarykhairunnisanature.docx","url":"https://assets-eu.researchsquare.com/files/rs-4766357/v1/5f6bc13d828600ad75f88ca6.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Theory-Based Flood Disaster Education Enhances Disaster Preparedness Among Adolescents in Selangor, Malaysia: A Cluster Randomized Controlled Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePreparedness is crucial for mitigating the severe impacts of floods, among the most destructive natural disasters globally. According to the Centre for Research on the Epidemiology of Disasters (CRED), in 2021, floods accounted for 52% of global disasters and 41% of disaster-related deaths in 2020\u003csup\u003e1\u003c/sup\u003e. Despite being outside the Pacific Ring of Fire, Malaysia is highly susceptible to floods, pollution, and landslides, with floods representing 74% of natural disasters from 1998 to August 2018\u003csup\u003e2\u003c/sup\u003e. From July 2012 to January 2019, Malaysia reported the highest number of individuals affected by floods in the ASEAN region\u003csup\u003e3\u003c/sup\u003e. The late 2021 and early 2022 floods caused extensive damage across various sectors, with losses estimated at RM6.1 billion, or approximately 0.40% of Malaysia\u0026apos;s nominal GDP\u003csup\u003e4\u003c/sup\u003e. Adolescents, particularly vulnerable due to their developmental stage, suffer disproportionately from floods, impacting their physical, mental, socioeconomic, and educational well-being\u003csup\u003e5\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eAdolescents, defined by the World Health Organization as individuals aged 10 to 19\u003csup\u003e6\u003c/sup\u003e and comprising nearly 11% of Malaysia\u0026apos;s population, are at a critical developmental juncture\u003csup\u003e7\u003c/sup\u003e. This phase presents both opportunities for capacity development and significant vulnerabilities\u003csup\u003e8,9\u003c/sup\u003e. Educating this demographic about flood risks and appropriate responses is essential for their safety and fostering community resilience\u003csup\u003e10,11\u003c/sup\u003e. Their involvement is crucial in promoting effective behaviours in disaster risk reduction, as outlined in the Sendai Framework for Disaster Risk Reduction 2015-2030\u003csup\u003e12\u003c/sup\u003e. It aligns with the global sustainable development agenda, particularly the SDG 2030 education target 4.7, aiming to equip youth with skills to promote sustainable development and resilience against climate challenges, including Target 13.3\u003csup\u003e13\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eBoth formal and informal disaster education are vital from an early age\u003csup\u003e14\u003c/sup\u003e. Advocates highlight the importance of initiating education and awareness efforts in childhood to lay a foundation for a culture of preparedness and resilience\u003csup\u003e15,16\u003c/sup\u003e. Although studies have shown that educating adolescents about disasters prepares them to handle such calamities, a systematic review of school-based disaster education programs in 27 countries revealed discrepancies between increased awareness and preparedness among adolescents\u003csup\u003e17\u003c/sup\u003e. It indicates a need for innovative strategies to enhance the effectiveness of school-based disaster education programs\u003csup\u003e11,17\u003c/sup\u003e. Furthermore, age\u003csup\u003e17\u0026ndash;19\u003c/sup\u003e, gender\u003csup\u003e18,20,21\u003c/sup\u003e, personal disaster experience\u003csup\u003e20,22,23\u003c/sup\u003e, perceived risk or threat\u003csup\u003e19,24,25\u003c/sup\u003e, perceived efficacy\u003csup\u003e26,27\u003c/sup\u003e, disaster knowledge\u003csup\u003e11,28\u003c/sup\u003e, and socioeconomic status\u003csup\u003e\u0026nbsp;29\u003c/sup\u003e influence adolescent flood disaster preparedness.\u003c/p\u003e\n\u003cp\u003eIn Malaysia, research on disaster education among adolescents has been promising, yet there is a shortage of disaster education modules specifically targeting this group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis research crafted a flood disaster preparedness educational module for adolescents based on the Extended Parallel Process Model (EPPM), a prominent framework in health communication\u003csup\u003e30,31\u003c/sup\u003e. The EPPM incorporates cognitive (efficacy) and emotional (threat) components to predict behavioural responses. By influencing how individuals perceive flood disasters and enhancing their ability to manage such situations, this model aims to encourage proactive behaviour. By systematically amplifying perceived threats and efficacy, the module seeks to mould adolescents\u0026apos; perceptions of flood risks and enhance their capability to implement protective measures\u003csup\u003e31\u003c/sup\u003e. EPPM is particularly suited for this purpose due to its proven effectiveness in previous studies on preparedness for various natural disasters, pandemics, and outbreaks\u003csup\u003e32\u0026ndash;35\u003c/sup\u003e. Therefore, by utilising the EPPM, this study aims to tailor a flood disaster education module for adolescents and evaluate its impact on their flood disaster preparedness.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e \u003cem\u003eResearch Objectives.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThis study aims to develop, implement, and assess the effects of a flood disaster education module based on the Extended Parallel Pathway Model on flood disaster preparedness among secondary school students in Selangor, Malaysia.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eTwo-armed, parallel, single-blinded, cluster-randomised control trial. Secondary schools designated as temporary shelters constitute this study's cluster. The clusters were divided into intervention and control groups. Both groups received follow-up during the trial. The intervention group received a 'Get-Ready DEM' flood disaster education program. The control group received no intervention and was put on the waiting list if the intervention group demonstrated a positive effect. The design and reporting of this study were performed in accordance to the CONSORT (Consolidated Standards of Reporting Trials) guidelines 2010, ensuring comprehensive and transparent documentation of the trial.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eLocation of the study\u003c/h2\u003e \u003cp\u003eThe research was carried out in Selangor, Malaysia. Selangor is one of 13 Malaysian states on the west coast of the Peninsular. Selangor has 6.99\u0026nbsp;million people, the most in Malaysia (21.6%), with approximately 674 people per square kilometres and 95.8% urban population \u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. The study was conducted in Selangor's four flood-prone districts: Klang, Hulu Langat, Gombak, and Sepang\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e,\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy population and respondent selection\u003c/h2\u003e \u003cp\u003eRandomisation was performed at the cluster level (school). Eight schools were selected based on the list of secondary schools provided by the Selangor State Education Department. The selected schools were randomly allocated into the control and intervention groups using a 1:1 ratio. The allocation concealment was done using the subsequentially numbered, opaque, sealed envelope (SNOSE) technique. The eight schools were labelled by randomly assigning them to names (A, B, C, D, E, F, G and H). Then, it was concealed in eight identical black opaque envelopes size 2-inch by 2-inch, containing different colour-coded cards by the other third party. The white and red cards were labelled as control and intervention groups, respectively. Envelopes were opened only after it was time to allocate the intervention by research assistant. It should be noted that the allocation codes were masked from the investigator during this step. The intervention allocation was masked to the school and participants only.\u003c/p\u003e \u003cp\u003eThe sampling population consisted of adolescents between 13 and 15 years old who attended the selected secondary school during the study period. Study participants were recruited upon approval of the school principal. The recruitment of the participants was based on the selected class from Form 1 to Form 3 based on the selection by the random application of the computer generator.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePopulation-sample\u003c/h2\u003e \u003cp\u003eThe sample size (N) for this study was calculated by comparing the population of two groups using Lemeshow and Lwanga's formula\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. The sample size was calculated by considering the intra-cluster correlation coefficient, the number of clusters, the expected effect, and the power of study (80%). This cluster randomised controlled study assumed an intracluster correlation (ρ) of 0.1, with a fixed number of clusters (k\u0026thinsp;=\u0026thinsp;8), cluster size (m) and considering design effect, 1 + (ρ(m-1), given the small cluster size and rare outcome\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. The final sample size was estimated to be 230 for both the intervention and control groups after adjusting for the 20% attrition rate of approximately 25 students per cluster.\u003c/p\u003e \u003cp\u003eIn secondary school in Selangor, there were approximately 25 to 40 students per classroom. Thus, based on the sample size calculation and the current local setting of classrooms, only eight clusters or schools were required to enrol in this study to fulfil the minimum sample size requirement. The process of recruiting schools and participants is presented in Fig.\u0026nbsp;1 in the supplementary.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStudy Instrument\u003c/h2\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eFlood Disaster Education Module for Intervention Group\u003c/h2\u003e \u003cp\u003eThe flood disaster education module, \"Get-Ready DEM,\" was meticulously developed based on the Extended Parallel Process Model (EPPM), effectively integrating the concepts of perceived threat and perceived efficacy. The module comprised three comprehensive sessions, which lasted approximately three hours and conducted at school during the school period. The initial session aimed to increase awareness of flood risks, thereby enhancing the participants' perception of the threat. The subsequent sessions were dedicated to improving flood disaster preparedness and disaster risk communication, focusing on boosting perceived efficacy.\u003c/p\u003e \u003cp\u003eThe intervention was implemented once following the initial baseline assessments of the participants. To facilitate active engagement and practical learning, various pedagogical tools were utilized. These tools included audio-visual aids, interactive group activities, and educational games, all designed to enhance participants' disaster awareness, knowledge, and preparedness skills. Among the key activities, participants were instructed on the essential steps to assemble an emergency bag and to devise an effective emergency evacuation plan through structured group activities. Furthermore, to aid in the retention of critical information, participants were provided with handouts in the form of stickers, along with models of emergency bags, first aid kits, and whistles. These stickers listed the essential items for an emergency bag and included vital emergency contact numbers, serving as a handy and accessible reference that reinforced the learning outcomes and preparedness for flood disasters. Additionally, each school received a model emergency bag and a poster detailing key flood disaster preparedness tips, which could be displayed in classrooms to promote and reinforce the message of flood disaster preparedness.\u003c/p\u003e \u003cp\u003eThe development of the \"Get-Ready DEM\" modules was guided by a dynamic instructional design framework, ensuring a systematic and structured approach to creating educational content for the flood disaster \u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e. The modules were crafted in Malay and English to accommodate the linguistic preferences of the participants, thereby enhancing accessibility and understanding. A comprehensive validation process was undertaken to ensure the relevance and appropriateness of the module content for the local context and the intended audience. It involved a panel of four expert committees consisting of two public health specialists, a disaster and risk management expert, and an educator. Prior to the full-scale implementation, a pilot study was conducted to assess the content validity and face validity of the modules. This preliminary phase was crucial in refining the modules based on expert feedback and ensuring their suitability for effectively conveying essential disaster preparedness education.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSelf-reported Questionnaires\u003c/h2\u003e \u003cp\u003eThis study used 24 items of the self-reported questionnaire that were mostly adapted from the pre-existing instrument and translated into the Malay language via forward and backward methods. A copy of the English version of the questionnaire is provided in the supplementary section.\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eFlood Disaster Preparedness Index Tools (14 items)\u003c/h2\u003e \u003cp\u003eIn this study, flood disaster preparedness is referred to as the knowledge and capacities of individuals, communities, institutions, or governments to efficiently anticipate, effectively respond to, and recover from disasters. The instrument used to measure flood disaster preparedness encompasses 14 items adopted from the Disaster Preparedness Index score, demonstrating a high Cronbach alpha reliability of 0.91 in a prior study in Chennai involving 445 participants\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e. It evaluates the adoption of essential precautions or measures necessary to safeguard life and property during and after a major natural disaster. For this study, the items were adapted to reflect the local context, and the study population showed satisfactory internal consistency of Cronbach's alpha 0.7, providing insights into the participants' perspectives on flood disaster preparedness practices at both individual and family levels\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe items in the questionnaire cover three main factors: indoor safety measures, document preparation, and collective efficacy and escape plans. For instance, items A1, A2, and A3 focus on evacuation plans, while items A4 to A6 and A9 address collective efficacy. Document preparation is assessed through items A7, A8, and A14, and indoor safety measures are captured by items A10 to A13 Adaptations included modifications like replacing the item from 'Acquired a fire extinguisher and learned how to operate' to 'Stored clean water supply for every household' and from 'Acquire an all-hazards alert radio' to 'Download applications or devices that help get related disaster information' to suit local needs. A copy of the questionnaire is enclosed in the supplementary.\u003c/p\u003e \u003cp\u003eThe response format is binary (Yes/No), with 'Yes' responses scored as one point and 'No' or 'Not Sure' as zero, summing up to a total score that categorises flood disaster preparedness into three levels: poorly prepared (0\u0026ndash;5 points), moderately prepared (6\u0026ndash;9 points), and well-prepared (10\u0026ndash;14 points).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eDetailed Participant's Background questionnaires (10 items)\u003c/h3\u003e\n\u003cp\u003eThis section asked about the participant's sociodemographic background (age,gender, parent\u0026rsquo;s educational background and family monthly income), disaster experience and severity, and exposure to disaster education. This question was requested once during the baseline or preliminary stage.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData collection method\u003c/h2\u003e \u003cp\u003eThe data collection point was taken face-to-face at three-time points for both intervention and control groups. Prior to the intervention, T0 data were collected. Second, a similar questionnaire was used for the immediate post-intervention evaluation (T1) after the disaster education intervention, except the sociodemographic section was skipped. Post-intervention assessment (T3) was done three months following the disaster education intervention using the same self-reported questionnaire as T2. It is estimated that each survey will take approximately 15\u0026ndash;20 minutes to complete.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData were analysed with SPSS 27.0. The Kolmogorov, Skewness and histogram tests were used to test continuous data normality. Continuous variable median, interquartile range, and mean rank were reported. An Independent T-test parametric test was used to determine any significant difference in baseline scores for the flood disaster preparedness score in the control and intervention groups. For categorical data (gender, parent's education, and monthly income), frequency and percentages were applied. The Chi-square test determined the significant difference in baseline categorical variable distribution between the intervention and control groups. This study established the alpha level for statistical significance at 0.05 across all tests conducted. Accordingly, p-values equal to or below 0.05 were deemed to reflect statistically significant results. This threshold, conventionally employed in empirical research, implies a 5% risk of committing a Type I error\u0026mdash;erroneously rejecting the null hypothesis. Adopting this standard minimises the probability that the observed effects are due to random variation. The effect of Get-Ready DEM intervention on flood disaster preparedness was measured by comparing scores within and across groups using a generalised estimation equation (GEE). The GEE assessed mean population average flood disaster preparedness and preferred robustness in predicting accurate outcomes or models.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eEthical Consideration\u003c/h2\u003e \u003cp\u003e Approval was obtained by the Ethics Committee of Human Research University Putra Malaysia (JKEUPM-2022-858) and the Ministry of Education, Malaysia (KPM.600-3/2/3-eras (15189). The study was registered under the Thailand Clinical Trial Registry: TCTR 2024040426001). Participants in the study were selected based on voluntary participation, and no personal identifiable information was gathered. Participants and their parents or guardians provided informed consent before the study. Participants have the option to withdraw from the study at any point.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eInclusion criteria for schools and participants\u003c/h2\u003e \u003cp\u003eThe selected schools were the public government secondary schools designated as temporary shelters in the districts of Klang, Gombak, Hulu Langat, or Sepang. These schools are coeducational and enroll students aged 13 to 15 years. Participants needed to be Malaysian citizens attending one of the selected schools, willing to participate in the study, and have parental or guardian consent. Additionally, participants were required to be proficient in either Malay or English.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eExclusion criteria for schools and participants\u003c/h2\u003e \u003cp\u003eAny school and the participant who wished to withdraw from the study at any point in time.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eExpected benefits of the study\u003c/h2\u003e \u003cp\u003eThis study is expected to significantly enhance the participants' knowledge of flood disaster preparedness through a targeted educational module, thereby contributing to the scientific foundation in public health and augmenting the existing literature. By integrating into national disaster preparedness programs, the study aims to bolster the capabilities of key agencies such as the National Disaster Management Agency of Malaysia (NADMA) and the Ministry of Health Malaysia (MOH) in equipping communities to handle flood disasters better. Additionally, aligning with Malaysia\u0026rsquo;s commitment to the Sendai Framework 2015\u0026ndash;2030, the research supports global efforts to strengthen disaster resilience. Focused specifically on adolescent education regarding flood disaster preparedness, this initiative not only empowers a vulnerable demographic but also cultivates a resilient community capable of effectively withstanding and recovering from catastrophic events.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eStart and End Dates of the Study and Estimated Duration\u003c/h2\u003e \u003cp\u003eThe data collection phase of the study was conducted between May 2023 to January 2024.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic Background of Participants\u003c/h2\u003e \u003cp\u003eThe study included 287 participants with a median age of 14 (\u0026plusmn;\u0026thinsp;1 year). Female participants constituted 54.7% of the sample, while males accounted for 45.3%. Most participants came from families with educational backgrounds up to the secondary school level (69%) and a monthly family income of less than RM4850 (64.8%). Notably, 68.1% of participants reported no prior experience with flood disasters. Conversely, 31.9% had experienced flood disasters, with 33% describing their experiences as moderately severe. Additionally, 60.2% of respondents indicated that their family or friends had encountered flood disasters, with 41.2% characterizing these experiences as moderately severe. Significant proportions of participants (82.9%) had not received any disaster education before the study, while 17.1% had some form of disaster education. Detailed sociodemographic and disaster experience data are presented in Table\u0026nbsp;1 in the supplementary section.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eParticipation Rate\u003c/h2\u003e \u003cp\u003eThe study achieved high response rates, with 97.2% immediately post-intervention and 96.5% at the three-month follow-up. Missing data were analysed using Little's MCAR test, indicating that the missingness was completely at random (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Given that only 4.9% of the data was missing, primarily from the sociodemographic section, no imputation was performed as it was unlikely to impact the outcomes significantly. Data analyses were conducted using the Generalized Estimating Equation (GEE) model on non-missing observations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eBaseline study of flood disaster preparedness score\u003c/h2\u003e \u003cp\u003eAt the baseline of the study, the flood disaster preparedness (FDP) scores, as assessed by the Independent T-test, revealed no statistically significant difference between the control group (Mean (SD)\u0026thinsp;=\u0026thinsp;7.442 (2.95)) and the intervention group (Mean (SD)\u0026thinsp;=\u0026thinsp;7.40 (2.42)). The t-value was 0.133 with a p-value of 0.894, indicating a mean difference of only 0.042 (95% CI: -0.59, 0.67). However, significant covariates were identified at baseline between the intervention and control groups concerning age (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), perceived efficacy (p\u0026thinsp;=\u0026thinsp;0.002), perceived threat (p\u0026thinsp;=\u0026thinsp;0.018), individual disaster experience (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and disaster severity (p-value\u0026thinsp;=\u0026thinsp;0.005), and family or friends' disaster experiences (p-value\u0026thinsp;=\u0026thinsp;0.019) and disaster severity (p-value\u0026thinsp;=\u0026thinsp;0.023).\u003c/p\u003e \u003cp\u003e \u003cem\u003eEffect of 'Get-Ready DEM' on flood disaster preparedness score on intervention group after adjusting the significant covariates.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe study employed a robust multivariable analysis using the Generalized Estimating Equation (GEE) to assess the impact of the \"Get-Ready DEM\" module, after accounting for significant covariates such as age, perceived efficacy, perceived threat, individual disaster experience and severity, as well as the severity of family or friends' disaster experiences. The findings indicated that the intervention group experienced a significant increase in flood disaster preparedness scores by an average of 0.89 units (β\u0026thinsp;=\u0026thinsp;0.89, 95% C: 0.21,1.58; p-value:0.011) compared with the control group.\u003c/p\u003e \u003cp\u003eAt three distinct evaluation timelines, only the immediate post-intervention assessment showed significant changes in FDP scores for both groups (β = -0.76,95% CI\u0026thinsp;=\u0026thinsp;9.21, 1.58; p-value\u0026thinsp;=\u0026thinsp;0.001). However, further interaction analysis between the timeline and trial groups revealed marked improvements in the intervention group's FDP scores. Specifically, there was a significant increase of 2.15 units in the intervention group's scores immediately post-intervention (β\u0026thinsp;=\u0026thinsp;2.15; 95%CI\u0026thinsp;=\u0026thinsp;1.64, 2.65 p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and a 1.53 unit increase at the three-month follow-up (β\u0026thinsp;=\u0026thinsp;1.53; 95% CI\u0026thinsp;=\u0026thinsp;0.96, 2.10, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001), compared to baseline. Figure\u0026nbsp;2 at the supplementary section illustrates the total mean score of flood disaster preparedness score between trial groups at three different time points.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study demonstrated a significant enhancement in flood disaster preparedness scores among adolescents in the intervention group compared to the control group, immediately post-intervention and at the three-month follow-up. These results underscore the effectiveness of the 'Get-Ready DEM' module, which is consistent with similar studies conducted in Malaysia\u003csup\u003e\u003cspan additionalcitationids=\"CR45\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e, Indonesia\u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e,\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e, Iran\u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e, Pakistan\u003csup\u003e\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e, Vietnam,\u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e and Nepal\u003csup\u003e\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e, all affirming the positive impact of disaster education on adolescent preparedness.\u003c/p\u003e \u003cp\u003eThe notable improvement in preparedness scores can be attributed to the comprehensive design of the 'Get-Ready DEM' module, which integrates theory-based (EPPM) with interactive and practical learning approaches\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. These include game-based activities and audio-video lectures, which have proven effective in enhancing understanding and retention of disaster preparedness concepts\u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e,\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e,\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e,\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u003c/sup\u003e. Such interactive strategies have been shown to keep participants engaged and facilitate the translation of learned behaviours into actual preparedness measures\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e. However, the study also observed a decline in preparedness scores at the three-month follow-up, suggesting that a single educational intervention may not be sufficient for long-term preparedness\u003csup\u003e\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e. This finding indicates the need for continuous education, periodic drills, and regular reinforcement to maintain and enhance disaster preparedness behaviours\u003csup\u003e\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u003c/sup\u003e. Implementing visual aids like banners and models of emergency kits within educational settings also played a crucial role in reinforcing learning and promoting a culture of preparedness\u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e,\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFurthermore, the study highlighted several covariates, such as age, perceived efficacy, and personal and family disaster experiences that significantly influenced the outcomes. Older adolescents often display a better understanding and are more responsive to disaster preparedness measures due to advanced cognitive and emotional development\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u003c/sup\u003e. Conversely, younger adolescents may require more tailored educational interventions that cater to their developmental stage\u003csup\u003e\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u003c/sup\u003e. Additionally, personal experience with disasters significantly impacted flood disaster preparedness actions, as those who have previously experienced floods are more likely to engage in proactive measures\u003csup\u003e\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e,\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u003c/sup\u003e. The severity of past experiences also enhances the perception of risk, prompting more robust preparedness efforts\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eEPPM-based flood disaster education programs have proven to be a powerful tool for enhancing adolescent preparedness, affirming the value of incorporating such targeted educational strategies within broader disaster risk reduction (DRR) initiatives. This approach is consistent with findings from other regions, reinforcing the broader literature's perspective that structured disaster education not only raises awareness but also arms adolescents with the crucial skills and knowledge necessary for effective response to disasters\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e,\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u003c/sup\u003e. The 'Get-Ready DEM' program, developed through systematic integration of effective communication theories and the strategic delivery of information via interactive practical sessions and audio-visual media, has effectively engaged participants. Situated within the school environment as the base for the program, it has significantly enhanced the learning process and successfully achieved the study\u0026rsquo;s objectives\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTherefore, school-based disaster education programs incorporating comprehensive disaster risk reduction (DRR) activities foster a safety culture and proactive disaster management among students \u003csup\u003e\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e,\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u003c/sup\u003e. These programs are particularly effective in environments with a strong synergy between community and school initiatives, underscoring the importance of collaborative strategies that include educators, community leaders, and policymakers. \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e\u003c/sup\u003e. Schools play a pivotal role in preparing a generation that is aware of natural disaster risks and adept at mitigating these risks\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e. This is achieved by integrating DRR education into standard curricula and complementing it with community-based preparedness strategies, ensuring active participation of adolescents and providing a sustainable avenue for delivering disaster education.\u003c/p\u003e \u003cp\u003eThis study encountered several limitations, including the reliance on participants' self-reported knowledge and awareness of flood disaster preparedness, which may introduce information bias and not necessarily reflect actual behaviours. The brief assessment period, devoid of actual flood events, further limits the reflection of true proactive behaviours. Additionally, the limited sample size restricts the generalizability of the findings across different populations and geographical areas with varying flood vulnerabilities and socio-economic conditions. Future research should broaden the study's scope to include diverse geographical areas and cultural backgrounds to enhance generalizability and understanding of flood disaster preparedness. Investigating dissemination mechanisms for disaster risk reduction education and the roles of educators, volunteers, and guardians are crucial, along with fostering community involvement to build resilient partnerships. Furthermore, addressing the psychological impact of flood disasters on adolescents is essential, with future studies focusing on timely assessments and interventions to reduce anxiety, promote effective coping strategies, and enhance social support to improve disaster preparedness.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study underscores the positive impact of the 'Get-Ready DEM' module in enhancing flood disaster preparedness among adolescents, affirming the need for ongoing educational initiatives and tailored interventions to sustain and elevate these behaviours. The findings align with an extensive body of research supporting the effectiveness of well-designed educational programs in bolstering disaster preparedness, especially when these initiatives are attuned to the developmental needs of their audience. The methodological rigour employed in this study, including the control of significant covariates, lends robust credibility to the outcomes, suggesting that similar educational approaches could benefit various disaster-prone regions and diverse populations. Hence, investing in disaster education is critical as it forms a cornerstone of sustainable disaster risk reduction strategies, emphasizing the development of future generations' resilience.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eAuthor contribution statement\u003c/h2\u003e \u003cp\u003eConception and design: K.M\u003c/p\u003e \u003cp\u003eAcquisition, analysis or interpretation of data: K.M\u003c/p\u003e \u003cp\u003eDrafting the work or revising: K.M, AZFA, RAM, MRB\u003c/p\u003e \u003cp\u003eFinal approval of the manuscript: KM, AZFA\u003c/p\u003e\u003ch2\u003eConflicts of Interest\u003c/h2\u003e \u003cp\u003eNo potential conflicts of interest relevant to this article were reported.\u003c/p\u003e \u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConception and design: K.MAcquisition, analysis or interpretation of data: K.MDrafting the work or revising: K.M, AZFA, RAM, MRBFinal Approval of the manuscript: KM, AZFA\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors extend their profound gratitude to the Ministry of Education and the participating schools for their invaluable cooperation and support, which were pivotal in facilitating the execution of this study. Additionally, heartfelt thanks are directed to the Universiti Putra Malaysia (UPM) for the financial support provided through the grant (6302015-14001) that ensured the seamless progression of this research. This collaboration and funding were essential in achieving the study's objectives and are deeply appreciated.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated during and/or analysed during the current study are not publicly available as it require permission from the Ministry of Education for data sharing. The original questionnaire, educational materials, and datasets used or analyzed during the current study are available from the corresponding author only at a reasonable request to protect the participants' privacy, as the dataset has some identifying variables.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUNDRR Centre for Research on the Epidemiology of Disasters (CRED), I. Ucl. \u003cem\u003eDisaster Year in Review 2020: Global Trends and Perspectives\u003c/em\u003e. \u003cem\u003eCred\u003c/em\u003e vol. May \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cred.be/index.php?q=work-with-us\u003c/span\u003e\u003cspan address=\"https://www.cred.be/index.php?q=work-with-us\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCFE-DM. \u003cem\u003eMalaysia Disaster Management Reference Handbook\u003c/em\u003e. \u003cem\u003eCenter for Excellence in Disaster \u0026amp; Humanitarian Assistance (CFE-DM)\u003c/em\u003e (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCenter for Excellence in Disaster Management \u0026amp; Humanitarian Assistance (CFE-DM) Organization. \u003cem\u003eMalaysia:Disaster Management Reference Handbook\u003c/em\u003e. (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDepartment of Statistic Malaysia. \u003cem\u003eSpecial Report on Flood Impact Assessments in Malaysia 2021\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.dosm.gov.my\u003c/span\u003e\u003cspan address=\"https://www.dosm.gov.my\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl Hussaini, M. H., Naseem Kausar \u0026amp; Indriani, F. Disasters and Their Effects on Child Development. International Journal of Learning Reformation in Elementary Education 1, 70\u0026ndash;79 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. Adolescent Health.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDepartment of Statistic Malaysia. Population Table: States | OpenDOSM. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://open.dosm.gov.my\u003c/span\u003e\u003cspan address=\"https://open.dosm.gov.my\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlakemore, S. J. \u0026amp; Choudhury, S. Development of the adolescent brain: Implications for executive function and social cognition. \u003cem\u003eJournal of Child Psychology and Psychiatry and Allied Disciplines\u003c/em\u003e vol. 47 296\u0026ndash;312 Preprint at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1469-7610.2006.01611.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1469-7610.2006.01611.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2006).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSawyer, S. M., Azzopardi, P. S., Wickremarathne, D. \u0026amp; Patton, G. C. The age of adolescence. Lancet Child Adolesc Health 2, 223\u0026ndash;228 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKurniawan, E., Suharini, E. \u0026amp; Dafip, M. How far disaster management implemented toward flood preparedness: A lesson learn from youth participation assessment in Indonesia. International Journal of Safety and Security Engineering 11, 175\u0026ndash;183 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSubarno, A. \u0026amp; Dewi, A. S. A systematic review of the shape of disaster education. IOP Conf Ser Earth Environ Sci 986, (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsian Disaster Reduction Center. \u003cem\u003eSendai Framework for Disaster Risk Reduction 2015\u0026ndash;2030\u003c/em\u003e. (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNation, U. Sustainable Development Goal. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.un.org/sustainabledevelopment/\u003c/span\u003e\u003cspan address=\"https://www.un.org/sustainabledevelopment/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKitagawa, K. Conceptualising \u0026lsquo;disaster education\u0026rsquo;. Educ Sci (Basel) 11, (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShaw, R., Sakurai, A. \u0026amp; Oikawa, Y. New Realization of Disaster Risk Reduction Education in the Context of a Global Pandemic: Lessons from Japan. International Journal of Disaster Risk Science 12, 568\u0026ndash;580 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHow, V., Azmi, E. S., Abdul Rahman, H. \u0026amp; Othman, K. The Way Forward: Opportunities and Challenges of Sustainable School Disaster Education in Malaysia. International Journal of Academic Research in Business and Social Sciences 10, (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeddighi, H. \u003cem\u003eet al.\u003c/em\u003e School-Based Education Programs for Preparing Children for Natural Hazards: A Systematic Review. \u003cem\u003eDisaster Medicine and Public Health Preparedness\u003c/em\u003e 1\u0026ndash;13 Preprint at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/dmp.2020.479\u003c/span\u003e\u003cspan address=\"10.1017/dmp.2020.479\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohammad, L. R. High school students seismic risk perception and preparedness in Savar, Dhaka. Educational Research and Reviews 14, 168\u0026ndash;177 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCodreanu, T. A. A multinational study of behavioural and practical disaster preparedness of final year high-school students. (The University of Western Australia, 2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWei, B., Su, G. \u0026amp; Li, Y. Evaluating the cognition and response of middle/high school students to earthquake\u0026mdash;a case study from the 2013 Mw6.6 Lushan earthquake-hit area, China. International Journal of Disaster Risk Reduction 51, (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeleg, K., Bodas, M., Shenhar, G. \u0026amp; Adini, B. Wisdom of (using) the crowds: Enhancing disasters preparedness through public training in Light Search and Rescue. International Journal of Disaster Risk Reduction 31, 750\u0026ndash;757 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePromsri, C. Exploring Flood Disaster Preparedness Awareness Factors through Historical Flood Victims in Bangkok Metropolitan and Vicinity by Using Factor Analysis. International Journal of Academic Research in Business and Social Sciences 7, (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFitriani, D. R., Rizal, A. A. F., Milkhatun, M. \u0026amp; Astiningsih, N. W. W. Analysis of Factors Related To Adolescents Preparedness in The Disaster-Prone Areas In Lempake Village, Samarinda. STRADA Jurnal Ilmiah Kesehatan 9, 1434\u0026ndash;1444 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQi, Y. \u003cem\u003eet al.\u003c/em\u003e Flood Disaster Risk Perception and Urban Households\u0026rsquo; Flood Disaster Preparedness: The Case of Accra Metropolis in Ghana. Water (Basel) (2021) doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/w13172328\u003c/span\u003e\u003cspan address=\"10.3390/w13172328\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNg, S. L. Effects of Risk Perception on Disaster Preparedness Toward Typhoons: An Application of the Extended Theory of Planned Behavior. International Journal of Disaster Risk Science Preprint at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s13753-022-00398-2\u003c/span\u003e\u003cspan address=\"10.1007/s13753-022-00398-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMhd Noor, M. T. \u003cem\u003eet al.\u003c/em\u003e Facing flood disaster: A cluster randomized trial assessing communities\u0026rsquo; knowledge, skills and preparedness utilizing a health model intervention. PLoS One 17, e0271258 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRao, S., Doherty, F. C. \u0026amp; Teixeira, S. Are you prepared? Efficacy, contextual vulnerability, and disaster readiness. International Journal of Disaster Risk Reduction 77, 103072 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNakano, G. \u0026amp; Yamori, K. Disaster risk reduction education that enhances the proactive attitudes of learners: A bridge between knowledge and behavior. International Journal of Disaster Risk Reduction 66, 102620 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGong, R. \u0026amp; Alrehaili, N. R. Flood Preparedness in United Kingdom and China: A Comparison Study Focusing on Social and Economic Factors. International Journal of Disaster Management 5, 181\u0026ndash;192 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePopova, L. The Extended Parallel Process Model: Illuminating the Gaps in Research. Health Education and Behavior 39, 455\u0026ndash;473 (2012).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWitte, K. \u0026amp; Allen, M. A Meta-Analysis of Fear Appeals: Implications for Effective Public Health Campaigns. \u003cem\u003eHealth Education \u0026amp; Behavior\u003c/em\u003e Preprint at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/109019810002700506\u003c/span\u003e\u003cspan address=\"10.1177/109019810002700506\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2000).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHyejung Yoon, Myoungsoon You \u0026amp; Changwoo Shon. An application of the extended parallel process model to protective behaviors against COVID-19 in South Korea. PLoS One 17, (22AD).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalita, C., Tiongco, R. E. \u0026amp; Kawano, R. Assessment of school teachers\u0026rsquo; disaster preparedness using the extended parallel process model: a cross-sectional study in Angeles City, Philippines. Journal of Public Health (Germany) 29, 1275\u0026ndash;1282 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeber, M. C., Schulenberg, S. E. \u0026amp; Lair, E. C. University employees\u0026rsquo; preparedness for natural hazards and incidents of mass violence: An application of the extended parallel process model. International Journal of Disaster Risk Reduction 31, 1082\u0026ndash;1091 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao, S. \u0026amp; Wu, X. From Information Exposure to Protective Behaviors: Investigating the Underlying Mechanism in COVID-19 Outbreak Using Social Amplification Theory and Extended Parallel Process Model. Front Psychol 12, (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJabatan Perangkaan Malaysia. \u003cem\u003ePoket Stats Negeri Selangor ST3 2020\u003c/em\u003e. \u003cem\u003eJabatan Perangkaan Malaysia\u003c/em\u003e (Putrajaya, 2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDrainage and Irrigation Department (DID). \u003cem\u003eAnnual Flood Report 2020\u003c/em\u003e. Department of Irrigation and Drainage Malaysia (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDrainage and Irrigation Department (DID), M. \u003cem\u003eAnnual Flood Report 2021\u003c/em\u003e. (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLemeshow, S., Hosmer Jr, D. W., Klar, J., Lwanga, S. K. \u0026amp; WHO, W. H. O. \u003cem\u003eAdequacy of Sample Size in Health Studies\u003c/em\u003e. (1990).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHemming, K., Girling, A. J., Sitch, A. J., Marsh, J. \u0026amp; Lilford, R. J. Sample size calculations for cluster randomised controlled trials with a fixed number of clusters. BMC Med Res Methodol 11, (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRita C. Richey \u0026amp; James D.Klein. \u003cem\u003eDesign and Development Research\u003c/em\u003e. (Lawrence Erlbaum Associates, Inc., Publishers, New Jersey, United States of America, 2007).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRohith, V. R., Kolathayar, S., Priyatham, K., Karan Kumar, V. \u0026amp; Nikil, S. Disaster Preparedness Index: A Valid and Reliable Tool to Comprehend Disaster Preparedness in India. in \u003cem\u003eUrbanization Challenges in Emerging Economies: Resilience and Sustainability of Infrastructure - Selected Papers from the ASCE India Conference 2017\u003c/em\u003e 156\u0026ndash;163 (American Society of Civil Engineers (ASCE), 2018). doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1061/9780784482032.017\u003c/span\u003e\u003cspan address=\"10.1061/9780784482032.017\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYusoff, M. S. B. ABC of Content Validation and Content Validity Index Calculation. Education in Medicine Journal 11, 49\u0026ndash;54 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAzmi, E. S., How, V. \u0026amp; Rahman, H. A. Effect of health belief model on flood-risk educational approach among elementary school children in Malaysia. Jamba: Journal of Disaster Risk Studies 13, 1\u0026ndash;6 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003edon, N. F. S., don, H. S. S., Alias, R. A. \u0026amp; Nakanishi, H. Flood Preparedness Module for Malaysian Higher Education Students via Metaverse Environment. IOP Conf Ser Earth Environ Sci (2023) doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1088/1755-1315/1144/1/012011\u003c/span\u003e\u003cspan address=\"10.1088/1755-1315/1144/1/012011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChong, K. L., Nifa, F. A. A., Abbas, S. R. \u0026amp; Zahir, N. M. Disaster education using board games technique: A case of SK Felda Bukit Tangga. in \u003cem\u003eAmerican Institute of Physics Conference Series\u003c/em\u003e vol. 2644 30017 (AIP, 2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmri, I. \u003cem\u003eet al.\u003c/em\u003e Effectiveness of an educational intervention for disaster preparedness for elementary school students in Central Sulawesi. Enferm Clin 31, S779\u0026ndash;S782 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiswi, D., Setioputro, B. \u0026amp; Wantiyah. The Effectiveness of Audiovisual Media Health Education on Flood Disaster Preparedness in Elementary School Children. Jurnal Kegawatdaruratan Medis Indonesia 2, 26\u0026ndash;42 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoradian, M. J. \u0026amp; Mehraein Nazdik, Z. Game versus Lecture-Based Learning in Disaster Risk Education; An Experience on Shiraz High School Students. Bull Emerg Trauma 7, 112\u0026ndash;117 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShah, A. A. \u003cem\u003eet al.\u003c/em\u003e Schools\u0026rsquo; Flood Emergency Preparedness in Khyber Pakhtunkhwa Province, Pakistan. International Journal of Disaster Risk Science (2018) doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s13753-018-0175-8\u003c/span\u003e\u003cspan address=\"10.1007/s13753-018-0175-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThi, T. \u0026amp; Shaw, R. School-based disaster risk reduction education in primary schools in Da Nang City, Central Vietnam. Environmental Hazards 15, 356\u0026ndash;373 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNakano, G., Suwa, S., Gautama, A. \u0026amp; Yamori, K. Long-term evaluation of proactive attitudes toward disaster education in Nepal. International Journal of Disaster Risk Reduction 50, (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRismayani, Paliling, A., Nurhidayani, A. \u0026amp; Pineng, M. Fundamental Design of Flood Management Educational Games Using Virtual Reality Technology. International journal of online and biomedical engineering 18, 19\u0026ndash;32 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHow, V., Azmi, E. S. B., Mohd Zaki, N. F. B. \u0026amp; Othman, K. Bin. Integrating Flood Education Miniature and Interactive E-Learning in a Prototype of Flood Learning Kit for Knowledge Resilience Among School Children. in 355\u0026ndash;368 (Springer Singapore, 2020). doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/978-981-32-9527-8_20\u003c/span\u003e\u003cspan address=\"10.1007/978-981-32-9527-8_20\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOktari, R. S. \u0026amp; Kumala, I. D. Improving Student Internalization of Disaster Knowledge by Participating in Learning Package Development. Jurnal Pengabdian kepada Masyarakat (Indonesian Journal of Community Engagement) 6, (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePickering, C. J. \u003cem\u003eet al.\u003c/em\u003e The Promotion of \u0026lsquo;Grab Bags\u0026rsquo; as a Disaster Risk Reduction Strategy. PLoS Curr (2018) doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/currents.dis.223ac4322834aa0bb0d6824ee424e7f8\u003c/span\u003e\u003cspan address=\"10.1371/currents.dis.223ac4322834aa0bb0d6824ee424e7f8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede Milliano, C. W. J. Luctor et emergo, exploring contextual variance in factors that enable adolescent resilience to flooding. International Journal of Disaster Risk Reduction 14, 168\u0026ndash;178 (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRonan, K. R., Johnston, D. M. \u0026amp; Daly, M. School Children\u0026rsquo;s Risk Perceptions and Preparedness: A Hazards Education Survey The Australasian Journal of Disaster and Trauma Studies School Children\u0026rsquo;s Risk Perceptions and Preparedness: A Hazards Education Survey. The Australian Journal of Disaster and Trauma Studies (2005).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiddique Akbar, M. A Phenomenological Study Of Lived Experiences Of 2022 Flood Survivors In Rajan Pur District-South Punjab-Pakistan. Pakistan Journal of Social Research vol. 4 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003c/span\u003e\u003cspan address=\"http://www.pjsr.com.pk\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDewi, R. P. \u003cem\u003eet al.\u003c/em\u003e Improving natural disater understanding of junior high school students. IOP Conf Ser Earth Environ Sci 986, 012010 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang, Z., Han, Z. \u0026amp; Li, Y. The Interplay between School Preparedness and Student\u0026rsquo;s Individual Protective Actions: The Mediating Role of Disaster Education. Sustainability 15, 14888 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMasini, A. \u003cem\u003eet al.\u003c/em\u003e Evaluation of school-based interventions of active breaks in primary schools: A systematic review and meta-analysis. J Sci Med Sport 23, 377\u0026ndash;384 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIsmail, N. \u003cem\u003eet al.\u003c/em\u003e Malaysian Experiences: Public-Private Partnership Involvement in Disaster Risk Reduction in Community Resilience in Malaysia. AIP Conf Proc 105, 169\u0026ndash;173 (2018).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Extended Parallel Pathway Model (EPPM), Flood disaster preparedness, disaster preparedness, disaster education, adolescent","lastPublishedDoi":"10.21203/rs.3.rs-4766357/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4766357/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eFlood disasters are prevalent and severely impact humans and the environment, with adolescents being particularly vulnerable. This study evaluated the \"Get-Ready DEM,\" a tailored disaster educational module based on the Extended Parallel Pathway Model (EPPM), to enhance flood disaster preparedness among adolescents in Selangor, Malaysia. A two-arm, single-blinded, cluster-randomised controlled trial involved 287 adolescents from eight secondary schools, divided into intervention (140 participants) and control (147 participants) groups. The intervention group received the \"Get-Ready DEM\" once after the baseline assessment, while the control group was on the waitlist. Preparedness was measured using the Flood Disaster Preparedness Index (FDPI) scores at baseline, immediate post-intervention, and three months post-intervention. Data were analysed using a generalised estimation equation. Results showed a significant increase in FDPI scores for the intervention group immediately post-intervention (β\u0026thinsp;=\u0026thinsp;2.15; 95% CI\u0026thinsp;=\u0026thinsp;1.64, 2.65; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and at the three-month follow-up (β\u0026thinsp;=\u0026thinsp;1.53; 95% CI\u0026thinsp;=\u0026thinsp;0.96, 2.10; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to the control group. These findings underscore the EPPM framework's efficacy in designing effective flood disaster education. Implementing modules like \"Get-Ready DEM\" can significantly enhance adolescents' resilience and preparedness, suggesting a promising approach for disaster preparedness programs.\u003c/p\u003e \u003cp\u003e This study was registered under Thai Clinical Trial Registry TCTR20240426001 on 26th April 2024 and obtained ethical approval by the Ethics Committee of Human Research University Putra Malaysia (JKEUPM-2022-858) and the Ministry of Education, Malaysia (KPM.600-3/2/3-eras (15189).\u003c/p\u003e","manuscriptTitle":"Theory-Based Flood Disaster Education Enhances Disaster Preparedness Among Adolescents in Selangor, Malaysia: A Cluster Randomized Controlled Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-26 06:01:53","doi":"10.21203/rs.3.rs-4766357/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-12T05:36:31+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-10T11:05:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"86842390450287461184854162818969744967","date":"2024-08-27T09:29:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-19T19:57:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"43333846110991783690346071314271433611","date":"2024-08-14T00:31:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-12T16:14:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-12T16:09:36+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-07-30T11:06:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-30T10:24:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-07-19T05:39:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"23c73b62-0b0c-46be-8833-c48f2fb47913","owner":[],"postedDate":"August 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":36469642,"name":"Earth and environmental sciences/Environmental social sciences"},{"id":36469643,"name":"Earth and environmental sciences/Natural hazards"}],"tags":[],"updatedAt":"2026-06-22T16:08:50+00:00","versionOfRecord":{"articleIdentity":"rs-4766357","link":"https://doi.org/10.1038/s41598-026-56110-7","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2026-06-16 16:01:48","publishedOnDateReadable":"June 16th, 2026"},"versionCreatedAt":"2024-08-26 06:01:53","video":"","vorDoi":"10.1038/s41598-026-56110-7","vorDoiUrl":"https://doi.org/10.1038/s41598-026-56110-7","workflowStages":[]},"version":"v1","identity":"rs-4766357","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4766357","identity":"rs-4766357","version":["v1"]},"buildId":"-HB7Z8yhvgn0wM9Nzuekk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}