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Users’ Perspective on Revised Simple Simulator for Calculating Nutritional Food Stocks in Preparation for Large-scale Disasters

Published online by Cambridge University Press:  06 September 2024

Tamaki Takeda,
Noriko SudoOpen the ORCID record for Noriko Sudo[Opens in a new window],
Ikuko Shimada and
Nobuyo Tsuboyama-Kasaoka
Tamaki Takeda
Affiliation:
Department of Food and Nutritional Science, Division of Life Sciences, Graduate School of Humanities and Sciences, Ochanomizu University, Bunkyo, Tokyo, Japan
Noriko Sudo*
Affiliation:
Natural Science Division, Faculty of Core Research, Ochanomizu University, Bunkyo, Tokyo, Japan
Ikuko Shimada
Affiliation:
Department of Nutrition, Faculty of Nutrition, University of Kochi, Kochi, Kochi, Japan
Nobuyo Tsuboyama-Kasaoka
Affiliation:
Section of Global Disaster Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Settsu, Osaka, Japan
*
Corresponding author: Noriko Sudo; Email: sudo.noriko@ocha.ac.jp.
Rights & Permissions [Opens in a new window]

Abstract

Objective:

In 2020, Japan’s Ministry of Health, Labour and Welfare developed an Excel workbook entitled “Simple Simulator for calculating nutritional food stocks in preparation for large-scale disasters.” In September 2021, it was modified as the “Revised Simulator” to plan food stockpiles in normal times and post-disaster meals. This study aimed to further improve the Revised Simulator.

Methods:

Eight group interviews were conducted with 12 public health dietitians, 9 disaster management officers, and 2 public health nurses from September to November 2021. They provided nutritional support during previous disasters or prepared for predicted future disasters. Qualitative analysis was conducted on interview transcriptions, then the Revised Simulator was improved based on their feedback.

Results:

The Revised Simulator was improved to the “Simulator for calculating nutritional food stocks and meals for large-scale disasters” with significant changes such as adding specific tags in the food list to denote long shelf life and elderly-friendly foods, as well as displaying bar graphs to visualize the required and supplied amounts of energy and nutrients.

Conclusions:

The Revised Simulator was upgraded for planning and assessing stockpiles and meals in ordinary conditions and emergencies. This study will contribute to enhancing the quality and quantity of food supplies during disasters.

Keywords

disaster planningdietfoodnutritiondisasters triggered by natural hazardslocal government

Information

Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 18 , 2024, e108
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

Introduction

Global climate change has increased the scale and frequency of disasters triggered by natural hazards. Reference van Aalst1 Japan is highly susceptible to such hazards, including earthquakes, typhoons, and tsunamis. In a major disaster, many affected residents need to live in evacuation shelters, where food supplies stocked by the municipality must last until relief supplies arrive. Therefore, stockpiling nutritionally adequate foods in each municipality is crucial for maintaining disaster victims’ health. This issue is particularly relevant, considering what is reported in the Sphere Handbook, i.e., food security, and nutrition interventions may determine nutrition and health status in the short term, as well as survival and well-being in the long term. Reference Association2

However, the food stockpiled by local governments in Japan remains inadequate. While 83% of local governments stockpile preprocessed rice or canned bread as staple foods, only 16% have canned or retort pouch side dishes. Reference Kubo, Ohara and Enshouiwa3 Regarding special foods for vulnerable people, 21% of local governments stockpile allergen-free food, and 6% have soft dishes for the elderly and infants. Reference Kubo, Ohara and Enshouiwa3 Because staple foods alone are insufficient to meet the “Nutritional Reference Values for Feeding at Evacuation Shelters” (RVs), 4–Reference Takeda, Sudo and Kozaki7 promoting the stockpile of nutritionally adequate food including side dishes is essential. Moreover, as nutritionally vulnerable individuals such as infants, elderly with aphagia, and individuals with food allergies are unable to eat regular food, enhancing stockpiles of special foods for them is also important.

In 2020, the Ministry of Health, Labour and Welfare (MHLW) created the “Simple Simulator for calculating nutritional food stocks in preparation for large-scale disasters” (Simulator). 8 The Simulator was developed to estimate the required amount of food stockpiles while considering nutrition and vulnerable people, such as infants, pregnant women, or patients with chronic diseases, at each local government. Additionally, it aimed to enhance the awareness and understanding of food stockpiling among municipal employees. 9 The Simulator is an Excel Macro-Enabled Workbook that can calculate daily nutritional requirements per person for the population of each municipality and the amounts of energy and nutrients of the stockpiled foods. The URL for downloading the Simulator was sent to the local governments’ health and welfare offices in April 2020. Additionally, since MHLW published the URL on its website, 8 anyone can download, operate, and save the Simulator on their own computer. More details on the Simulator have been reported by Sudo et al. Reference Sudo, Tsuboyama-Kasaoka and Shimada10

In September 2021, the Simulator was upgraded to the “Revised Simulator,” based on the opinions of local government personnel collected through online surveys and group interviews. Reference Sudo, Tsuboyama-Kasaoka and Shimada10 The Revised Simulator is an Excel Macro-Enabled Workbook like the Simulator; however, it is comprised of 2 sheets: a “Food Stock Planning Sheet” (Figure 1) and a “Daily Meal Planning Sheet” (Figure 2). Three major improvements are described below:

  1. 1) The food list of the Food Stock Planning Sheet was updated by excluding food items with a shelf life of less than 3 months at room temperature.

  2. 2) The nutritional requirements/ stock comparison table display of the Food Stock Planning Sheet was revised by displaying the total amounts needed per person per day and how many people’s required amounts are met by current stockpiles (Middle right panel, Figure 1).

  3. 3) The Daily Meal Planning Sheet was added to planned menus for breakfast, lunch, and dinner after a disaster.

Figure 1.

Screenshot of the food stock planning sheet (revised simulator).

After entering information about the municipality in which you plan to stockpile, select stockpile foods from the food list using pull-down menus. Input the quantity of each food item to display nutrient content used in the Standard Tables of Food Composition in Japan. The nutritional requirements/ stock comparison table (middle right) compares the total required amounts of energy and nutrients with the quantities supplied by food stocks.

*Total required amount: Dietary reference intake value (per person per day), weighed by the municipality’s sex and age group composition; Total supply amount: Amount of nutrients supplied by the municipality’s food stockpile; Evaluation: If the total supply amount is more than the total required amount, an “○” will be displayed; otherwise, an “X” will be displayed.

Figure 2.

Screenshot of the daily meal planning sheet (revised simulator).

It allows users to enter menus for breakfast, lunch, and dinner of a day using the built-in menus and “List of foods with high energy and nutrient content” (right). The built-in menu items are automatically displayed after selecting the menu group and menu name from the dropdown lists. In the List of foods, 0 – 100 items are registered for each component (energy or nutrient). In the “Daily totals” section, the total amount of energy and nutrient supplies (A) is compared to the total required amount (B), and if A is greater than B, “○” will be displayed. The reference amounts are the same as those in the Food Stock Planning Sheet.

*Revised RVs: Revised Nutritional Reference Values for Feeding at Evacuation Shelters.

The Food Stock Planning Sheet contains the following data from government sources: population by age group; injury and illness information; “Revised Nutritional Reference Values for Feeding at Evacuation Shelters,” Reference Sudo, Shimada and Tsuboyama-Kasaoka11 i.e., the target daily intakes per person for energy, and protein, as well as vitamins B1, B2, and C, plus salt; and a food list containing nutritional values for 159 items selected from the Standard Tables of Food Composition in Japan (eighth revision). Therefore, by entering basic information about the municipality (e.g., the name of the prefecture, name of the city, town, or village, as well as percentage of estimated victims, and response period) (Top left, Figure 1), the Simulator automatically calculates the total required amount of energy and each nutrient, and the number of vulnerable people (Right, Figure 1). Moreover, by selecting stockpiled food items from the list and entering their net weight (g) and quantity, the Simulator automatically calculates the total supply amount of energy and each nutrient.

The Daily Meal Planning Sheet comes loaded with 5 model menus prepared by combining foods served at evacuation shelters after a past heavy rain disaster in Japan. Reference Takeda, Sudo and Tsuboyama-Kasaoka12 Additionally, this sheet enables suitable menus to be arranged by selecting foods from the food list in the Food Stock Planning Sheet and the “List of foods with high energy and nutrient content”—food items provided in shelters in the past, ordered by energy and each nutrient supply per serving (Right panel, Figure 2).

The Revised Simulator significantly improves the original Simulator; however, it remains unclear whether it will be useful for municipal officials. Therefore, this study aimed to further improve the Revised Simulator based on collecting feedback from local government officials, investigating whether it can be used in each municipality, and analyzing the obstacles to its use.

Methods

Study Design

Eight group interviews were conducted from September to November 2021 via an online platform, Zoom. Table 1 shows specific information on interview dates and participants. The study participants included 12 public health dietitians, 9 disaster management officers, and 2 public health nurses. The public health dietitians were selected from 3 prefectures (A, B, and C), each damaged by large-scale disasters triggered by natural hazards in the 2010s. All the dietitians had been involved in food relief during previous disasters triggered by natural hazards. The disaster management officers, and public health nurses were selected from 4 prefectures: 1 affected by earthquakes (Prefecture W), 1 damaged by earthquakes and tsunamis (Prefecture X), 1 predicted to be at risk for a Nankai Trough earthquake (Prefecture Y), and 1 at risk for a Tokyo megaquake (Prefecture Z). These officers were nominated by their respective divisions as the most qualified to participate, such as the staff responsible for managing stockpiled food. Each group’s participants were selected from different administrative levels (i.e., prefectures, cities, and towns, as well as public health centers) to ensure that the groups would include diverse affiliations.

Table 1.

Number of dietitians, disaster management officers, and public health nurses and their affiliations at the time of the interviews (2021)

*D: Disaster management officers, **P: Public health nurses, †Registered dietitian.

Interview Content

Each semi-structured interview was conducted for approximately 2 hours. The corresponding author conducted all interviews and asked the questions while sharing the screen displaying the operation of the Revised Simulator. There were 9 interview questions from 4 perspectives.

  1. a) User’s experience of using the Simulator

    1. 1) Have you heard of the Simulator?

    2. 2) Have you used the Simulator before? How did you hear about it?

  2. b) Feedback on the modified features from the Simulator based on previous research. Reference Sudo, Tsuboyama-Kasaoka and Shimada10

    1. 3) What are your opinions on the food list in the Food Stock Planning Sheet?

    2. 4) What are your opinions on how the “Nutritional requirements/ stock comparison table” is displayed in the Food Stock Planning Sheet?

    3. 5) What are your opinions on the built-in menus, food list, and meal planning function in the Daily Meal Planning Sheet?

  3. c) Use of the Revised Simulator in each municipality

    1. 6) Would you find the Daily Meal Planning Sheet helpful in determining which items to request as relief supplies or which items to order from boxed meal vendors?

    2. 7) To fully utilize the Daily Meal Planning Sheet, coordination with dietitians seems necessary, but do you have such systems in place?

  4. d) Opinions on areas for further improvement in the Revised Simulator

    1. 8) Do you have any suggestions for improving the Daily Meal Planning Sheet?

    2. 9) What features would you like to see in the Revised Simulator?

Some questions for the public health dietitians were not asked to the disaster management officers and public health nurses, and vice versa. Questions 3, 4, and 6 were asked of all participants; whereas 1, 2, and 7 were only for disaster management officers and public health nurses. The remaining items (5, 8, and 9) were answered only by public health dietitians. The public health dietitians responded to questions 1 and 2 in the previous interviews. Reference Sudo, Shimada and Tsuboyama-Kasaoka11

The interviews were recorded using Zoom with participants’ consent, and a professional transcribed them. All the interviews were conducted in Japanese. The participants’ statements quoted in this paper were translated by a professional translator, then the first and second authors checked and revised the translations.

Analysis

All interview transcriptions were qualitatively evaluated, similar to previous studies. Reference Sudo, Shimada and Tsuboyama-Kasaoka11,Reference Sato, Sudo and Takeda13 As this study had a specific focus and featured segmented interviews, it was easy to identify the parts of the responses relevant to it. Coding or labeling methods were not used, and the qualitative analysis method used was novel. Responses to each question were independently extracted from the transcripts by the first and second authors. The content to be included in the study was discussed and determined by all authors. Then, the statements were summarized and categorized as functional opinions and suggestions for improving the Revised Simulator. All improvement suggestions that were technically feasible were implemented. Instances of disagreement were discussed, and the researchers adopted the best method for improving the nutritional aspects of local governments’ stockpiles.

Revised Simulator Improvement

The Revised Simulator was improved based on the opinions extracted from the interviews.

Ethical Considerations

Ethical approval was granted by the Ethical Review Committee of the Humanities and Social Sciences Studies of Ochanomizu University (approval no. 2021-10). All participants submitted written informed consent before the interview, and the study protocol conformed to the Declaration of Helsinki.

Results

Participants’ feedback are summarized below, by section, and in the order in which they were asked during the interviews.

User’s Experience of Using the Simulator

Out of 11 public health nurses and disaster management officers, only a registered dietitian working for the city government had heard of the Simulator. None of them had ever used the Simulator. Some participants mentioned the lack of collaboration between disaster management and health departments: “Disaster prevention departments do not usually involve health departments that have dietitians” (Town government, Prefecture W); “Dietitians are assigned to the health management division. We were not informed about the Simulator” (City government, Prefecture Z).

Feedback on the Modified Features From the Simulator

Food stock planning sheet: “food list”

Table 2 summarizes the opinions and recommendations on the food list. Several participants noted the large variety of foods on the list and their short shelf life. Moreover, some foods were suggested to be added to the list.

Table 2.

Opinions and recommendations of the participants on the food list in the Food Stock Planning Sheet (Revised Simulator)

Food stock planning sheet: “nutritional requirements/ stock comparison table”

Nine of the 12 public health dietitians mentioned that this part was easier to see than before. Additionally, disaster management officers and public health nurses stated that the circles (○) and crosses (X) used in the evaluation field were easy to understand. Their opinions and recommendations are shown in Table 3.

Table 3.

Opinions and recommendations of the participants on the comparison table in the Food Stock Planning Sheet (Revised Simulator)

Daily meal planning sheet: built-in menus, food list, and post-disaster meal planning

Three participants preferred to use the sheet during evaluations, rather than planning: “Since we don’t know what food will be provided [at an evacuation center after a disaster] until it is delivered, I’d use it for evaluation, rather than planning” (City-run public health center, Prefecture C). One participant noted a lack of food options in the food list and built-in menus: “There aren’t many foods that can be added or substituted, which makes it difficult to choose. If they were expanded more, I could use them. It would be better to add fresh fruits such as bananas and mandarin oranges” (Prefecture-run public health center, Prefecture B). However, the “List of foods with high energy and nutrient content” (Right panel, Figure 2) received positive feedback: “[This list] is a good feature: anyone can choose high-energy and vitamin-rich foods just by looking at it” (Prefecture-run public health center, Prefecture B).

Use of the Revised Simulator in Each Municipality

Daily meal planning sheet: utility in determining food aid and items in boxed meals to request

Table 4 summarizes the responses about the Daily Meal Planning Sheet. Several interviewees agreed it would be helpful; however, a public health dietitian commented, “Dietitians don’t get involved in requesting supplies” (City government, Prefecture C).

Table 4.

Feedback on the Daily Meal Planning Sheet’s utility in determining food aids and items in boxed meals to request

Daily meal planning sheet: systems in place for dietitian coordination

Disaster management officers at prefectural governments implied a lack of collaboration with public health dietitians: “There’s a lack of communication between disaster management and health departments” (Prefecture X). In city and town governments where dietitians are assigned, some respondents indicated they have a system to coordinate with dietitians (Prefectures W and Z). A public health nurse shared her experiences working with dietitians: “During a disaster, if I needed nutritional support, I’d ask a dietitian at a health center in my jurisdiction” (Prefecture Z).

Other disaster management officers did not emphasize the nutritional aspects of stockpiled food: “We don’t emphasize nutritional aspects” (Prefecture Y); “Preparing stockpiles is of greater priority than nutrition. Ensuring proper nutrition at evacuation centers will eventually become a problem. We’ll need to collaborate with dietitians in the future” (Prefecture Z).

Suggestions for Improvement of the Revised Simulator

Daily meal planning sheet: ideas for improvement

  • “It would be better if the food list had a subset of foods that are suitable for older adults, so users could consider [the needs of] the elderly.” (Prefecture-run public health center, Prefecture B)

  • “There should also be a section for snacks. It would be convenient to include a ‘total’ cell above each meal that changes as you adjust it, so you wouldn’t have to scroll.” (Prefecture-run public health center, Prefecture A)

  • “The evaluation field should also have a remainder, a number showing the amount [of nutrients] lacking.” (City-run public health center, Prefecture A)

  • “If surpluses and shortfalls were emphasized more in the evaluation results, you could easily tell the supplies place, ‘We’re short on this’.” (City government, Prefecture C)

Desired features

  • “A function for recording the meal contents and menus at a shelter daily and showing cumulative nutrition numbers.” (Prefectural office, Prefecture Y)

  • “A function to show deficient nutrients based on meal provision history.” (Prefectural office, Prefecture Z)

  • “A function that suggests items that can supplement deficient nutrients.” (Town in Prefecture Y; public health nurse)

Updating the Revised Simulator: Changes in Response to the Group Interview Feedback

The Revised Simulator was entirely improved as the “Simulator for calculating nutritional food stocks and meals for large-scale disasters” (hereafter, the Updated Simulator) in January 2022. While maintaining the Excel Macro-Enabled Workbook format, the population data was updated according to the 2020 Population Census. This section details the improvements with supporting rationale.

Naming changes

  1. 1) The Food Stock Planning Sheet was renamed the “Food Stock Sheet.”

This change was made in response to the feedback from public health dietitians that the sheet is intended more to be used for nutritional assessments after a disaster rather than in planning situations.

  1. 2) The Daily Meal Planning Sheet was renamed the “Disaster Meal Sheet.”

This change was made based on multiple comments, such as “I would use it more for evaluating rather than planning.”

  1. 3) The Simulator was renamed the “Simulator for calculating nutritional food stocks and meals for large-scale disasters.”

The Simulator tool’s name was revised to reflect the upgraded Simulator’s intended usage for planning and assessing stockpiles and meals in ordinary and emergencies.

Food stock sheet

A screenshot of the Food Stock Sheet is shown in Figure 3.

  1. 1) The food list was updated with tags for long shelf life and elderly-friendly foods.

Figure 3.

Screenshot of food stock sheet (updated simulator).

The nutritional requirements/ stock comparison table (top right) compares the total required amount of energy and nutrients with the quantities supplied by food stocks. In the bar graphs (middle right), the red bars indicate the total required energy or nutrient per person per day, and the blue bars indicate the corresponding total supply amount covered by food stockpiles.

*●: Foods suitable for stockpiles (i.e., shelf life of ≥ 1 year); ▴: Foods suitable for consumption by older adults; Total required amount: Dietary reference intake value (per person per day), weighed by the municipality’s gender and age group composition; Total supply amount: Amount of nutrients supplied by the municipality’s food stockpile; Evaluation: If the total supply amount is more than the total required amount, “○” will be displayed (otherwise, “X” will be displayed).

Foods suitable for stockpiles (i.e., having a shelf life of 1 year or longer) are preceded by a dot (●). In contrast, a triangle precedes suitable foods for consumption by older adults (▴). These symbols are intended to make it easier for users to select foods that meet their needs. Suggestions to highlight the main foods that should be stockpiled (Table 2), and to have a subset of foods that are suitable for the elderly were adopted.

  1. 2) The food list was reorganized.

Foods anticipated to be frequently used were relocated to the top of the dropdown food list according to the suggestion by a public health dietitian (Table 2).

  1. 3) The food list was supplemented with new foods.

Several foods were added to the food list based on desires expressed in the interviews: instant miso soup (powder), instant miso soup (paste), milk, and sports drink, as well as orange jelly, mandarin orange, and banana (Table 2).

  1. 4) The “Nutritional requirements/ stock comparison table” was enhanced with bar graphs.

This section was augmented with separate bar graphs to compare the energy and nutrients in food stocks with those required for evacuees (Right panel, Figure 3). This change was made based on the suggestion of a nutrition chart or graph display.

  1. 5) The “Basic information about municipality” section now allows input of the number of estimated evacuees.

The section for entering a municipality’s basic information (Top left, Figure 3) was revised because the participants commented that they would like to input the population.

Disaster meal sheet

A screenshot of the Disaster Meal Sheet is shown in Figure 4.

  1. 1) An export function was added.

Figure 4.

Screenshot of disaster meal sheet (updated simulator).

The “Snacks” section was added, and the “Daily totals” section was relocated to the top of the sheet. In the “Daily totals” section, if the total amount of energy and nutrient supplies (A) exceeds the total required amount (B), the row “A – B” indicates positive numbers and the row “Evaluation” displays “○.” Clicking on the “Export” button in the orange box (top) will allow users to export the contents of the sheet to a new Excel file for editing.

This feature allows users to export the data in the Disaster Meal Sheet as a new Excel file to edit it. Potential use cases include recording several days of menus and, using Excel functions, calculating cumulative nutritional data. Suggestions were adopted to record the meal contents and menus at a shelter daily and show cumulative nutritional information.

  1. 2) “Daily totals” were reorganized and augmented.

This section was moved to the top of the sheet and reorganized, with the total amount of energy and nutrient supplies (A) and total required amounts (B) in the top 2 rows, and the difference between them (A – B: i.e., surplus/ shortfall) in a new row below them. These changes were made in response to a proposed improvement to place a “total” cell above each meal and indicate the amount of nutrients lacking.

  1. 3) A “Snacks” section was added.

This section was added based on a public health dietitian’s suggested addition of a section for snacks.

  1. 4) The “List of foods with high energy and nutrient content” was expanded.

This built-in list was enlarged to 150 foods based on a request to extend it.

Discussion

This study revealed further areas for improving the Revised Simulator and improved it to the “Simulator for calculating nutritional food stocks and meals for large-scale disasters” (Updated Simulator). Moreover, 3 challenges to adopting the Updated Simulator in municipalities were identified: low recognition of the Simulator among disaster management officers; a lack of collaboration between public health dietitians and disaster management departments; and overlooked nutritional aspects of stockpiled food among public health nurses and disaster management officers.

The improvements from the Simulator to the Revised Simulator were typically well-received, with particular praise for the “Nutritional requirements/ stock comparison table.” Additionally, as the aging rate in Japan is approximately 30%, 14 adding tags for elderly-friendly foods was important to encourage consideration for the elderly. The Ration Calculator in NutVal is a similar tool to the Updated Simulator, first developed by the United Nations High Commissioner for Refugees for calculating the nutritional content of food assistance rations for individuals. 15 While the Updated Simulator and the Ration Calculator share some features (e.g., evaluation display in bar graphs and export functions), the Ration Calculator lacks a feature emphasizing foods for vulnerable people. Therefore, the highlight of easily chewable and swallowable foods in the food list of the Food Stock Sheet is a distinctive feature of the Updated Simulator.

Two proposed functions could not be implemented to show deficient nutrients based on meal provision history and suggest items that can supplement deficient nutrients. These suggestions from disaster management officers might be beneficial for users without specialized knowledge in nutrition. However, dietitians can identify deficient nutrients and propose adequate foods to supplement them. Consequently, effective utilization of the Updated Simulator requires collaboration with dietitians.

The biggest challenge with the Updated Simulator is limited awareness of the original Simulator among disaster management officers. One cause is a lack of collaboration between public health dietitians and food procurement departments. Since the MHLW publicized the Simulator to the health and welfare offices in municipalities, disaster management officers may not be aware of the Simulator without information from the health department. In our previous survey of local government personnel, only about 50% of the respondents reported that this information had been shared between disaster prevention and health departments. Reference Sudo, Tsuboyama-Kasaoka and Shimada10 Additionally, previous studies have revealed that public health dietitians are rarely involved in selecting stockpiled food. According to Kubo et al., only 30.5% of Japanese municipalities planned to engage dietitians while procuring food during a disaster. Reference Kubo, Ohara and Enshouiwa3 Sudo et al. reported that municipal officials, mainly public health dietitians, thought that they would not use the Simulator in the future because “a different department handles purchase food stocks” and “dietitians cannot make suggestions about which food to purchase for stockpiles.” Reference Sudo, Tsuboyama-Kasaoka and Shimada10 Therefore, to accelerate the adoption of the Updated Simulator, health departments should inform disaster prevention departments, and disaster management officers should involve public health dietitians in selecting stockpiled food.

Furthermore, the results suggested that most disaster management officers and public health nurses do not emphasize the importance of nutritional aspects in their food stockpiles, as Mori pointed out. Reference Mori16 However, some comments suggested that the Revised Simulator could increase the interest of disaster management officers in planning nutritional, balanced, healthy meals. One participant made the following remark on the evaluation field in the Food Stock Sheet, “Seeing the “X (inadequate)” compels me to think about nutritional aspects” (Table 3). This easy-to-understand evaluation could contribute to raising awareness regarding the importance of nutrition in food stockpiling.

Opinions from participants suggested that the Updated Simulator will also apply to households and nursing homes because it allows users to input the “number of estimated evacuees” (how many people a stockpile needs to cover). Additionally, the food list in the Food Stock Sheet includes recommended and exemplified foods in 2 food stocking guides for household and vulnerable people published by Japan’s Ministry of Agriculture, Forestry, and Fisheries. 17,18 Using the Updated Simulator with these guides, it will contribute to promoting and educating nutritionally adequate food stockpiling in households and facilities.

This study is crucial for enhancing the quality and quantity of food supply during disasters from preparedness and response perspectives. Moreover, the application scope of the Updated Simulator could potentially extend beyond meals during disasters triggered by natural hazards to meal planning and assessment in situations such as pandemics, or in refugee camps. This study will be useful for other countries considering establishing systems to plan and evaluate emergency meals with nutritional considerations.

Limitations

This study was conducted with participants from selected municipalities that have experienced or are expected to experience a disaster. Therefore, the findings cannot be generalized to all municipalities in Japan. Nevertheless, because of the diverse and professional participants, this study provided more multifaceted opinions than the previous study about the Simulator.

Conclusions

The Revised Simulator was improved to “Simulator for calculating nutritional food stocks and meals for large-scale disasters” for planning and assessing the stockpiles and meals in ordinary and emergencies. Two of the most significant changes were: (1) adding specific tags in the food list to highlight long shelf life and elderly-friendly foods, and (2) displaying bar graphs in evaluation field to visualize the required and supply amounts of energy and nutrients. Furthermore, this study revealed some challenges in adopting the Updated Simulator, such as low recognition of the Simulator, lack of collaboration between public health dietitians and disaster management departments, and nutritional value not being considered a top priority in food stockpiling. The application scope of the Updated Simulator could potentially expand to simulate household and facilities stockpiles, as well as plan and assess meals in situations such as pandemic or refugee camps. This study is crucial for enhancing the quality and quantity of food supply during disasters from preparedness and response perspectives.

Acknowledgements

We thank all the interviewees for their valuable opinions in this study.

Author contributions

NS and NT-K contributed to funding acquisition. TT and NS, IS and NT-K designed the study and contributed to data collection. TT performed data analysis and wrote the results. TT and NS were major contributors to writing the manuscript. All authors read and approved the final version of the manuscript.

Funding statement

This study was funded by Grand-in Aid for Scientific Research from the MHLW (Grant Number 20FA2001).

Competing interests

The authors declare none.

Abbreviations

MHLW, Ministry of Health, Labour, and Welfare; RVs, Nutritional Reference Values for Feeding at Evacuation Shelters.

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Figure 0

Figure 1.Screenshot of the food stock planning sheet (revised simulator).After entering information about the municipality in which you plan to stockpile, select stockpile foods from the food list using pull-down menus. Input the quantity of each food item to display nutrient content used in the Standard Tables of Food Composition in Japan. The nutritional requirements/ stock comparison table (middle right) compares the total required amounts of energy and nutrients with the quantities supplied by food stocks.*Total required amount: Dietary reference intake value (per person per day), weighed by the municipality’s sex and age group composition; Total supply amount: Amount of nutrients supplied by the municipality’s food stockpile; Evaluation: If the total supply amount is more than the total required amount, an “○” will be displayed; otherwise, an “X” will be displayed.

Figure 1

Figure 2.Screenshot of the daily meal planning sheet (revised simulator).It allows users to enter menus for breakfast, lunch, and dinner of a day using the built-in menus and “List of foods with high energy and nutrient content” (right). The built-in menu items are automatically displayed after selecting the menu group and menu name from the dropdown lists. In the List of foods, 0 – 100 items are registered for each component (energy or nutrient). In the “Daily totals” section, the total amount of energy and nutrient supplies (A) is compared to the total required amount (B), and if A is greater than B, “○” will be displayed. The reference amounts are the same as those in the Food Stock Planning Sheet.*Revised RVs: Revised Nutritional Reference Values for Feeding at Evacuation Shelters.

Figure 2

Table 1.Number of dietitians, disaster management officers, and public health nurses and their affiliations at the time of the interviews (2021)

Figure 3

Table 2.Opinions and recommendations of the participants on the food list in the Food Stock Planning Sheet (Revised Simulator)

Figure 4

Table 3.Opinions and recommendations of the participants on the comparison table in the Food Stock Planning Sheet (Revised Simulator)

Figure 5

Table 4.Feedback on the Daily Meal Planning Sheet’s utility in determining food aids and items in boxed meals to request

Figure 6

Figure 3.Screenshot of food stock sheet (updated simulator).The nutritional requirements/ stock comparison table (top right) compares the total required amount of energy and nutrients with the quantities supplied by food stocks. In the bar graphs (middle right), the red bars indicate the total required energy or nutrient per person per day, and the blue bars indicate the corresponding total supply amount covered by food stockpiles.*●: Foods suitable for stockpiles (i.e., shelf life of ≥ 1 year); ▴: Foods suitable for consumption by older adults; Total required amount: Dietary reference intake value (per person per day), weighed by the municipality’s gender and age group composition; Total supply amount: Amount of nutrients supplied by the municipality’s food stockpile; Evaluation: If the total supply amount is more than the total required amount, “○” will be displayed (otherwise, “X” will be displayed).

Figure 7

Figure 4.Screenshot of disaster meal sheet (updated simulator).The “Snacks” section was added, and the “Daily totals” section was relocated to the top of the sheet. In the “Daily totals” section, if the total amount of energy and nutrient supplies (A) exceeds the total required amount (B), the row “A – B” indicates positive numbers and the row “Evaluation” displays “○.” Clicking on the “Export” button in the orange box (top) will allow users to export the contents of the sheet to a new Excel file for editing.