Advanced theoretical-applied model based on the PD approach in the light of healthcare-associated infections: what have we achieved so far?

Healthcare-associated infections remain a persistent concern despite decades of research and intervention efforts. Adherence to infection prevention and control guidelines by health professionals remains a challenge, necessitating innovative strategies. The Positive Deviance (PD) approach, rooted in harnessing localized solutions, holds promise but lacks comprehensive frameworks and empirical validation to bolster its theoretical underpinnings. This perspective article serves a dual purpose: first, to examine the unique challenges of applying the PD approach in the context of HAIs; and second, to introduce a robust theoretical-applied model developed in response to these challenges. This article addresses these gaps through a multi-faceted model developed in a mixed-methods study across three Israeli governmental hospitals and comprises four essential components that address the identified gaps in existing research. This article enriches the dialog on PD's applicability in HAIs by providing a robust model that not only offers solutions but reshapes the approach to healthcare hygiene and safety. It responds to critical gaps highlighted in the literature, offering tailored interventions by practical, context-specific solutions to improve adherence to IPC guidelines in the long term. Methodological clarity is also a key focus, offering a toolkit for practical implementation. This bottom-up approach empowers HPs to drive change, fostering a culture of innovation and improvement in healthcare settings.

Meaning reconstruction 70 years later: Processing older adults' unfinished business in a drama therapy group.

Unfinished business (UB), when individuals appraise their relationship with others or themselves as incomplete or unresolved, entails difficult emotions such as regret, remorse, and guilt. UB is often associated with bereavement and is considered to be a predictor of complicated grief. Here we report two case studies describing the processing of the sudden death of a significant other in the context of a randomized controlled study of 12-week drama therapy groups for older adults. The intervention followed the format of Playback Theater, an improvised form of theater based on personal stories, and a life review paradigm. A mixed-methods approach explored the course of individual therapy within the group and potential mechanisms of change. The participants completed mental health questionnaires in a pre-post-follow-up design. The qualitative data included video recordings and postintervention interviews. One participant reported a clinically significant (CS) change in depressive symptoms and psychological well-being on the post and follow-up measurement indices. The second reported a CS change in self-esteem and relationship satisfaction at the end of the intervention, but not at follow-up. The findings suggest that the drama therapy contributed to the resolution of UB through restorative work in the three domains defined in meaning reconstruction theory: the "event story" of the loss, the "back story" of the relationship with the deceased, and the "personal story" of self. The results point to the need for additional research on meaning reconstruction in the context of drama therapy and encourage the broader application of performative techniques to treat complicated bereavement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Common Way in Which the Ministry of Health Conveys Information to the Public: A Simulation Among Israeli Parents with Different Attitudes and Behaviors Regarding Vaccination During a Measles Outbreak in Israel.

BACKGROUND: Despite several empirical studies that have emphasized the problematic and ineffective way in which health organizations 'correct' information which does not come from them, they have not yet found ways to properly address vaccine hesitancy. OBJECTIVES: (1) Examining the responses of groups with different attitudes/ behaviors regarding vaccination; (2) Examining the effect of the common methods of correcting information regarding the response of subgroups, while examining issues of reliability, satisfaction, and information seeking, as well as how health organization tools aid the decision-making process regarding vaccines. METHODS: A simulation study that included 150 parents of kindergarten children was carried out. RESULTS: Significant difference was found among the various groups (with respect to vaccination behavior) regarding the extent of their trust in the Ministry of Health (χ2(3) = 46.33; P < 0.0001), the reliability of the Ministry of Health's response (χ2(3) = 31.56; P < 0.0001), satisfaction with the Ministry of Health's response (χ2(3) = 25.25; P < 0.0001), and the level of help they felt the Ministry of Health's tools provided them regarding vaccine-related decision making (χ2(3) = 27.76; P < 0.0001). CONCLUSION: It is important for health organizations to gain the public's trust, especially that of pro-vaccination groups with hesitant attitudes, while addressing the public's fears and concerns.

Children in the Anthroposophical Education System Have Lower Rates of Obesity, and Higher Rates of Health Promoting Behaviors.

BACKGROUND: The anthroposophical philosophy is a holistic educational and lifestyle approach. Limited information exists on the health-promoting behavioral norms and obesity rates among children living anthroposophical vs. conventional lifestyles. AIMS: This study aims to compare the prevalence of childhood obesity, and parents' perceptions of their children's food environment, between anthroposophical and conventional education systems. METHODS: We performed a cross-sectional analysis of the National Anthropometric Measurement Survey for first grade students in Israel, comparing anthroposophical schools with matched conventional schools. Additionally, an online survey was distributed among parents of children in both school systems, assessing children's eating norms and dietary intake. RESULTS: Overweight and obesity rates were higher among students in conventional schools (n = 205,500) compared to anthroposophical schools (n = 2247) (11.2% vs. 9.6%, and 7.8% vs. 4.8%, respectively; Pv < 0.001). Anthroposophical schools were perceived by more parents to have health-promoting curricula, health promoting teacher behavior, and health promoting social dietary norms, while their children's dietary intake was perceived as healthier both in school and in the after-school, social, and familial environment (Pv < 0.001). CONCLUSIONS: Children in anthroposophical education exhibited lower overweight and obesity rates, and engaged in more health-promoting behaviors. Further research is needed to explore the relationship between the anthroposophical lifestyle and childhood obesity, and to identify effective anthroposophical strategies for health promotion among children.

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

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

Hesitant and anti-vaccination groups: A qualitative study on their perceptions and attitudes regarding vaccinations and their reluctance to participate in academic research- an example during a measles outbreak among a group of Jewish parents in Israel.

Background: Vaccination is widespread in Western countries and, overall, there is a high vaccination rate. However, immunization is still an enduring challenge. In recent years, the number of parents who choose to delay or refuse vaccines has risen. Objectives: (1) to identify the perceptions and attitudes of hesitant and anti-vaccination parents regarding vaccination in general, and vaccinating their children in particular and; (2) to describe the responses of potential participants to the request to participate in academic research regarding their perceptions and attitudes on the subject of vaccines. Methods: The research employs the qualitative hermeneutic phenomenological method using two research tools: (1) in-depth interviews with 7 hesitant and 11 anti-vaccination Jewish parents in Israel; and (2) the researchers' field notes from this study process, which describe the responses of 32 potential participants to the request to participate in this academic research. Results: The main findings indicate that while most of the interviewees admit to the efficacy of vaccines in preventing diseases, they oppose the way in which vaccines are promoted-based on providing partial information and disregarding parents' concerns and questions. Therefore, they demand transparency about the efficacy and safety of vaccines. The findings also point to a paradoxical finding. On the one hand, these groups claim that health organizations do not understand their position, referring to them as "science-deniers", even though they are not. On the other hand, these parents choose to refrain from participating in scientific studies and voicing their opinions, thereby perpetuating the situation of being misunderstood. Conclusion: Hesitant and anti-vaccination groups express mistrust in academic institutions and health organizations. Therefore, an effective dialogue that would include hesitant and anti-vaccination groups, the academy, and health organizations may contribute to a better understanding of the barriers that prevent these groups from getting vaccinated or vaccinating their children and promote public health.

Translating a theory-based positive deviance approach into an applied tool: Mitigating barriers among health professionals (HPs) regarding infection prevention and control (IPC) guidelines.

BACKGROUND: Although a wide range of intervention programs and methods have been implemented to increase health professionals' (HPs) adherence with infection prevention and control (IPC) guidelines and decrease the incidence of healthcare associated infections (HAIs), a significant discrepancy remains between the guidelines and their implementation in practice. OBJECTIVES: This study proposes an applied tool based on the integrated theoretical framework of the positive deviance (PD) approach for developing more effective interventions to mitigate this discrepancy. METHODS: A qualitative study guided by the PD approach based on data from two sources: (1) in-depth archival analysis of systematic review articles, and (2) integration and synthesis of findings based on an extensive empirical study we conducted, involving 250 HPs (nurses, physicians, support staff and cleaning staff) from three governmental hospitals in Israel, over 35 months (January 2017 to November 2020). RESULTS: The barriers faced by HPs were classified into four main categories: (1) individual-motivational, (2) social-cultural, (3) organizational, and (4) work environment and resource-centered. For each barrier, we constructed a set of questions based on the PD approach. For each question, we adapted and applied methodological tools (e.g., in-depth interviews, focus groups, social network maps, video clips and simulations) to help solve the problem. CONCLUSION: Translating a theory-based approach into an applied tool that offers step-by-step actions can help researchers and practitioners adopt and implement the approach within intervention programs to mitigate barriers.

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

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

Pro-vaccination Groups Expressing Hesitant Attitudes: A Cross-Sectional Study About the Difference Between Attitudes and Actual Behavior in Israel.

Background: Vaccines have contributed to the decline in mortality, morbidity, and even the eradication of various infectious diseases. Over time, the availability of information to the public and the request for public involvement in the health decision-making process have risen, and the confidence in vaccines has dropped. An increasing number of parents and individuals are choosing to delay or refuse vaccines. Objectives: (1) Identifying hesitant attitudes among pro-vaccination parents; (2) testing the difference between the rate of hesitant attitudes and the rate of hesitancy in practice among pro-vaccination parents; and (3) examining the association of sociodemographic characteristics (gender, age, marital status education and religious affiliation) with the difference between hesitant attitudes and hesitancy in practice among pro-vaccination parents. Methods: Descriptive cross-sectional survey using an online survey that measured vaccine hesitancy among pro-vaccination parents (n = 558) whose children were in kindergarten (3-5 years), according to a variety of sociodemographic characteristics. Results: A significant difference was found between the rate of hesitant attitudes and the rate of hesitation in actual vaccination among pro-vaccination and hesitant parents, where despite that 26% of the parents had hesitant attitudes, only 19% hesitated in practice [P = 0.0003]. There was also a significant difference between the rate of hesitant attitudes and the rate of hesitancy in practice among women [P = 0.0056] and men [P = 0.0158], parents between 30 and 39 years of age [P = 0.0008], traditional parents [P = 0.0093], Non-academic parents [P = 0.0007] and parents with BA degree [P = 0.0474]. Conclusion: Pro-vaccination individuals may have hesitant attitudes regarding vaccines. Therefore, it is very important for health authorities to address the public's fears and concerns, including those who are classified as pro-vaccination.

Risk perceptions regarding inclusion of seasonal influenza vaccinations in the school immunization program in Israel: Arab vs. Jewish mothers.

BACKGROUND: The issue of whether to include seasonal influenza vaccinations in school-located vaccination programs (SLIV) has been examined in many countries, mainly in the context of economic effectiveness and morbidity prevention. Yet not enough studies have examined the impact of parental risk perceptions, health literacy and SLIV on parental vaccination uptake. OBJECTIVES: The most recent statistics in Israel point to a higher rate of seasonal influenza vaccination among Arab children (aged 7-9 years) than among Jewish children in the same age group. The present study attempts to explain this high vaccination uptake among mothers from Arab society by comparing their risk perceptions regarding seasonal influenza vaccination and disease to those of Jewish mothers. The study further examines the impact of SLIV on parental risk perceptions and influenza vaccination uptake. METHODS: This cross-sectional study included mothers of children in the second and third grades faced with the decision of whether their children should receive the seasonal influenza vaccination at school. The study population included a stratified sample of Jewish mothers (n = 159) and Arab mothers from all the Arab population sub-groups: Muslim, Christian, Druse and Bedouin (n = 534). RESULTS: A comparison of the Arab and Jewish populations revealed a significant difference in vaccination rates; 61.7% among Arab mothers compared to 33.5% among Jewish mothers (χ2(1) = 39.15, P<0.0001). Moreover, significant differences emerged between the Arab and Jewish populations in health literacy and ability to seek information regarding the seasonal influenza vaccination (t (691) = -5.81, p < 0.0001). While no differences emerged in mothers' perceptions regarding influenza as a disease (t (691) = 1.20, p = 0.2318), Arab mothers perceived the vaccination to be safer than Jewish mothers (t (691) = 2.74, p = 0.0063) and saw its inclusion in the school-located vaccination program as providing more legitimacy (Z = -6.6719, P < .0001). CONCLUSION: This study showed that the factors influencing vaccination uptake among both the Arab and the Jewish populations include perceived influenza risk, perceived vaccination risk, inclusion in the school-located vaccination program and health literacy. Moreover, influenza vaccination uptake is higher among those who have positive attitudes toward vaccinations, low risk perceptions regarding the vaccine, and low health literacy that impedes their ability to seek information. The research also points to the need for education and tools to boost health literacy among minority groups so that mothers can make independent and informed decisions about whether or not to vaccinate their children.

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

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

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

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

Synchrony in Old Age: Playing the Mirror Game Improves Cognitive Performance.

OBJECTIVES: Studies have shown that synchronized motion between people positively affects a range of emotional and social functions. The mirror-game is a synchrony-based paradigm, common to theater, performance arts, and therapy, which includes dyadic synchronized motion, playfulness, and spontaneity. The goal of the current study is to examine the effects of the mirror-game on subjective and cognitive indices in late life. METHODS: Thirty-four older adults (aged 71-98) participated in a within-group study design. Participants conducted two sessions of 9-minute movement activities: the mirror-game and the control condition - a physical exercise class. Several measures were taken before and after experimental sessions to assess socio-emotional and attentional functions. RESULTS: The mirror-game enhanced performance on the attention sub-scale and led to faster detections of spoken words in noise. Further, it enhanced perceived partner responsiveness and led to an increase in positive reported experience. CONCLUSIONS: Our preliminary findings suggest that the mirror-game, rather than the exercise class, may have an immediate impact on mood and some attentional functions. CLINICAL IMPLICATIONS: The mirror-game is a novel intervention, with potential benefits of social-emotional and cognitive functioning, which can be easily implemented into the daily routine care of older adults. Future studies should explore the effect of the mirror-game on additional cognitive and socio-emotional aspects.

The Structure of Tweets About Vaccine Safety Between Health Organizations, Experts, and the Public: Analyzing Risk Communication Conversations.

OBJECTIVE: This article considers how health education organizations in the World Health Organization's 9 Vaccine Safety Network (VSN) use Twitter to communicate about vaccines with the public, and whether they answer questions and engage in conversations. Almost no research in public health, to our knowledge, has explored conversational structure on social media among posts sent by different accounts. METHODS: Starting with 1,017,176 tweets by relevant users, we constructed 2 corpuses of multi-tweet conversations. The first was 1,814 conversations that included VSN members directly, whereas the second was 2,283 conversations mentioning vaccines or vaccine denialism. The tweets and user metadata were then analyzed using an adaptation of rhetorical structure theory. RESULTS: In the studied data, VSN members tweeted 12,677 times within conversations, compared to their 37,587 lone tweets. Their conversations were shorter than those in the comparison corpus (P < 0.0001), and they were involved in fewer multilogues (P < 0.0001). CONCLUSION: While there is diversity among organizations, most were tied to the pre-social media broadcast model. In the future, they should try to converse more, rather than tweet more, and embrace best practices in risk communication.

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

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

Factors associated with seasonal influenza and HPV vaccination uptake among different ethnic groups in Arab and Jewish society in Israel.

BACKGROUND: Parents in the Arab population of Israel are known to be "pro-vaccination" and vaccinate their children at higher rates than the Jewish population, specifically against human papilloma virus (HPV) and seasonal influenza. OBJECTIVES: This study seeks to identify and compare variables associated with mothers' uptake of two vaccinations, influenza and HPV, among different subgroups in Arab and Jewish society in Israel. METHODS: A cross-sectional study of the entire spectrum of the Israeli population was conducted using a stratified sample of Jewish mothers (n = 159) and Arab mothers (n = 534) from different subgroups: Muslim, Christian, Druse and Northern Bedouins. From March 30, 2019 through October 20, 2019, questionnaires were distributed manually to eighth grade pupils (13-14 years old) who had younger siblings in second (7-8 years old) or third (8-9 years old) grades. RESULTS: Arab mothers exhibited a higher rate of uptake for both vaccinations (p < .0001, HPV - 90%; influenza - 62%) than Jewish mothers (p = 0.0014, HPV - 46%; influenza - 34%). Furthermore, results showed that HPV vaccination uptake is significantly higher than seasonal influenza vaccination uptake in both populations. Examination of the different ethnic subgroups revealed differences in vaccination uptake. For both vaccinations, the Northern Bedouins exhibited the highest uptake rate of all the Arab subgroups (74%), followed by the Druse (74%) and Muslim groups (60%). The Christian Arab group exhibited the lowest uptake rate (46%). Moreover, the uptake rate among secular Jewish mothers was lower than in any of the Arab groups (38%), though higher than among religious/traditional Jewish mothers, who exhibited the lowest uptake rate (26%). A comparison of the variables associated with mothers' vaccination uptake revealed differences between the ethnic subgroups. Moreover, the findings of the multiple logistic regression revealed the following to be the most significant factors in Arab mothers' intake of both vaccinations: school-located vaccination and mothers' perceived risk and perceived trust in the system and in the family physician. These variables are manifested differently in the different ethnic groups. CONCLUSIONS: This research shows that all Arabs cannot be lumped together as one monolithic group in that they exhibit major differences according to religion, education and access to information. Ranking of variables associated with uptake of the two vaccines can provide decision-makers an empirical basis for tailoring appropriate and specific interventions to each subgroup to achieve the highest vaccine uptake rate possible. Media campaigns targeting the Arab population should be segmented to appeal to the various sub-groups according to their viewpoints, needs and health literacy.

Creating safe spaces to prevent unintentional childhood injuries among the Bedouins in southern Israel: A hybrid model comprising positive deviance, community-based participatory research, and entertainment-education.

BACKGROUND: Despite several intervention programs, the Bedouin population living in the Southern District of Israel has the highest mortality rate among children and adolescents from unintentional injuries. Our research questions asked: (1) How does increasing the involvement and participation of Bedouin community members influence the issue of unintentional injuries among children? (2) How does reframing of the technical issue of safety into security influence community involvement and cooperation? OBJECTIVES: 1) To identify effective and efficacious positive deviance practices through community-based participatory research with adults, children, and professionals in the Bedouin community. 2) To create wider and deeper connections and cohesion between and among diverse Bedouin communities by seeding and sparking opportunities for social networking and cross-learning. METHODS: The study used a qualitative multi-method approach to generate a hybrid intervention model for reducing unintentional childhood injuries among the Bedouins. To frame the issue of unintentional injuries from the lived perspective of the Bedouins, we employed the Positive Deviance (PD) and Community Based Participatory Research (CBPR) approach. Drawing upon theatrical traditions, entertainment-education (EE), was employed as a way to narratively engage and persuade the Bedouins. RESULTS: Our research resulted in: (1) the emergence of several PD ideas and practices for preventing and avoiding children's injuries; (2) the actual creation of a safe and secure playroom for children at a neighborhood mosque; and (3) the creation of cascading and cross-learning social networks between and among members of the Bedouin community spread across various locations. CONCLUSION: This study helped in reframing the technical issue of accidents and safety into the notion of sacredness and security, enhanced the association between emotions and cognition by means of experiential and EE methods, and stimulated creative thinking and the emergence of new culturally and contextually relevant ideas and practices through the PD process. It demonstrated the synergistic power of using a hybrid model that combined the rigor and vigor of different health communication approaches to address a significant disparity in the burden of child accidents faced by the Bedouins. Our study generated solutions that emerged from, and directly benefitted, Bedouin children-those, who face overwhelming risk of injury and death from preventable accidents.

Shopping online for children: Is safety a consideration?

INTRODUCTION: There has been a significant increase in online purchasing and product safety problems have been identified in e-commerce. This study examines consumer behavior and safety perceptions among parents purchasing child products online. METHOD: A mixed methods approach, including focus groups and a survey with parents, identified key characteristics and behaviors. Cluster analysis was used to determine different population segments (including "Informed," "Uninformed," and "Infrequent" consumer groups) based on their frequency of online shopping and search for product information. "Safe" and "Unsafe" behavior groups were identified related to their search for safety information on child products. Logistic regression analysis was used to study the effects of consumer type groups and demographic variables on the chances of being a safer consumer. RESULTS: Findings indicate that child product safety considerations are not a priority for parents when shopping online. Only 62% of the survey respondents indicated that they search for information prior to buying a child product online, of which only 13% of the respondents noted that they search for information on product safety. Risky consumer behaviors were identified including the purchase of imitation products (counterfeit or knockoff products) and autonomous checks for product safety in lieu of safety standards. The logistic regression analysis found that being an "Uninformed Consumer" increases the odds of an individual being an "Unsafe Consumer" by 8.4 times (χ2(11) = 97.33, p < .001). Practical Applications: Design of a social marketing campaign that targets these different population segments to change perceptions and promote safe online purchasing is recommended.

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.