Self-employed workers with chronic health conditions: A qualitative study.

Chronic health conditions affect many individuals of working age, who cope with physical, psychological, and social difficulties that often involve limited work ability. This qualitative study explored experiences of self-employed individuals with chronic health conditions to advance our understanding of the effect of chronic illness on work. In-depth semi-structured interviews were conducted with 23 self-employed individuals coping with cancer, heart disease, inflammatory bowel disease, lung disease, or asthma. Data were analyzed with thematic analysis. Analysis of the interviews revealed four themes: uncertainty in planning work and committing to customers, acceptance versus denial of reduced work abilities, disclosure of health status to workers and customers, and temporal substitutes as a source of both support and concern. The results indicate that self-employed workers with a chronic health condition cope with unique challenges due to the need to sustain their business in the face of illness and a sense of sole responsibility.

On their own: Business profitability and job satisfaction among self-employed with chronic health conditions.

OBJECTIVES: This study examined (a) characteristics of maintenance of business activity among self-employed individuals with chronic health conditions (CHCs) and (b) the relationships of coping strategies with maintenance of business activity. METHOD: This cross-sectional study involved 294 self-employed participants aged 26-77 who were at most 2 years since their diagnosis and had one of the following CHCs: cancer (23.4%), cardiac disease (21.7%), respiratory disease (36.2%), or inflammatory bowel disease (18.6%). Participants answered questionnaires on workability limitations, business maintenance, sense of mastery, and coping strategies. RESULTS: Participants reported a substantial decrease in business profitability since their CHC diagnosis but high job satisfaction. The structural equation model had good fit indicators and revealed that the association between workability limitations and lower maintenance of business profitability was partially mediated by lower use of disengaged coping strategies. The association between sense of mastery and job satisfaction was partially mediated by engaged and disengaged coping strategies. CONCLUSIONS: Self-employed individuals with CHCs are at risk of declining of business profitability; however, degree of workability limitations alone did not explain business profitability maintenance or job satisfaction, but it was related to coping resources and strategies. Interventions that strengthen personal resources and promote engaged coping strategies should be provided with direct support to business maintenance. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Perceived loss of resources and adherence to guidelines during the COVID-19 pandemic in Israel.

Following the outbreak of the global COVID-19 pandemic, governments around the world issued guidelines designed to prevent contagion. This longitudinal study explored variables associated with citizens' adherence to these guidelines. Questionnaires were administered to a panel of Israeli citizens three times: in June (Time 1, n = 896), July (Time 2, n = 712) and August (Time 3, n = 662) 2020. The relationships of perceived loss of resources (e.g. stable employment) at Time 1 with adherence to guidelines at Time 2 and Time 3 were moderated by assumptions about controllability: The relationships were stronger for people who believed that appropriate behavior would lead to positive outcomes and prevent negative outcomes. The results indicate that messages about the pandemic should be accompanied by encouraging messages regarding the ability to control.

The role of perceived supervisor resistance in successful work sustainability among cancer survivors.

BACKGROUND: Research has indicated that managerial contact with cancer survivors during a long absence from work is related to cancer survivors' inclination to return to work. OBJECTIVE: The present study explored the roles of cancer survivors' perception of supervisor resistance to return to work (RTW) and symptom severity in the relationship between supervisor-initiated contact during the cancer survivors' absence from work and successful work sustainability (SWS). METHODS: Israeli cancer survivors (N = 149) who had been working at least 6 months after the termination of treatment completed online questionnaires. The scales measured frequency of contact, perceived supervisor resistance to RTW, SWS, and symptom severity. To test the relationship between perceived and actual resistance, a partial sample of the cancer survivors' direct supervisors (N = 49) reported their resistance to RTW of cancer survivors. RESULTS: The results show that perceived supervisor resistance mediated the relationship between supervisor-initiated contact during absence and SWS. Symptom severity moderated the negative effect of perceived supervisor resistance on SWS: The relationship was stronger for cancer survivors experiencing severe symptoms. Cancer survivors' perception of supervisor resistance to RTW was positively related to their supervisors' self-report of resistance. CONCLUSION: These results suggest the need for clear guidelines and managerial training programs regarding contact and communication with cancer survivors during long absences from work.

Posttraumatic stress and COVID-19-related stressors: a prospective observational study.

BACKGROUND: The COVID-19 pandemic may trigger posttraumatic stress symptoms (PTSS) due to its threat to health, well-being, and survival. OBJECTIVES: We sought to assess levels of change in PTSS at three waves during the COVID-19 pandemic. Our second objective was to examine the role of four objective and subjective predictors salient to COVID-19-loss of resources, sense of loneliness, perceived COVID-19 threat, and uncertainty stress-on the trajectory of PTSS. METHODS: The study consisted of three waves, a month apart, between June and August 2020, with 903, 718, and 684 participants in each wave, respectively. RESULTS: At T0, participants had a medium level of PTSS (M = 2.07, SD = 0.89), which increased at T1 (M = 2.46, SD = 0.97) and decreased at T2 (M = 2.24, SD = 0.93). Linear mixed-effects modeling showed that loss of resources, sense of loneliness, perceived COVID-19 threat, and uncertainty stress were significant predictors of PTSS over the three time-points. Significant interactions between these predictors (except sense of loneliness) and time were found: At higher levels of resource loss, uncertainty stress, and COVID-19 threat, there was a steeper increase in PTSS from baseline to 1 month. CONCLUSIONS: The four predictors of PTSS should be addressed via strengthening resilience of individuals and communities.

Burnout among oncologists and oncology nurses: A systematic review and meta-analysis.

BACKGROUND: Significant proportions of burnout have been reported among both oncologists and oncology nurses. However, these groups have not been compared in a meta-analytic design. It is important to compare how burnout affects different types of health professionals to understand its individual implications and devise ways of minimizing and treating it. OBJECTIVE: The current meta-analysis study aimed to systematically compare burnout prevalence between oncologists and oncology nurses. METHOD: Authors assessed 34 studies (four included nurses and oncologists and 30 focused either on oncologists or oncology nurses) that used the Maslach Burnout Inventory (MBI) to measure burnout. Both fixed- and random-effects models were used to calculate meta-analytic estimates of the burnout subscales: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). RESULTS: The pooled sample size was 4,705 oncologists and 6,940 oncology nurses. The average proportions of EE, DP, and PA were 32%, 26%, and 25%, respectively, among oncologists and 32%, 21%, and 26%, respectively, among oncology nurses. Higher DP was found among oncologists compared with oncology nurses, only in the analysis of studies that included samples of both oncologists and oncology nurses. The subgroup analysis showed higher levels of DP in Europe and Asia and lower PA in Asia and Canada. No evidence of publication bias was found. CONCLUSIONS: Findings suggest differences in burnout between oncologists and oncology nurses and among geographic regions. This highlights the need for tailored interventions for different professions and regions. Hospitals should provide support and encourage teamwork to improve oncology professionals' well-being and provide optimal care for patients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cancer patients attending treatment during COVID-19: intolerance of uncertainty and psychological distress.

PURPOSE: The COVID-19 pandemic presents specific challenges for cancer patients attending oncology treatment. Using a mixed-methods design (convergent parallel design), we aimed to assess the experience, perceptions, and reactions of cancer patients during the COVID-19 pandemic. METHODS: Participants were cancer patients receiving treatment at the hospital during the pandemic (July to August 2020). In study 1, 95 participants filled out a questionnaire measuring COVID-19 experiences and perceptions, psychological distress, and intolerance of uncertainty. In study 2, in-depth interviews were conducted with 10 cancer patients, probing their experience during the COVID-19 period. RESULTS: Most participants experienced the COVID-19 pandemic as a major threat that would affect future health, most attended all or most of their scheduled treatments, and their mean level of psychological distress was low. A mild decrease in social support was reported, and remote contacts and support from the community had not compensated for decreased person-to person contacts. In addition, intolerance of uncertainty was related to higher psychological distress, which was partially mediated by perceptions of threat. The analysis of in-depth interviews strengthened the quantitative findings by elucidating the experience of fear of contagion alongside determination to continue treatment. CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS: The mixed-methods design enabled us to examine the responses of cancer patients attending treatment. The findings suggest that in times of extreme uncertainty such as COVID-19, health experts need to screen cancer patients and survivors for emotional and instrumental support needs and identify patients and survivors with high intolerance of uncertainty as a risk factor for psychological distress.

Family members' experiences of the return to work of cancer survivors.

Although family members play an important role in various aspects of coping with cancer and are significantly affected by it, little is known about their perspectives regarding return to work (RTW). This study explored attitudes and experiences of cancer survivors' family members related to cancer survivors' RTW. The present study consists of a qualitative research design, employing in-depth semistructured interviews with first-degree family members (N = 21) of cancer survivors who were approached through online social networks: spouses, children, parents and siblings. Grounded theory techniques were used for data analysis. Four themes emerged from the interviews: (a) the family's cautious voice in return-to-work decision making; (b) work-home imbalance; (c) inhibiting or promoting the effect of work on the recovery process and (d) expectations and appreciation of unconditional workplace support. The findings suggest that psychosocial and health care professionals should help family members play an active role in the decision of RTW. Professionals should also prepare family members for potential costs of RTW for the family and help them develop realistic expectations regarding workplace support of the cancer survivor.

Servant leadership, engagement, and employee outcomes: the moderating roles of proactivity and job autonomy / El liderazgo de servicio, la implicación y los resultados de los empleados: roles moderadores de la proactividad y de la autonomía en el puesto

This paper presents a moderation-mediation model suggesting that proactivity and job autonomy moderate the mediating effects of engagement on the relationship of servant leadership with job performance and lateness. Data were collected from a sample of 50 bank departments from three sources: managers (n = 50), employees (n = 165), and objective data provided by human resources departments. The results show that as expected, the association of servant leadership with work engagement was stronger for employees with low levels of proactivity and job autonomy. Proactivity moderated the mediating effect of engagement on the relationship of servant leadership with both job performance and lateness; autonomy moderated the mediating effect of engagement on the relationship between servant leadership and lateness. The results imply that placing employees with low levels of proactivity and job autonomy under the supervision of servant leaders can engender higher job engagement and better organizational outcomes (AU)

El artículo presenta un modelo de moderación-mediación que indica que la proactividad y la autonomía en el puesto de trabajo moderan los efectos mediadores de la implicación en la relación del liderazgo de servicio con el desempeño e impuntualidad de los empleados. Se recogieron datos de una muestra de 50 departamentos bancarios procedentes de tres fuentes: directivos (n = 50), empleados (n = 165) y datos objetivos facilitados por los departamentos de recursos humanos. Los resultados muestran que, tal y como se esperaba, la asociación del liderazgo de servicio y la implicación en el trabajo era mayor en los empleados con baja proactividad y autonomía en el puesto. La proactividad moderaba el efecto mediador de la implicación en la relación del liderazgo de servicio con el desempeño y la impuntualidad. La autonomía moderaba el efecto mediador de la implicación en el puesto en la relación entre el liderazgo de servicio y la impuntualidad de los empleados. Los resultados indican que poner a los empleados con bajo nivel de proactividad y autonomía en el puesto bajo la supervisión de líderes servidores puede mejorar la implicación en el puesto y los resultados organizativos (AU)

A multidisciplinary working model for promoting return to work of cancer survivors.

BACKGROUND: Despite wide recognition of the necessity of an integrative maintenance and return to work (RTW) program for cancer survivors, no such program has been described in the literature. AIMS: To examine a working model of an integrative multidisciplinary health care approach for promoting RTW, using the Delphi method. METHODS: A working model for promoting cancer survivors' RTW by oncology health professionals was subjected to two rounds of evaluation by an expert panel in accordance with the Delphi research method. Twenty-six international experts in oncology (social workers, nurses, psychologists, physicians, and cancer patients) participated in the first round and 16 participated in the second round. RESULTS: The mean score of the working model's applicability was 6.07 (SD = 1.07, range = 1-7). The model outlines in detail an integrative approach for promotion of RTW according to two axes: the oncology health professionals' role and the timeline axis featuring four stages of oncology treatment and follow-up. CONCLUSIONS: Our proposed model addresses the need for an integrated program that may increase the rate of RTW and improve the quality of life of cancer survivors. The model should be subjected to further evaluation, especially its adaptability to different health systems in different countries.

Physicians' cognitive strategies for avoiding overconfidence.

BACKGROUND: Physicians' overconfidence damages the quality of medical care. Due to their high social status and intense impact on people lives, physicians need to develop strategies to avoid overconfidence. Yet until now, the strategies physicians use to avoid overconfidence have not been explored. This study aimed to identify strategies physicians use to minimize potential overconfidence. METHODS: This qualitative study relied on face-to-face semi-structured interviews. Participants were 22 physicians specializing in ophthalmology, gynaecology, rheumatology, cardiology, anaesthesiology, paediatrics, radiology, orthopaedics, otolaryngology, gastroenterology, family and paediatrics. The interviews were analyzed with the grounded theory approach. RESULTS: Analysis of the interviews revealed three prominent strategies physicians use to minimize overconfidence: awareness of the risks of overconfidence, framing a mundane professional identity, and cultivation of a positive self-view through pride based on effort rather than skills. CONCLUSIONS: The study demonstrates the on-going nature of establishing physicians' professional identity and implies that it is shaped by a motivation to adapt their identity to fundamental requirements of medical practice. Medical training and education might promote strategies for minimization of potential overconfidence among physicians.

Trust in the referring physician reduces anxiety in an integrated community-to-hospital care system.

BACKGROUND: Continuity of care between the community and hospital is considered of prime importance for quality of care and patient satisfaction, and for trust in the medical system. In a unique model of continuity of care, cardiologists at our hospital serve as primary, community-based cardiologists one day a week. They refer patients from the community to our hospital for interventional procedures such as coronary angiography and angioplasty. We examined the hypotheses that patient anxiety during hospital-based coronary angiography is lower when a patient trusts the referring cardiologist and when the performing cardiologist also treated him/her in the community. METHODS: We administered questionnaires to 64 patients in our cardiology department within 90 min of completion of coronary angiography. The questions assessed anxiety, trust in the medical system and trust in the referring physician. Data were also collected regarding patients' demographic variables, the number of visits to the referring physician, and whether the physician who performed the coronary angiography was the physician who referred the patient to the hospital. RESULTS: Mean levels (on 7-point Likert scales) were 2.1, 5.6 and 6.7 for patient anxiety, trust in the medical system and trust in the referring physician, respectively. Multivariate regression analysis showed that trust in the referring physician was significantly and negatively correlated with anxiety level. The number of visits to referring physicians, patients' demographic characteristics and whether the physician who performed the angiography was the same physician who referred the patient from the community were not found to be associated with patient anxiety. CONCLUSION: In this study, trusting the referring physician was associated with lower anxiety among patients who underwent coronary angiography. This trust seemed to have more positive impact than did previous contact with the physician who performed the procedure.

Justification of aggression against nurses: The effect of aggressor distress and nurse communication quality.

AIMS: To explore the conditions that contribute to justification of aggression against nurses. DESIGN: A 2 (aggressor distress as reflected in stressful behaviour: high vs. low) × 2 (target nurse's communication quality as reflected in provision of information and expression of caring: high vs. low) factorial design. Communication quality was operationalized as caring for half the respondents and information provision for the other half. METHODS: Data were collected online in 2018. Respondents (N = 305) were presented with one of the eight versions of a hypothetical vignette. Aggressor distress and caring were manipulated for half the participants and aggressor distress and information provision for the other half. After reading the vignette, respondents reported their attitudes towards the aggressor's behaviour and sense of warmth towards the target nurse. Additional data collected included trait empathy (a control variable), demographic variables and responses to a manipulation check. Data were analysed using the analyses of variance. FINDINGS: The results show the main effects of aggressor distress and nurse communication quality on justification of aggression and sense of warmth towards the nurse. An interaction effect between aggressor distress and (poor) nurse information provision was found on justification of aggression. CONCLUSION: The results extend extant research on the causes of aggression against the nurses by highlighting a tendency to view certain circumstances as justifying such behaviour. IMPACT: The study explored conditions that increase the justification of aggression against nurses, from the perspective of a third party. The results show that aggressor's distress, as well as the attacked nurse's communication quality affect the justification of aggression. The results contribute to knowledge about the causes of aggression against nurses and highlight the need for healthcare policy and public education activities designed to undermine the view that aggression against nurses can be justified.

The challenge of return to work in workers with cancer: employer priorities despite variation in social policies related to work and health.

PURPOSE: This study explored employer's perspectives on (1) their experience of good practice related to workers diagnosed with cancer and their return to work (RTW), and (2) their perceived needs necessary to achieve good practice as reported by employers from nine separate countries. METHODS: Twenty-five semi-structured interviews were held in eight European countries and Israel with two to three employers typically including HR managers or line managers from both profit and non-profit organisations of different sizes and sectors. Interviews were recorded and transcribed verbatim. A grounded theory/thematic analysis approach was completed. RESULTS: Employers' experience with RTW assistance for workers with cancer appears to be a dynamic process. Results indicate that good practice includes six phases: (1) reacting to disclosure, (2) collecting information, (3) decision-making related to initial actions, (4) remaining in touch, (5) decision-making on RTW, and (6) follow-up. The exact details of the process are shaped by country, employer type, and worker characteristics; however, there was consistency related to the need for (1) structured procedures, (2) collaboration, (3) communication skills training, (4) information on cancer, and (5) financial resources for realizing RTW support measures. CONCLUSIONS: Notwithstanding variations at country, employer, and worker levels, the employers from all nine countries reported that good practice regarding RTW assistance in workers with a history of cancer consists of the six phases above. Employers indicate that they would benefit from shared collaboration and resources that support good practice for this human resource matter. IMPLICATIONS FOR CANCER SURVIVORS: Further research and development based on the six phases of employer support as a framework for a tool or strategy to support workers with a history of cancer across countries and organisations is warranted.

Dyadic resources in the return to work of cancer survivors: exploring supervisor-employee perspectives.

Purpose: The number of working-age people recovering from cancer is gradually on the rise; yet, cancer survivors have higher rates of unemployment compared to other employees. Cancer survivors returning to work cope with symptoms of fatigue, distress, cognitive difficulties and physical limitations. The present article addresses the supervisor-cancer survivor dyad as the unit of analysis, in an attempt to identify the dyadic resources that underlie the coping of the supervisor-employee unit with return to work. Materials and methods: In-depth, semi-structured individual interviews were conducted with 12 dyads of cancer survivors and their supervisors, representing successful return to work, followed by comparative content analysis of the data. Results: Four themes were revealed: (1) Congruent supervisor-cancer survivor views regarding personalized/standard management of cancer survivors' returning to work; (2) Return to work as a team work approach; (3) Commitment and persistence in the face of obstacles, and (4) Supervisor and cancer survivor mutual appreciation. Conclusions: Joint coping of supervisors and cancer survivors with the difficulties of the return to work process is perceived to contribute significantly to the success of return to work. Training of cancer survivors and supervisors conducted by rehabilitation professionals regarding aspects of the orientation toward return to work is suggested. Implication for rehabilitation Cancer survivors have different preferences regarding standard versus exceptional organizational treatment following return to work. Organizational acknowledgment of the cancer survivor's value for the organizations supports cancer survivors' return to work. Cancer survivors can benefit from a sense of responsibility and involvement in decision making regarding the process of return to work.

Return to Work of Cancer Survivors: Predicting Healthcare Professionals' Assumed Role Responsibility.

Purpose Returning to work is highly beneficial for many cancer survivors. While research has documented the significance of healthcare professionals in the process of return to work (RTW), very little is known about those professionals' views regarding their responsibility for RTW. The purpose of the present study was to identify factors that predict the extent to which healthcare professionals view involvement in the RTW of cancer survivors as part of their role. Methods In a cross-sectional design, questionnaires measuring attitudes regarding personal role responsibility for RTW, team role responsibility for RTW and benefits of RTW were administered to 157 healthcare professionals who care for working-age cancer survivors: oncologists, occupational physicians, family physicians, oncology nurses, oncology social workers, and psychologists. Results Both belief in the benefits of RTW, and the view that RTW is the team responsibility of healthcare professionals working with cancer survivors, are positively related to viewing RTW as part of the responsibilities of one's personal professional role. Moderation analysis indicated that perception of team responsibility for RTW moderates the effect of the perceived benefits of RTW, such that the perception of benefits is significantly associated with personal role responsibility only when there is a low level of perceived team responsibility. Conclusions Issues related to RTW should be routinely included in basic and advanced training of healthcare professionals involved in the treatment of working-age cancer survivors, to increase awareness of this aspect of cancer survivors' well-being and position RTW as part of healthcare professionals' role responsibilities.

Health care professionals' perspective on return to work in cancer survivors.

OBJECTIVE: Health care professionals play a significant role in cancer survivors' decisions regarding return to work (RTW). While there is ample research about cancer survivors' views on RTW, little is known about the views of the professionals who accompany them from diagnosis to recovery. The study explores professionals' perceptions of cancer survivors in the RTW context, as well as their views about their own role in the process. METHODS: In-depth interviews (N = 26) with professionals specializing in physical or mental health working with working-age cancer survivors: occupational physicians, oncologists, oncology nurses, social workers, and psychologists specializing in oncology. RESULTS: An analysis of the interviews revealed 2 prominent perceptual dimensions among professionals: the cancer survivor's motivation to RTW and understanding illness-related implications upon returning to work. The 2 dimensions imply the following 4 groups of cancer survivors in the RTW context, as viewed by health professionals: the "realist," the "enthusiast," the "switcher," and the "worrier." The results also indicate that social workers and psychologists view their role in terms of jointly discussing options and implications with the cancer survivor, while physicians and nurses view their role more in terms of providing information and suggestions. CONCLUSIONS: The training of professionals should increase awareness of the assumptions they make about cancer survivors in regard to RTW. Additionally, training might elaborate professionals' view of their role in the interaction with cancer survivors regarding RTW.

Personally committed to emotional labor: Surface acting, emotional exhaustion and performance among service employees with a strong need to belong.

Individual differences in emotional labor and subsequent vulnerability to burnout have been explored through the prism of Congruence Theory, which examines the congruence between personality traits and job requirements (Bono & Vey, 2007; Moskowitz & Coté, 1995). Drawing on theory and research dealing with the association between the need to belong and self-regulation (Baumeister, DeWall, Ciarocco & Twenge, 2005), this study examined the relationship between need to belong and service employees' surface acting and associated outcomes. In Study 1, participants (N = 54) were asked to write a response to an aggressive email from a hypothetical customer. The need to belong was positively related to display of positive emotions and negatively to display of negative emotions in the responses, but not related to felt anger, suggesting that it is associated with the inclination to engage in surface acting. In Study 2, a field study conducted with 170 service employee-customer dyads, surface acting mediated the positive relationship between fear of isolation and emotional exhaustion, and emotional exhaustion mediated the relationship between surface acting and customer satisfaction. These results suggested that service employees with a strong need to belong might have a heightened risk of burnout because of their inclination to engage in emotional labor. (PsycINFO Database Record

When authenticity matters most: Physicians' regulation of emotional display and patient satisfaction.

OBJECTIVE: The emotions expressed by physicians in medical encounters have significant impact on health outcomes and patient satisfaction. This study explored how physicians' regulation of displayed emotions affects patients' satisfaction, under low and high levels of patient distress and length of physician-patient acquaintance. METHODS: Questionnaires were administered to 46 physicians and 230 of their patients (before and after the medical encounter) in outpatient clinics of two hospitals. RESULTS: Data were analyzed with hierarchical linear modeling which takes the nested data structure into account. We found a significant interaction effect of physician regulation of displayed emotions and patient distress on satisfaction: When distress was high, physician regulation of emotions was negatively related to patient satisfaction. The results also show a significant interaction effect of physician regulation of displayed emotions and length of physician-patient acquaintance: With a longer acquaintance, physician regulation of emotions was negatively related to patient satisfaction. CONCLUSION: The effect of the physicians' emotional display on patient satisfaction depends on contextual factors, such as patient distress and length of physician-patient acquaintance, which affect patients' emotional needs and expectations. PRACTICAL IMPLICATIONS: When patients have high emotional involvement in the encounter it is suggested that physicians consider presenting genuine emotions to patients.

Older Adults' Coping With the Stress Involved in the Use of Everyday Technologies.

PURPOSE: This study was conducted to examine the frequency of reported use of everyday technologies (EDT) and its associations with self-efficacy, stress appraisal, and coping strategies. DESIGN AND METHODS: Cross-sectional data were collected from 150 participants (aged ≥ 65 years), measuring use of EDT by means of self-report questionnaires and a computerized simulator of an automatic teller machine (ATM), and EDT-related self-efficacy, stress appraisal, and coping strategies questionnaires. RESULTS: Structured equation modeling analysis showed that EDT-related self-efficacy was related to higher use of EDT, through the mediation of EDT-related stress and coping strategies. Logistic regression showed that use of ATM simulator was predicted by self-efficacy, younger age, and female gender. IMPLICATIONS: Enhancing EDT-self efficacy is suggested to increase the use of EDT among elder adults. The use of simulators may be an efficient mean to promote EDT self-efficacy and use.