Determinants of physical activity habit formation: a theory-based qualitative study among young adults.

PURPOSE: Engagement in physical activity significantly contributes to reducing the onset and severity of chronic diseases. Nonetheless, establishing habits around this behaviour remains a persistent challenge. This research endeavours to discern the determinants influencing the formation of physical activity habit among young adults in Israel, drawing upon a socio-ecological model. METHODS: A qualitative approach with phenomenological-hermeneutical method was used. In-depth interviews were carried to cover four levels of the socio-ecological model. RESULTS: Interviewees were categorized into three subgroups according to their physical activity habit strength: Habitually physically active (n = 8), Variably physically active (n = 11), and physically inactive (n = 6). The content analysis yielded four overarching themes associated with physical activity habit formation. Intrapersonal determinants encompassed personal traits, perceptions and attitudes, perceived benefits, and emotional responses related to physical activity. Interpersonal determinants encompassed social support, modelling support, and peer pressure. Community determinants pertained to social norms, resource availability, and accessibility. Finally, public policy considerations encompassed educational policies as well as workplace policies and cultural influences. CONCLUSIONS: This study highlights the unique determinants contributing to the formation of physical activity habit. As intrapersonal and interpersonal factors are significant determinants, interventions should focus on these elements in order to promote this behaviour among young adults.

Winning isn't everything: Guilt proneness and competitive vs. non-competitive motivation.

OBJECTIVE: Guilt proneness is associated with both high motivation to succeed and enhanced concern for others. However, in competition, achieving success requires harming others' interests, which demotivates guilt-prone individuals. Given the prevalence of competition in social and professional life, we examine the relation between guilt proneness, general motivation, and competitive motivation. METHOD: Two experiments and two laboratory studies (N = 1735) measured guilt proneness, general motivation, and competitive motivation, and their effects on competitive preferences and choices. Study settings included students' choice of playing a game individually vs. competitively (Study 1), physicians' likelihood to seek residency in medical fields characterized by high competitiveness (Study 2), amateur athletes' preferences between inclusive and win-oriented team strategies (Study 3), and online workers' evaluations of a hypothetical scenario (Study 4). RESULTS: Guilt proneness was related positively to general motivation, but negatively to competitive motivation. Guilt proneness, indirectly through lower competitive motivation, predicted a lower likelihood of pursuing competitive paths and preference for non-competitive strategies. Emphasizing prosocial aspects of competitiveness attenuated these effects. CONCLUSIONS: Guilt proneness is related to high general motivation but to a lower desire to win. Guilt-prone individuals strive for excellence, but through non-competitive paths, whereas people with lower guilt proneness prefer competing.

How national leaders keep 'us' safe: A longitudinal, four-nation study exploring the role of identity leadership as a predictor of adherence to COVID-19 non-pharmaceutical interventions.

OBJECTIVES: To investigate whether citizens' adherence to health-protective non-pharmaceutical interventions (NPIs) during the COVID-19 pandemic is predicted by identity leadership, wherein leaders are perceived to create a sense of shared national identity. DESIGN: Observational two-wave study. Hypotheses testing was conducted with structural equation modelling. SETTING: Data collection during the COVID-19 pandemic in China, Germany, Israel and the USA in April/May 2020 and four weeks later. PARTICIPANTS: Adults in China (n=548, 66.6% women), Germany (n=182, 78% women), Israel (n=198, 51.0% women) and the USA (n=108, 58.3% women). MEASURES: Identity leadership (assessed by the four-item Identity Leadership Inventory Short-Form) at Time 1, perceived shared national identification (PSNI; assessed with four items) and adherence to health-protective NPIs (assessed with 10 items that describe different health-protective interventions; for example, wearing face masks) at Time 2. RESULTS: Identity leadership was positively associated with PSNI (95% CI 0.11 to 0.30, p<0.001) in all countries. This, in turn, was related to more adherence to health-protective NPIs in all countries (95% CI 0.03 to 0.36, 0.001≤p≤0.017) except Israel (95% CI -0.03 to 0.27, p=0.119). In Germany, the more people saw Chancellor Merkel as engaging in identity leadership, the more they adhered to health-protective NPIs (95% CI 0.04 to 0.18, p=0.002). In the USA, in contrast, the more people perceived President Trump as engaging in identity leadership, the less they adhered to health-protective NPIs (95% CI -0.17 to -0.04, p=0.002). CONCLUSIONS: National leaders can make a difference by promoting a sense of shared identity among their citizens because people are more inclined to follow health-protective NPIs to the extent that they feel part of a united 'us'. However, the content of identity leadership (perceptions of what it means to be a nation's citizen) is essential, because this can also encourage people to disregard such recommendations.

A trouble shared is a trouble halved: The role of family identification and identification with humankind in well-being during the COVID-19 pandemic.

The COVID-19 pandemic has triggered health-related anxiety in ways that undermine peoples' mental and physical health. Contextual factors such as living in a high-risk area might further increase the risk of health deterioration. Based on the Social Identity Approach, we argue that social identities can not only be local that are characterized by social interactions, but also be global that are characterized by a symbolic sense of togetherness and that both of these can be a basis for health. In line with these ideas, we tested how identification with one's family and with humankind relates to stress and physical symptoms while experiencing health-related anxiety and being exposed to contextual risk factors. We tested our assumptions in a representative sample (N = 974) two-wave survey study with a 4-week time lag. The results show that anxiety at Time 1 was positively related to stress and physical symptoms at Time 2. Feeling exposed to risk factors related to lower physical health, but was unrelated to stress. Family identification and identification with humankind were both negatively associated with subsequent stress and family identification was negatively associated with subsequent physical symptoms. These findings suggest that for social identities to be beneficial for mental health, they can be embodied as well as symbolic.

Identity Leadership, Employee Burnout and the Mediating Role of Team Identification: Evidence from the Global Identity Leadership Development Project.

Do leaders who build a sense of shared social identity in their teams thereby protect them from the adverse effects of workplace stress? This is a question that the present paper explores by testing the hypothesis that identity leadership contributes to stronger team identification among employees and, through this, is associated with reduced burnout. We tested this model with unique datasets from the Global Identity Leadership Development (GILD) project with participants from all inhabited continents. We compared two datasets from 2016/2017 (n = 5290; 20 countries) and 2020/2021 (n = 7294; 28 countries) and found very similar levels of identity leadership, team identification and burnout across the five years. An inspection of the 2020/2021 data at the onset of and later in the COVID-19 pandemic showed stable identity leadership levels and slightly higher levels of both burnout and team identification. Supporting our hypotheses, we found almost identical indirect effects (2016/2017, b = -0.132; 2020/2021, b = -0.133) across the five-year span in both datasets. Using a subset of n = 111 German participants surveyed over two waves, we found the indirect effect confirmed over time with identity leadership (at T1) predicting team identification and, in turn, burnout, three months later. Finally, we explored whether there could be a "too-much-of-a-good-thing" effect for identity leadership. Speaking against this, we found a u-shaped quadratic effect whereby ratings of identity leadership at the upper end of the distribution were related to even stronger team identification and a stronger indirect effect on reduced burnout.

Professional characteristics and work attitudes of hospital nurses who leave compared with those who stay.

AIM: To compare characteristics and attitudes of nurses who resigned and those who remained in two Israeli hospitals and assess the reasons for leaving. BACKGROUND: Nurse turnover is a current global problem in health care system, especially given the severe nurse shortages. Retention of nurses requires an understanding of the characteristics of the resigning nurses, their attitudes and their reasons for leaving. METHODS: A matching case-control study was conducted among 100 resigning nurses and 200 matched remaining nurses. Questionnaires were used to survey the professional characteristics and attitudes of the participating nurses. In addition, exit interviews were used to assess the reasons to leave of resigning nurses. RESULTS: Resigning nurses had higher education, less seniority and fewer managerial positions compared with remaining nurses. In addition, resigning nurses had lower professional autonomy and higher aspirations for professional advancement. The reasons to leave cited by the resigning nurses were distance of the workplace from home and working conditions as well as aspiring for professional advancement. CONCLUSIONS: The interface between high education and having few opportunities for advanced positions may lead to resignation. IMPLICATIONS FOR NURSING MANAGEMENT: We recommend organisational interventions for training new hospital nurses through professional career path development, such as mentoring programme.

The effect of regulatory focus and time preference on the dual process of physical activity: A cross-sectional study among nurses.

AIMS: To examine the dual process of physical activity adoption among nurses and its relationships with two personal orientations-regulatory focus-the tendency to focus on promotion (vs. prevention) goals and time preference as measured by delay discounting: the tendency to overvalue immediate rewards over long-term ones. BACKGROUND: The dual process theory suggests that both conscious and non-conscious processes influence the adoption of physical activity. However, the role of regulatory focus and time preference in this process was not yet examined. DESIGN: A cross-sectional online survey among 143 nurses during August-November 2017. METHODS: Validated measures were used to estimate physical activity habit strength (a non-conscious process) and intention, planning and behaviour control (conscious processes), physical activity level, regulatory focus and time preference. Multivariable ordered logit and logistic models were specified to examine determinants of both processes. RESULTS: Promotion focus was positively associated with having a strong habit of physical activity among nurses with moderate-to-low activity levels, but it was negatively associated with habit for active nurses. As for time preference, higher delay discounting was negatively associated with nurses' conscious intention to adopt physical activity and with their action planning. CONCLUSION: Promotion focus and time preference are associated with both conscious and non-conscious processes of physical activity adoption among nurses and should be considered in future health promotion interventions targeted to this population. IMPACT: Promotion focus and time preference have a significant role in this dual process. Enhancing physical activity of health providers by adjusting the intervention to personal orientations may improve public health.

At Least I Tried: The Relationship between Regulatory Focus and Regret Following Action vs. Inaction.

Regret is an unpleasant feeling that may arise following decisions that ended poorly, and may affect the decision-maker's well-being and future decision making. Some studies show that a decision to act leads to greater regret than a decision not to act when both resulted in failure, because the latter is usually the norm. In some cases, when the norm is to act, this pattern is reversed. We suggest that the decision maker's regulatory focus, affects regret after action or inaction. Specifically, promotion-focused individuals, who tend to be more proactive, view action as more normal than prevention-focused individuals, and therefore experience regulatory fit when an action decision is made. Hence, we hypothesized that promotion-focused individuals will feel less regret than prevention-focused individuals when a decision to act ended poorly. In addition, we hypothesized that a trigger for change implied in the situation, decreases the level of regret following action. We tested our hypotheses on a sample of 330 participants enrolled in an online survey. The participants received six decision scenarios, in which they were asked to evaluate the level of regret following action and inaction. Individual regulatory focus was measured by two different scales. Promotion-focused individuals attributed less regret than prevention-focused individuals to action decisions. Regret following inaction was not affected by regulatory focus. In addition, a trigger for change decreases regret following action. Orthodox people tend to attribute more regret than non-orthodox to a person who made an action decision. The results contribute to the literature by showing that not only the situation but also the decision maker's orientation affects the regret after action vs. inaction.

Regulatory focus and adherence to self-care behaviors among adults with type 2 diabetes.

The aims of this study were, first, to test the association between regulatory focus of adults with type 2 diabetes and their adherence to two types of self-care behaviors - lifestyle change (e.g. physical activity and diet) and medical care regimens (blood-glucose monitoring, foot care and medication usage). Second, to explore whether a fit between the message framing and patients' regulatory focus would improve their intentions to adhere specifically when the type of behavior fits the patients' regulatory focus as well. A cross-sectional study was conducted among 130 adults with type 2 diabetes who were hospitalized in an academic medical center. The patients completed a set of questionnaires that included their diabetes self-care activities, regulatory focus, self-esteem and demographic, socioeconomic and clinical data. In addition, participants were exposed to either a gain-framed or a loss-framed message, and were then asked to indicate their intention to improve adherence to self-care behaviors. A multivariable linear regression model revealed that promoters reported higher adherence to lifestyle change behaviors than preventers did (B = .60, p = .028). However, no effect of regulatory focus on adherence to medical care regimens was found (B = .46, p = .114). In addition, preventers reported higher intentions to adhere to medical care behaviors when the message framing was congruent with prevention focus (B = 1.16, p = .023). However, promoters did not report higher intentions to adhere to lifestyle behaviors when the message framing was congruent with promotion focus (B = -.16, p = .765). These findings justify the need to develop tailor-made interventions that are adjusted to both patients' regulatory focus and type of health behavior.

Attitudes toward expanding nurses' authority.

BACKGROUND: In recent years, an increasing number of care procedures previously under the physician's authority have been placed in the hands of registered nurses. The purpose of this study was to examine the attitudes of nurses towards expanding nurses' authority and the relationships between these attitudes and job satisfaction facets, professional characteristics, and demographics. METHOD: A cross-sectional study was conducted between 2010 and 2011 in three major medical centers in Israel. Participants included 833 nurses working in 89 departments. Attitudes toward the expansion of nurses' authority were assessed by self-report questionnaire, as well as job satisfaction facets including perception of professional autonomy, nurse-physician working relations, workload and burnout, perceptions of quality of care, and nursing staff satisfaction at work. RESULTS: Nurses reported positive attitudes toward the expansion of nurses' authority and moderate attitudes for interpretation of diagnostic tests in selected situations. The results of multivariate regression analyses demonstrate that the nurses' satisfaction from professional autonomy and work relations were the most influential factors in explaining their attitudes toward the expansion of nurses' authority. In addition, professionally young nurses tend to be more positive regarding changes in nurses' authority. CONCLUSIONS: In the Israeli reality of a nurse's shortage, we are witnessing professional transitions toward expansion of the scope of nurses' accountability and decision-making authority. The current research contributes to our understanding of attitudes toward the expansion of nurses' authority among the nursing staffs. The findings indicate the necessity of redefining the scope of nursing practice within the current professional context.

Life-threatening event reduces subjective well-being through activating avoidance motivation: a longitudinal study.

Drawing on the approach-avoidance theory, we have examined the role of avoidance motivation in explaining the negative effects of a life-threatening event on subjective well-being (SWB). Residents of the south of Israel were surveyed during heavy missile attacks in January 2009 (T1; n = 283), and again after 6 months (T2; n = 212) and 1 year (T3; n = 154). During the missile attacks, we also surveyed a group from the center of the country (T1; n = 102), not exposed to the attacks. The results indicate that avoidance motivation was activated by the life threat and further mediated its detrimental influence on SWB measures (positive/negative affects, anxiety, and subjective health). Moreover, within the southern sample, the drop in avoidance motivation over time mediated the parallel drop in SWB. In contrast to avoidance motivation, approach motivation remained stable over time and was related to positive emotions. The role of avoidance and approach motivations in life-threatening situations is further discussed.

[Job satisfaction, intention to leave and leaving the practice of medicine among physicians in Israel: a survey of physicians receiving their licenses in 2000, 2002, 2004, 2006].

INTRODUCTION: There is recent evidence that physicians are increasingly dissatisfied with the medical profession and are leaving the profession. GOALS: To measure job satisfaction and the rate of Leaving the profession among physicians recently licensed in israeL. METHODS: A telephone survey among 733 doctors; graduates of medical schools in Israel who received their license in 2000, 2002, 2004 and 2006. FINDINGS: A total of 5.5% of the physicians interviewed had stopped practicing medicine. However, among those graduating in 2000 and 2002, 8% Left the profession. Furthermore, 6.5% live abroad, suggesting that 12% of those receiving Israeli Licenses in 2000-2006 are not currently employed as physicians in Israel. In addition to the physicians who actually left, a further 9% had made contact with human resources companies, and 13% reported often thinking about leaving. Satisfaction with external professional factors (physical conditions, work relations, wages, career-family balance) was significantly Lower among those who remain in the profession, compared with those who left. Satisfaction with internal professional factors (significance of work, interest/challenge) was slightLy higher among those staying than those Leaving. The internal factors were the best predictors of intentions to Leave the profession. CONCLUSION: (1) Discontinuation of medical practice among physicians in Israel has increased in recent year. (2) Satisfaction from work conditions among physicians is lower than among those who Left the medical profession for other positions (e.g., hi-tech, research, medical firms). SUMMARY AND DISCUSSION: Intentions to leave the profession, combined with dissatisfaction with working conditions (e.g., wages and work relations), paint a gloomy picture of the attitudes towards medicine reported by those remaining in the profession, and of the likelihood of staying, in light of the more prestigious and rewarding employment alternatives.

Feedback, the various tasks of the doctor, and the feedforward alternative.

OBJECTIVES: This study aims to alert users of feedback to its dangers, explain some of its complexities and offer the feedforward alternative. METHODS: We review the damage that feedback may cause to both motivation and performance. We provide an initial solution to the puzzle of the feedback sign (positive versus negative) using the concepts of promotion focus and prevention focus. We discuss additional open questions pertaining to feedback sign and consider implications for health care systems. RESULTS: Feedback that threatens the self is likely to debilitate recipients and, on average, positive and negative feedback are similar in their effects on performance. Positive feedback contributes to motivation and performance under promotion focus, but the same is true for negative feedback under prevention focus. We offer an alternative to feedback--the feedforward interview--and describe a brief protocol and suggestions on how it might be used in medical education. CONCLUSIONS: Feedback is a double-edged sword; its effective application includes careful consideration of regulatory focus and of threats to the self. Feedforward may be a good substitute for feedback in many settings.

Factor analysis of the Beer Sheva Psoriasis Severity Score (BPSS).

BACKGROUND: The Beer Sheva Psoriasis Severity Score is a novel instrument for the assessment of psoriasis severity, designed for use in routine clinical conditions. OBJECTIVE: To identify the main factors of the BPSS. METHODS: The sample used to study the BPSS comprised 70 patients with psoriasis vulgaris treated by climatotherapy at the Dead Sea. Psoriasis severity was assessed using BPSS and PASI (Psoriasis Area and Severity Index). Factor analysis was used to identify the main factors of BPSS. Internal consistency analysis was performed. Correlation matrices were generated to compare BPSS factors. RESULTS: Factor analysis demonstrated that BPSS included six factors that explained 74.0% of the variance as follows: patient assessment 26.0%; physician assessment 13.2%; palms and soles involvement 11.9%; genitals, nails, and pruritus 9.0%; face involvement 7.3%; and scalp involvement 6.6%. Total scale Cronbach's alpha was 0.76; alpha for the factors ranged between 0.39 and 0.81. CONCLUSIONS: The major factors of BPSS were identified. BPSS may be used as a comprehensive tool for measuring psoriasis severity.

Advanced and specialist nursing practice: attitudes of nurses and physicians in Israel.

BACKGROUND: With the introduction of new and advanced nursing roles, the nursing profession is undergoing dynamic change. Realizing changes will be easier to accomplish if the nursing community and other healthcare professionals welcome the process. Recently the nursing staff mix in Israel has been undergoing a transformation: encouraging registered nurses to enhance their status by acquiring academic degrees and advanced professional training, and initiating the adoption of new nursing roles. OBJECTIVE: Our goal is to evaluate Israeli nurses' and physicians' attitudes to the introduction of new nursing roles and to expanding the scope of nursing practice. METHODS: Two hundred and fifteen nurses and 110 physicians from three large general hospitals and 15 community clinics filled in a questionnaire. FINDINGS: In general the majority of the nurses supported expansion of nursing practice, and such expansion did not cause significant opposition among physicians. However when the task affected patients' health, physicians were less willing to permit nurses to perform skills previously their responsibility alone. In addition, using multiple logistic regressions, support of the expansion of nursing practice was significantly higher among nurses in management or training positions, and among academically accredited nurses. Support for expanded roles was prominent among hospital physicians, graduates from Israeli schools of medicine, and less-tenured physicians. CONCLUSIONS: We suggest that confirmation by various groups of physicians and nurses of standardized definitions of the new boundaries in the scope of nursing practice roles could successfully promote development of new roles and facilitate integration of the Israeli healthcare system into the global context of change. CLINICAL RELEVANCE: Inter- and intra-professional collaboration, agreement, and understanding regarding advanced nursing practice roles and their introduction into the healthcare system might improve the relationship between healthcare professions and ultimately increase quality of care and patient satisfaction.

Effectiveness of climatotherapy at the Dead Sea for psoriasis vulgaris: A community-oriented study introducing the 'Beer Sheva Psoriasis Severity Score'.

BACKGROUND: Climatotherapy at the Dead Sea (CDS) is a therapeutic modality for moderate to severe psoriasis vulgaris. OBJECTIVE: To evaluate the effectiveness of CDS in patients with psoriasis, using the PASI score and a novel simplified tool for the assessment of psoriasis - the Beer Sheva Psoriasis Severity Score (BPSS). METHODS: A total of 70 patients with psoriasis vulgaris were treated by CDS. In all patients, the severity of psoriasis was assessed before and after CDS using PASI score and BPSS. BPSS includes eight items that are recorded by the physician (total severity of the disease, and seven items relating to the physical distribution of the disease) and eight items that are recorded by the patient (total severity, physical and psychological severity, pruritus and assessment of involvement in the face, nails, palms and soles and genital regions). RESULTS: The study included 70 patients (40 men, 30 women; age 19-78 years). There was a 75.9% reduction in PASI score, from a mean of 16.6+/-11.0 before treatment to 4.0+/-4.2 after treatment (p<0.001). There was a 57.5% reduction in BPSS, from a mean of 72.8+/-19.6 before treatment to 31.0+/-21.2 after treatment (p<0.001). PASI score significantly correlated with BPSS before CDS treatment (r = 0.59, p<0.001) and after CDS treatment (r = 0.53, p<0.001). CONCLUSION: CDS is an effective therapy for patients with psoriasis, as evaluated by either PASI score or BPSS. BPSS was considered shorter and more user-friendly by the participating physicians.