The impact of Muslim and Christian religious leaders responding to COVID-19 in Israel.

Background: The COVID-19 pandemic is one of the most significant public health emergencies in decades and has affected all countries worldwide. Religious leaders have been recognized as playing a pivotal role in health promotion during times of crisis. This study explored the role that Muslim and Christian religious leaders played in Israel during the pandemic, and the impact that their activities had on the community. Methods: A qualitative study involving semi-structured interviews was conducted with Muslim and Christian religious leaders and health policy makers from the Arab community. Intensive purposeful sampling was used to locate the two target audiences. Interview protocols were developed and included questions about the role they played during the pandemic, challenges they faced, and dialogue and partnerships they had. Interviews were audio-recorded, transcribed, and analyzed using thematic content analysis. Results: Ten Muslim Sheikhs, three Christian clergy, and four health policy makers were interviewed. Religious leaders played a predominant role in promoting health during the COVID-19 crisis. Both religious leaders and health policy makers reported similar challenges including dealing with fake news and the conspiracy theory, social events and gatherings, frustrations about gaps in policy toward religious institutions, and lack of trust toward State. Health policy makers recognized the key role religious leaders played and emphasized the importance of engaging religious leaders. Conclusion: The COVID-19 pandemic has been a catalyst for partnership between health policy makers and religious leaders. Religious leaders should play an integral and integrated role in promoting health during future health crises, not only in implementation of guidelines but also in development of policy so that the guidelines are tailored and sensitive to specific communities to avoid conflicts. As trusted authorities, religious leaders serve as a bridge between health authorities and communities and can be mediators who reconcile science, policy and religious perspectives. The routine cooperation between decision makers, opinion leaders, and religious leaders as social gatekeepers can increase the public's level of trust in the system.

It Takes Two to Tango: How the COVID-19 Vaccination Campaign in Israel Was Framed by the Health Ministry vs. the Television News.

Background: The internet has become a major resource in information transfer during COVID-19, and traditional means of communication are digitized and accessible online to the public at large. Objectives: This study seeks to examine how Israel's two main television news channels (Channel 12 and Channel 13) covered the Covid-19 vaccination campaign, compared to how the Ministry of Health ran the campaign. Methods: A qualitative study based on triangulation of online content analyses from three different sources: advertising campaigns, social media posts and reports on television news channels. The research sample included 252 reports from the newsrooms of Channel 13 (n = 151) and Channel N12 (n = 101), Israel's two leading news channels, all broadcast between December 1, 2020 and November 30, 2021. The sample also included posts from Israel Ministry of Health Facebook page and advertising campaigns from the Facebook page of the Israel Government Advertising Agency (LAPAM), which constructs advertising campaigns for the MOH (113 items). Results: The research findings reveal congruence between the way the MOH framed its vaccination campaign and news coverage of the vaccination issue. The vaccination campaign used three primary framing strategies: (1) positive framing (emphasizing the vaccine's advantages and stressing that the vaccine is safe and effective based on cost-benefit calculations and public health perspectives); (2) fear appeal strategy (conveying persuasive messages that seek to arouse fear through threats of impending danger or harm); (3) attribution of responsibility strategy (blaming the unvaccinated and targeting all those who criticized Israel's generic vaccination policy). Conclusion: As the watchdog of democracy, the news should function as a professional and objective source that criticizes government systems if necessary and strives to uncover the truth throughout the crisis. Public trust, which is so essential during such a crisis, can be achieved only if the news channels provide reports and meaningful journalistic investigations that challenge the system. By doing so, they can help fight conflicts of interest that divert management of the crisis from the professional health field to the political-economic arena.

Physicians' Perspective on Vaccine-Hesitancy at the Beginning of Israel's COVID-19 Vaccination Campaign and Public's Perceptions of Physicians' Knowledge When Recommending the Vaccine to Their Patients: A Cross-Sectional Study.

Because public healthcare workers (HCWs) are at the forefront of the battle against COVID-19, they must be able to provide vaccination information to their patients and respond to their anxieties and concerns. This research objectives were to (1) examine physicians' perceptions of how they received information about the Pfizer COVID-19 vaccine, their attitudes toward hesitant colleagues, and their own knowledge and self-efficacy in communicating information to their patients, and (2) to examine the public's perceptions of physicians' knowledge when recommending the COVID-19 vaccine to their patients. At the beginning of the vaccination campaign, a survey examined the attitudes of physicians in the Israeli public healthcare system (n = 295) regarding the Pfizer vaccine. In addition, the attitudes of a representative sample (n = 500) of the Israeli adult population (age 18+) were examined through interviews. Most of the participating physicians (81%) reported they had already been vaccinated or intended to be vaccinated. When asked about their reasons for vaccine hesitancy, 27% cited concerns about long-term side effects and doubts about the vaccine's effectiveness in preventing contagion. They cited system pressure and departmental norms as explanations for their eventual compliance. Moreover, they saw the system as less tolerant of hesitant physicians, while they themselves tend to be more tolerant. The results of the survey of the public showed that mostly young people (under 44) who tend to be critical believe that physicians do not have sufficient knowledge to make recommendations about the COVID-19 vaccine. The findings indicate that the health system should employ complete transparency in conveying the advantages and disadvantages of the COVID-19 vaccine to physicians. The system should be more tolerant of physicians' worries and concerns and grant legitimacy to their reservations and misgivings. Moreover, medical studies should reinforce physicians' immunological knowledge regarding vaccinations so they can help their patients make informed decisions.

Application and implementation of telehealth services designed for the elderly population during the COVID-19 pandemic: A systematic review.

BACKGROUND: Telehealth has many benefits, in routine care and especially during times of epidemics in which restrictions to direct patient/healthcare-provider interaction exist. OBJECTIVE: To explore the availability, application, and implementation of telehealth services during the Covid-19 era, designed for the aged population (age 65 and more). METHODS: This systematic review/analysis was conducted by searching the most popular databases including PubMed, Embase, and Web of Science. We included studies that clearly defined any use of telemedicine services in any aspect of healthcare during the COVID-19 pandemic, aimed at the elderly population, published in peer-reviewed journals. We independently assessed search results, extracted the relevant studies, and assessed their quality. RESULTS: 3225 articles were identified after removing duplicates. After reading the full texts of 40 articles, 11 articles were finally included. Among the telehealth services, there were services aimed for triage and control during the outbreak of the COVID-19 pandemic, remote monitoring and treatment, follow-ups online meetings for patients residing in health centers, and application of online services. CONCLUSIONS: Although the elderly population may benefit the most from telehealth services, especially during pandemics and social distancing restrictions, not enough services were developed and implemented to satisfy the needs of this population.

How to Make Health and Risk Communication on Social Media More "Social" During COVID-19.

Social media have changed the way citizens participate in and express opinions about government policy. Social media serve organizations in achieving four main goals: interacting with citizens; fostering citizen participation; furthering open government; and analyzing/monitoring public opinion and activities. We contend that despite the importance of social media, international and local health organizations have been slow to adopt to them, primarily due to the discrepancy between intraorganizational discourse modes and the type of discourse suitable for dialogue with the public. In this perspective paper, we recommend strategies for such public dialogue based on understanding the challenges faced by organizations on the road to becoming more "social" in their social media presence and in their health and risk communication. Subsequently, we propose an integrative approach that combines three complementary paths: (1) putting the "social" back into health organizations' culture by inserting more "social" content into the internal organizational discourse through consultation with experts from different fields, including those who diverge from the scientific consensus. (2) Using strategies to enable health organizations to respond to the public on social networks, based on health communications research and studies on emerging infectious disease (EID) communication. (3) Engaging the public on social media based on the participatory approach, which considers the public as a partner that understands science and can work with the organizations to develop an open and innovative pandemic realm by using crowdsourcing to solve complex global health problems. For each path, we define the current challenges, among which are (1) overcoming organizational groupthink and hidden profiles, (2) treating all unofficial information as misleading, and (3) insufficient public engagement in solving complex global problems. We then offer recommendations for dealing with each challenge.

Who are the "Real" Experts? The Debate Surrounding COVID-19 Health Risk Management: An Israeli Case Study.

BACKGROUND: The uncertainty surrounding the COVID-19 crisis and the different approaches taken to manage it have triggered scientific controversies among experts. This study seeks to examine how the fragile nature of Israeli democracy accommodated differences of opinion between experts during the COVID-19 crisis. OBJECTIVE: To map and analyze the discourse between experts surrounding issues that were the topic of scientific controversy. To examine the viewpoints of the public regarding the positions of the different experts. METHODS AND SAMPLE: A sequential mixed study design. The qualitative research was a discourse analysis of 435 items that entailed mapping the voices of different experts regarding controversial topics. In the quantitative study, a total of 924 participants answered a questionnaire examining topics that engendered differences of opinion between the experts. RESULTS: The results showed that there was no dialogue between opposition and coalition experts. Moreover, the coalition experts labeled the experts who criticized them as "coronavirus deniers" and "anti-vaxxers." The coalition changed its opinion on one issue only-the issue of lockdowns. When we asked the public how they see the scientific controversy between the coalition and the opposition experts, they expressed support for opposition policies on matters related to the implications of the lockdowns and to transparency, while supporting government policy mainly on topics related to vaccinations. The research findings also indicate that personal and socio-demographic variables can influence how the public responds to the debate between experts. The main differentiating variables were the personal attribute of conservatism, locus of control, age, and nationality. CONCLUSION: Controversy must be encouraged to prevent misconceptions. The internal discourse in the committees that advise the government must be transparent, and coalition experts must be consistently exposed to the views of opposition experts, who must be free to voice their views without fear.

Using Narrative Evidence to Convey Health Information on Social Media: The Case of COVID-19.

During disease outbreaks or pandemics, policy makers must convey information to the public for informative purposes (eg, morbidity or mortality rates). They must also motivate members of the public to cooperate with the guidelines, specifically by changing their usual behavior. Policy makers have traditionally adopted a didactic and formalistic stance by conveying dry, statistics-based health information to the public. They have not yet considered the alternative of providing health information in the form of narrative evidence, using stories that address both cognitive and emotional aspects. The aim of this viewpoint paper is to introduce policy makers to the advantages of using narrative evidence to provide health information during a disease outbreak or pandemic such as COVID-19. Throughout human history, authorities have tended to employ apocalyptic narratives during disease outbreaks or pandemics. This viewpoint paper proposes an alternative coping narrative that includes the following components: segmentation; barrier reduction; role models; empathy and support; strengthening self-efficacy, community efficacy, and coping tools; preventing stigmatization of at-risk populations; and communicating uncertainty. It also discusses five conditions for using narrative evidence to produce an effective communication campaign on social media: (1) identifying narratives that reveal the needs, personal experiences, and questions of different subgroups to tailor messaging to produce targeted behavioral change; (2) providing separate and distinct treatment of each information unit or theory that arises on social networks; (3) identifying positive deviants who found creative solutions for stress during the COVID-19 crisis not found by other members of the community; (4) creating different stories of coping; and (5) maintaining a dialogue with population subgroups (eg, skeptical and hesitant groups). The paper concludes by proposing criteria for evaluating the effectiveness of a narrative.

When Politics Meets Pandemic: How Prime Minister Netanyahu and a Small Team Communicated Health and Risk Information to the Israeli Public During the Early Stages of COVID-19.

BACKGROUND: The coronavirus brought the world's leaders to the center of the media stage, where they not only managed the COVID-19 pandemic but also communicated it to the public. The means they used to communicate the global pandemic reveal their strategies and the narratives they chose to create in their nation's social consciousness. In Israel, the crisis broke out after three election cycles, such that the government in charge of the crisis was an interim government under the leadership of Prime Minister Benjamin Netanyahu, who was operating under three criminal indictments. This study sought to examine the ways in which Prime Minister Netanyahu and two senior Israel Ministry of Health officials-Director General Moshe Bar Siman Tov and Prof. Sigal Sadetsky, Head of Public Health Services-communicated information about the health crisis in Israel during what has been termed the first wave and the beginning of the second wave. METHODS AND SAMPLE: The research adopted qualitative methods (discourse, content and thematic analysis) to analyze the communication strategies and compare them to health and risk communication. Triangulated data collection from different data sources was used to increase the credibility and validity of the results. The research sample comprised the following sources from March 3 through June 21, 2020: transcripts of 19 press conferences and 12 press interviews, 95 emergency regulations signed by Prime Minister Netanyahu, and 52 articles in major Israeli newspapers. RESULTS: Netanyahu and the Health Ministry Director General used an apocalyptic narrative to communicate COVID-19 to the public. The main strategies used in constructing this narrative were intimidation, lack of information transparency, giving the public conflicting instructions contrary to the health and risk communicating approach, and using a health crisis to promote political intentions and actions. CONCLUSION: Communicating health crises to the public, particularly ongoing crises like COVID-19, requires that leaders implement the health and risk communication approach and create a cooperative narrative that does not rely on a strategy of intimidation, but rather on empathy and on fact-based and transparent information.

A mixed-methods sequential explanatory design comparison between COVID-19 infection control guidelines' applicability and their protective value as perceived by Israeli healthcare workers, and healthcare executives' response.

BACKGROUND: Healthcare workers (HCWs) are on the front line of the COVID-19 outbreak, and their constant exposure to infected patients and contaminated surfaces puts them at risk of acquiring and transmitting the infection. Therefore, they must employ protective measures. In practice, HCWs in Israel were not fully prepared for this sudden COVID-19 outbreak. This research aimed to identify and compare: (1) Israeli HCWs' perceptions regarding the official COVID-19 guidelines' applicability and their protective value, and (2) HCWs executives' response to HWCs' concern regarding personal protective equipment (PPE) shortage. METHODS: A mixed-methods sequential explanatory design consists of: (1) An online survey of 242 HCWs about the application of the guidelines and PPE, and (2) Personal interviews of 15 HCWs executives regarding PPE shortage and the measures they are taking to address it. RESULTS: A significant difference between the perceived applicability and protective value was found for most of the guidelines. Some of the guidelines were perceived as more applicable than protective (hand hygiene, signage at entrance, alcohol rub sanitizers at entrance, and mask for contact with symptomatic patients). Other were perceived as less applicable than protective (prohibited gathering of over 10 people, maintaining a distance of 2 m', and remote services). CONCLUSIONS: HCWs need the support of the healthcare authorities not only to provide missing equipment, but also to communicate the risk to them. Conveying the information with full transparency, while addressing the uncertainty element and engaging the HCWs in evaluating the guidelines, are critical for establishing trust.

Analysis of Public Perception of the Israeli Government's Early Emergency Instructions Regarding COVID-19: Online Survey Study.

BACKGROUND: On March 11, 2020, the World Health Organization (WHO) officially declared coronavirus disease (COVID-19) to be a pandemic. This posed challenges to many countries, prominent among which is communication with the public to gain their cooperation. Israel faces different challenges from other countries in its management of the COVID-19 crisis because it is in the midst of a deep constitutional crisis. OBJECTIVE: The objective of this paper was to examine the response of the Israeli public to the government's emergency instructions regarding the pandemic in terms of correlations between overall risk perception and crisis management; overall risk perception and economic threat perception; crisis management and compliance with behavioral guidelines; and crisis management and economic threat perception. We also made comparisons between crisis management and spokesperson credibility and between crisis management and the credibility of information sources. METHODS: The sample was established using an online survey that enabled rapid and effective distribution of an online questionnaire during the COVID-19 crisis. The self-selection online survey method of nonprobability sampling was used to recruit participants (N=1056) through social network posts asking the general public (aged ≥18 years) to answer the survey. RESULTS: Participants aged ≥65 years perceived higher personal risk compared to those aged 18-30 years (mean difference 0.33, 95% CI 0.04-0.61) and those aged 46-64 years (mean difference 0.38, 95% CI 0.12-0.64). Significant correlations were found between overall risk perception and attitudes toward crisis management (r=0.19, P<.001), overall risk perception and economic threat perception (r=0.22, P<.001), attitudes toward crisis management and compliance with behavioral guidelines (r=0.15, P<.001), and attitudes toward crisis management and economic threat perception (r=-0.15, P<.001). Participants who perceived that the prime minister was the most credible spokesperson evaluated the crisis management significantly higher than all other groups. The crisis management was evaluated significantly lower by participants who stated that infectious disease specialists were the most credible spokespersons. Participants for whom the Ministry of Health website was the most credible source of information evaluated the crisis management higher than all other groups. Participants for whom scientific articles were the most credible source of information evaluated the crisis management lower than those who perceived that the WHO/Centers for Disease Control and Prevention websites or Ministry of Health/hospital websites and health care workers were the most credible. CONCLUSIONS: The higher the public trust and evaluation of crisis management, the greater the compliance of the public with guidelines. It was also found that crisis management and information cannot be approached in the same way for the overall public. Furthermore, unlike other epidemics, the COVID-19 crisis has widespread economic and social consequences; therefore, it is impossible to focus only on health risks without communicating economic and social risks as well.