Climate change and human activity are intensifying wildfires, endangering health, ecosystems, and infrastructure, especially in wild-urban interface regions. This study examined how communication, public perception, and psychological readiness influence wildfire preparedness and health outcomes across Los Angeles, Hawaii, Asturias (Spain), and Canada. A cross-sectional survey (n = 156, August 2023-April 2025) employed a 77-item questionnaire available in both English and Spanish. Chi-square analysis and Poisson generalized linear mixed models were used to assess the associations between perceived evacuation safety, communication tools, health impacts, and government response effectiveness. Fuzzy-set Qualitative Comparative Analysis identified region-specific combinations linked to effective governance. Participants rated preparedness and communication as moderately effective, with only 19% finding evacuation plans accessible. Social media and community engagement increased trust but also caused confusion. Effective preparedness relies on transparent communication, community resources, and coordinated institutional actions. Enhancing these factors, alongside psychological preparedness and citizen engagement, is essential to mitigate health risks during wildfires.
