Interventions to reduce the impact of flooding on people with long-term health conditions in high-income countries

Background Flooding is an escalating climate-related public health challenge, with over six million UK residents currently at risk. Beyond immediate physical dangers, floods significantly impact mental health and exacerbate chronic conditions by disrupting healthcare, medication access, and social support. Vulnerable populations - such as older adults, those with disabilities, and socio-economically disadvantaged groups - face increased risks and health inequalities. Aims and objectives To systematically identify and evaluate interventions that reduce the health and well-being impacts of flooding on individuals with long-term health conditions in high-income countries, focusing on evidence-based strategies for resilience and continuity of care. Inclusion criteria • Population: Adults with chronic conditions (especially respiratory and mental health disorders) exposed to risk of flooding in high-income countries. • Intervention: Adaptation measures implemented before flooding (e.g., early warning systems, community preparedness, health service continuity planning), with a focus on the UK context. • Comparator: No intervention or alternative adaptation measures. • Outcomes: Physical and psychological health and well-being impacts, short- and long-term. • Study Types: Quantitative and qualitative studies published since 2005. Methods • Study design: Systematic review following Cochrane and PRISMA 2020 guidelines; protocol registered with PROSPERO. • Search Strategy: Comprehensive searches across major databases (MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library) and relevant websites. • Data collection: Title and abstract screening by one reviewer, with a 20% random sample independently checked by a second reviewer. Full-text screening by two independent reviewers. Data extraction performed by one reviewer and independently cross-checked by a second reviewer. Risk of bias assessment using validated tools (e.g. OHAT, MMAT, JBI). • Analysis: Quantitative synthesis (risk ratios, mean differences) where feasible; otherwise, narrative and thematic synthesis. Integration of qualitative and quantitative evidence when possible. Study Within a Review (SWAR) Includes a SWAR to compare AI-assisted data extraction (ChatGPT) with human-led methods for equity-related data (PRO EDI), assessing accuracy and efficiency. Stakeholder Engagement An Advisory Group comprising researchers, policy experts, and Patient and Public Involvement (PPI) partners will guide relevance, interpretation, and dissemination. PPI ensures findings address community needs and inform accessible communication strategies. Expected Impact This review will fill critical evidence gaps on health-protective interventions for flood resilience, informing policy, practice, and future research. Findings will inform strategies that address health equity and continuity of care during climate-related flooding events.