Workplace Violence against Hospital Workers during the COVID-19 Pandemic in Israel: Implications for Public Health

Workplace violence (WPV) against healthcare workers, a serious public health problem with profound implications, has worsened during the COVID-19 pandemic. This study examined the incidence of different types of WPV in a public hospital in Israel during the pandemic and analyzes the factors associated with its occurrence. A cross-sectional study was performed via an online questionnaire with 486 workers at a government hospital in Israel. Data were collected about sociodemographic and occupational characteristics, exposure to different forms of WPV over the preceding six months, and the responsibility and reasons for WPV from the workers' perspective. Approximately 71% of respondents were exposed to WPV and 64% perceived that WPV escalated during the pandemic. The prevalence of verbal/psychological and physical WPV were 69 and 11%, respectively. The main reason for WPV was frustration over long wait times (70%). The escalation during the pandemic can be attributed to patients' or relatives' anxiety and mental states following the onset of the COVID-19 pandemic (72%), an increase in waiting time since the pandemic began (54%), lack of hospital resources to care for everyone (45%), and the inability to visit critically ill relatives with COVID-19 (44%). Increased exposure to WPV was attributed to lower seniority, working in emergency or internal departments, and being a nurse or a doctor. The findings raise an urgent need to develop strategies to reduce WPV in hospitals at all levels: national, organizational, and individual. Further research could focus on the effectiveness of innovative strategies and interventions to prevent violence against healthcare workers.

Factors that affect Israeli paramedics' decision to quit the profession: a mixed methods study

Background

The rate of Israeli paramedics leaving the profession has been increasing in recent years: 50% leave the profession in three years, for the most part before retirement. While approximately 2500 paramedics have been trained, only about a third of them are still active.

The number of paramedics per 100,000 in Israel is only 8, compared to around 66 in the US, and in light of the shortage of paramedics it is important to enhance retention rates. The purpose of the study was to examine the factors related to paramedics leaving the profession in Israel.

Methods

1. An online survey was sent to 1000 paramedics via Email. 533 were recruited of whom 200 have left the profession. Questions included demographics, job satisfaction, and reasons for leaving or remaining in the profession.

2. In-depth interviews with 15 paramedics who left the profession.

Results

Out of 1000 emails sent, 533 Paramedics responded, of which 200 paramedics who left the profession responded (73% left five years after completing training and 93% after 10 years). Among these former paramedics, choosing the paramedic profession was based mainly on an idealistic sense of mission and eagerness to help others, yet leaving the paramedic profession was related to extrinsic factors: lack of career options, extensive and strenuous physical demands accompanied by unrewarding salaries, unusually long work hours, and shift work that negatively affected family and personal life.

Conclusions

It seems that work conditions, including the lack of opportunities for promotion, lack of professional prospects, and inappropriate compensation for hard work are crucial factors in the decision to leave.

Recommendations

A joint committee of the Ministries of Health, Justice, and Finance and MDA (Magen David Adom, the national EMS in Israel) should be established for the purpose of improving the conditions and modalities of employment of paramedics and providing appropriate emotional support for paramedics who are exposed daily to work under extreme conditions of stress and human suffering. A joint effort could greatly reduce rates of leaving, training costs, and costs incidental to turnover, as well as increase job satisfaction. Moreover, regulating the profession and expanding the scope of practice to new fields like community paramedicine as part of the EMS service and expanding the scope of physician assistants as an academic profession can create opportunities for advancement and diversity at work that will help retain paramedics in the profession.

Telemedicine and eHealth Literacy in the Era of COVID-19: A Cross-Sectional Study in a Peripheral Clinic in Israel

The COVID-19 pandemic mandating isolation, quarantine, and social distancing has accelerated and expanded the use of telemedicine. This study examines the extent of the use of telemedicine and the relationship between eHealth literacy and satisfaction with using telemedicine during the pandemic. A total of 156 participants from a clinic in a peripheral community in southern Israel completed an online questionnaire. We found that 85% knew how to use the internet for health information, but only one third felt safe using it to make health decisions. Furthermore, 93% used the internet for technical needs, such as renewing prescriptions or making a doctor's appointment. Even lower use for telemedicine was found (38%) for consultation or treatment sessions. A positive association was found between eHealth literacy and satisfaction variables with using telemedicine (rp = 0.39, p < 0.001). Although respondents understood the benefits of telemedicine, they were not satisfied nor interested in online sessions after the epidemic's end, preferring a meeting involving personal interaction. Young people and academics benefit more from telemedicine, thereby creating usage gaps and potentially increasing existing inequality. We recommend developing intervention programs, especially among vulnerable populations, to strengthen eHealth literacy and remove barriers causing skepticism about the use of telemedicine during and after the pandemic.

Perceptions of Practicing Physicians and Members of the Public on the Attributes of a "Good Doctor"

Since physician–patient relationships are a central part of the medical practice, it is essential to understand whether physicians and the general public share the same perspective on traits defining a “good doctor”. Our study compared the perceptions of physicians and members of the public on the essential traits of a “good doctor.” We conducted parallel surveys of 1000 practicing specialist-physicians, and 500 members of the public in Israel. Respondents were asked about the two most important attributes of a “good doctor” and whether they thought the physicians’ role was to reduce health disparities. Many physicians (56%) and members of the public (48%) reported that the role of physicians includes helping to reduce health disparities. Physicians emphasized the importance of non-technical skills such as humaneness and concern for patients as important traits of a “good doctor,” while the public emphasized professional and technical skills. Internal medicine physicians were more likely than surgeons to emphasize humaneness, empathy, and professionalism. Future research should focus on actionable approaches to bridge the gap in the perceptions between the groups, and that may support the formation of caring physicians embedded in a complex array of relationships within clinical and community contexts.

Reducing health disparities: the social role of medical schools

INTRODUCTION

Medical education based on the principles of social medicine can contribute toward reducing health disparities through the "creation" of doctors who are more involved in community programs.

PURPOSE

This study compared the social medicine orientation of graduates from various medical schools in Israel.

METHODS

The authors conducted an online cross-sectional survey in May 2011 among physicians who are graduates of Israeli medical schools.

RESULTS

The study included 1050 physicians practicing medicine in Israel: 36% who are graduates from the Hebrew University, 26% from Tel Aviv University, 22% from the Technion and 16% from Ben-Gurion University. A greater percentage of physicians who studied either at the Technion or Ben-Gurion are working or have worked in the periphery (∼50% vs. ∼30% at the Hebrew and Tel Aviv Universities). Among Ben-Gurion graduates, 47% are active in social medicine programs vs. 34-38% from other schools. Among physicians active in social medicine programs, 32% of Ben-Gurion alumni estimated that their medical education greatly influenced their social medicine involvement vs. 8-15% from other schools. Hebrew University alumni described their studies as more research-oriented. In contrast, Ben-Gurion graduates described their studies as more social medicine-oriented and they exhibited more positive attitudes about the role of physicians in reducing health disparities.

DISCUSSION

Social medicine-oriented medical education induces a socialization process reinforcing human values regarding doctor-patient relationships and produces positive attitudes among future doctors about social involvement. Findings emphasize the need to develop educational programs with this orientation and to strengthen medical schools in the periphery.

Health locus of control in cancer patient and oncologist decision-making: An exploratory qualitative study

Objective

To investigate how cancer patients’ and family members’ perspective and health locus of control are presented in clinical encounter decision-making.

Methods

Semi-structured in-depth interviews were carried out with 16 cancer patients and 6 family members living in Israel (n = 22). Interviews were transcribed verbatim, and data were analyzed using thematic analysis.

Results

Following the health locus of control model, the findings were divided into an external and internal locus of control themes, and we added a theme regarding shared decision-making. Internal locus of control sub-themes included asking for a second opinion, negotiating with the doctor, asking questions, looking for information, and fighting for their rights. External locus of control sub-themes included powerful others, oncologists, and fate. The dominant approach of most of the interviewees was an external locus of control. Women demonstrated more external locus of control than men. On the direct question of who should decide on treatment—the doctor, the patient, or both jointly—the answers ranged from only the doctor (n = 8) to together (n = 7) to only the patient (n = 8).

Conclusions

This study provides insights into different aspects of locus of control in the clinical encounter involving cancer patients. The findings reflect the need to devote comprehensive attention to cancer patients’ perceptions and experiences in the clinical encounter. A patient-centered care approach and a personalized framework for decision-making in cancer care are essential to achieving better treatment outcomes. Further research can engage in the development and validation of an up-to-date health locus of control questionnaire for cancer patients based on the findings of this study.

The Future Public Health Workforce in a Changing World: A Conceptual Framework for a European-Israeli Knowledge Transfer Project

Health services quality and sustainability rely mainly on a qualified workforce. Adequately trained public health personnel protect and promote health, avert health disparities, and allow rapid response to health emergencies. Evaluations of the healthcare workforce typically focus on physicians and nurses in curative medical venues. Few have evaluated public health workforce capacity building or sought to identify gaps between the academic training of public health employees and the needs of the healthcare organizations in which they are employed. This project report describes the conceptual framework of "Sharing European Educational Experience in Public Health for Israel (SEEEPHI): harmonization, employability, leadership, and outreach"-a multinational Erasmus+ Capacity Building in Higher Education funded project. By sharing European educational experience and knowledge, the project aims to enhance professionalism and strengthen leadership aspects of the public health workforce in Israel to meet the needs of employers and the country. The project's work packages, each jointly led by an Israeli and European institution, include field qualification analysis, mapping public health academic training programs, workforce adaptation, and building leadership capacity. In the era of global health changes, it is crucial to assess the capacity building of a well-qualified and competent workforce that enables providing good health services, reaching out to minorities, preventing health inequalities, and confronting emerging health challenges. We anticipate that the methods developed and the lessons learned within the Israeli context will be adaptable and adoptable by other countries through local and cultural adjustments.

The Organizational Atmosphere in Israeli Hospital during COVID-19: Concerns, Perceptions, and Burnout

The COVID-19 crisis poses challenges to healthcare systems and requires micro- and macro-organizational adaptations. This study examined the organizational atmosphere in Israeli hospitals by evaluating workers’ perceptions and concerns about the COVID-19 crisis and its management. At the end of the pandemic’s first wave in Israel, 547 healthcare workers responded to an online survey, which inquired about COVID-19 concerns at the individual and family level, perceptions at the national and organizational level, perceptions of the way the crisis was managed, self-assessment of coping with the crisis and burnout, and demographics. Findings showed that healthcare workers expressed deep concerns for family members and apprehension at a national level. Respondents noted that they were coping well with the crisis while expressing negative perceptions of how the crisis was managed. A regression model showed that the low self-assessment of medical staff of coping with the crisis, deep concerns at the organizational level, negative perceptions of crisis management, and providing care for COVID-19 patients were predictors of burnout. The findings emphasize the importance of developing a supportive organizational culture for hospital workers. Awareness of their concerns and perceptions is essential to improve organizational culture and healthcare systems’ ability to continue fighting the virus and confront future health crises.

Identifying the Gaps Between Public Health Training and Practice: A Workforce Competencies Comparative Analysis

Objectives: The study aimed to generate insights on how best to enhance the compatibility between Public Health training program competencies and the implementation of competencies required by employers to address current and emerging public health needs. Methods: A survey adapted from the WHO-ASPHER Competency Framework for the Public Health Workforce was conducted online among Israeli public health managers from August to November 2021. The survey was formulated to mirror Essential Public Health Operations. Forty-nine managers participated (37.6% response rate) in an assessment of 44 public health competencies and the core organizational public health operations. Results: Analysis of Essential Public Health Operations revealed a notably high deficiency reported for Advocacy Communication and Social Mobilization for health competencies. Collaborations and Partnership and, Leadership and System Thinking were the most reported insufficient competencies, particularly in health departments and research institutes. Governmental offices reported Organizational Literacy and Adaptability competencies being deficient. Deficiencies were more impactful as the level of expertise increased. Conclusion: There is a clear need for public health professionals to acquire versatile and innovative competencies in response to the ever-changing health threats.

Emerging lessons from the COVID-19 pandemic about the decisive competencies needed for the public health workforce: A qualitative study

The global COVID-19 crisis exposed the critical need for a highly qualified public health workforce. This qualitative research aimed to examine public health workforce competencies needed to face COVID-19 challenges and identify the gaps between training programs and the competency demands of real-world disasters and pandemics. Through a sample of thirty-one participant qualitative interviews, we examined the perspectives of diverse stakeholders from lead public health organizations in Israel. Grounded Theory was used to analyze the data. Six themes emerged from the content analysis: public health workforce's low professional status and the uncertain future of the public health workforce; links between the community and Higher Education institutions; the centrality of communication competencies; need to improve health promotion; the role of leadership, management, and partnership, and innovation in public health coherence. Increasing the attractiveness of the profession, professional and financial support, and improving the working conditions to ensure a sustainable and resilient PH system were deemed necessary. This paper describes and cultivates new knowledge and leadership skills among public health professionals, and lays the groundwork for future public health leadership preparedness programs.

Reducing resistance to treatment, through group intervention, improves clinical measurements in patients with type 2 diabetes

BACKGROUND

Studies have shown that group Therapeutic Patient Education (TPE) may empower patients with type 2 diabetes to better manage their disease. The mechanism of these interventions is not fully understood. A reduction in resistance to treatment may explain the mechanism by which TPE empowers participants to improve self-management. The Objective of this study was to examine the effectiveness of diabetes groups in reducing resistance to treatment and the association between reduced resistance and better management of the disease.

METHODS

In a program evaluation study, we administered validated questionnaires to measure resistance to treatment (RTQ) in 3 time periods: before the intervention (T1), immediately after the intervention (T2) and six months later (T3). Clinical measures (HbA1C, blood pressure, HDL, LDL and total cholesterol, Triglycerides and BMI) were retrieved from Maccabi Healthcare Services computerized systems, for T1;T2 and a year post intervention (T3). Linear mixed models were used adjusting for age, gender, social support and family status.

RESULTS

157; 156 and 106 TPE participants completed the RTQ in T1; T2 and T3 respectively. HbA1C and systolic and diastolic blood pressure were significantly reduced in the group which achieved a reduction in three out of the five RTQ components. For the other clinical measurements no significant changes were observed.

CONCLUSION

Our findings suggest that reducing resistance to treatment, through an educational program for patients with diabetes, is associated with a better disease control. Identifying patients with higher resistance to treatment, and including components that reduce resistance in patient education programs, have the potential to increase the effectiveness of these programs.

Recommending Unfunded Innovative Cancer Therapies: Ethical vs. Clinical Perspectives among Oncologists on a Public Healthcare System-A Mixed-Methods Study

Over the past decade, there has been a growing development of innovative technologies to treat cancer. Many of these technologies are expensive and not funded by health funds. The present study examined physicians' perceptions of the ethical and clinical aspects of the recommendation and use of unfunded technologies for cancer treatment. This mixed-methods study surveyed 127 oncologists regarding their perceptions toward using unfunded innovative cancer treatment technologies, followed by in-depth interviews with 16 oncologists. Most respondents believed that patients should be offered all treatment alternatives, regardless of their financial situation. However, 59% indicated that they often face dilemmas regarding recommending new unfunded treatments to patients with financial difficulties and without private health insurance. Over a third (38%) stated that they felt uncomfortable discussing the cost of treatment with patients. A predictive model found that physicians facing patients whose medical condition worsened due to an inability to access new treatments, and who expressed the opinion that physicians can assist in locating funding for patients who cannot afford treatments, were more likely to recommend unfunded innovative therapies to patients (F = 5.22, R2 = 0.15, p < 0.001). Subsequent in-depth interviews revealed four key themes: economic considerations in choosing therapy, patient-physician communication, the public healthcare fund, and discussion of treatment costs. Physicians feel a professional commitment to offer patients the best medical care and a moral duty to discuss costs and minimize patients' financial difficulty. There is a need for careful and balanced use of innovative life-prolonging technologies while putting patients at the center of discourse on this complex and controversial issue. It is essential to develop a psychosocial support program for physicians and patients dealing with ethical and psychosocial dilemmas and to set guidelines for oncologists to conduct a comprehensive and collaborative physician-patient discourse regarding all aspects of treatment.

The Role of Nurses in the Quality of Cancer Care Management: Perceptions of Cancer Survivors and Oncology Teams

OBJECTIVES

This study aimed to explore the perceptions of cancer survivors and oncology professionals of quality in cancer care and the role of oncology nurses in prompting and maintaining quality across the cancer care continuum.

DATA SOURCES

Semistructured in-depth interviews were conducted with 16 cancer survivors and 22 healthcare professionals between August and October 2021. The interviews were transcribed and analyzed using ATLAS.ti v8 software according to a thematic analysis method based on grounded theory. The COnsolidated criteria for REporting Qualitative research (COREQ) was used to guide the report of the study.

CONCLUSION

Four main themes emerged from the interviews, which are outlined as follows. (1) Patient participation in the cancer care plan: shared information and decision-making; (2) emotional and support aspects in cancer care; (3) continuity in cancer care: from being a patient at the hospital to a survivor in the community; and (4) cancer care management. Cancer survivors pointed to elements that can increase the quality of cancer care, including the ongoing provision of information, support in decision-making, and continuity of care. Oncology staff interviewees mentioned the need for a single staff member to manage the cancer care plan and serve as a case manager for patients and survivors.

IMPLICATIONS FOR NURSING PRACTICE

Nurses have a central role in achieving the highest possible quality of cancer care for the growing number of survivors and their families. It is recommended to expand the role of oncology nurses, providing them the training and competencies needed to formally declare them as care managers throughout the continuum of cancer care.

The Association between Levels of Trust in the Healthcare System and Influenza Vaccine Hesitancy among College Students in Israel

Influenza is a contagious respiratory disease caused by the influenza virus. Vaccination proves an effective approach to preventing influenza and minimizing the risk of experiencing associated complications. However, the influenza vaccine coverage rate among Israeli college students is low due to a sense of complacency, lack of knowledge, and vaccine hesitancy. The current study examined the relationship between the level of trust in the healthcare system and influenza vaccine hesitancy among college students in Israel. This cross-sectional study was conducted via an online questionnaire in April-May 2023. In total, 610 students were surveyed, of whom 57% had been vaccinated against influenza in the past; however, only 12% were vaccinated this year. Negative, significant, and moderate relationships were found between the level of trust in the healthcare system and influenza vaccine hesitancy. Students who had been vaccinated in the past had a higher level of trust in the healthcare system and a lower level of vaccination hesitancy. The linear regression model revealed that the variables of being a woman, not Jewish, vaccinated, and trusting the Ministry of Health, family doctor, and health professionals were associated with a decrease in vaccine hesitancy. These findings are in line with previous research in the field. Based on the present results, it may be advisable to develop intervention programs aimed at increasing confidence in the healthcare system and vaccinations by providing knowledge and addressing students' concerns regarding vaccination.

Simulation as a key training method for inculcating public health leadership skills: a mixed methods study

Background

Successful management of public health challenges requires developing and nurturing leadership competencies. We aimed to evaluate the effectiveness of training simulations to assess public health leadership and decision-making competencies during emergencies as an effective learning and training method.

Methods

We examined the effects of two simulation scenarios on public health school students in terms of their experience (compared to face-to-face learning) and new skills acquired for dealing with similar emergent situations in the future. A mixed-methods design included developing a validated and pre-tested questionnaire with open-and closed-ended questions that examined the simulation impact and the degree of student satisfaction with the conditions in which it was conducted. Semi-structured in-depth interviews were conducted with the students after going through the simulations. The questionnaire results were evaluated using descriptive analytics. The interviews were analyzed using thematic analyses. All data were collected during June 2022.

Results

The questionnaire results indicate that students strengthened their interpersonal communication skills and learned about the importance of listening to the opinions of others before formulating their positions. Four themes emerged from 16 in-depth interviews, according to Kolb's experimental learning cycle. Students emphasized the effectiveness of experiential learning versus traditional classroom learning. The simulation scenarios were felt to realistically convey critical issues regarding leadership, decision-making, and teamwork challenges. They effectively conveyed the importance of building a culture of conducting substantive and respectful discussions.

Conclusion

Simulation is a powerful pedagogical training tool for public health leadership competencies. Simulations were seen to be advantageous over face-to-face learning in imparting a range of leadership skills and hands-on practice. We recommend integrating simulations in all public health leadership training programs.

Nurses and Physicians' Perceptions Regarding the Role of Oncology Clinical Nurse Specialists in an Exploratory Qualitative Study

The purpose of the study was to examine the attitudes of nursing and medical teams about the role of oncology clinical nurse specialists in the healthcare system in Israel, where, unlike many countries in the world, such a role has not yet been developed or professionally defined. We conducted 24 interviews with physicians and nurses between August and October 2021. The interviews were transcribed and analyzed using a thematic analysis method. The Consolidated Criteria for Reporting Qualitative Research checklist was used to report the study. Five main themes emerged from the interviews: (1) contribution to the healthcare system, (2) contribution to the patient, (3) drawing professional boundaries, (4) additional responsibilities and authority for oncology clinical nurse specialists, and (5) the field's readiness for a new position of oncology clinical nurse specialists. The findings provide evidence about the need to develop the role of clinical nurse specialists in the oncology field due to its potential benefits for nurses, physicians, patients, family members, and the healthcare system. At the same time, an in-depth exploration of the boundaries of the role and its implementation, in full cooperation with the oncologists and relevant professional unions, is needed to prevent unnecessary conflicts in the oncology field. Professional development training programs in nursing must create a platform for open dialogue between key stakeholders, nurses, and physicians, in order to help all involved parties, place the benefits to the patients above any personal or status considerations.

Vaccination of the Elderly in Assisted Living by the Israeli Emergency Medical Services

Emergency Medical Services (EMS) in Israel was called on to vaccinate the most vulnerable population-the elderly in assisted living facilities and their caregivers. Two parameters led the operation: (1) maximum use of the scarce COVID-19 vaccine, and (2) minimizing the time it took to reach this entire population. We present the process of vaccinating 126 245 people in two weeks at 756 locations countrywide, focusing on the planning and logistics of this operation. Resilience, flexible logistics, and dedicated personnel provided an efficient public health operation.

Revisiting the Relationship between Altruism and Organ Donation: Insights from Israel

The number of people on the waiting list for an organ transplant increases year after year. However, the number of donated organs available for transplantation does not rise in line with this increased demand. This study examines the associations between altruism, attitudes towards organ donation, and behavioral intentions regarding organ donation within the Jewish population in Israel. In a cross-sectional study, 452 participants completed an online questionnaire. Data collection occurred between November and December 2020. Convenience sampling was used, and participation was voluntary. Data were analyzed using Pearson correlations and independent samples t-tests. Within the study population, we found high levels of altruistic behaviors and positive attitudes toward organ donation. However, the level of behavioral intentions toward organ donation was low. No associations were found between altruism levels and attitudes toward organ donation, or between altruism levels and the degree of behavioral intentions toward organ donation. However, a positive relationship was found between attitudes toward organ donation and willingness to sign an organ donor card. In addition, positive associations were found between religiosity and altruism, while negative associations were found between religiosity and attitudes towards organ donation, and between religiosity and willingness to sign an organ donor card. Positive attitudes toward organ donation may result in increased organ donation in the future. Thus, raising awareness and positive attitudes toward organ donation among the wider public and, in particular, the ultra-Orthodox population in Israel in particular is necessary. Consequently, it is essential that information about the organ donation process is accessible and culturally adaptive to different sectors.

In Service of the Society? Medical Associations as Agents of Social Change-Implications for Health Policy and Education in Israel

This study aims to explore what medical associations in Israel do to promote public health, what values underpin their activities, and how their actions can be interpreted. For this purpose, an analysis of both individual and organizational levels was applied in an effort to yield a more nuanced understanding of the relationship between society and the medical profession. In-depth interviews with senior physicians were conducted, combined with a review of policy and public initiatives of medical associations between 2008 and 2018. The findings of this study reveal that medical associations engage in a range of social and policy initiatives designed to promote public health, but, at the same time, they tend to construct socially related health issues as medical problems in a manner that fits their sectorial agendas. This may reflect organized medicine’s efforts to extend its dominance over society through the application of the biomedical model to social issues. It is necessary to integrate biosocial training with medical education to ensure that future physicians are equipped with the skills needed to implement social medicine.

Identifying distinctive traits of healthcare leaders in Israel: in-depth interviews with senior physicians – an exploratory study

Purpose

This paper aims to examine the views of physicians in senior management positions regarding the distinctive characteristics and roles of leaders in the Israeli health-care system and what might be the interactions between management and leadership.

Design/methodology/approach

In total, 13 semi-structured in-depth interviews were conducted with physicians in senior management positions. Interviews were recorded, transcribed and analyzed using the qualitative-phenomenological method.

Findings

Interviewees discerned leaders as exhibiting traits of transformational leadership and managers, as expressing characteristics of transactional leadership. Most interviewees asserted that physicians should act as social leaders promoting public health and equality in health care, beyond their clinical practice. They agreed that physicians should fill most senior positions in the health-care system, provided they undergo appropriate training in management, leadership and interdisciplinary collaboration.

Originality/value

Interviewees revealed gaps between the aspiration to lead, perceptions of physicians as leaders and what occurs in reality: physicians wish to assume leadership roles in the health-care system and emphasize the qualities of transformative leadership, but medical education does not include leadership training. Therefore, there is a need to develop training programs for physicians in management and leadership. There is also a need to integrate physicians from various communities to promote local leadership in the health-care field and to reduce disparities. The consideration of health-care leadership is especially applicable in the context of the Covid-19 pandemic, which has placed the question of leadership within and outside of the medical community in a broader social context.

Role of Grassroots Public Health Leadership in Bedouin Society in Israel in Reducing Health Disparities

Introduction

Negev Bedouin settlements suffer from poor infrastructure, and the population's health status is low across all indicators. While it is difficult for Bedouin citizens of Israel to integrate into the Israeli employment market, integrating this population into the health system is far-reaching. The aim of this study is to analyze the barriers and motivational factors experienced by Bedouin doctors to promote public health in the Bedouin community in southern Israel and to examine the perceptions these doctors have around the concept of leadership in a public health setting.

Methods

We conducted semi-structured interviews with Bedouin doctors from the Negev Bedouin community and analyzed them using thematic analysis.

Results

Most interviewees saw themselves as leaders whose role was to improve public health in their community. They stressed the need for health leadership in Negev Bedouin society, and their desire to lead change in the community from within. All interviewees had grown used to a different way of life and a higher standard of living, and as a result, had difficulty returning home. Interviewees presented that trust in the health system is a critical factor for the success of health promotion programs. However, they noted the evolving trends of general mistrust in the government and its institutions that form the infrastructure for mistrust in the health system. Lack of time and workload were barriers to exercising leadership. Interviewees reported their perception of how socioeconomic status, the standard of living, and lack of infrastructure, education, and training affect health outcomes and collaboration potential.

Discussion

This study presents a unique perspective on the views of doctors from the Negev Bedouin population on their involvement with grassroots leadership as a strategy to reduce health disparities in this community.

Professional development: a mixed methods study of Masters of Public Health alumni

Introduction

We examined the perceptions of the Master of Public Health (MPH) degree graduates regarding their personal competencies, job performance and professional development using a mixed method, explanatory sequential design.

Methods

A cross-sectional, self-administered questionnaire of the Haifa School of Public Health alumni who graduated between 2005 and 2022 was disseminated to 849 graduates between March and June 2022, from which 127 responded (response rate: 14.90%). This was followed by 24 in-depth interviews with alumni from the same sample (conducted between November 2022 and March 2023).

Results

The sample included 74.8% of females with a mean age of 40.7 years, 35% of alumni agreed that the MPH degree helped them attain a promotion in their present position (in rank or salary), and 63.8% felt that the degree helped them improve their job performance and contribute to their current workplace. Most (80.3%) alumni reported not changing jobs after graduation. The interview themes revealed that the MPH contributed to their personal and professional lives, provided them with a holistic view of public health and health systems, and improved their in-depth scientific skills. The main reported barriers to professional development included missing core competencies, low salaries, and a lack of information regarding suitable jobs. Surprisingly, an MPH was not a requirement for some public health sector jobs. Alumni reported that the MPH degree contributed to improving many graduates' careers and satisfaction levels and to build their leadership competencies in public health.

Discussion

There seems to be a lack of coordination between the academic curriculum and the jobs available for alumni, hindering better alumni professional development. Regular discussions, information sharing, and curriculum refinements between MPH program leaders and health sector leaders might help address many of the concerns of MPH degree graduates.

War-Related Stress among Israeli College Students Following 7 October 2023 Terror Attack in Israel

BACKGROUND

Warfare represents a significant source of stress in contemporary times, with enduring implications beyond the immediate casualties, fostering a pervasive atmosphere of danger and anxiety within affected populations. The Israel-Hamas war, marked by ongoing armed incursions and missile attacks, stands as a recent example of such turmoil, inflicting widespread trauma and disruption.

METHODS

This study, conducted among students at the Ashkelon Academic College in southern Israel, aimed to investigate the stress levels and associated factors amidst the ongoing conflict. Utilizing a cross-sectional survey design, data were collected from 625 participants between January and February 2024, approximately four months after the commencement of the initial attack. The survey encompassed demographic information, perceived stress levels, sleep quality, and social media usage.

RESULTS

The findings revealed moderate to high stress levels among participants, with significant differences observed based on gender, parental status, and residency in conflict zones. Moreover, poorer sleep quality was reported among students residing in conflict-affected areas. Regression analysis identified several predictors of elevated stress, including gender, parental status, sleep quality, residency in conflict zones, and social media usage.

CONCLUSIONS

These findings underscore the profound impact of ongoing conflict on college students' mental well-being, highlighting the need for tailored interventions and support services within higher education institutions. The limitations include the study's focus on a specific college population and the timing of the data collection relative to the onset of the war. Nonetheless, this research contributes valuable insights concerning the stress dynamics within the unique context faced by Israeli students amidst ongoing warfare.