Understanding preparedness for extreme weather events among adults with chronic diseases: the interplay of illness perceptions, threat appraisal, and weather-related worry.

Background: Extreme weather events are an increasing public health concern, particularly for adults living with chronic diseases. In this study, we examined whether illness perceptions were associated with preparedness for extreme weather events through a theoretically informed serial indirect association involving threat appraisal and weather-related worry, and whether these associations differed across respiratory disease, cancer, and cardiovascular disease groups. Methods: A cross-sectional study was conducted among 450 Israeli adults aged 50 years or older with a physician-diagnosed respiratory disease, cancer, or cardiovascular disease. Participants completed self-report measures of illness perceptions, threat appraisal, weather-related worry, and preparedness for extreme weather events. Results: More negative illness perceptions showed a significant serial indirect association with greater preparedness for extreme weather events through higher threat appraisal and greater weather-related worry. This indirect association was significant for both "intuitive" and "planned" preparedness behaviors across all three disease groups. The pattern of indirect associations specified in the serial mediation model was similar across groups. Of the nine interaction terms tested, one was significant, where disease group moderated the association between illness perceptions and weather-related worry. This association was significant among participants with respiratory disease, but not among those with cancer or cardiovascular disease. This exploratory finding should be examined in future research. Conclusions: This study found that illness perceptions, threat appraisal, weather-related worry, and preparedness for extreme weather events were interrelated among adults with chronic diseases, with a similar pattern of indirect associations across respiratory disease, cancer, and cardiovascular disease groups. Given the cross-sectional design, the proposed ordering of these variables should be interpreted as theoretically informed rather than as evidence of a temporal or causal pathway. These findings contribute to research at the intersection of illness self-regulation and climate-health adaptation and may inform future longitudinal research and preparedness interventions for medically vulnerable populations.