ABSTRACT
Following the Fukushima Daiichi Nuclear Power Plant accident, Japan enhanced its nuclear disaster preparedness framework. However, personnel shortages stemming from fear and anxiety persist as a critical issue during such disasters. This study investigated the willingness of medical professionals at four university hospitals in Kyushu to participate in nuclear disaster response activities and explored factors influencing this willingness. A cross-sectional web-based survey was conducted among staff at Nagasaki, Kyushu, Saga and Kagoshima University Hospitals. Participants answered 19 questions assessing their willingness to participate in nuclear or radiological emergency response and associated psychosocial and occupational factors. Multiple regression analysis was used to identify predictors of willingness (Q1). A total of 378 valid responses were analyzed. Demographic variables, including age, sex, occupation and disaster experience, did not significantly influence willingness. However, interest in nuclear or radiological emergencies (β =0.383, P < 0.05), Incentives (β =0.249), Family understanding (β =0.116) and Occupational norms (β =0.114) were positively associated with willingness. Conversely, Anxiety (β = −0.151), Expectation of routine training (β = −0.138) and Perceived frequency of nuclear disasters (β = −0.104) were negatively associated with willingness. Medical staff’s willingness to respond to nuclear or radiological emergencies is influenced more by psychological and occupational perceptions than by demographic factors. Interventions such as incentive programs, family support initiatives, targeted training and anxiety-reduction strategies may enhance preparedness for and participation in future nuclear or radiological emergencies.
Keywords: nuclear disaster activities, radiological/nuclear, university hospital, willingness
INTRODUCTION
Natural and biological disasters have posed significant challenges throughout human history [1, 2]. The advent of modern technology has increased calamities and introduced new types of disasters, including chemical, radiological, nuclear and explosive events. One of the unexpected catastrophic nuclear disaster, occurred in 2011, at the Fukushima Daiichi Nuclear Power Plant, triggered by a devastating earthquake and tsunami [3]. Moreover, after the nuclear disaster in Fukushima, many hospitals experienced personnel shortages due to fear of radiation and safety concerns. A study conducted in the Soso district (Fukushima prefecture) revealed that personnel shortages peaked within 1 month after the disaster, with only 47% of staff reporting to work [4]. Similar staffing challenges occurred in Minami-soma City (Fukushima prefecture), where many nurses left their positions due to concerns about their families’ safety, particularly those with young children [5]. Willingness to engage in disaster response activities is also essential for maintaining effective emergency operations and preserving public trust in the healthcare system.
Following the Fukushima accident, the Japanese government reassessed its emergency medical response system for nuclear disasters. Japan restructured its nuclear emergency response framework through amendments to the Atomic Energy Basic Act [6]. These bodies were tasked with defining the roles of the newly formed Nuclear Regulation Authority (NRA), the Ministry of the Environment and local governments, delineating responsibilities for on-site safety and off-site crisis management [7]. All prefectures hosting nuclear power plants updated their disaster prevention plans in accordance with the NRA’s Nuclear Emergency Response Guidelines during the first half of 2013. These plans included evacuation zones, patient triage protocols and iodine prophylaxis procedures [8]. Since April 2019, the National Institute of Radiological Sciences (NIRS–QST) has served as the Core Advanced Radiation Emergency Medical Support Center, responsible for coordinating other Advanced Radiation Emergency Medical Support Centers and leading nationwide drills and the development of dose-assessment protocols and equipment stockpiling [9].
Despite these systemic reforms, operational challenges persist. During disasters, hospitals can become overwhelmed by the influx of patients, exceeding their capacity. Therefore, the willingness of medical professionals to participate is crucial for preventing personnel shortages when managing increased patient volumes. Staff willingness to engage in disaster response represents an essential factor for successful crisis management. Previous research indicates that demographic characteristics like age, sex and occupation influence commitment levels. Young, male professionals with higher education levels tend to show greater motivation for disaster response [10]. Conversely, another study found that physicians demonstrated higher willingness to engage than nurses [11]. Additionally, physicians who receive advanced disaster response training and demonstrate personal readiness for specific disasters show increased willingness to respond [12]. Experience is another contributing factor, particularly individuals with previous disaster experience are more willing to participate in future disaster activities [13]. Beyond demographic and experiential factors, some studies have highlighted the role of personal risk perception in determining participation willingness. Higher risk perception and awareness correlate with greater willingness to participate in rescue operations [14].
Given Japan’s new nuclear disaster medical system, it is important to assess the current willingness of medical professionals who may be involved in such situations to ensure adequate future preparedness. However, no survey has been conducted among medical personnel at Core Nuclear Emergency Hospitals. Therefore, this study surveyed staff at four university hospitals in the Kyushu region that are expected to take leadership roles in responding to nuclear disasters. Within Japan’s new nuclear disaster medical system, ascertaining the current willingness of potentially involved medical professionals is crucial for future disaster preparedness.
MATERIALS AND METHODS
An anonymous web-based survey was conducted from July to August 2024 among four university hospitals in the Kyushu region that respond to nuclear disasters: Nagasaki University Hospital (2571 staff), Kyushu University Hospital (3183 staff), Saga University Hospital (1647 staff) and Kagoshima University Hospital (1976 staff). The locations of the four university hospitals and two nuclear power plants are shown in Fig. 1. A participation request and quick response code for accessing the online questionnaire were distributed via email to all staff members at each facility. Informed consent was obtained from the directors of each hospital in writing and from the participants through a web-based survey, and all participant data were included in the analysis.
Fig. 1.
Map of Kyushu showing the facilities included in this survey. Free stock image was used on the map of the Kyushu region. (http://www.craftmap.box-i.net)
To gain deeper understanding of the willingness to participate in nuclear disaster activities, an anonymous online questionnaire survey, including 19 questions (Table 1), was distributed to personnel at four university hospitals. The questionnaire was adapted from a previously validated survey developed by Iyama et al. [15], which assessed willingness and preparedness to engage in disaster response activities, including nuclear or radiological emergencies. Minor modifications were made to tailor the items to the specific target population and study objectives. In addition to the main items, information on respondents’ age, sex, family status, occupation and experience in natural and chemical, biological, radiological, nuclear and explosive (CBRNE) disaster activities was collected. To evaluate the level of willingness to participate in nuclear or radiological emergency response activities, the following question was asked: ‘Q1: Would you willingly actively engage in response activities during nuclear or radiological emergencies?’ The respondents were asked to rate their level of agreement with the question on a scale of 0–10, representing their willingness to participate in disaster response, where 0 indicates strongly disagree and 10 strongly agree. Respondents were required to answer the remaining 18 questions in Table 1 in a similar manner.
Table 1.
Summary of questionnaire responses assessing the willingness to engage in nuclear or radiological emergency responses (Median, IQR)
| Questions | Median (IQR) |
|---|---|
| Q1. Would you willingly actively engage in response activities during nuclear or radiological emergency? | 4 (0–5) |
| Q2. How much interest do you have in nuclear or radiological emergencies? | 5 (3–6) |
| Q3. Do you think that your occupation should actively respond to a nuclear or radiological emergency? | 5 (2–7) |
| Q4. How many opportunities do you have to learn about nuclear or radiological emergencies in your environment? | 5 (0–5) |
| Q5. Are you anxious about the activities in a nuclear or radiological emergency situation? | 8 (5–10) |
| Q6. Do you have self-confidence in nuclear or radiological emergency response activities? | 0 (0–3) |
| Q7. How much do you think your family will understand about your activity during a nuclear or radiological emergency? | 3 (0–5) |
| Q8. Will you engage in nuclear or radiological emergency response activities if there are incentives, such as insurance and special salaries? | 5 (0–5) |
| Q9. Do you think that education and training are indispensable for nuclear or radiological emergency response activities? | 8 (5–10) |
| Q10. If your colleagues are preparing for nuclear or radiological emergencies (e.g. education or training), do you think you should take action as well? | 5 (1–7) |
| Q11. Would you willingly actively participate in seminars on nuclear or radiological emergencies? | 5 (3–7) |
| Q12. Does your workplace offer seminars on nuclear or radiological emergency response? | 5 (0–5) |
| Q13. At your own workplace, is it easy to obtain information about seminars for nuclear or radiological emergency response? | 5 (0–5) |
| Q14. How often do you think a nuclear or radiological emergency will occur in your area? | 5 (0–5) |
| Q15. Would you willingly actively work on nuclear or radiological emergency countermeasures? | 5 (1–5) |
| Q16. If your family is safe, can you be exposed to nuclear or radiological emergencies during a disaster response? | 0 (0–5) |
| Q17. Do you feel sorry for your family if you are exposed to nuclear or radiological emergencies? | 8 (5–10) |
| Q18. Do you think that your own occupation should be routinely educated and trained on nuclear or radiological emergencies to meet the expectations of citizens? | 5 (3–7) |
| Q19. How much do you think it is important to prepare for a nuclear or radiological emergency (e.g. education or training)? | 6 (5–10) |
The respondents were asked to rate their level of agreement with the questions on a scale of 0–10, where 0 indicates strongly disagree and 10 strongly agree.
To identify independent predictors of willingness to engage in nuclear or radiological emergency response activities, multiple regression analysis was performed. The dependent variable was the willingness score (Q1), and the independent variables included age, sex, occupation, experience with natural disasters, experience with CBRNE disasters, presence of family members and responses to Q2–19. Multicollinearity among independent variables was assessed using the variance inflation factor (VIF) to ensure the validity of the model. VIF values above 10 indicated serious multicollinearity, whereas values below 5 were acceptable, confirming that multicollinearity did not compromise the model. The details of regression equation are provided in the Supplementary document. The full questionnaire was originally administered in Japanese, as shown in Supplementary Table 1. JMP pro 18.1.0 (SAS Institute Inc.; Cary, North Carolina USA) was used for all statistical analyses, and a significance level of 0.05 was adopted.
RESULTS
A total of 378 responses were collected from staff members across four university hospitals. With a combined staff population of 9377, this represents an overall response rate of 4.0%. Table 2 presents the sociodemographic characteristics of the participants. Most respondents (n: 322, 85%) were from Nagasaki University Hospital, followed by 45 (12%) from Kagoshima University Hospital. Kyushu University Hospital and Saga University Hospital contributed 9 (2%) and 2 (1%) participants, respectively. Most participants were in their 40s (33%), followed by those in their 30s (26%) and 50s (21%), with 12% in their 20s and 7% >60 years old. Of the participants, 36% were men and 64% were women. Overall, 65% of participants reported living with their families, whereas 35% reported living without family members. Only 8% of respondents had experienced a natural disaster, and 1% had experienced a CBRNE incident, indicating that disaster experience was relatively rare. The population was further divided into four occupation groups: physicians (21%), nurses (35%), other medical staff (26%) and administrative staff (18%).
Table 2.
Participants’ sociodemographic characteristics
| n = 378 | Percentage (%) | ||
|---|---|---|---|
| Institutions | Nagasaki University Hospital Kagoshima University Hospital Kyushu University Hospital Saga University Hospital |
322 45 9 2 |
85 12 2 1 |
| Age | 20s | 46 | 12 |
| 30s | 99 | 26 | |
| 40s | 126 | 33 | |
| 50s | 80 | 21 | |
| over 60 | 27 | 7 | |
| Sex | male | 136 | 36 |
| female | 242 | 64 | |
| Family | with family | 244 | 65 |
| without family | 134 | 35 | |
| Experience in natural disasters | yes | 31 | 8 |
| no | 347 | 92 | |
| Experience in CBRNE disasters | yes | 2 | 1 |
| no | 376 | 99 | |
| Occupation | physician | 79 | 21 |
| nurse | 131 | 35 | |
| other medical staff | 100 | 26 | |
| nonmedical staff | 68 | 18 |
Table 1 illustrates that participants have a moderate level of interest in radiation/nuclear hazard response (median 5, IQR 3–6) and strongly agreed that education and training were necessary to prepare for such events (median 8, IQR 5–10). They reported virtually no confidence in their ability to respond effectively during an actual incident (median 0, IQR 0–3) and experienced high anxiety regarding participating in response activities (median 8, IQR 5–10). Perceptions of workplace support, including seminar availability and practical learning opportunities, yielded a median score of 5, with responses varying widely from nonexistent to substantial support (IQR 0–5).
Table 3 represents the results of the multiple regression analysis that was conducted to determine the readiness of medical professionals working in four university hospitals to perform specific duties during a nuclear disaster. All VIF values were <5, indicating that the regression coefficient estimates are stable and reliable. The data reflect standardized beta coefficients from regression analyses of nuclear disasters. The standardized beta test results for nuclear disasters reveal several key factors influencing respondents’ attitudes and intentions regarding disaster response activities. The multivariate linear regression model predicting readiness for nuclear disaster response produced an overall R-squared of 0.64 and an adjusted R-squared of 0.61.
Table 3.
Standardized beta coefficients from regression analyses among nuclear disaster response
| Questions | Standardized β | VIF |
|---|---|---|
| RSquare | 0.64 | |
| RSquare Adj | 0.61 | |
| Age vs over 60 | ||
| Age[20s] | 0.01 | 1.62 |
| Age[30s] | 0.01 | 1.21 |
| Age[40s] | −0.03 | 1.18 |
| Age[50s] | 0.01 | 1.26 |
| Sex[female] | −0.03 | 1.56 |
| Occupation vs. physician | ||
| nurse | 0.06 | 2.25 |
| other medical staff | 0.08 | 2.05 |
| nonmedical staff | −0.13 | 1.94 |
| Experience in natural disasters [no] | −0.06 | 1.16 |
| Experience in CBRNE disasters [no] | 0.00 | 1.08 |
| Family [Without family] | 0.05 | 1.47 |
| Q2. How much interest do you have in nuclear or radiological emergencies? | 0.40 | 2.22 |
| Q3. Do you think that your occupation should actively respond to a nuclear or radiological emergency? | 0.09 | 2.60 |
| Q4. How many opportunities do you have to learn about nuclear or radiological emergencies in your environment? | −0.01 | 3.11 |
| Q5. Are you anxious about the activities in a nuclear or radiological emergency situation? | −0.17 | 2.56 |
| Q6. Do you have self-confidence in nuclear or radiological emergency response activities? | 0.03 | 2.19 |
| Q7. How much do you think your family will understand about your activity during a nuclear or radiological emergency? | 0.10 | 2.02 |
| Q8. Will you engage in nuclear or radiological emergency response activities if there are incentives, such as insurance and special salaries? | 0.26 | 2.37 |
| Q9. Do you think that education and training are indispensable for nuclear or radiological emergency response activities? | −0.07 | 3.41 |
| Q10. If your colleagues are preparing for nuclear or radiological emergencies (e.g. education or training), do you think you should take action as well? | 0.10 | 2.88 |
| Q11. Would you willingly actively participate in seminars on nuclear or radiological emergencies? | 0.06 | 4.04 |
| Q12. Does your workplace offer seminars on nuclear or radiological emergency response? | 0.03 | 3.25 |
| Q13. At your own workplace, is it easy to obtain information about seminars for nuclear or radiological emergency response? | 0.08 | 3.98 |
| Q14. How often do you think a nuclear or radiological emergency will occur in your area? | −0.11 | 1.61 |
| Q15. Would you willingly actively work on nuclear or radiological emergency countermeasures? | 0.04 | 3.50 |
| Q16. If your family is safe, can you be exposed to nuclear or radiological emergencies during a disaster response? | 0.08 | 1.43 |
| Q17. Do you feel sorry for your family if you are exposed to nuclear or radiological emergencies? | −0.03 | 3.01 |
| Q18. Do you think that your own occupation should be routinely educated and trained on nuclear or radiological emergencies to meet the expectations of citizens? | −0.14 | 3.80 |
| Q19. How much do you think it is important to prepare for a nuclear or radiological emergency (e.g. education or training)? | 0.01 | 3.49 |
Bold, italic and underlined values indicate statistical significance (P < 0.05).
VIF = variance inflation factor
The effects of age, sex, prior disaster response experience and family status were not statistically significant for willingness to participate. Conversely, occupation was a significant factor, with nonmedical staff showing a negative association with willingness to engage in nuclear disaster response activities (β = −0.13, P < 0.05). In terms of the content of the questions, Q2, 5, 7, 8, 14, 16 and 18 had a significant impact on the willingness. Figure Fig. 2 shows a heatmap of Pearson correlation coefficients among the variables, visually summarizing the key associations in the data. Interest in nuclear disasters was the largest positive predictor (Q2; β = +0.40, P < 0.05), followed by the willingness to engage if incentives are provided (Q8; β = +0.26, P < 0.05) and expected Family understanding (Q7; β = +0.10, P < 0.05). Other positive associations included the belief that exposure to radiation during disaster response activities was acceptable provided one’s family remained safe (Q16; β = +0.08, P < 0.05). Some variables had negative standardized associations: The anxiety about response activities had the strongest negative effect (Q5; β = −0.17, P < 0.05), followed by the question that their occupation should be routinely educated and trained (Q18; β = −0.14, P < 0.05), the Perceived frequency of nuclear disasters in their own area (Q14; β = −0.11, P < 0.05).
Fig. 2.
Grayscale heatmap of Pearson correlations among nine variables. Positive and negative associations are indicated by lighter and darker shades, respectively, with numerical values shown in each cell. Nonmedical staff were coded as 1.
DISCUSSION
Nuclear disasters and emergency preparedness are always in the spotlight of the Japanese government on account of its tragic history and the extensive reliance on nuclear power. After the nuclear disaster at the Fukushima Daiichi Nuclear Power Plant, Japan further strengthened its nuclear emergency medical system to avoid the shortage of personnel during radiation hazards. Currently, several special Nuclear Emergency Core Hospitals (NECHs) function in Japan, located in cities with atomic energy facilities. Their main functions include preparedness for and engagement in nuclear disasters as well as the detection, decontamination, diagnosis and treatment of radiation-related disorders. Nevertheless, emergency readiness is usually higher during the disaster and then gradually decreases. Despite all the revised nuclear disaster preparedness policies and medical training programs, a 2018 survey found that only 31% of the 36 NECHs in Japan expected a future nuclear disaster [16]. Against this backdrop of fluctuating institutional preparedness, our own analysis identified eight key factors that significantly influence medical staff’s willingness to engage in nuclear disaster activities:
• Positive factors: Interest (Q2), Incentive (Q8), Family understanding (Q7) and Family safety (Q16).
• Negative factors: Non-medical staff, Anxiety (Q5), Routine education (Q18) and Perceived frequency of disaster occurrence (Q14).
Positive factors
Interest (Q2) was the strongest positive predictor. Individuals with greater interest in nuclear or radiological emergencies were more willing to participate, consistent with prior research. Barnett et al. [17] reported that workers who combined awareness of threats with confidence were more likely to respond. Yamada et al. [18] found that 35.3% of nurses in nuclear disaster hospitals expressed interest in nuclear or radiological emergency medicine training, and these nurses demonstrated higher willingness to participate. Similarly, technologists in Fukushima core hospitals showed enthusiasm despite limited formal training [19]. These findings highlight personal interest as a critical motivator.
Incentives (Q8) emerged as the second most significant positive factor. Financial incentives, such as hazard pay, insurance and bonuses, as well as non-financial incentives, such as recognition, days off and logistical support, improve willingness to participate. Liong et al. [20] emphasized that financial benefits not only provide security for first responders’ families but also serve as a tangible sign of organizational appreciation. Non-monetary incentives, including childcare and transportation assistance, further reduce participation barriers. Our findings confirm that incentives, whether financial or non-financial, play a crucial role in encouraging participation.
Family understanding (Q7) was another key determinant. Staff who felt supported by their families reported a greater willingness to respond. Furthermore, family safety (Q16)—the belief that exposure to radiation during disaster response activities is acceptable as long as one’s family remains safe—also positively influenced willingness to respond. Family-related concerns are consistently identified as barriers across multiple contexts. For example, Khan et al. [21] found that more than half of Pakistani healthcare professionals would not respond to a disaster due to concerns for their families’ safety. Similarly, Shubayr reported that family communication issues prevented Saudi nurses from responding to nuclear or radiological emergencies [22]. These findings suggest that hospitals should engage families in preparedness through educational sessions, liaison programs and practical support (e.g. childcare and eldercare). Addressing family needs directly can reduce a significant barrier to participation.
Negative factors
In this study, non-medical staff, who typically perform administrative roles at hospitals, demonstrate low willingness to participate in nuclear or radiological emergency response. The results are similar to those of previous reports. Compared with physicians and emergency medical technicians, non-medical staff such as administrative and support personnel demonstrated lower willingness to respond to catastrophic disasters, with only about half of non-medical local government employees reporting that they would definitely report for duty during a disaster [23, 24]. Compared with ‘core clinical staff’ such as physicians and nurses, nonmedical personnel—even those with Disaster Medical Assistance Team (DMAT) certification—may feel less obligated to report for duty and be more influenced by factors such as personal or family anxieties and household responsibilities. To strengthen their commitment, it is essential to clearly communicate the importance and necessity of their roles, including those of nonmedical staff, and to broadly promote this understanding.
Anxiety (Q5) emerged as the strongest negative factor, with numerous studies indicating that it significantly reduces willingness to participate in disaster response [25, 26]. This effect is particularly pronounced in nuclear disasters, where the invisible and persistent nature of radiation fosters ongoing fear and health anxieties. Even when radiation levels are deemed safe, the perception of an unseen threat can lead to chronic psychological distress. Fear, particularly when coupled with uncertainty and low self-confidence, is a strong predictor of unwillingness to respond [27]. This aligns with Witte’s Extended Parallel Process Model, which posits that individuals who perceive a high threat but have low self-efficacy tend to engage in avoidance behaviors [28]. Our findings corroborate this framework, demonstrating that elevated anxiety significantly undermines willingness to act. Previous research suggests that targeted training, clear protocols and robust mental health support can effectively mitigate these fears [29]. Therefore, it is crucial to reduce anxiety through education, regular drills, precise risk communication and accessible psychological support. Administrators should build confidence by providing transparent information, hands-on protective training and stress management resources. Ultimately, fostering self-efficacy and a sense of security is essential for preparedness in radiological emergencies.
Unexpectedly, routine training (Q18) was negatively correlated with willingness to respond. Although previous studies have suggested that training boosts confidence [28], our findings indicate that staff who perceived training as a routine obligation were less willing to respond. Iyama et al. [15] reported similar findings among DMAT members, where mandatory training reduced willingness to respond. Another study on DMAT revealed that individuals with pre-established ‘acceptable personal limits of radiation exposure’ demonstrated greater commitment to participation in a nuclear disaster response [30]. This may be because individuals with low baseline motivation perceive routine training as an unwelcome burden rather than as a form of preparation. Given that 99% of our participants reported no prior experience with nuclear or radiological emergencies, reluctance may also reflect low personal confidence. Training programs should therefore be designed to be engaging, relevant and supportive. Interactive methods, such as simulation and virtual reality, have been shown to boost confidence in responding to nuclear disasters [31, 32]. Tailoring training by occupation, age and gender may also improve acceptance. Further qualitative studies are needed to explore staff perceptions of training and ways to align programs with their needs.
The Perceived frequency of disasters (Q14) was another negative indicator. Surprisingly, staff members who believed their region had a high probability of a nuclear disaster were less willing to respond. Given that 85% of respondents were from Nagasaki University, which is not located near a nuclear power plant, it is plausible that individuals who perceived their area as safe were more willing to assist in neighboring prefectures such as Saga or Kagoshima, where nuclear facilities are located. Conversely, those with limited understanding of nuclear disaster or who were unwilling to participate in relief efforts may have perceived a more immediate local threat. Alternatively, individuals who perceive a personal risk may have experienced heightened anxiety and prioritized self-preservation, whereas those in lower-risk areas might have been more inclined to support affected regions. This finding underscores the need to differentiate between local responders, who may themselves be victims, and external responders from unaffected areas. Future research should explore how risk perception interacts with role expectations in disaster response.
Subanalysis
Because Nagasaki University Hospital accounted for 85% of respondents, a subanalysis was performed using only Nagasaki data. Results revealed two key differences from the overall analysis: occupational norms (Q3) showed a significant positive correlation, whereas family safety (Q16) was no longer significant (Supplementary Table 2). Nagasaki University is designated as the only Advanced Radiation Emergency Medical Support Center in Kyushu, which may contribute to stronger professional norms among its staff [33]. Conversely, its geographical distance from nuclear power plants (Fig. 1) places it in an area where families are largely unaffected, likely explaining why family safety (Q16) ceased to be a significant factor.
CONCLUDING REMARKS
This study has several limitations. The cross-sectional design of this study means that all identified relationships are correlational; therefore, causality cannot be inferred, and we cannot demonstrate that modifying a predictor will necessarily alter willingness. The sample was drawn from NECHs in a single region (Kyushu), and the response rate was only 4.0%, which may limit the generalizability of the findings to other healthcare systems or cultural contexts. A previous report indicated that even with thorough and appropriate procedures, online surveys targeting physicians achieved only an 8.7% response rate [34]. Consequently, a lower response rate is expected for surveys targeting all university hospital staff, representing a future challenge. Response rates were particularly low at two facilities: Kyushu University Hospital and Saga University Hospital. A subanalysis excluding these two facilities was conducted; however, no significant differences were observed. Supplementary Table 3 presents the details of the multiple regression analysis excluding these facilities. Respondents reported limited direct experience with actual nuclear or radiological emergencies; consequently, their stated willingness may differ from their actual behavior in high-stakes, real-world scenarios. The findings may be subject to social desirability bias or selection bias, given the low response rate, as individuals with a pre-existing interest in disaster preparedness might have been more inclined to participate in the survey.
Our findings demonstrate that willingness to respond to nuclear disasters is shaped by a complex interplay of motivating and inhibiting factors. Strengthening personal interest, family support, incentives and professional duty while addressing anxiety and training perceptions is essential. Hospitals should: (i) foster personal interest by offering engaging and relevant training opportunities; (ii) provide adequate financial and non-financial incentives, including recognition and logistical support; (iii) engage families in preparedness programs and ensure their safety and welfare; (iv) reduce anxiety through clear communication, psychological support and confidence-building drills; and (v) reframe training as purposeful and empowering, avoiding the perception of unnecessary obligation.
By implementing these strategies, NECHs can enhance staff preparedness and build a resilient response system for future radiological and nuclear disasters.
Supplementary Material
ACKNOWLEDGEMENTS
We are extremely grateful to the members who responded to this web questionnaire survey belonging to four university hospitals.
Contributor Information
Arkhat Omarbek, Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
Keita Iyama, Acute and Critical Care Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Takanobu Otaguro, Acute and Critical Care Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Goro Tajima, Acute and Critical Care Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Kazunori Yamashita, Acute and Critical Care Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Osamu Tasaki, Acute and Critical Care Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
FUNDING
This work was supported by Nagasaki University Hospital Young Researchers Support Project.
ETHICAL STATEMENT
This study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Nagasaki University Graduate School of Biomedical Sciences (Approval no. 24032202).
PRESENTATION AT A CONFERENCE
Not presented at any conference.
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