Factors Predicting Compliance with the Uptake of the Third COVID-19 Vaccine among the Arab Minority in Israel

Between December 2020 and February 2021, Israel administered two doses of COVID-19 vaccine to >50% of its adult population. Nonetheless, due to declining immunity and the spread of the COVID-19 delta variant, the government offered a third COVID-19 vaccine dose in July 2021. Although the vaccine was shown to provide effective protection against severe illness, the compliance rate among the Arab minority remained low. The present study sought to identify the factors predicting willingness to uptake the COVID-19 vaccine in the Arab community. An online survey of 2486 participants was conducted in November 2021 to assess vaccination-related behaviours, such as perceived benefits, barriers, incentives (e.g., the green pass), subjective norms, and pandemic fatigue. Positive correlations were found among reasons for obtaining a green pass, trust in formal authorities, perceived effectiveness of the third COVID-19 vaccine dose, subjective norms, and attitudes toward the booster dose. Pandemic fatigue was positively correlated with vaccination barriers. Trust in authorities, perceived booster dose effectiveness, subjective norms, and attitudes were negatively related to pandemic fatigue and barriers to vaccination. Demographic variables such as age, education level, and income level were positively related to odds of getting the booster. Participants who reported being religious exhibited a lower rate of booster dose compliance than secular participants. The study findings show that the reasons for acquiring a green pass were positively correlated with the perceived effectiveness of the booster dose, demonstrating that individuals understood the vaccine benefits. Further, having a green pass was negatively related to barriers. Incentives such as the green pass play a major role in encouraging the population to take the COVID-19 vaccine. In addition, public campaigns to explain the health benefits and refute erroneous myths support higher vaccination rates.

Depression, Stress and the Mediating Role of Intimate Partner Violence (IPV) Among Israeli Women of Childbearing Age in the Shadow of the COVID-19 Pandemic.

Dealing with the outbreak of the new coronavirus has generated unprecedented challenges around the world, including in Israel. Women of childbearing age may be forced to live under particularly difficult circumstances during the pandemic. The current study among Israeli women of childbearing age has three main objectives related to the specific period of the COVID-19 pandemic: to study the prevalence and predictors of intimate partner violence (IPV); to investigate the prevalence and predictors of depression; to examine whether IPV mediates the association between general stress, fear of COVID-19 and depression as an outcome. In a cross-sectional study, 722 married women, Jewish and Arab residents of Israel, were recruited to answer an online self-completion questionnaire during the first wave of the COVID-19 pandemic. The questionnaire included an assessment of their degree of general stress and depression, fear of COVID-19, experiences of IPV and demographic variables. The results of the current study show that a high percentage of women reported IPV (with Muslim women reporting higher IPV than Jewish women), perceived stress (PSS), perceived COVID-19 stress and depression. The findings also show that IPV and its three dimensions mediate the relationship between COVID-19 stress and depression, such that higher stress was related to higher IPV, raising the odds for depression. Moreover, the total scores for IPV and emotional violence were found to mediate the relationship between stress and depression. That is, domestic violence explains part of the association between stress and depression during the COVID-19 pandemic. Indeed, the current pandemic has resulted in an increase in IPV and depression, and especially in the specific stress associated with the disease itself. Based on the findings of the current study, preventing violence will reduce stress-related depression. The Muslim population, and especially those who are more religious, is in particular need of intervention.

Low Response to the COVID-19 Vaccine Among the Arab Population in Israel: Is It a Cultural Background, or a Systemic Failure, or Maybe Both?

INTRODUCTION: A low response to COVID-19 vaccination was observed among the Arab population in Israel. Efforts to improve this achieved moderate results. OBJECTIVES: The aim of this study was to examine the extent to which demographic and cultural factors, the media, trust, perceptions, and government policies influence the willingness of Arabs to be vaccinated against COVID-19. METHODS: A cross-sectional survey was conducted among Israeli Arabs (558 respondents). The questionnaire was distributed through social networks between January 16 and 26, 2021. The t-tests, Chi-square tests, Z tests, which were used to evaluate the significance of variables, and Pearson correlations calculated for the study variables were used for statistical analysis. Hierarchical logistic regression was calculated to assess the extent of background influence on the odds for vaccination, and mediation was examined using the Process procedure. RESULTS: Moderate means were found for attitudes towards vaccination, vulnerability, vaccine effectiveness, and pandemic fatigue. A lower score was found for accessibility to medical services, social norms, and emotional barriers. Trust was highest in health-related authorities, whereas trust in government and the media was the lowest. Higher pandemic fatigue was associated with lower trust and lower odds for vaccination. DISCUSSION: Lack of awareness of the specific needs of the Arab minority in Israel, lack of vaccination campaigns in Arabic language, long neglect of Arabs in the Israeli health system, mistrust of governmental authorities by the Arabs, and low socioeconomic background of Israeli Arabs might have led to lower trust levels and incompliance with governmental policies among Arabs. Addressing these issues may benefit the entire population. The authors believe that "A chain (in population health) is only as strong as its weakest link."

Cross-Sectional Study of Factors Influencing Perceived Threat and Stress among the Arab Minority in Israel during the COVID-19 Pandemic.

This study aimed to examine the impact of the locus of control, coping strategies and loneliness on perceived threat and stress among the Arab minority in Israel during the first COVID-19 closure. This was a cross-sectional online study, with 486 participants who completed a questionnaire measuring the study variables during the period of 28-31 March 2020. Statistical analyses included t-tests and analyses of variance. Means, standard deviations and intercorrelations for the study variables were calculated. The results revealed a moderate-low level of stress and a moderate-high level of perceived threat. Higher stress was related to higher perceived threat, a greater external locus of control, lower problem-focused coping, higher emotion-focused coping and social support-seeking and higher loneliness. Perceived threat was positively related to both problem-focused coping and emotion-focused coping. The results show that the Arab population in Israel coped as a strong minority group. This study contributes to our understanding of how minority groups cope in the current epidemic and to the identification of effective strategies for reducing stress during this challenging period. The study's results may help devise intervention programs that foster more effective coping capabilities among this and other minority populations.

Compliance with COVID-19 Preventive Guidelines Among Minority Communities: the Case of Israeli Arabs.

OBJECTIVES: The Arab ethnic minority makes up 21% of Israel's population and accounted for 40.5% of confirmed cases during the second wave of COVID-19. This study aims to assess the characteristics of compliance with the guidelines of the Ministry of Health and related factors that can explain the outbreak of COVID-19 among the Arab population during the second wave. METHODS: A cross-sectional online survey was conducted among 810 respondents from the Arab community during October 2020. The survey was distributed via social media such as Facebook and WhatsApp. The health belief model items, the theory of reasoned action items, trust in formal institutions, and pandemic fatigue were assessed, and a path analysis was performed. RESULTS: Positive correlations were demonstrated between both personal and social networks compliance (nuclear family, extended family, friends, etc.) and perceived severity of COVID-19, trust in formal institutions, attitudes toward compliance, and subjective norms (r = .12 to r = .64, p < .001, N = 810). Pandemic fatigue was negatively correlated with personal and social networks compliance, perceived severity of COVID-19, trust in institutions, attitudes toward compliance, and subjective norms (r = - .21 to r = - .48, p < .001). Positive correlations were evident between compliance with quarantine and perceived severity of COVID-19 and attitudes (r = .31 and r = .28, p < .001, respectively). Personal compliance was significantly lower among men (M = 3.93, SD = 0.94) and younger respondents (M = 4.14, SD = 0.71), while social networks compliance was lower among Muslims (M = 3.78, SD = 0.75). The negative relationship between pandemic fatigue and personal compliance was mediated by lower perceived severity of COVID-19, attitudes toward compliance, and subjective norms (p < .001). The negative relationship between pandemic fatigue and social network compliance was mediated by lower trust in institutions and subjective norms (p < .001). Lower perceived severity of COVID-19 mediated the relationship between higher pandemic fatigue and lower quarantine compliance (p = .003). CONCLUSIONS: The results highlight the important of perception of the disease severity, social and subjective norms, and the central role of trust in determining adherence to guidelines. Thus, increasing trust on authorities and planning tailored-maid interventions can raise compliance with the preventive guidelines and prevent the spread of the virus. Such interventions will address the characteristics of minority populations and take into account the implications of the guidelines and the possibility that may lead to fatigue, which in turn will lead to non-compliance with those guidelines.

Factors Associated with Decisions of Arab Minority Parents in Israel to Vaccinate Their Children against COVID-19.

The Arab ethnic community in Israel is characterized by low social economic status and is at risk due to the typically crowded households. Understanding parents' level of awareness is important to avoid new outbreaks. OBJECTIVES: This study seeks to identify predicting factors associated with perceived susceptibility to COVID-19, and barriers to COVID-19 vaccination. MATERIALS AND METHODS: A survey was conducted through social media, using snowball sampling via social networks. Additionally, t-tests, Chi-square tests, and Z tests were used to evaluate differences between independent proportions. Pearson correlations were calculated for the study variables. Multiple logistic regression examined the extent to which the background variables were related to the intention to vaccinate the child. RESULTS: A total of 2843 Arab parents participated in the study. Older parents, higher socioeconomic status, higher trust in the authorities, vaccinated parents, and low psychological and physical barriers were positively correlated with willingness to vaccinate children. Pandemic fatigue was associated with less positive attitudes and reduced perceived effectiveness toward vaccination. CONCLUSION: Addressing minorities' poor standards of living and physical and psychological barriers posed by the authorities to minorities' access to vaccination may increase compliance with COVID-19 vaccination and protect the health of the entire population.

Distancing Adherence and Negative Emotions among the Israeli Elderly Population during the COVID-19 Pandemic.

Social distancing was found to prevent COVID-19 contagion. Therefore, understanding the factors associated with the public's adherence is important. Acknowledging the importance of emotional wellbeing regarding older people's health, and understanding their emotional state during the pandemic, are crucial. This study assessed factors associated with older people's adherence to social distancing and their emotional status. A cross-sectional online survey was conducted among 1822 respondents above the age of 60. Distancing adherence, negative emotion, trust, social support, threat perception, attitudes, and subjective norms were assessed, and a path analysis was performed. Adherence was positively associated with attitudes (ß = 0.10; p < 0.001), and with subjective norms (ß = 0.19; p < 0.001). Negative emotions were positively associated with threat perception (ß = 0.33; p < 0.001), and negatively associated with social support (ß = -0.13; p < 0.001) and subjective norms (ß = -0.10; p < 0.001). Attitudes mediated the relationship of threat perception (95% CI = 0.009, 0.034), trust (95% CI = 0.008, 0.029), and social support (95% CI = 0.006, 0.023) with distancing adherence. Subjective norms mediated the relationship between threat perception (95% CI = 0.014, 0.034), trust (95% CI = 0.026, 0.055), and social support (95% CI = 0.002, 0.048) with distancing adherence. Subjective norms mediated the relationship between threat perception (95% CI = -0.022, -0.006), trust (95% CI = -0.034, -0.010), and social support (95% CI = -0.029, -0.009) with negative emotions. When promoting social distancing adherence, subjective norms and attitudes must be considered, as they play a role in promoting adherence and negative-emotion regulation.

Stress and perceived discrimination among the Arab population in Israel: the mediation role of the perceived COVID-19 threat and trust in the healthcare system.

During pandemics, minorities may experience high stress levels, which could harm their mental and physical health. However, to the best of our knowledge, this has not been examined among minorities in Israel during the COVID-19 pandemic. This study, therefore, explores stress among the Arab minority in Israel during the first wave of the COVID-19 outbreak, and its association with the population's perceived COVID-19 threat, trust in the healthcare system, adherence to preventative guidelines, and perceived discrimination.The study analyzed a cross-sectional online survey of 626 Israeli Arabs. Most participants (65%) reported moderate levels of stress, and 10% reported severe levels. The Bedouin population reported significantly higher levels of stress compared to other minority groups. The participants also reported a high degree of perceived threat, a moderate-to-high level of discrimination, a moderate level of trust in the healthcare system, and very high adherence to guidelines.Hierarchical regression analysis showed that age, religion, trust in the healthcare system, perceived threat, and adherence to guidelines were all significant predictors of stress [F(11,600), p < .001]. The model explained 24% of the variance in stress. Structural equation modeling (SEM) revealed that the participants' perceived threat and trust mediated the association between their perceived discrimination and stress [indirect effect = 0.13, SE = 0.03 CI = (0.08, 0.18)], whereby discrimination was negatively associated with trust (ß = -0.52), which, in turn, was negatively associated with stress (ß = -0.10). Furthermore, discrimination was positively associated with perceived threat (ß = 0.21), which, in turn, was positively associated with stress (ß = 0.35). Discrimination is an important social determinant of health - especially during health emergencies when trust in healthcare systems and perceived threats are crucial. As such, our findings could assist policymakers in developing fair policies that are tailored to various population groups and that may reduce stress levels among minorities, thereby improving both their mental and physical health.