Matching Digital Intervention Affordances with Tasks: The Case of a Zoom and WhatsApp Mental Health Intervention for Seniors during the COVID-19 Pandemic.

During the first COVID-19 wave, we conducted a Zoom and WhatsApp digital group intervention that promoted community-dwelling seniors' mental health. A total of 82 community-dwelling adults participated in this intervention. Based on the media richness theory (MRT) and the affordances approach, we used netnography to explore how group moderators and technical support team members (n = 9), but not the seniors themselves, perceived the ways Zoom and WhatsApp technological affordances/constraints matched intervention tasks and increased intervention performance. We identified four Zoom and WhatsApp affordances: temporality, interactivity, multimediality, and portability. Empirically, our findings represent a first step in creating a conceptual framework for analyzing digital intervention performances that addresses users' perceptions of technologies and intervention goals. Theoretically, our synergic analysis of MRT and the affordances approach offers a cohesive framework that shifts from a focus on users' interactions with one type of media to their interactions with all media that are used in attaining intervention goals.

Changes in General and Virus-Specific Anxiety During the Spread of COVID-19 in Israel: A 7-Wave Longitudinal Study.

We compared 3 hypothetical trajectories of change in both general and coronavirus disease 2019 (COVID-19)-specific anxiety during the first wave of the spread in the state of Israel: panic (very high anxiety, either from the outset or rapidly increasing), complacency (stable and low anxiety), and threat-sensitive (a moderate, linear increase compatible with the increase in threat). A representative sample of 1,018 Jewish-Israeli adults was recruited online. A baseline assessment commenced 2 days prior to the identification of the first case, followed by 6 weekly assessments. Latent mixture modeling analyses revealed the presence of 3 trajectories: 1) "threat-sensitivity" (29% and 66%, for general and virus-specific anxiety, respectively), 2) panic (12% and 25%), and 3) complacency (29% and 9%). For general anxiety only, a fourth class representing a stable mid-level anxiety was identified ("balanced": 30%). For general anxiety, women and the initially anxious-both generally and specifically from the spread of the virus-were more likely to belong to the panic class. Men and older participants were more likely to belong to the complacency class. Findings indicate a marked heterogeneity in anxiety responses to the first wave of the spread of COVID-19, including a large group evincing a "balanced" response.

Perceptions about the accessibility of healthcare services among ethnic minority women: a qualitative study among Arab Bedouins in Israel.

BACKGROUND: Access to healthcare services has major implications for vulnerable populations' health. Socio-cultural and gender characteristics shape the utilization and access of healthcare services among ethnic minorities worldwide. One such vulnerable ethnic minority is the Arab Bedouin women in Israel. As women, they are marginalized in their community, where women do not have full equity and they experience multiple barriers to healthcare services The main objective of this study is to provide a nuanced, experiential, emic description of healthcare accessibility issues among Bedouin women in Israel. Identifying the barriers, they face in accessing healthcare may help healthcare policymakers make changes based on and tailored to Bedouin women's needs. METHODS: A qualitative study included in-depth semi-structured interviews with 21 Arab Bedouin village residents, consisting of 14 women and 7 men. Eligible participants were Arab Bedouins over 18 years of age and who used healthcare services at least once in the last 5 years. The interviews were carried out in Arabic-Bedouin dialect and included demographic questions, open-ended questions that asked about participants' perceptions regarding their experiences with healthcare services, including the factors that helped and hindered them in accessing these services and questions regarding suggestions for improving the accessibility of healthcare services based on the identified needs. Data collected were analyzed using thematic analysis. Study trustworthiness was ensured using audit, reflexivity, and peer debriefing. RESULTS: Arab Bedouin women experienced varied barriers while accessing healthcare services. This study uncovered how language, cultural and gender barriers intersect with other disadvantages ingrained in social norms, values and beliefs and affect the access of a minority women subgroup to healthcare services. The participants identified subgroups of Bedouin women (e.g. elderly Bedouin women) affected differently by these barriers. CONCLUSION: Taking into consideration the identified needs and the Arab Bedouin women's unique characteristics, along with adopting the intersectional approach should help improve access to healthcare services among such a vulnerable subgroup and other subgroups within minorities worldwide.

Culture and personal influences on cardiopulmonary resuscitation- results of international survey.

BACKGROUND: The ethical principle of justice demands that resources be distributed equally and based on evidence. Guidelines regarding forgoing of CPR are unavailable and there is large variance in the reported rates of attempted CPR in in-hospital cardiac arrest. The main objective of this work was to study whether local culture and physician preferences may affect spur-of-the-moment decisions in unexpected in-hospital cardiac arrest. METHODS: Cross sectional questionnaire survey conducted among a convenience sample of physicians that likely comprise code team members in their country (Indonesia, Israel and Mexico). The questionnaire included details regarding respondent demographics and training, personal value judgments and preferences as well as professional experience regarding CPR and forgoing of resuscitation. RESULTS: Of the 675 questionnaires distributed, 617 (91.4%) were completed and returned. Country of practice and level of knowledge about resuscitation were strongly associated with avoiding CPR performance. Mexican physicians were almost twicemore likely to forgo CPR than their Israeli and Indonesian/Malaysian counterparts [OR1.84 (95% CI 1.03, 3.26), p = 0.038]. Mexican responders also placed greater emphasison personal and patient quality of life (p <  0.001). In multivariate analysis, degree of religiosity was most strongly associated with willingness to forgo CPR; orthodox respondents were more than twice more likely to report having forgone CPR for apatient they do not know than secular and observant respondents, regardless of the country of practice [OR 2.12 (95%CI 1.30, 3.46), p = 0.003]. CONCLUSIONS: In unexpected in-hospital cardiac arrest the decision to perform or withhold CPR may be affected by physician knowledge and local culture as well as personal preferences. Physician CPR training should include information regarding predictors of patient outcome at as well as emphasis on differentiating between patient and personal preferences in an emergency.

Healthcare workers' willingness to respond following a disaster: a novel statistical approach toward data analysis.

BACKGROUND: The willingness of healthcare workers (HCW) to respond is an important factor in the health system's response capacity during emergencies. Although much research has been devoted to exploring this issue, the statistical methods employed have been predominantly traditional and have not enabled in-depth analysis focused on absenteeism-prone employees during emergencies. The present study employs an innovative statistical approach for modeling HCWs' willingness to respond (WTR) following an earthquake. METHODS: A validated questionnaire measuring knowledge, perceptions, and attitudes toward an earthquake scenario was distributed among Israeli HCWs in a hospital setting. Two regression models were employed for data analysis - a traditional linear model, and a quantile regression model that makes it possible to examine associations between explanatory variables across different levels of a dependent variable. A supplementary analysis was performed for selected variables using broken line spline regression. RESULTS: Females under the age of forty, and nurses were the most absenteeism-prone sub-groups of employees (showed low WTR) in earthquake events. Professional commitment to care and perception of efficacy were the most powerful predictors associated with WTR across all quantiles. Both marital status (married) and concern for family wellbeing, designated as statistically significant in the linear model, were found to be statistically significant in only one of the WTR quantiles (the former in Q10 and the latter in Q50). Gender and number of children, which were not significantly associated with WTR in the linear model, were found to be statistically significant in the 25th quantile of WTR. CONCLUSIONS: This study contributes to both methodological and practical aspects. Quantile regression provides a more comprehensive view of associations between variables than is afforded by linear regression alone. Adopting an advanced statistical approach in WTR modeling can facilitate effective implementation of research findings in the field.

Quality of coding diagnoses in emergency departments: effects on mapping the public's health.

BACKGROUND: Emergency department (ED) attendees reflect the health of the population served by that hospital and the availability of health care services in the community. OBJECTIVES: To examine the quality and accuracy of diagnoses recorded in the ED to appraise its potential utility as a guage of the population's medical needs. METHODS: Using the Delphi process, a preliminary list of health indicators generated by an expert focus group was converted to a query to the Ministry of Health's database. In parallel, medical charts were reviewed in four hospitals to compare the handwritten diagnosis in the medical record with that recorded on the standard diagnosis "pick list" coding sheet. Quantity and quality of coding were assessed using explicit criteria. RESULTS: During 2010 a total of 17,761 charts were reviewed; diagnoses were not coded in 42%. The accuracy of existing coding was excellent (mismatch 1%-5%). Database query (2,670,300 visits to 28 hospitals in 2009) demonstrated potential benefits of these data as indicators of regional health needs. CONCLUSIONS: The findings suggest that an increase in the provision of community care may reduce ED attendance. Information on ED visits can be used to support health care planning. A "pick list" form with common diagnoses can facilitate quality recording of diagnoses in a busy ED, profiling the population's health needs in order to optimize care. Better compliance with the directive to code diagnosis is desired.

[How deaf people cope in routine and emergency situations - suggested paths for thought and action].

Deaf people have unique characteristics and needs. There is a limited amount of research regarding the needs of deaf people, and no studies were found concerning deaf people in emergency situations. The absence of the sense of hearing in deaf people is only one component of the complexity of their world. Many factors contribute to this complexity, but the most striking is the means of communication between the deaf and the hearing person and vice versa. Changes during emergency situations present a challenge for hearing individuals, and even more so, for deaf people. Deaf individuals experience difficulty in obtaining and transmitting information, accessing care and more. These difficulties often result in the dependency of the deaf person on others. The State of Israel enacted laws targeted to facilitate the access of individuals with disabilities in general, and deaf people in particular, to public services. In emergencies, the Home Front Command and the Ministry of Social Welfare distribute pagers to the deaf population, as a device to communicate warning alerts. However, these devices do not fulfil the need for accessible care, bi-directional flow of information, and additional needs that arise during times of emergency. The deaf population is a cultural minority, whose needs in emergency situations are unknown. Familiarity with the deaf population is the first step towards improving treatment and communication that are apt for this population. This paper reviews what is known in the literature about this topic and presents an attempt to bridge the gap of knowledge and barriers to communication between the deaf population and

[How deaf people cope in routine and emergency situations - suggested paths for thought and action].

Oeaf people have unique characteristics and needs. There is a limited amount of research regarding the needs of deaf people, and no studies were found concerning deaf people in emergency situations. The absence of the sense of hearing in deaf people is only one component of the complexity of their world. Many factors contribute to this complexity, but the most striking is the means of communication between the deaf and the hearing person and vice versa. Changes during emergency situations present a challenge for hearing individuals, and even more so, for deaf people. Deaf individuals experience difficulty in obtaining and transmitting information, accessing care and more. These difficulties often result in the dependency of the deaf person on others. The State of Israel enacted laws targeted to facilitate the access of individuals with disabilities in general, and deaf people in particular, to public services. In emergencies, the Home Front Command and the Ministry of Social Welfare distribute pagers to the deaf population, as a device to communicate warning alerts. However, these devices do not fulfil the need for accessible care, bi-directional flow of information, and additional needs that arise during times of emergency. The deaf population is a cultural minority, whose needs in emergency situations are unknown. Familiarity with the deaf population is the first step towards improving treatment and communication that are apt for this population. This paper reviews what is known in the literature about this topic and presents an attempt to bridge the gap of knowledge and barriers to communication between the deaf population and

Cardiopulmonary resuscitation skills retention and self-confidence of preclinical medical students.

BACKGROUND: Sudden cardiac death is the most common lethal manifestation of heart disease and often the first and only indicator. Prompt initiation of cardiopulmonary resuscitation (CPR) undoubtedly saves lives. Nevertheless, studies report a low level of competency of medical students in CPR, mainly due to deterioration of skills following training. OBJECTIVES: To evaluate the retention of CPR skills and confidence in delivering CPR by preclinical medical students. METHODS: A questionnaire and the Objective Structured Clinical Examination (OSCE) were used to assess confidence and CPR skills among preclinical, second and third-year medical students who had passed a first-aid course during their first year but had not retrained since. RESULTS: The study group comprised 64 students: 35 were 1 year after training and 29 were 2 years after training. The groups were demographically similar. Preparedness, recollection and confidence in delivering CPR were significantly lower in the 2 years after training group compared to those 1 year after training (P < 0.05). The mean OSCE score was 19.8 +/- 5.2 (of 27) lower in those 2 years post-training than those 1 year post-training (17.8 +/- 6.35 vs. 21.4 +/- 3.4 respectively, P = 0.009). Only 70% passed the OSCE, considerably less in students 2 years post-training than in those 1 year post-training (52% vs. 86%, P < 0.01). Lowest retention was found in checking safety, pulse check, airway opening, rescue breathing and ventilation technique skills. A 1 year interval was chosen by 81% of the participants as the optimal interval for retraining (91% vs. 71% in the 2 years post-training group vs. the 1 year post- training group respectively, P = 0.08). CONCLUSIONS: Confidence and CPR skills of preclinical medical students deteriorate significantly within 1 year post-training, reaching an unacceptable level 2 years post-training. We recommend refresher training at least every year.

Conjoint Community Resiliency Assessment Measure-28/10 items (CCRAM28 and CCRAM10): A self-report tool for assessing community resilience.

Community resilience is used to describe a community's ability to deal with crises or disruptions. The Conjoint Community Resiliency Assessment Measure (CCRAM) was developed in order to attain an integrated, multidimensional instrument for the measurement of community resiliency. The tool was developed using an inductive, exploratory, sequential mixed methods design. The objective of the present study was to portray and evaluate the CCRAM's psychometric features. A large community sample (N = 1,052) were assessed by the CCRAM tool, and the data was subjected to exploratory and confirmatory factor analysis. A Five factor model (21 items) was obtained, explaining 67.67 % of the variance. This scale was later reduced to 10-item brief instrument. Both scales showed good internal consistency coefficients (α = .92 and α = .85 respectively), and acceptable fit indices to the data. Seven additional items correspond to information requested by leaders, forming the CCRAM28. The CCRAM has been shown to be an acceptable practical tool for assessing community resilience. Both internal and external validity have been demonstrated, as all factors obtained in the factor analytical process, were tightly linked to previous literature on community resilience. The CCRAM facilitates the estimation of an overall community resiliency score but furthermore, it detects the strength of five important constructs of community function following disaster: Leadership, Collective Efficacy, Preparedness, Place Attachment and Social Trust. Consequently, the CCRAM can serve as an aid for community leaders to assess, monitor, and focus actions to enhance and restore community resilience for crisis situations.

Do Attachment Orientations Relate to Coping with Crises? Lessons from a Cross-Sectional Study during the COVID-19 Pandemic.

This study was designed to explore whether attachment orientations were related to distress and resilience during the COVID-19 pandemic. The sample included 2000 Israeli Jewish adults who answered an online survey during the first phase of the pandemic. The questions referred to background variables, attachment orientations, distress, and resilience. Responses were analyzed using correlation and regression analyses. A significant positive relationship was found between distress and attachment anxiety, and a significant negative relationship was found between resilience and attachment insecurities (avoidance and anxiety). Women suffered higher distress, as did people with lower income, poor health, secular religious affiliation, a lack of a sense of spacious accommodation, and a dependent family member. The findings indicate that attachment insecurities are associated with the severity of mental health symptoms during the peak period of the COVID-19 pandemic. We recommend strengthening attachment security as a protective factor for psychological distress in therapeutic and educational settings.

[Factors influencing the performance of medical teams in the early assessment of exposure to radiation--in accident or man-made radiological disasters].

"RadioLogical events" are the general term used to describe various scenarios that involve radiological and nuclear mishaps. These may occur in different settings such as in a nuclear plant, during transportation of isotopes, in a medical or industrial venue, as a result of an accident, natural disaster or as a means of terror or war. Radiological events carry dire medical consequences and are therefore of great concern to both the public and the authorities. The recent disaster in Japan brought the issue of the safety of nuclear pLants to the civil populations residing around them to the public eye once again. A nuclear disaster poses a professional challenge to the medical teams that need to treat victims. Studies show that the readiness and willingness to care for radiation victims is influenced by many factors, among them are knowledge and skills, the resources available and more. The ability of triage staff to identify radiation victims and to identify those prone to deteriorate, will have an effect on the staff's feeling of competitiveness and willingness to treat. Risk communication is an important contributor to the ability to handle the situation properly. Good communication can alleviate concerns in the public and mediate the response in a way that will prevent an overflow of the system by "worried well". The aim of this literature review is to describe the factors that encourage the functioning of teams in a radiological event and to identify and highlight the factors that can influence their performance (positively or negatively).

Inequalities in Trust Levels and Compliance With Physical Distancing During COVID-19 Outbreaks: Comparing the Arab Minority and Jewish Populations in Israel.

Objectives: This study explores associations between trust in directives and compliance with physical distancing by comparing two populations in Israel. Methods: Following two lockdowns, we conducted two cross-sectional surveys among the Arab minority and Jewish citizens of Israel (first survey, N = 613; second survey, N = 542). We conducted multivariable logistic regression analyses for the association between trust and compliance with physical distancing separately for each group in each survey. Results: In both surveys trust levels were significantly lower among Arabs than Jews (p < 0.001). Compared to Jews, Arabs were less likely to report compliance with physical distancing in the first and second surveys (OR = 0.52, 95% CI 0.32-0.84 and OR = 0.62, 95% CI 0.39-0.98, respectively). In both surveys trusting the directives was an important determinant of compliance with physical distancing among Jews only. Conclusion: Our findings indicate that momentum is important in building and maintaining public trust and compliance during pandemics. Policymakers should note the lack of trust among Arabs, which warrants further research and interventions.

Conservation of Resources, Psychological Distress, and Resilience During the COVID-19 Pandemic.

Objectives: The Conservation of Resources (COR) theory suggests that stress results from threatened or actual loss of resources following significant life events. This study used COR theory as the framework to explore the reflection of loss of resources during the COVID-19 pandemic on psychological distress and resilience, in an adult Jewish Israeli population. Methods: We examined the association between background variables, stress, loneliness, concern, COVID-19-related post traumatic symptoms (PTS), resilience factors and COR via an online survey among 2,000 adults during April 2020. Results: Positive relationships were identified between resource loss and PTS (r = 0.66, p < 0.01), and between resource gain and resilience (r = 0.30, p < 0.01). Psychological variables were significantly associated with PTS and explained 62.7% of the variance, F (20, 1,413) = 118.58, p < 0.001. Conclusion: Loss of resources, stress, loneliness and concern were found to be risk factors for distress and PTS, whereas resilience factors played a protective role. We thus recommend using the COR theory to explore COVID-19 effects elsewhere.

Evaluation of a Short-Term Digital Group Intervention to Relieve Mental Distress and Promote Well-Being Among Community-Dwelling Older Individuals During the COVID-19 Outbreak: A Study Protocol.

Older individuals are at an increased risk of experiencing adverse social and health consequences due to both the COVID-19 pandemic and the measures taken to manage it, such as social distancing. To promote community-dwelling older individuals' well-being during this time, the aims of the current project are to develop effective strategies in order (a) to increase older individuals' digital literacy, and (b) to help them acquire behavioral and cognitive skills that will improve their coping abilities with the stressful situation created as a result of the pandemic, as well as reducing adverse mental health effects. The project comprises an intervention arm that includes digital group sessions for older individuals meant to improve their digital literacy, promote their effective coping, and relieve their mental distress and loneliness. Subjects receive a short-term (seven sessions), twice-weekly, digitally guided group intervention through Zoom (a video conferencing app), and WhatsApp (instant messaging app). The wait list control-group participants receive twice-weekly telephone calls from a research assistant during a parallel period. Web-based questionnaires are filled in pre- and post-participation. The effectiveness of the intervention will be analyzed by comparing pre- and post-measures, between intervention and control groups. This protocol offers a model for helping to support vulnerable populations during the COVID-19 pandemic. However, it is applicable regardless of the outbreak of a global health crisis or the imposition of lockdown rules; in fact, it has the potential to contribute to the social inclusion of vulnerable populations during routine times as well as during emergencies. Furthermore, ideas for future expansion include the integration of multilingual facilitators in order to reach seniors from underserved minority groups in various social contexts, even across borders.

Development and validation of the Continuous Traumatic Stress Response scale (CTSR) among adults exposed to ongoing security threats.

BACKGROUND: Current diagnostic criteria for posttraumatic stress disorder (PTSD) do not include symptoms resulting from exposure to continuous or ongoing traumatic stress. Thus existing assessment tools do not fully capture stress symptoms associated with exposure to threats that extend over months or years. To address this void, we enumerated the symptoms associate with ongoing exposure to stress including those that are distinct from existing PTSD diagnostic criteria. OBJECTIVES: To develop the Continuous Traumatic Stress Response Scale (CTSR) and assess its psychometric properties. METHOD: We sampled 313 adults exposed and unexposed to ongoing security threat between December 2016 and February 2017. Respondents lived in communities bordering the Gaza Strip in southern Israel where they are exposed to frequent rocket attacks, requiring they locate and find shelter in 30 seconds or less. We assessed the concurrent validity of CTSR relative to the Posttraumatic Diagnostic Scale (PDS). RESULTS: On the basis of exploratory factor analysis (EFA), we retained 11 of 25 items measuring three distinct factors: exhaustion/detachment, rage/betrayal, and fear/helplessness. We found moderate concurrence between the scales; that is, the CTSR appears to measure a construct related to, but distinct from PTSD. This conclusion is supported by confirmatory factor analysis (CFA) indicating that each factor significantly contributes to measurement of a higher-order, continuous traumatic stress latent construct. CONCLUSIONS: These results support the psychometric properties of CTSR. Future research is required to confirm these findings in other countries and cultures and among individuals exposed to other forms of continuous traumatic stress.

Teaching and Practicing Cognitive-Behavioral and Mindfulness Skills in a Web-Based Platform among Older Adults through the COVID-19 Pandemic: A Pilot Randomized Controlled Trial.

The outbreak of the COVID-19 pandemic has led to an acceleration in the development of web-based interventions to alleviate related mental health impacts. The current study explored the effects of a short-term digital group intervention aimed at providing cognitive behavioral and mindfulness tools and skills to reduce loneliness and depression and to increase social support among older adults in Israel. This pilot randomized controlled trial included community-dwelling older adults (n = 82; aged between 65-90 years; 80% female) who were randomized either to an intervention group (n = 64) or a wait-list control group (n = 18). The intervention included seven online sessions, over 3.5 weeks. Depression, loneliness, and social support measures were administered at baseline, immediately post-intervention, and at 1-month follow-up. Repeated measures ANOVA revealed statistically and clinically significant reductions in depression in the intervention group, with results maintained at one-month follow-up. Loneliness levels also significantly decreased post-intervention; however, this benefit was not maintained at one-month follow-up. Social support slightly increased both post-intervention and 1-month follow-up-but these changes were not statistically significant. There were no overall changes for the wait-list control group. Our intervention provided promising evidence regarding the effectiveness of an online group intervention to alleviate mental health effects and to promote the coping of older adults during the COVID-19 pandemic. This relatively simple model can be effectively utilized by communities globally to help connect lonely and isolated older inhabitants, both during the pandemic and in more routine times.

A pilot randomized controlled trial of a group intervention via Zoom to relieve loneliness and depressive symptoms among older persons during the COVID-19 outbreak.

While effective in reducing infections, social distancing during the COVID-19 outbreak may carry ill effects on the mental health of older adults. The present study explored the efficacy of a short-term digital group intervention aimed at providing seniors with the tools and skills necessary for improving their coping ability during these stressful times. A total of 82 community-dwelling adults aged between 65 aged 90 (Mage = 72 years, SD = 5.63) were randomized to either an intervention group (n = 64) or a wait-list control group (n = 18). The intervention comprised online guided sessions in small groups in which behavioral and cognitive techniques were learned and practiced via the ZOOM videoconferencing platform. Loneliness and depression levels were measured pre- and post-participation. The results demonstrated a significant improvement in the intervention group in terms of both loneliness and depressive symptoms, compared with the control group. Results of mixed effect models indicated a medium ameliorative effect on loneliness (d = 0.58), while that for depressive symptoms was only marginally significant and smaller in size (d = 0.43). Our intervention presents a relatively simple and effective technique that can be efficiently utilized to support older adults both during emergencies such as the COVID-19 outbreak, as well as in more routine times for older adults who live alone or reside in remote areas.

Factors influencing the willingness of volunteer paramedics to re-volunteer in a time of war.

BACKGROUND: Professional volunteers play a crucial role in reinforcing emergency medical services in Israel. In order to encourage volunteers to return for additional shifts, the organization should provide conditions that will assure the return, particularly at a time of self-risk such as war. In 2009 Israeli emergency medical services (Magen David Adom) were required to increase preparedness in the southern part of the country due to missile attacks on civilian populations, while continuing their routine activities, i.e., responding promptly to emergency events. In order to perform these multiple functions, MDA stations in the towns under attack were strengthened with volunteers from other regions of the country. These volunteers, trained as paramedics, served in 24-48 hour shifts. OBJECTIVES: To identify the factors influencing the willingness of volunteers to return. METHODS: A questionnaire was used to assess the satisfaction of volunteers participating in the reinforcement with regard to their physical environment, job assignment and the actual activity they were involved in. Data were analyzed using SPSS statistical software. RESULTS: During the 10 days of the study, 121 volunteers reinforced southern MDA stations and 99 (81%) of them responded to the questionnaire. We found that volunteers' willingness to return to do more shifts was affected by their welcome and reception at the station, their job assignment, and their training and preparation for performing the necessary tasks. The sleeping conditions and the number of events they participated in were also contributing factors. CONCLUSIONS: Factors that contribute to the willingness of volunteers to re-volunteer should be taken into account by organizations that rely on them.

Giving a voice to medically vulnerable populations: A mixed-methods investigation of their unique perceptions and needs in emergency situations.

Older adults in poor health represent a growing sector of the population worldwide. These medically vulnerable individuals often tend to be ill-prepared for emergencies. In times of crisis they are at higher risk of experiencing adverse health outcomes and are liable to place an additional burden on health and social care services. The aim of this study was to explore the unique perceptions and diverse needs of community-dwelling medically vulnerable individuals in Israel in order to gain insights that could be used to promote future preparedness. A mixed methods design was employed that included 16 in-depth interviews, followed by a quantitative survey of 179 participants. Data were collected between 2016 and 2017. The analysis process included thematic analysis for qualitative data. Quantitative data analysis focused on estimating associations between preparedness levels and participants' characteristics and perceptions. The results indicated low levels of preparedness-only 13.5% of participants reported having prepared a full emergency kit with supplies. Family members played a key role in almost every dimension related to emergency preparedness; alongside certain authorities perceived by the participants as responsible for initiating the preparedness process. Additional issues that emerged were related to information and communication and to the logistics of medication handling and special nutrition. The findings suggest that it is vital to adopt a proactive approach to the problem of preparedness in this population. This conclusion should be of value to health and social care practitioners in the community as well as to family members and caregivers. Practical and simple recommendations for enhancing preparedness based on these findings are provided. Viewing preparedness as a process that is the joint responsibility of the individual, the family, caregivers, and community health and social welfare services could contribute to maintaining continuity of care among vulnerable populations and mitigate adverse health outcomes in future events.