Assessment of Intraorganizational Collaboration in the health sector during Disasters: Exploring a Valid and Reliable Assessment Tool for Disaster Risk Management

Shiva Yousefian, Katayoun Jahangiri, Yadollah Mehrabi, Sanaz Sohrabizadeh


Background: Collaboration, as a key factor in disaster risk management, is a mechanism that prevents the loss of time, investment, and resources. The variety of units in the health sector has made collaboration a major challenge. The present study aimed at developing a tool for assessing collaboration in the health sector during disasters.

Methods: In this mixed‑methods study, a questionnaire was developed by integrating the findings of a systematic literature review and a qualitative study. Face and content validation were performed. The reliability of the tool was tested through a 15‑day interval test–retest by Cronbach’s alpha and intraclass correlation coefficient (ICC) with 30 participants. Confirmatory factor analysis was done to test the validity and reliability of instrument using SmartPLS in a case study with 450 health sector staff.

Results: The factors affecting intraorganizational collaboration of the health sector were identified in six categories and 19 subcategories by searching 46 articles in the systematic review and content analysis of 16 semistructured interviews with health sector staff. The results of content validity ratio (=0.81), content validity index (=0.92), Cronbach’s alpha (=0.975), and ICC (=0.970) confirmed the validity and reliability of the tool. Convergent validity, discriminant validity, and reliability were approved by AVE (average variance extracted) >0.5, Fornell and Larcker matrix, and CR (composite reliability) >0.7. According to the positive result of R2 , Q2 , and goodness‑of‑fit (GOF) criteria, the model fit was confirmed.

Conclusion: The results of validity and reliability measurements approved the proposed tool. The use of this tool is recommended for developing collaboration in the health sectors of different countries.


Disaster planning; disasters; health care sector; intersectoral collaboration; natural disasters; surveys and questionnaires

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Bazyar J, Pourvakhshoori N, Safarpour H, Farrokhi M,

Khankeh HR, Daliri S, et al. Hospital disaster preparedness in

Iran: A systematic review and meta‑analysis. Iran J Public Health


Ghomian Z, Yousefian S. Natural disasters in the middle‑east

and North Africa with a focus on Iran: 1900 to 2015. Health in

Emergencies and Disasters 2017;2:53‑62.

Pourvakhshoori N, Norouzi K, Ahmadi F, Hosseini M,

Khankeh H. Nursing in disasters: A review of existing models.

Int Emerg Nurs 2017;31:58‑63.

Hatami H, Razavi SM, Eftekhar Ardabili H, Eftekhar Ardabili,

Majlesi F, Sayed Nozadi M, et al. Persian Textbook of Public

Health. 4th ed. Tehran: Arjmand, 2019.

Nasiri A, Aryankhesal A, Khankeh H. Leadership in limbo:

Characteristics of successful incident commanders in health

sector of a disaster-prone country. Int J Health Plann Manage


Khankeh HR, Khorasani‑Zavareh D, Johanson E, Mohammadi R,

Ahmadi F, Mohammadi R. Disaster health‑related challenges and

requirements: A grounded theory study in Iran. Prehosp Disaster

Med 2011;26:151‑8.

Ardalan A, Rajaei MH, Masoumi G, Azin A, Zonoobi V,

Sarvar M. 2012‑2025 roadmap of IR Iran’s disaster health

management. PLoS Curr 2012;4:e4f93005fbcb34.

Bahadori M, Khankeh HR, Zaboli R, Malmir I. Coordination in

disaster: A narrative review. Int J Med Rev 2015;2:273‑81.

Nakhaei M, Khankeh H, Masoumi G, Hosseini M, ParsaYekta Z.

Health management in past disasters in Iran: A qualitative study.

Health in Emergencies and Disasters 2014;1:107‑15.

Chatterjee A, Gupta D, Jain N. Coordination of disaster response:

Potential and challenges from Indian experiences: Knowledge

Community on Children in India; 2010.

Moshtari M, Gonçalves P. Factors influencing interorganizational

collaboration within a disaster relief context. Voluntas:

International Journal of Voluntary and Nonprofit Organizations


Campanella TJ. Urban resilience and the recovery of New

Orleans. Journal of the American planning association


Bradt DA, Drummond CM. From complex

emergencies to terrorism‑‑new tools for health‑sector

coordination in conflict‑associated disasters.

Prehosp Disaster Med 2003;18:263‑71.

Khankeh HR, Mohammadi R, Ahmadi F. Health care services

at time of natural disasters: A qualitative study. Iran J Nurs


Bahadori M, Khankeh HR, Zaboli R, Ravangard R, Malmir I.

Barriers to and facilitators of inter‑organizational coordination in

response to disasters: A grounded theory approach. Disaster Med

Public Health Prep 2017;11:318‑25.

Sohrabizadeh S, Yousefian S, hosein Bahramzadeh A,

Vaziri MH. Health system preparedness for coincidence

of natural disasters and COVID‑19: A Systematic

Literature Review. 2021. doi:‑118316/v1.

Rabiee A, Ardalan A, Poorhoseini S. Assessment of coordination

among lead agencies of natural disasters management in Iran.

Hakim Res J 2013;16:107‑17.

Abbas R, Norris T, Parry D. Pinpointing what is wrong with

cross‑agency collaboration in disaster healthcare. J Int Soc

Telemed eHealth 2018;6:e3(1‑10).

Jahangiri K, Eivazi MR, Mofazali AS. The role of Foresight in

avoiding systematic failure of natural disaster risk management.

International journal of disaster risk reduction 2017;21:303-11.

Keykaleh MS, Sohrabizadeh S. The Emergency Medical

System (EMS) response to Iraqi pilgrims’ bus crash in Iran:

A case report. BMC emergency medicine 2019;19:38.

Raju E, Van Niekerk D. Intra‑governmental coordination for

sustainable disaster recovery: A case‑study of the Eden District

Municipality, South Africa. International Journal of Disaster Risk

Reduction 2013;4:92‑9.

Emerson K. Collaborative governance of public health in low‑ and

middle‑income countries: Lessons from research in public

administration. BMJ Glob Health 2018;3(Suppl 4):e000381.

Bahadori M, Khankeh HR, Zaboli R, Raiszadeh M, Malmir I.

Health sector coordination in disasters: Barriers and facilitators.

Health Emerg Disasters 2016;1:177‑86.

Amirkhanyan AA. Collaborative performance measurement:

Examining and explaining the prevalence of collaboration in

state and local government contracts. J Public Administration

Res Theory 2008;19:523‑54.

Julnes PDL, Holzer M. Promoting the utilization of performance

measures in public organizations: An empirical study of factors

affecting adoption and implementation. Public administration

review 2001;61:693‑708.

Ward KD, Varda DM, Epstein D, Lane B. Institutional factors

and processes in interagency collaboration: The case of

FEMA corps. The American Review of Public Administration


Ward KD, Epstein D, Varda D, Lane B. Measuring performance

in interagency collaboration: FEMA corps. Risk Hazards Crisis

Public Policy 2017;8:172‑200.

Patel H, Pettitt M, Wilson JR. Factors of collaborative

working: A framework for a collaboration model. Appl Ergon


Glik DC, Eisenman DP, Donatello I, Afifi A, Stajura M,

Prelip ML, et al. Reliability and validity of the Assessment for

Disaster Engagement with Partners Tool (ADEPT) for local

health departments. Public Health Rep 2014;129(Suppl‑4):77‑86.

Sohrabizadeh S, Shabanikiya HR, Kavousi A, Safarpour H.

Developing a valid and reliable gender analysis tool applied in

disaster management: A community‑based survey. Disaster Med

Public Health Prep 2020:1‑10. doi: 10.1017/dmp. 2020.24.

Bryson JM, Crosby BC, Stone MM. Designing and implementing

cross‑sector collaborations: Needed and challenging. Public

administration review 2015;75:647‑63.

Schwandt TA, Lincoln YS, Guba EG. Judging interpretations:

But is it rigorous? Trustworthiness and authenticity in naturalistic

evaluation. New directions for evaluation 2007;114:11‑25.

Jafari MJ, Yazdi FDF, Mehrabi Y, Rakhshanderou S, Saremi M.

Development and validation of a new scale for prediction of low

back pain occurrence among nurses. EXCLI J 2019;18:277‑86.

Safarpour H, Safi‑Keykaleh M, Eskandari Z, Yousefian S,

Faghisolouk F, Sohrabizadeh S. Hospital’s preparedness in

road traffic injuries with mass casualties: Exploring a valid and reliable checklist. Hong Kong J Emerg Med 2019. doi:


Lawshe CH. A quantitative approach to content validity.

Personnel psychology 1975;28:563‑75.

Polit DF. Essentials of Nursing Research: Wolters Kluwer

Health/Lippincott Williams and Wilkins; 2010.

Hair Jr JF, Howard MC, Nitzl C. Assessing measurement model

quality in PLS‑SEM using confirmatory composite analysis.

Journal of Business Research 2020;109:101‑10.

Yousefian S, Sohrabizadeh S, Jahangiri K. Identifying the

components affecting intra‑organizational collaboration of

health sector in disasters: Providing a conceptual framework

using a systematic review. International Journal of Disaster Risk

Reduction 2021;57:102146.

Shahbazi M, Tahmasebi Boroujeni S, Motasharee E.

Determination of factorial validity and reliability of person

version of test of performance strategies‑2 (TOPS‑2). Motor

Behav 2014;6:15‑42.

Thomson AM, Perry JL. Collaboration processes: Inside the

black box. Public administration review 2006;66:20‑32.

Safari M, Seyedin H, Jahangiri K. Disaster risk governance in

Iran: Document analysis. J Edu Health Promot 2019;8:142.

Petri L, editor Concept Analysis of Interdisciplinary

Collaboration. Nursing forum: Wiley Online Library; 2010.

Bikdelo F, Rahnavard F. Measuring inter‑organizational

coordination and identifying factors affecting it in public

organizations . Journal of Management and Development Process


Greer PA. Elements of Effective Interorganizational

Collaboration: A Mixed Methods Study. Antioch University;

Chang K. Understanding Cross‑Sector Collaboration in

Emergency Management: The Dynamics of Vertical and

Horizontal Networks. The Florida State University; 2012.

Salmon P, Stanton N, Jenkins D, Walker G. Coordination during

multi-agency emergency response: Issues and solutions. Disaster

Prevention and Management 2011;20:140‑58.

Hermansson HM. Disaster management collaboration in Turkey:

Assessing progress and challenges of hybrid network governance.

Public administration 2016;94:333‑49.

Bedwell WL, Wildman JL, DiazGranados D, Salazar M,

Kramer WS, Salas E. Collaboration at work: An integrative

multilevel conceptualization. Human Resource Management

Review 2012;22:128‑45.

Noran O. Collaborative disaster management: An interdisciplinary approach. Computers in Industry 2014;65:1032‑40.

Liu J, Hao J, Shi Z, Bao HX. Building the COVID‑19

collaborative emergency network: A case study of COVID‑19

outbreak in Hubei Province, China. Nat Hazards 2020:1‑31. doi:


Markus ML, Fedorowicz J, Bodeau D, Brooks J. Characterizing

and improving collaboration and information‑sharing across

emergency preparedness and response communities. Proceedings

of ICEG, 2009.