What Can Be Learned from Health-Related Tensions and Disparities in Ultra-Orthodox Jewish Families?

Barriers and enablers to vaccination in the ultra-orthodox Jewish population: a systematic review

Background

The Jewish Ultra-Orthodox (UO) population is an under-vaccinated minority group that has been disproportionally affected by outbreaks of vaccine-preventable diseases (VPD) such as measles and polio. Underlying reasons remain poorly characterized. We aimed to identify vaccination barriers and enablers in this population.

Methods

We systematically reviewed the literature (PROSPERO: CRD42021273001), searching Pub-med, Web of science, Medline, PsychNet and Scopus from 1995 to 2021 for quantitative and qualitative primary research in English. Studies published outside the date range, not including barriers or enablers, or that were non-primary research were excluded. We assessed included publications for quality and extracted relevant data based on the 5As taxonomy: access, awareness, affordability, acceptance and activation.

Results

We included nine qualitative and seven quantitative studies from the 125 studies identified. Access barriers included scheduling difficulties, inconvenient opening hours, and logistical difficulties related to having multiple young children. Acceptance barriers included safety concerns. Insufficient knowledge about the importance of vaccine and timely vaccination and the perception of being shielded from infections because of seclusion from wider society were key awareness barriers. Competing priorities, such as work and housework, were the main affordability barriers. Mainstream religious leadership's support for vaccination was an enabler, although recent studies suggest their influence on vaccination behavior is decreasing and influence of anti-vaccination messages is growing.

Discussion

Barriers to vaccination among the UO were mainly logistical, with little religious framing. Safety and efficacy concerns were similar to those reported in the wider community. Decreasing influence of the traditionally pro-vaccine mainstream religious leadership and growing influence of anti-vaccination movements targeting the UO community are new phenomena that require close monitoring. Tailored interventions are required to protect the community and wider society against future VPD outbreaks.

Systematic review registration

PROSPERO: CRD42021273001.

Religious Minorities' Perceptions of Official COVID-19 Health Guidelines: The Case of Ultra-Orthodox Society in Israel

This article focuses on perceptions of the Jewish ultra-Orthodox population in Israel-a religious minority-regarding guidelines enacted by the Israeli Ministry of Health (MOH) during the country's second wave of COVID-19, and ways the community coped with the pandemic. Semi-structured interviews with 30 ultra-Orthodox individuals revealed five major discourses reflecting participants' perceptions. Three discourses objected to MOH guidelines, while the other two aligned with them. The study's findings also indicate a lack of cooperation between the ultra-Orthodox population and state health authorities, emphasizing the need to implement culturally adapted health interventions. Study limitations are discussed, and future research recommendations are provided.

Do Ultra-Orthodox Israeli Jews Suffer more than Secular Israeli Jews from Obesity? Gender, Cohort Effect and the Yule-Simpson Paradox

The Yule-Simpson paradox indicates contradicting statistical outcomes for the pooled sample and for each stratified group separately. The objective of the current study is to demonstrate this paradox. The sample is based on a 2015-2016 longitudinal survey carried out by the Israeli Central Bureau of Statistics. The sample includes 1194 individuals, where the responses of 1140 individuals were assessed twice (in 2015 and 2016) and the responses of 54 individuals were recorded only once. This gives a total sample of 2334 observations × years. The sample includes 609 females and 585 males. We use the limited dependent binary probit regression model. The dependent variable is a dummy variable that equals 1 if the individual is obese (BMI ≥ 30, where BMI = WEIGHT ÷ (HEIGHT²), WEIGHT is measured in kilograms and HEIGHT is measured in meters) and zero otherwise. The independent variables are the denomination (secular vs. ultra-Orthodox) and age in years. Findings suggest that on the one hand, for the pooled sample of 21-50-year-old females and males, results clearly support the conclusion that compared with secular Israeli Jews, projected probability of obesity (BMI ≥ 30) among ultra-Orthodox Israeli Jews is higher (p = 0.0128). On the other hand, when stratified by gender, one cannot reject the opposite conclusion, according to which projected probability of obesity is equal for all cohorts among ultra-Orthodox and secular Israeli Jews. Research findings thus stress the importance of cautious and rigorous statistical analysis and robustness tests prior to statistical inference.

Promoting a Culturally Adapted Policy to Deal with the COVID-19 Crisis in the Haredi Population in Israel

COVID-19 has caused high morbidity and mortality in Israel but, as in other countries, not all groups were equally affected. Haredi Jews (often called ultra-Orthodox), a religious minority, were disproportionately harmed by the pandemic. This group has distinctive cultural, lifestyle, and demographic characteristics, which may be related to these higher COVID-19 rates and call for policies specifically adapted for this community. This paper describes in detail the steps the Israeli Ministry of Health (MoH) took to try to improve the quality of care and prevent morbidity in the Haredi population through working in cooperation with the leadership and members of the Haredi community and strengthening mutual trust in order to increase adherence to government regulations and recommendations. This case study is based on the unique perspective of the two people who worked in the Israeli MoH and led the initiative as well as a review of relevant government documents and statistics. It discusses to what extent the initiative seemed to have been successful and what lessons can be learned not only for Haredim but for other religious and/or minority groups and closed communities in Israel and elsewhere.

Perceptions among diabetic patients in the ultra-orthodox Jewish community regarding medication adherence: a qualitative study

BACKGROUND

Promoting a healthy lifestyle and achieving strict adherence to medical treatment among patients with diabetes are key objectives in public health. Yet health behaviors are often culturally driven, especially in closed religious communities. This study seeks to reveal key cultural-religious factors, attitudes and behaviors characterizing the lifestyle in one such closed community-the ultra-Orthodox Jewish community-by understanding the attitudes of ultra-Orthodox patients with diabetes toward coping with their illness and the factors impacting their adherence to medicinal treatment.

METHOD

Qualitative interviews were conducted with 16 ultra-Orthodox patients with diabetes using a semi-structured, in-depth questionnaire.

RESULTS

Three main themes emerged: 1) "The disease as a secret": Hiding the disease among patients with diabetes in ultra-Orthodox society; 2) "Distinguishing between sacred and secular occasions": ultra-Orthodox diabetes patients distinguish between treatment adherence on weekdays and treatment adherence on holidays or special occasions; 3) "Ask the rabbi": In cases of dilemmas that involved conflicts between halakhic rulings and doctors' instructions, the rabbi's decision was usually the final one.

CONCLUSIONS

The findings of this study may help provide an in-depth understanding of the obstacles and motives of ultra-Orthodox patients in adhering to medicinal treatment of diabetes in particular and to medicinal treatment in general, thus helping family physicians who treat this population provide optimal and appropriate treatment.

"Over-preoccupation with healthy food is perceived as worship of the body": Food, culture and beliefs in Ultra-Orthodox Jewish families

BACKGROUND

Eating behaviours vary by culture and religion, and an understanding of attitudes and practices are essential for providing culturally competent nutritional guidance. The Ultra-orthodox Jewish community is characterized by poor diet, high rates of obesity, anemia and diabetes. This study aimed to acquire insights that could influence the promotion of healthier eating in the Ultra-orthodox and other closed religious communities, particularly regarding children's eating habits and the food they consume.

METHODS

In depth face-to-face recorded interviews were conducted with 20 information-rich participants: religious leaders, opinion leaders and education/health professionals from Gur and Chabad, two Ultra-orthodox Jewish religious communities in Israel. The focus was on exploring young family eating behaviours and perceived challenges to encouraging healthier nutrition in the community. Interviews were transcribed and thematic analysis employed using grounded theory.

RESULTS

Seven themes were identified with findings that had clear implications for the promotion of health at both the community and individual level. These included spiritual aspects of eating, deficits in knowledge and awareness, less relevance of kashrut than previously thought, the centrality of motherhood and family meals, the quality of food in educational institutions, the significance and sensitivity of Sabbath and festive meals and pragmatic considerations.

DISCUSSION AND CONCLUSIONS

By illuminating attitudes and behaviors, the study broadens and enhances our understanding of the Ultra-orthodox communities' perspectives on eating behaviours in the family. The findings have the potential to contribute to strengths-based health promotion for children's nutrition. Recommendations regarding culturally competent guidance and implications for other secluded religious communities are discussed.

COVID-19 Amongst the Ultra-Orthodox Population in Israel: An Inside Look into the Causes of the High Morbidity Rates

The current paper focuses on the circumstances that have led to the high COVID-19 infection rates amongst the ultra-Orthodox population in Israel. The current study utilizes a qualitative design and is based on in-depth interviews, email correspondence and online records of 25 ultra-Orthodox individuals who either tested positive for COVID-19 or had contact with a verified COVID-19 patient. The data were analyzed through identification of main themes and an interpretation of their meanings. The findings showed that a wide range of causes led to the high infection rate, including aspects that derive from a structural element, a religious element and a social-ideological element—all of which are directly or indirectly connected to religion. These findings demonstrate the central role of religion in health outcomes among the ultra-Orthodox community in general and during pandemics in particular, and they shed light on the central role of religion in health outcomes among closed-religious communities. The findings further reveal the importance of cooperation between the state authorities and the religious ones, and of providing culturally adapted health service solutions in the fight against COVID-19 and promoting health more generally. Study limitations are discussed and recommendations for future research are provided.

Analysis of Youth Physical Activity Promotion in a Nationally Representative Sample of U.S. Synagogues

Faith-based organizations are entities recommended to promote and provide health-related physical activity to youth. Meanwhile, religious institutions—including synagogues—typically use diverse media, including websites, bulletins/newsletters, and calendars to inform current and potential members about both general (e.g., theological) and specific practical messages (e.g., about the occurrence of services, meetings, and programs). Given the historical role synagogue centers played in the early- to mid-twentieth century in providing members recreational and sport programming, we were interested to know what physical activities synagogues currently advertise through the aforementioned media. From January through May 2019, we completed a line-by-line analysis of the public websites of a large nationally representative sample of synagogues (n = 1383 sites from 337 U.S. cities in 39 states) to assess content (including links to bulletins/newsletters and calendars) related to child and adolescent physical activity. Only 35.4% of the sampled websites used these media to mention that their synagogue provided even a single physical activity program/event. Thus, most synagogues either (a) did not provide physical activity programs for children and adolescents, or (b) neglected to use online platforms to promote engagement in them. We found 938 distinct programs/events and 1667 specific activities across synagogue websites that mentioned at least one physical activity. Programs by type and proportion (i.e., percentage of programs overall) included youth group (39.1%), preschool (26.9%), youth worship (18.0%), and youth education (16.0%). We situate our findings by explicating past and current functions of synagogues related to the provision of youth programming. Future research should examine the beliefs that synagogue rabbis and media gatekeepers hold toward physical activity in general and youth physical activity specifically. Youths should also be queried as to what role synagogue programming can/should play in promoting/providing and accommodating their physical activity needs and preferences.

Forming an Affiliation Between Two Culturally Different Academic Institutions of Nursing Studies

Introduction

This article describes the association of two culturally different institutions opening a joint Bachelor of Science in Nursing (BSN) program for ultra-Orthodox Jewish (Haredi) women in order to enable them to find jobs due to changes in their society and increasing global demand for nurses in the labor market. The objective of this description is to illustrate the efforts and changes needed to facilitate the affiliation of two culturally and ideologically different organizations and the implications and conclusions of such a program.

Methods

The study is based on interviews with past administrators, a review of the literature, and supporting institution documents.

Conclusions

A joint nursing academic program was founded by two culturally different educational institutions for the ultra-Orthodox Jewish women population. Creating a culturally sensitive nursing academic program helped ultra-Orthodox women acquire an academic profession which enabled their integration into the academic professional's work world and add more nurses to the labor market.The authors reviewed the efforts and changes needed to facilitate the affiliation of two culturally and ideologically different organizations based on the Bolman and Deal four frames model.