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.

Motivating healthcare professionals (nurses, nurse assistants, physicians) to integrate new practices for preventing healthcare-associated infections into the care continuum: turning Positive Deviance into positive norms.

BACKGROUND: The literature examining healthcare-associated infections (HAI) points to two main problems in conforming to infection prevention and control (IPC) guidelines among healthcare professionals (HP). One is the discrepancy between HPs' behavioral intentions and their implementation in practice. The other refers to how HPs maintain these practices after the intervention stage ends. The method proposed in this study seeks to address both these issues by using the Positive Peviance (PD) approach to focus on the dissemination stage of interventions. The study seeks to offer a method for disseminating 27 PD practices to 135 HPs, among them nurses, nurse assistants and physicians, so as to help them maintain IPC guidelines, offer feedback on the dissemination process and examine the impact of the dissemination stage on changes in their behavior. METHODS: The theoretical model underlying this qualitative research was the Recognition-Primed dDecision (RPD) model, which we implemented in the field of healthcare-associated infections (HAIs). Moreover, we used the Discovery & Action Dialogue (DAD) and Think Aloud (TA) techniques to describe the methodological development of simulations for HPs. Feedback from the HP demonstrators underwent content analysis, while descriptive statistics were used to characterize behavioral changes. RESULTS: HPs' information processing regarding infection prevention shifts from peripheral/automatic processing to intuition and analytical/central processing, turning PD practices into positive norms. The HPs personally experienced finding a solution and made repeated corrections until they overcame the barriers. Most of the HPs (69.4%) reported that the practices were fully implemented, together with additional practices. CONCLUSIONS: Implementation of the dissemination stage indicates that in order for HPs to integrate and assimilate practices that are not in the official guidelines, merely observing simulations is not sufficient. Rather, each staff member must personally carry out the procedures.

The influence of new information that contradicts common knowledge about earthquake preparedness in Israel: A mixed methods experiment study.

BACKGROUND: A major earthquake in Israel is inevitable. Individual risk perceptions and preparedness can mitigate harm and save lives. The gap between the public's concerns and those of experts is reflected in their differential perceptions regarding the components that influence the occurrence of an earthquake in Israel. Whereas the public believes that geographic location is the critical variable, the experts note additional variables that need to be considered. Common knowledge regarding the risks of earthquake occurrence in Israel is based on a distinction between high and low-risk areas, such that the closer a residential area is to the Great Rift Valley, the higher the risk that an earthquake will occur. OBJECTIVES: To examine the variables affecting public preparedness in Israel (effective communication agent (communicator), high and low earthquake risk areas) and the degree to which experts' knowledge contradicts respondents' common knowledge. METHODS: The study used a mixed-methods approach combining qualitative and quantitative research. The first stage included in-depth interviews with earthquake experts (n = 19). The second stage consisted of an experiment conducted among a representative sample of the public (n = 834). RESULTS: Most people believe that geographical location constitutes the main risk factor for earthquakes in Israel. Yet experts claim that additional variables affect earthquake intensity and damage: building strength, earthquake magnitude, distance from earthquake epicenter, soil type, and interaction between these four. The study found that knowledge of expert information affects public willingness to prepare. The direction of this influence depends on participants' risk perceptions regarding residential area and on degree of consistency with common knowledge. In low-risk areas, added knowledge increased willingness to prepare whereas in high-risk areas this knowledge decreased willingness. CONCLUSION: To turn expert information into common knowledge and to increase earthquake preparedness, the authorities must educate the public to generate a new public preparedness norm.

Discourse on hygiene between hospitalized patients and health care workers as an accepted norm: Making it legitimate to remind health care workers about hand hygiene.

BACKGROUND: Despite World Health Organization recommendations that patients should play a role in encouraging hand hygiene (HH) as a means of preventing infection, patient engagement remains an underused method. From the perspectives of hospitalized patients (HPs) and health care workers (HCWs) at 2 major public hospitals in Haifa, Israel, this research investigated (1) HP barriers to reminding HCWs to maintain HH, (2) HCW barriers to giving HPs instruction on proper hygiene, (3) what could help HPs and HCWs overcome these barriers, and (4) how video clips can be used to devise tailored strategies governing discourse on HH between HCWs and HPs. METHODS: Intervention type 2 design and examination of 2 population groups-HPs and HCWs-before and after intervention by means of mixed methods research. RESULTS: Both HPs and HCWs reported partial knowledge, embarrassment, and fears regarding commenting to staff, as well as a lack of cultural adaptation. The interviewees indicated that the video clips granted legitimacy to reminding HCWs about hygiene through strategies designed to identify and solve barriers, authenticity, and cultural adaptation. CONCLUSIONS: To overcome HP and HCW barriers to maintaining HH, tailored video clips on HH should specify barriers and solutions with which they can both identify, thus turning discourse on HH into an accepted norm.

Beyond the hospital infection control guidelines: a qualitative study using positive deviance to characterize gray areas and to achieve efficacy and clarity in the prevention of healthcare-associated infections.

Background: The literature is replete with attempts to design and promote customized guidelines to reduce infections during the care continuum. Paradoxically, these efforts sometimes result in gray areas where many staff members are unaware of what is required of them, which then leads to confusion, frustration, and uncertainty.We coined the phrase "gray areas" in this context to encompass the variety of situations on the care continuum that are not addressed in the accepted guidelines, and where staff members are unsure of how to proceed.The purpose of the present study was to characterize the gray areas that were reported by staff and to identify the practices of Positive Deviance (PD) individuals. We define to PD individuals as people who independently develop creative solutions to solve problems not identified by the majority in their community. Methods: A qualitative constructivist research methodology was used that included personal interviews, observations and video recordings of identified PD practices to enhance infection control. The study was conducted January through March 2018, in two Intensive Care Units (ICU) units at Hadassah Hospital, Jerusalem, Israel. Personal interviews were conducted with 82 staff members from the General ICU (GICU) and Medical ICU (MICU). Results: The study confirmed that guidelines cannot cover all the different situations that arise during the care continuum and can paradoxically result in the increased spread of hospital infections. Our study found there are numerous individuals who independently develop and implement solutions for gray areas. The creative and practical solutions of PD individuals can address the barriers and difficulties on the care continuum that were encountered by the staff in their communities. For example, inserting a central venous line is a complex practice in the general guidelines, while the PDs provided clear situation-specific solutions not covered in the guidelines. Conclusions: The recommendations of the present study are to encourage hospital personnel to create their own solutions for various situations on the care continuum, and to disseminate them within their units to achieve a bottom up change, in lieu of investing in new or specific written guidelines.

What variables are associated with the public's willingness to take measures to maintain a hygienic hospital environment?

BACKGROUND: Most of the studies on hospital infections have focused on the perceptions and reported behavior of the medical personnel. This research explore the practices undertaken both by Israeli patients and visitors, in order to maintain a hygienic hospital environment, and to locate the variables that are associated with them. METHODS: An online survey of national representative sample of Israeli hospital's visitors and patients adult population, who were hospitalized in the five years before the interview (n=209), and who visited patients in hospitals in the three years before the interview (n=454). RESULTS: Only a minority of patients (24%) comment to medical personnel about maintaining hygiene, while a majority (67%-69%) took active steps to maintain a hygienic environment. The main variables that were found to be associated with patients' making comments were level of religiousness and gender, whereas priorities, namely whether hospital infections were a high priority, and the frequency of the patient's visits to hospital outpatient clinics, were associated with self-initiated action. CONCLUSIONS: In order to reduce barriers to commenting to hospital personnel, we propose framing the subject of hospital hygiene as a matter of health literacy and a subject of public discourse, rather than a sole medical issue.

Perceptions, intentions and behavioral norms that affect pre-license driving among Arab youth in Israel.

The present study examines reported pre-license driving among youth from the population of Arab citizens of Israel. The purpose of the present study is to examine which sociodemographic variables, attitudes and perceptions about safe driving and individual and societal behavioral norms are associated with pre-license driving. The research distinguished between the factors that actually contribute to pre-license driving (reported behavior, peer norms, gender and parents' messages) and the factors that explain the intention (parental authority, social norms, parents' messages and fear of road crashes). Even though there was a significant partial overlap (84%) between those who intend to drive without a license and those who reported driving without a license, the main factors that distinguish pre-license driving groups are different from the factors that distinguish the intention to drive before receiving a license. What is unique about the findings is the identification of the context in which social norms are influential and that in which parental authority is influential. The study indicated that in the case of pre-license driving, the main motivating factor is subjective norms, whereas in the case of expecting to drive without a license, the main motivating factor is the interaction between parental authority and the messages that parents convey. While actual behavior pertains to the behavioral level, we argue that intended behavior pertains to the cognitive level. At this level, rational considerations arise, such as fear of parental punishment and fear of accidents. These considerations compete with the influence of friends and their norms, and may outweigh them. The findings suggest that it is important to safeguard youth against the influence of peer pressure as early as the stage of behavioral intentions. Follow-up studies can simulate situations of pre-license driving due to social pressure and identify the factors that might affect young people's decision-making. Moreover, providing parents with training before the accompaniment period is highly recommended.

Food consumption and nutritional labeling among immigrants to Israel from the former Soviet Union.

Nutritional labeling helps consumers make healthier choices regarding food product purchases. In this study, we examined the difference between immigrants from the former Soviet Union who emigrated to Israel beginning in 1990 (IIFSU) and the general population of Israel regarding food consumption broadly and the use of nutritional labeling specifically. A representative sample of each population (n = 592) was composed and interviewed. According to the findings, compared to the general population, the IIFSU attribute less importance to health factors in purchasing food products and information about the ingredients contained in food products; they tend not to follow nutritional labels; and report less on the need for nutritional integrative labeling. Following from this, in the second part of the study, we investigated which of the socio-economic variables is most dominant in shaping attitudes towards food consumption and nutritional labeling. Only immigration and age were found in correlation with attitudes related to healthy food consumption. In contrast, gender, education and religious observance did not affect food selection. Immigration was recognized as the main factor with more clout than the other variables. In conclusion, it is crucial to clarify immigrants' perceptions of the concept of "health" and "proper nutrition" in formulating health promotion programs.

Estimation of the prevalence of rheumatic diseases in Israel.

OBJECTIVES: To study the prevalence of rheumatic diseases in Israel by applying the Community Oriented Program for the Control of Rheumatic Diseases core questionnaire (CCQ). METHODS: Representative samples (total of 2520 people) of the Israeli Jewish population aged ≥20 were surveyed for rheumatic complaints on 4 separate occasions by the CCQ telephone interview. The findings of the telephone interview were compared with a face-to-face interview and to rheumatologist examination, in 2 separate stages. RESULTS: The telephone applied CCQ had a sensitivity level of 88.6% and specificity of 70.0% when compared with the rheumatologist evaluation (κ = 0.576) (P < 0.001). A lower prevalence of rheumatic complaints was found in the summer months (17.7%) than in winter months (26.2%, P < 0.01). Prevalence was related to country of origin (0.008 < P < 0.03) (P range in separate surveys) and increasing age (P < 0.001) and was higher in women than in men (0.003 < P < 0.043). Body sites most affected were the lower back (63%) and the knees (47%). Medically related unemployment was more common in those with rheumatic complaints (7.9%) than in those without such complaints (2.9%, P < 0.01). Among those with rheumatic ailments, 12.7% had a related discapacity recognized by the Israeli National Insurance Institute. CONCLUSIONS: The telephone applied CCQ was reliable in screening for rheumatic complaints. Rates for rheumatic complaints in Israel were similar to those in some other countries. Rheumatic complaints were common, age- and gender-related, associated with work discapacity, and with country of origin. This is the first longitudinal prevalence survey of rheumatic complaints in Israel.