Addressing non-communicable disease management during disasters in the US Virgin Islands: A mixed methods study

Michelle Teresa Wiciak¹Stephen Perez²Tess Richards³Karla Escobar^1,2Dabney Evans²Marcella Nunez-Smith⁴Saria Hassan^1,2*

• ¹School of Medicine, Emory University, Atlanta, Georgia, United States
• ²Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
• ³St Thomas East End Medical Center Corporation, St Thomas, US Virgin Islands
• ⁴School of Medicine, Yale University, New Haven, Connecticut, United States

Introduction: Extreme weather events, like hurricanes Irma and Maria, have disproportionately impacted individuals with non-communicable diseases (NCDs) in the U.S. Virgin Islands (USVI), exacerbating health disparities due to healthcare disruptions. The USVI and other Caribbean islands face increased morbidity and mortality from NCDs from rising risk factors and lack of improving in quality of care. This study explores the experiences of individuals with NCDs during these hurricanes to identify strategies for improving disaster preparedness and response.Methods: A mixed-methods cross-sectional study was conducted at a Federally Qualified Health Center (FQHC) in St. Thomas, USVI. One-hundred and thirteen quantitative surveys assessed preparedness, healthcare access, and mental health impacts. Fifteen semi-structured qualitative interviews provided deeper insights into patient experiences and coping strategies. Data integration followed a narrative approach.Results: Quantitative findings revealed nearly one third of participants struggled to manage their NCDs post-disaster, citing stress-related exacerbation of conditions (42.3%), lack of medication access (34.6%), and disrupted healthcare services (34.6%). Mental health burdens were significant, with nearly a third reporting anxiety (28%) and depression (27.8%), and 5.2% meeting PTSD criteria. Many participants (39.7%) had not received disaster preparedness information tailored to NCDs, with only 47.5% receiving guidance from healthcare providers. Qualitative interviews underscored these findings, highlighting that NCD management was deprioritized post-disaster due to immediate survival needs. Participants emphasized the role of family and community support in coping, yet also noted mental health stigma and limited healthcare access as ongoing barriers. Preferred communication strategies included social media, radio, and trusted sources.Conclusions: Findings reveal critical gaps in disaster preparedness for persons with NCDs in the USVI. Strengthening healthcare infrastructure, enhancing mental health support, and providing targeted education can improve resilience and reduce morbidity in future disasters.