Climate change threatens human health and well-being in myriad ways: warmer temperatures are expected to increase the risk of vector-borne diseases [26]; elevated temperatures are projected to result in deaths of millions by the year 2100 [27]. Of particular concern among certain island nations and coastal zone communities is the rise in sea levels which could result in the submergence of these locations. This could lead to large-scale displacement of people [28,29]. The impacts of a changing climate are already evident across the United States: in 2012 alone, the economic cost of climate change effects including wildfires, ozone pollution, heat waves, mosquito-borne disease was US $10 billion (in 2018 dollars) [30]. While direct impacts on health include morbidity and mortality associated with extreme weather events such as heatwaves and floods, indirect health impacts to adults and children are caused by changes in the dynamics of vector-borne and water-borne diseases, malnutrition due to decreased food security, and population displacement that may arise through alterations in our environmental and social systems [31-33].

Climate resilience refers to the ability to prepare for, recover from, and adapt to the threats associated with a changing climate, including but not limited to more frequent and severe extreme weather events and prolonged droughts. Climate resilience centers around societies and communities mobilizing resources and partners to anticipate these risks, reducing community vulnerability to those risks through infrastructure and other investments, preparing for, responding to, and recovering from these events.

Crisis informatics, also known as disaster informatics, is “a multidisciplinary field combining computing and social science knowledge of disasters” [34,35]. Crisis informatics has a major focus on the informatics needs of first responders such as firemen, construction workers, and health care workers including medics, nurses, and physicians. Crisis informatics tools have been proposed to improve the efficiency of crisis response methods such as evacuations, provision of medical supplies, and disaster preparation. Mobile tools [36] have been used during crises to assist affected individuals and these can be viewed as examples of RI tools for, typically, short-term immediate responses to crises. By contrast, RI has its sole focus on improving the ability of people and communities to successfully cope not only with disasters but also to prepare for long-lasting and recurrent threats to health.

The nature, design, requirements, and development processes of RI tools could vary across 2 types of stressor events as defined below. We identify drivers of resilience whose impact could be enhanced by RI tools and systems.

Responding to stressors can require people and communities to change their behavior. A vivid illustration occurred during the COVID-19 pandemic. People worldwide needed to change their normal behavior both on individual and social levels. Frequent handwashing and the use of sanitizing wipes were recommended. Mask-wearing was mandatory when doing commonplace activities such as shopping and traveling on public transport.

Persuasive Technology (PT) [52] is concerned with the design of noncoercive tools and technologies to change human behavior. Following the original work of Fogg [52,53], Oinas-Kukkonen and Harjumaa [54] developed the Persuasive Systems Design (PSD) framework to guide the development of PT tools. Apart from Fogg 7 primary task support postulates, the PSD framework includes 3 major components in the design of PT tools: dialog support, system credibility support, and social support. A major focus in recent years has been the application of PT to support healthful behavior change [55-57]. Since, as noted above, behavior change can be an important comment on developing resilience, PT and PSD could help guide the design of effective RI tools and systems.

Drivers of resilience include social contexts, community factors, economics, institutions, and infrastructure. An important area of future research is to identify the role of RI and the designs of RI systems to enhance the effectiveness of these drivers of resilience.

Systems development can be greatly aided by following a conceptual framework. Apart from systematic development and evaluation, the benefits of doing so can include flexibility, extensibility (the ability to add features easily), scalability (the ability of the system to be used by greater numbers of people without redevelopment), and others [68]. We propose the following 6-component framework (Textbox 1) [25] as a guide for efficient and effective development of RI systems.

Beginning in March 2020, the COVID-19 pandemic caused immense disruptions to normal life. These disruptions led to an atmosphere of fear in which uncertainty, rumors, and misinformation caused widespread public confusion preventing people from responding effectively.

To help alleviate this situation and enhance resilience among Arizonans, faculty including some of the authors of this paper, at the University of Arizona identified the need for an informatics strategy to provide much-needed authoritative and timely COVID-19 information to the public, and to gather information on how the pandemic was impacting communities’ health, well-being, and them financially.

We chose text messaging, also known as SMS, as the messaging modality because it is low-footprint, ubiquitous, and eliminates the time and expense of multi-language app development for iOS and Android. SMS text messaging is an established multi–operating system technology, shown to be effective in health care [72,73], usage of text messaging is universal, and no specific training is needed for individuals to read and respond to text messages. SMS text messaging is inexpensive, and unlimited text messaging is often included in many cell phone plans. Enrollment occurred by text messaging a toll-free number, and via the AZCOVIDTXT website during which enrollees indicate their preference for receiving messages or surveys in English or Spanish. Enrollment was limited to those providing Arizona zip codes. For data collection we developed a simple REDCap (Research Electronic Data Capture; Vanderbilt University)-based [74] mobile survey tool (Figure 1).

Requirements identified included supporting individuals in both English and Spanish, ease of use and installation, and the capability to gather data on COVID-19–related challenges. A mobile health approach was identified as the optimal strategy since even among disadvantaged groups, cell phone access or ownership is at 100% and smartphone access is at least 85% [75]. The resulting system, called AZCOVIDTXT, was developed and deployed in 4 weeks beginning in April 2020 and operated until March 2022.

Messages and other content were developed and curated by specialists in public health, health behavior change, and health communications, assisted by graduate students and staff at the University of Arizona. The message content was derived from authoritative sources such as the Centers for Disease Control, and new messages were developed weekly to reflect the latest information, including countering misinformation, on the availability of vaccines, outbreaks of SARS-CoV-2 variants, and other evolving events.

By March 2022, a total of 3746 households from 225 Arizona zip codes were enrolled in AZCOVIDTXT, and more than 522,000 text messages providing COVID-19–related information had been sent. Except for a few outages, surveys were sent about every 10 days and messages 3 times a week. Curated content consisting of nearly 200 news updates, SMS text messages to enrollees, and social media posts (@AZCOVIDTXT on Instagram [Instagram from Meta], Facebook [Meta], and Twitter [X Corp]) had been developed.

AZCOVIDTXT applied the 6-components principles for RI (Textbox 2) and successfully developed and deployed the system.

Due to the waning of the COVID-19 pandemic in early 2023, this system was discontinued.

The public health system comprised of a web of federal, state, and local agencies, hospitals, nonprofit agencies, and businesses is at the forefront of the health response to climate change. Building climate resilience for the public health system requires understanding the complexity of the climate, health, and human systems that have unique innate behaviors and structures that contribute to risks and vulnerabilities and need to be considered when informing any community resilience-building strategy. The development of resilience could benefit from a systems-wide informatics approach that engages partners and stakeholders in the processes involved in recognizing threats, determining capacity, informing solutions, recovering from a crisis, and adapting the process to enhance our capacity to deal with the next crisis. RI systems could also play an important supporting role in the US Agency for International Development’s Program Cycle [76] for enhancing resilience.

It is important to note that RI tools and systems are subject to operating limitations caused by the stressor event. For example, issues such as inaccessibility to sufficient cellular network connection, low health literacy, and fragility of cellular networks may interfere with the effectiveness of an RI project. Older adult populations, who often tend to be largely represented in rural areas, may not be able to access new technology easily due to the rapid development of new technologies. Additionally, cellular networks may be overused in the case of an emergency which may lead to issues with communication via technology. Initiatives, such as FirstNet, are being put into place to try to address this issue, especially for first responders and others who need to react quickly and coordinate with their teams during an emergency, but the public at large may still be negatively impacted [77]. Additionally, it is important to recognize the limitations of informatics tools being able to support and enhance resiliency. Resilience is a very large issue that requires a multilevel and multifaceted response, and informatics is only one part of the larger response that would need to occur for a community to be able to cope effectively in the face of a disaster.

The current issues and limitations of RI data communication lie within already existing socioeconomic discrimination and access difficulty of the methods of communication. Yang et al [78] discuss how underserved communities, identified as minorities, older adults, and the poor, were not considered in deciding systems for spreading disaster informatics data. By effect, these groups experience sizable differences in the disaster relief provided to them. As RI systems continue to become more heavily technology-reliant, these gaps in treatment could be further emphasized. Virapongse et al [79] detail how these gaps are becoming ever more important to address, as communities become more reliant on the data provided to them. They argue that working directly with stakeholders in underserved communities would allow for their issues to be directly addressed and prevent further inequitable treatment of these groups.

Tailored tools, interventions, and programs are a critical aspect of informing resilience and RI allows for this strategic, locally relevant decision-making. No model for RI will be effective for every community, as the conventions and resources of each area differ greatly. Therefore, RI system designs must allow decision makers to adapt the model to fit the needs of their area. For information distribution, this would mean that decision makers would adapt their RI systems to account for the technology available to the given community and the preferences of each group of people in how they desire to receive information.

RI has great potential to enable and support strategies, resources, and technologies that enhance the ability of individuals, populations, and the environment to respond successfully to natural and man-made stressors. The conditions under which RI systems function impose design and other constraints that make RI distinct from other informatics environments. There is a great need for research to establish the basic principles of RI leading to the efficient development of RI systems to support resilience in the United States and globally. The 6-component framework presented here could be a useful guide to the efficient development and effective deployment of informatics tools to promote resilience in public health.