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Trust in COVID-19 policy among public health professionals in Israel during the first wave of the pandemic: a cross-sectional study

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Background: The COVID-19 pandemic has highlighted the important role of professionals in designing and communicating effective policies. The purpose of this study was to evaluate the level of trust in the COVID-19 national public health policy among public health professionals in Israel and its correlates during the first wave of the pandemic. Methods: A purposive sampling of public health professionals in Israel, through professional and academic public health networks (N = 112). The survey was distributed online during May 2020. Level of trust was measured by the mean of 18 related statements using a 5-point Likert scale, where 1 means not at all and 5 means to a very high extent, and grouped as low and high trust by median (2.75). Results: A moderate level of trust in policy was found among professionals (Mean: 2.84, 95% Cl: [2.70, 2.98]). The level of trust among public health physicians was somewhat lower than among researchers and other health professionals (Mean: 2.66 vs. 2.81 and 2.96, respectively, p = 0.286), with a higher proportion expressing low trust (70% vs. 51% and 38%, respectively, p < 0.05). Participants with a low compared to high level of trust in policy were less supportive of the use of Israel Security Agency tools for contact tracing (Mean = 2.21 vs. 3.17, p < 0.01), and reported lower levels of trust in the Ministry of Health (Mean = 2.52 vs. 3.91, p < 0.01). A strong positive correlation was found between the level of trust in policy and the level of trust in the Ministry of Health (rs = 0.782, p < 0.01). Most professionals (77%) rated their involvement in decision making as low or not at all, and they reported a lower level of trust in policy than those with high involvement (Mean = 2.76 vs. 3.12, p < 0.05). Regarding trust in the ability of agencies to deal with the COVID-19 crisis, respondents reported high levels of trust in the Association of Public Health Physicians (80%) and in hospitals (79%), but very low levels of trust in the Minister of Health (5%). Conclusions: This study shows that Israeli public health professionals exhibited moderate levels of trust in COVID-19 national public health policy and varied levels of trust in government agencies during the first wave of COVID-19. The level of trust in policy was lower among most of the participants who were not involved in decision making. The level of trust found is worrisome and should be monitored, because it may harm cooperation, professional response, and public trust. Professionals' trust in policy-making during early stages of emergencies is important, and preemptive measures should be considered, such as involving professionals in the decision-making process, maintaining transparency of the process, and basing policy on scientific and epidemiological evidence.
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Zoharetal.
Israel Journal of Health Policy Research (2022) 11:20
https://doi.org/10.1186/s13584-022-00529-6
ORIGINAL RESEARCH ARTICLE
Trust inCOVID-19 policy amongpublic
health professionals inIsrael duringtherst
wave ofthepandemic: across-sectional study
Tamar Zohar1* , Maya Negev1, Maia Sirkin1 and Hagai Levine2
Abstract
Background: The COVID-19 pandemic has highlighted the important role of professionals in designing and commu-
nicating effective policies. The purpose of this study was to evaluate the level of trust in the COVID-19 national public
health policy among public health professionals in Israel and its correlates during the first wave of the pandemic.
Methods: A purposive sampling of public health professionals in Israel, through professional and academic public
health networks (N = 112). The survey was distributed online during May 2020. Level of trust was measured by the
mean of 18 related statements using a 5-point Likert scale, where 1 means not at all and 5 means to a very high
extent, and grouped as low and high trust by median (2.75).
Results: A moderate level of trust in policy was found among professionals (Mean: 2.84, 95% Cl: [2.70, 2.98]). The level
of trust among public health physicians was somewhat lower than among researchers and other health professionals
(Mean: 2.66 vs. 2.81 and 2.96, respectively, p = 0.286), with a higher proportion expressing low trust (70% vs. 51% and
38%, respectively, p < 0.05). Participants with a low compared to high level of trust in policy were less supportive of the
use of Israel Security Agency tools for contact tracing (Mean = 2.21 vs. 3.17, p < 0.01), and reported lower levels of trust
in the Ministry of Health (Mean = 2.52 vs. 3.91, p < 0.01). A strong positive correlation was found between the level of
trust in policy and the level of trust in the Ministry of Health (rs = 0.782, p < 0.01). Most professionals (77%) rated their
involvement in decision making as low or not at all, and they reported a lower level of trust in policy than those with
high involvement (Mean = 2.76 vs. 3.12, p < 0.05). Regarding trust in the ability of agencies to deal with the COVID-19
crisis, respondents reported high levels of trust in the Association of Public Health Physicians (80%) and in hospitals
(79%), but very low levels of trust in the Minister of Health (5%).
Conclusions: This study shows that Israeli public health professionals exhibited moderate levels of trust in COVID-
19 national public health policy and varied levels of trust in government agencies during the first wave of COVID-19.
The level of trust in policy was lower among most of the participants who were not involved in decision making. The
level of trust found is worrisome and should be monitored, because it may harm cooperation, professional response,
and public trust. Professionals’ trust in policy-making during early stages of emergencies is important, and preemptive
measures should be considered, such as involving professionals in the decision-making process, maintaining transpar-
ency of the process, and basing policy on scientific and epidemiological evidence.
Keywords: COVID-19, Decision making, Health policy, Pandemic, Public health, Trust
© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
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Open Access
*Correspondence: Zohar.tamars@gmail.com
1 School of Public Health, University of Haifa, Haifa, Israel
Full list of author information is available at the end of the article
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Zoharetal. Israel Journal of Health Policy Research (2022) 11:20
Background
e coronavirus (COVID-19) pandemic is one of the
most severe public health crises to occur in recent his-
tory. On January 30th 2020, the COVID-19 outbreak was
declared a public health emergency of international con-
cern by the World Health Organization (WHO) [1]. By
March 2020, the virus had spread to almost all countries
around the world, and on March 11th 2020, the COVID-
19 outbreak was declared a pandemic [2]. With uncer-
tainty surrounding the source and spread of the virus,
many countries and organizations initially relied solely
on WHO guidelines, rather than constructing their own
[3]. As the pandemic persisted, countries began to create
guidelines that matched the needs of their populations
with the assistance of public health professionals (hereaf-
ter, ‘professionals’).
Israel is a democratic country in the Middle East [4],
with 9.3 million people [5], and a centralized public
health system administered by the Ministry of Health
[6, 7]. Israel was one of the first countries to respond to
the crisis by putting guidelines and restrictions in place
in response to the virus. ese guidelines included
lockdowns, social distancing precautions such as clos-
ing schools and forbidding public gatherings, and new
technological methods for contact tracing [8] which
increased government monitoring of citizens. e con-
tact tracing was conducted by the surveillance system of
the Israeli Security Agency (ISA), which has expertise in
national security and monitoring terrorism. Following
the adoption of emergency regulations, the ISA was acti-
vated to assist the national effort to reduce the spread of
COVID-19 via large-scale surveillance of civilians for the
purposes of COVID-19 contact tracing [9, 10].
e COVID-19 outbreak has highlighted the impor-
tance of creating and communicating effective public
health policies. A major determining factor in the suc-
cess of a public health intervention is trust, both from the
public and among decision makers. Studies on trust in
government and on previous epidemics have shown that
trust in the government is an important determinant of a
population’s compliance with public health policies and
guidelines [11, 12]. e level of public trust influences the
response of the public to the threat of an infectious dis-
ease and its acceptance of health information, ultimately
determining the success of a public health intervention
[13]. If decision-making processes do not seem justified
or transparent, public trust can be threatened, putting
an emerging public health intervention in jeopardy [14].
It has been suggested that one way to increase govern-
ment trust is to use credible information intermediaries,
such as experts in the field, to increase the credibility of
information and subsequently increase public trust and
motivation to comply with health policies [15]. With this
in mind, professionals have an important and unique
role in mediating public trust toward the government
and among public health leaders during public health
emergencies. For this reason, it is crucial to evaluate and
promote trust in national policies among professionals,
in order to encourage public trust and create successful
public health interventions.
In emergency events, public health officials are
required to make rapid decisions to maintain public
health [16, 17]. In the case of an emerging infectious dis-
ease such as COVID-19, these policies need to be created
and evaluated under strict time constraints, and with
limited information. ere are many tools and strate-
gies used by public health officials to make quick and
effective decisions. Professionals have expertise in these
decision-making strategies, specifically in evidence-
based research, which is commonly used in response
to an infectious disease outbreak [18, 19]. Since profes-
sionals are trained in evidence-based research, they play
a key role in facilitating evidence-based decisions in the
development of health policy. Additionally, an important
aspect of evidence-based research and decision making
includes access to credible sources. Understanding which
sources are used and trusted by professionals facilitates
the evaluation of credibility of organizations involved in
making policy and increases the transparency of the deci-
sion-making process.
A public health professional can be defined as someone
who studied or works in the field of public health, which
may include a range of related health fields such as medi-
cine, nursing, research, nutrition etc. e demographics,
primary occupations, and seniority levels among profes-
sionals can vary greatly and may contribute to differences
in practice and opinions. A report on the views of public
officials from the Chinese Centers for Disease Control
(CDC) found that senior Chinese CDC staff displayed
less confidence in their surveillance systems for infec-
tious disease than lower level staff [20]. is suggests
that the professional status of professionals may affect
their reported perceptions of interventions. Similarly, a
study reviewing risk perception among Japanese health-
care workers during the SARS outbreak in 2002–2004
highlighted differences in perception between physicians
and nurses; nurses displayed a higher level of preventa-
tive measures, while physicians demonstrated a greater
acceptance of risk. is again emphasizes the variation in
perception among different professionals regarding pub-
lic health practices [21].
Although there have been many studies of public
opinion on public health guidelines and policies, little
research has been done on the perceptions and opin-
ions of professionals in response to country-wide public
health interventions or epidemics. Moreover, the level of
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Zoharetal. Israel Journal of Health Policy Research (2022) 11:20
trust among professionals was not known at the begin-
ning of the COVID-19 pandemic. Professionals in this
field often play an important role in both public health
decision making and influencing public trust, since the
success of a public health response during a pandemic
relates to public trust in experts, and on the public believ-
ing that these scientists are involved in decision-making
processes [22, 23]. In recent years, the level of public con-
fidence in politicians and decision-makers has declined
worldwide [22] and within Israeli society [24]. e mis-
trust demonstrated by professionals towards policies may
have exacerbated public mistrust of these policies. ere-
fore, it is important to better understand whether the
public’s low trust in decision makers also appears among
professionals, by examining professionals’ level of trust in
decision makers, government agencies, and policies.
Moreover, examining professionals’ trust in COVID-
19-related health policy has the potential to provide
valuable lessons for improving management of future
large-scale emergencies such as pandemics, particu-
larly in the early stages when an immediate response is
needed. Accordingly, the goal of the current study was to
evaluate Israeli professionals’ level of trust in COVID-19
national public health policy (hereafter, ‘policy’) and its
correlations, during the first wave of the pandemic. Spe-
cifically, to assess the level of trust in policy and its corre-
lation to personal compliance with COVID-19 guidelines,
perceptions regarding the use of ISA tools for contact
tracing and monitoring morbidity, socio-demographic
factors (position, seniority, age, gender, and religion) of
participants, involvement in decision-making processes,
level of trust in the various agencies dealing with the
COVID-19 crisis and level of credibility of sources of
information (study framework in Additional file1).
We hypothesized that the level of trust will be cor-
related with personal compliance with COVID-19
guidelines, perceptions regarding the use of ISA tools,
socio-demographic factors, involvement in decision
making, the level of trust towards the various agencies
and credibility of sources of information.
Methods
We performed an online cross-sectional study. A survey
instrument was developed to evaluate perceptions and
attitudes towards policy among professionals in Israel
during the first wave of the COVID-19 pandemic. A pilot
study was conducted to ensure readability and validity
by sending the draft survey instrument to several people
who provided feedback on the quality and clarity of the
questions; it was then corrected according to these com-
ments before being distributed. e survey was distrib-
uted online during the first 2 weeks of May 2020 using
a Qualtrics XM online survey to obtain rapid responses
from professionals in Israel during the first wave of the
COVID-19 pandemic. e use of an online survey made
it compliant with the social distancing restrictions that
were in force during this time period. e survey was
in Hebrew and all answers were recorded anonymously
in the Qualtrics system. In order to reach profession-
als, purposive sampling [2527] was conducted among
professionals in Israel. To obtain a broad sample of pro-
fessionals, an effort was made to contact all relevant
agencies involved in public health and the questionnaire
was distributed through relevant lists and social networks
of the Ministry of Health, Schools of Public Health, and
the Israel Association of Public Health Physicians (which
is the official scientific association of public health pro-
fessionals in Israel). A general request was made online
through these communication networks for voluntary
participation in the study by answering a directed ques-
tionnaire of approximately 15min in length. e survey
was approved by the Ethics Committee of the Faculty of
Social Welfare and Health Sciences, University of Haifa.
Online informed consent was obtained from all partici-
pants, participation was voluntary, and all data and infor-
mation were kept anonymous.
A total of 227 participants entered the survey platform.
However, 66 (29%) participants entered only the first
page of the consent document in the survey and 49 (21%)
surveys were not fully completed. ose surveys were
omitted from the sample, leaving a total of 112 eligible
participants, with each respondent only able to partici-
pate in the survey once. e questions about credibility of
sources of information were at the beginning of the sur-
vey and were also answered by the 49 participants who
didn’t complete the survey. ere were no significant dif-
ferences in credibility of sources of information between
those who completed the survey and those who did not.
e structured survey (Additional file2) included ques-
tions regarding: (1) Credibility of the source of infor-
mation and frequency of use; (2) Self-involvement in
decision making during the COVID-19 outbreak; (3)
Perceptions of the decision-making process during the
COVID-19 outbreak; (4) Level of compliance with the
COVID-19 guidelines; (5) Perceptions of credibility of
various agencies dealing with COVID-19; (6) Evaluation
of the quality of measures adopted to maintain public
health; (7) Perceptions regarding the use of ISA tools for
contact tracing; and (8) Socio-demographic information,
such as: age, gender, profession, level of religiosity etc.
Most of the questions were on a 5-point Likert scale from
1 (not at all) to 5 (high agreement).
Level of trust in policy among professionals was calcu-
lated as a numerical value for an average score from the
5-point Likert scale for 18 related statements (Cronbach
α = 0.95) regarding perceptions of the decision-making
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Zoharetal. Israel Journal of Health Policy Research (2022) 11:20
process, evaluation of the quality of guidelines adopted
to maintain and protect public health, and transparency
during the decision-making process, such as: "Decisions
were made based on data from local and global informa-
tion", "e measures requested by the Ministry of Health
are important for reducing or preventing the spread of
COVID-19", "e official guidelines were given clearly
and were accompanied by an appropriate information
system", "e official guidelines were based on profes-
sional logic" and "e decision-making process was con-
ducted transparently". e level of trust in policy was
divided into two categories: participants with higher than
median (2.75) level of trust were merged into a high level
of trust in policy category and participants with lower
than and equal to median levels of trust were merged into
a low level of trust in policy category.
Personal compliance with national guidelines was a
numerical value for the average of four related questions
covering the level of compliance with guidelines pub-
lished regarding COVID-19, maintaining a distance of
2m between people, and wearing a mask in public spaces
and at work (Cronbach α = 0.81).
Perceptions regarding the use of ISA tools for contact
tracing were a numerical value that calculated as an aver-
age score on the 5-point Likert scale from 1 (not at all)
to 5 (very high) for four related statements (Cronbach
α = 0.79), such as: "ere was justification for using Secu-
rity Agency tools to locate patients in order to reduce/
prevent infection by COVID-19" and "ere was justifi-
cation for using Security Agency tools to locate patients
even at the cost of violating the rights and privacy of the
citizen".
Involvement in decision making was categorial value
that calculated from responses on a 5-point Likert scale
to one main statement: "To what extent are you involved
in decision-making processes?". Level of involvement
in decision-making was calculated by merging scores 1
and 2 (representing not at all and low level of involve-
ment) from the question into a low level of involvement
in decision-making category and by merging scores
3–5 (representing medium, high, and very high level of
involvement) into a high level of involvement category.
Involvement in decision making was categorial value
that calculated from responses on a 5-point Likert scale
to one main statement: "To what extent do you partici-
pate in the discussions in which decisions are made?"
Level of involved in discussions was calculated by merg-
ing scores 1 and 2 (representing not at all and low level
of involvement) from the question into a low level of
involvement in discussions category and merging 3–5
(representing medium, high, and very high level of
involvement) into a high level of involvement in discus-
sions category.
e level of trust in the various agencies dealing with
the COVID-19 crisis for each agency is presented as a
frequency of the total number of answers in each cate-
gory on a 5-point Likert scale from 1 (not at all) to 5 (very
high) in response to the statement: "Please describe the
level of trust you have in the following agencies’ ability to
deal with the COVID-19 pandemic".
Level of perceived credibility of sources of informa-
tion was calculated as an ordinal value for each source of
information on a 5-point Likert scale from 1 (not at all)
to 5 (very high).
Credibility of sources of information is presented as the
frequency of high and very high scores on a 5-point Lik-
ert scale for one statement, "To what extent do you trust
the reliability of information about the COVID-19 pan-
demic, from any of the following sources?" and frequency
of use is presented as the frequency of daily use or sev-
eral times a day scores on a 5-point Likert scale for one
statement, "How often are you updated on information
about the COVID-19 pandemic, from any of the follow-
ing sources?".
Statistical analyses
A Mann–Whitney U test was performed to assess the
differences between the participants that completed the
survey compere and those who did not, regarding the
questions about credibility of sources of information.
One-way ANOVA was used to compare mean level
of trust in policy between public health physicians,
researchers and other health professionals. A chi-square
test of independence was used to assess the association
between low and high levels of trust in policy and public
health professionals (public health physicians, research-
ers and other health professionals), professional senior-
ity in public health (below and above 10years), gender
(male and female), religion (Jewish and other), level of
religiosity (secular and other), and level of involvement in
decision-making processes (low and high level of involve-
ment). For significant association between low and high
levels of trust in policy and public health profession, we
also present the percentage of low and high level of trust
in policy for every profession category. A Mann–Whit-
ney U test was used to compare differences between low
and high levels of trust in policy and trust in the Minis-
try of Health, Minister of Health and Prime Minister. An
independent-samples t-test was used to compare profes-
sionals with a low level of trust in policy to those with
a high level of trust in policy, with respect to mean age,
perceptions regarding the use of ISA tools and personal
compliance.
e Pearson correlation coefficient was used to assess
two different relationships: (1) the relationship between
personal compliance with guidelines and the level of trust
Page 5 of 14
Zoharetal. Israel Journal of Health Policy Research (2022) 11:20
in policy among professionals: and (2) the perceptions
regarding the use of ISA tools and the level of trust in
policy among professionals.
Univariate tests were performed to examine the rela-
tionship between sociodemographic characteristics and
level of trust in policy. e Pearson correlation coefficient
was used to assess the relationship between age and level
of trust in policy. An independent-samples t-test was
used to compare the level of trust in policy between cat-
egories within the following variables: seniority (below
and above 10years), gender (male and female), level of
religiosity (secular and other). A multiple linear regres-
sion was performed to predict the level of trust in policy
among professionals based on profession, seniority, age,
gender, and level of religiosity, where gender was coded
as 0 = male, 1 = female, level of religiosity was coded
as 0 = secular, 1 = religious, professional seniority was
coded as 0 = below 10years, 1 = above 10years, profes-
sion was coded as 0 = public health physicians, 1 = other,
and age was measured in years.
An independent-samples t-test was used to compare
the difference in the level of trust in policy between pro-
fessionals with a low level of involvement and those with
a high level of involvement. Spearman’s rho correlation
coefficient was used to assess the relationships between
two questions regarding the level of involvement in deci-
sion making and in discussions.
Spearman’s rho correlation coefficient was used to
assess three different relationships: (1) the relationship
between the level of trust in the various agencies dealing
with the COVID-19 crisis and the level of trust in policy
among professionals; (2) the relationship between the
perceived level of credibility of sources of information
and the level of trust in policy among professionals; and
(3) the relationship between the credibility of sources of
information regarding COVID-19 and their frequency of
use.
Results
Participants
A total of 112 participants completed 95–100% of
the online survey; 33 (30%) were men and 75 (67%)
were women. Ninety-four (84%) participants provided
information about their age, which ranged from 29 to
82years, with a mean of 48 years. Currently, there are
approximately 163 public health physicians in Israel; 27
of them (17%) completed the survey. Twenty-seven (24%)
participants were public health physicians (item “a” in
question J.2, see Additional file2), 42 (38%) were other
health professionals (other than public health physicians)
(d, e, i), 35 (31%) were researchers (b, c, f, g, h) and 8 (7%)
were missing (Table1).
Level oftrust
Level of trust in policy among professionals was found
to be moderate (Mean = 2.84, SD = 0.76, Median = 2.76).
e mean level of trust in policy among public health
physicians (Mean = 2.66, SD = 0.69) was somewhat lower
than among researchers (Mean = 2.81, SD = 0.78) and
other health professionals (Mean = 2.96, SD = 0.78), but
the differences among the groups were not significant
(p = 0.286).ere were no significant differences in the
socio-demographic characteristics (professional seniority
in public health, gender, religion and level of religiosity)
of the participants with low vs. high levels of trust in pol-
icy, besides the difference by profession (Table2). Nota-
bly, a higher proportion of public health physicians had
low trust in policy compared to researchers and other
health professionals (70% vs. 51% and 38%, respectively,
Table 1 Socio-demographic characteristics of the participants
*N = 112. M issing data: profession in public health—7.1%, highest degree
in public health—9.8%, professional seniority in public health—0.9%,
gender—3.5%, age—16.1%, level of religiosity—3.6%
Variable* Value Distribution
Profession in public health Public health physician 24.1%
Other health professional 37.5%
Researcher 31.3%
Highest degree in public
health PhD 20.5%
MPH 39.3%
MSc 12.5%
MHA 6.3%
Student of public health 11.6%
Professional seniority in public
health 1–4 years 15.2%
5–10 years 22.3%
11–15 years 15.2%
Over 16 years 46.4%
Gender Male 29.5%
Female 67.0%
Age 21–40 19.6%
41–50 30.4%
51–60 22.3%
61–70 11.6%
Minimum 29
Maximum 82
Mean 48
SD 11.6
Religion Jewish 89.0
Muslim 4.6%
Christian 5.5%
Druze 0.9%
Level of religiosity Secular 74.1%
Traditional 8.9%
Religious 12.5%
Ultra-Orthodox 0.9%
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Zoharetal. Israel Journal of Health Policy Research (2022) 11:20
Table 2 Socio-demographic characteristics of the participants with low and high levels of trust in COVID-19 policy (by percentage)
and comparison between the groups
* Percentage of participants with low and high levels of trust in COVID-19 policy by socio-demographic characteristics
** Mean and standard deviation for levels of trust in the various agencies, age, use of Israeli Security Agency tools and personal compliance, between participants with
low compared to high levels of trust in COVID-19 policy
a Pearson’s chi-squared test
b Mann–Whitney U test
c Independent samples t-test
Variable Value Trust in COVID-19 policy*
Low level (n = 56) [%] High level (n = 56) [%] p-value
Public health professiona < 0.05
Public health physician 35.8 15.7
Researcher 34.0 33.3
Other health professional 30.2 51.0
Professional seniority in public
healtha0.751
1–4 years 12.7 17.9
5–10 years 23.6 21.4
11–15 years 18.2 12.5
Over 16 years 45.5 48.2
Gendera0.531
Male 33.3 27.8
Female 66.7 72.2
Religiona0.741
Jewish 89.1 87.0
Muslim 7.3 1.8
Christian 1.8 9.3
Level of religiositya0.429
Secular 80.0 73.6
Traditional 9.1 9.4
Religious 10.9 15.1
Ultra-Orthodox 0.0 1.9
Involvement in decision-making
processesa0.654
Low 78.6 75.0
High 21.4 25.0
Mean SD Mean SD **
Trust in Ministry of Healthb2.52 0.786 3.91 0.769 < 0.001
Trust in Minister of Healthb1.23 0.504 1.89 0.985 < 0.001
Trust in Prime Ministerb1.59 0.848 2.64 1.23 < 0.001
Agec48.7 12.8 50.2 10.1 0.530
Use of Israeli Security Agency toolsc2.21 0.695 3.17 0.638 < 0.001
Personal compliancec4.05 0.883 4.42 0.541 < 0.01
p < 0.05). Participants with low trust in policy were less
supportive of the use of ISA tools than those with high
trust in policy (Mean = 2.21 vs. 3.17, p < 0.001). Simi-
larly, participants with low trust in policy reported lower
levels of trust in the Ministry of Health, the Minister of
Health and the Prime Minister, than those with high trust
in policy (Mean = 2.52 vs. 3.91, 1.23 vs. 1.89, and 1.59 vs.
2.64, respectively; p < 0.001 for all). ere were no sig-
nificant associations of age and other socio-demographic
characteristics with the level of involvement in decision-
making processes.
Page 7 of 14
Zoharetal. Israel Journal of Health Policy Research (2022) 11:20
Personal compliance withguidelines
Personal compliance with national guidelines was rela-
tively high (Mean = 4.2, SD = 0.75). A low positive corre-
lation was obtained for the relationship between personal
compliance and the level of trust in policy among profes-
sionals (R = 0.296, p < 0.01).
Perceptions regardingtheuse ofIsraeli Security Agency
tools
A strong positive correlation was obtained for the rela-
tionship between perceptions regarding the use of ISA
tools for contact tracing and the level of trust in policy
among professionals (R = 0.601, p < 0.001).
Level oftrust inCOVID-19 policy bysocio-demographic
factors
e level of trust in policy among professionals in Israel
was examined with respect to socio-demographic factors.
e univariate tests that were performed to examine the
relationship between sociodemographic characteristics
and level of trust in policy found no significant difference
for any of the variables. Similarly, age was not signifi-
cantly correlated with the level of trust in policy. A multi-
ple linear regression was calculated to predict the level of
trust in policy among professionals based on profession,
seniority, age, gender, and level of religiosity. e regres-
sion equation was not significant (F5,81 = 0.910, p = 0.479;
R2 = 0.053) overall or for any of the variables.
Involvement indecision-making processes
Most professionals (77%) rated their involvement in
decision making as low. ere was a lower level of trust
among those with lower involvement compared to those
with high involvement (M = 2.76, SD = 0.73 vs. M = 3.12,
SD = 0.81, p < 0.05). Most professionals (76%) rated their
involvement in discussions as low, and the responses
to the two questions regarding involvement in deci-
sion making and in discussions were highly correlated
(rs = 0.771, p < 0.001). ere was a marginally lower level
of trust among those with lower involvement in discus-
sions compared to those with high involvement in dis-
cussions (M = 2.77, SD = 0.71 vs. M = 3.08, SD = 0.87,
p = 0.064).
Level oftrust inthevarious agencies dealing
withtheCOVID-19 crisis
ere were marked differences in participants’ evaluation
of their level of trust in the ability of different agencies
to deal with the COVID-19 crisis during the first wave
of COVID-19 (Fig.1). A very high percentage reported
a high level of trust in the Association of Public Health
Physicians (80%) and in hospitals (79%), compared to
only 5% who reported a high level of trust in the Minister
of Health, 8% in the government and 15% in the Prime
Minster. Moreover, less than half (40%) reported a high
level of trust in the Ministry of Health.
Association betweenlevel oftrust inagencies andlevel
oftrust inCOVID-19 policy
e mean level of trust in policy is presented for each cat-
egory on a 5-point Likert scale (Figs.2, 3, 4). e results of
the Spearman’s rho test between trust in policy and trust in
various agencies’ ability to deal with the COVID-19 crisis
(Table3) indicate a significant positive relationship for the
following agencies: Ministry of Health (rs = 0.782, p < 0.01;
Fig. 2), Prime Minister (rs = 0.558, p < 0.01; Fig. 3), Min-
ister of Health (rs = 0.483, p < 0.01; Fig. 4), Government
(rs = 0.454, p < 0.01), Knesset (Israeli parliament) (rs = 0.337,
19
5
24
19
66
17
71
56
50
64
86
80 79
40 38
15 13 11 8 8 7 5
% Level of trust in agencies
Not at all/To a small extent To a great/Very great extent
Physicians
Fig. 1 Proportions (%) of high (4–5 on a 5-point Likert scale) and low (1–2) levels of trust in agencies during the first outbreak of COVID-19
Page 8 of 14
Zoharetal. Israel Journal of Health Policy Research (2022) 11:20
p < 0.01), Ministry of Education (rs = 0.337, p < 0.01), Mini s-
try of Finance (rs = 0.303, p < 0.01) and Hospitals (rs = 0.252,
p < 0.01). No significant relationships were found between
professionals’ level of trust in policy and their level of trust
in other agencies, such as the Association of Public Health
Physicians, the Israeli media and local authorities.
Level ofperceived credibility ofsources ofinformation
andtrust inpolicy
Spearman’s rho correlation coefficient was used to assess
the relationship between the level of credibility of sources
of information and the level of trust in policy among pro-
fessionals. A significant positive relationship was found
between the level of trust in policy and the level of cred-
ibility of the following sources of information: Ministry of
Health (rs = 0.713, p < 0.01), Websites of government minis-
tries in Israel other than the Ministry of Health (rs = 0.391,
p < 0.01), foreign government websites (rs = 0.209, p < 0.05),
Israeli media (rs = 0.192, p < 0.05) and WHO (rs = 0.189,
p < 0.05). It was found that when the level of perceived cred-
ibility of these sources of information is higher, the level
of trust in policy increases. No significant relationships
01
2
3
4
5
10
20
30
40
50
Very highHighMediumLowNot at all
Mean level of trust in COVID-19 policy
Level of trust in Ministry of Health
Level of trust in Ministry of Health (Frequency) Level of trust in COVID-19 health policy (Mean)
Fig. 2 Association between level of trust in Ministry of Health and level of trust in COVID-19 policy
1
2
3
4
5
0
10
20
30
40
50
Very highHighMediumLowNot at all
Mean level of trust in COVID-19 policy
Level of trust in Prime Minister
Level of trust in Prime Minister (Frequency) Level of trust in COVID-19 health policy (Mean)
Fig. 3 Association between level of trust in Prime Minister and level of trust in COVID-19 policy
Page 9 of 14
Zoharetal. Israel Journal of Health Policy Research (2022) 11:20
were found between the level of trust in policy among
professionals and other sources of information, such as:
WhatsApp groups, the WhatsApp group "Public Health",
academic journals, groups online or on social media.
Sources ofinformation: credibility andusage
Descriptive statistics for credibility of sources of infor-
mation and frequency of use are presented in Fig. 5.
Although most professionals reported high or very high
levels of credibility for academic journals (80%), WHO
(78%), and foreign government websites (75%), only 38%
reported a high frequency of use of academic journals,
18% of WHO, and 13% of foreign government websites.
is is in contrast to Israeli media, for which only 8%
reported high or very high levels of credibility, but 63%
reported a high frequency of use.
The results of the Spearman’s rho test between
credibility and usage were significant for WhatsApp
groups (rs = 0.549, p < 0.05), the WhatsApp group
"Public Health", managed by the Association of Public
Health Physicians (rs = 0.362, p < 0.01), foreign gov-
ernment websites (rs = 0.347, p < 0.01), the Ministry
of Health (rs = 0.307, p < 0.01), the Israeli media (TV,
radio, newspapers, news sites) (rs = 0.289, p < 0.01),
WHO (rs = 0.271, p < 0.01), websites of government
ministries in Israel other than the Ministry of Health
(rs = 0.263, p < 0.01), and groups online or on social
media (rs = 0.219, p < 0.05). There was no significant
correlation between credibility and usage for academic
journals (rs = 0.095, p = 0.0318).
Discussion
This study found a moderate level of trust in policy
among professionals. The proportion of professionals
with a low level of trust in policy was especially high
among public health physicians, while a higher level
of trust in policy among professionals was found for
those with a higher level of involvement in decision-
making processes. Notwithstanding these differ-
ences, reported personal compliance with COVID-19
guidelines was relatively high among all responders.
A strong positive correlation was found between per-
ceptions regarding the use of ISA tools and the level
1
2
3
4
5
0
10
20
30
40
50
60
70
80
Very highHighMediumLowNot at all
Mean level of trust in COVID-19 policy
Level of trust in Minister of Health
Level of trust in Minister of Health (Frequency) Level of trust in COVID-19 health policy (Mean)
Fig. 4 Association between level of trust in Minister of Health and level of trust in COVID-19 policy
Table 3 Correlation between level of trust in various agencies
and level of trust in COVID-19 policy
* N = 112
Authority* Correlation
coecient Signicance
(2-tailed)
Ministry of Health 0.782 < 0.001
Prime Minister 0.558 < 0.001
Minister of Health 0.483 < 0.001
Government 0.454 < 0.001
Knesset 0.337 < 0.001
Minister of Education 0.337 < 0.001
Ministry of Finance 0.303 < 0.001
Hospitals 0.252 < 0.001
Association of Public Health
Physicians 0.134 0.158
The Israeli media 0.097 0.308
Local authorities 0.050 0.602
Page 10 of 14
Zoharetal. Israel Journal of Health Policy Research (2022) 11:20
of trust in policy. Similarly, strong positive associa-
tions were found between the level of trust in policy
and the level of trust in the Ministry of Health and the
Prime Minister. In contrast, no correlation was found
between the level of trust in policy and professionals’
socio-demographic factors.
ese results can contribute to further improving the
management of public health policy and credibility of
national agencies, from the perspective of profession-
als, especially during future large-scale emergencies
such as pandemics or other types of emergencies, par-
ticularly in their early stages.
Level oftrust inCOVID-19 policy
In our study, professionals rated their level of trust in
policy as moderate during the first 2 weeks of May 2020,
as we had hypothesized. e level of trust was based on
professionals’ perceptions of the decision-making pro-
cess, their evaluation of the quality of the guidelines
adopted to maintain public health, and the transparency
of the decision-making process.
A recent study conducted among Israeli citizens dur-
ing 2009–2015, years before the COVID-19 outbreak,
found similar moderate levels of citizen trust in local
government (Mean = 2.76, S .D = 0.37) [24]. Furthermore,
a study conducted in Israel and Switzerland during the
COVID-19 pandemic, over a similar time frame as the
current study, found that Israeli participants reported a
lower level of trust than Swiss participants in local gov-
ernment as well as in healthcare institutions, feeling that
there was insufficient action taken by these institutions
to protect personal health, public health, and wellbeing
[22]. is significantly lower trust may reflect the cir-
cumstances which preceded the COVID-19 crisis, such
as a lack of confidence in the political leadership, which
could have decreased trust in the government by the
Israeli public. Professionals’ mistrust may have exacer-
bated public mistrust of health policies, which was par-
ticularly low around the world [22], including in Israel
[24], even before the COVID-19 outbreak. In contrast,
a study focusing on attitudes of nurses during the first
wave of COVID-19 found that over 90% of the partici-
pants agreed with the policies of the Ministry of Health
regarding patient isolation, social distancing, lockdowns,
and the obligation to wear masks in public spaces, which
attempted to limit the spread of the virus [28]. ese high
levels of agreement can be attributed to the nature of the
work nurses perform in hospitals and the prevailing fear
of collapse of the health system due to the high volume
of patients at that time, which might explain the nurses’
eager acceptance of the Ministry of Health’s COVID-19
regulations, intended to reduce the pandemic, and pre-
vent the health system from collapsing.
In this context, it is important to note that despite the
moderate level of trust, and the significant difference
between participants with low and high levels of trust in
COVID-19 policy, professionals reported very high per-
sonal compliance with the guidelines. A recent report
also found similar findings and showed that despite a
decline in trust in government and governance in the
80 78 75
55
44
21
8 6 2
38
18
13
37
53
9
63
30 29
%
High/very high level of crediability Frequency of daily use/several times a day
Groups online or on social
media (e.g. Facebook)
Other WhatsApp groups
Israeli media (TV, radio,
newspapers, news sites)
Websites of government ministries in
Israel other than the Ministry of Health
Ministry of Health
The WhatsApp group "Public Health",
managed by the Association of
Public Health Physicians
Foreign government websites
World Health Organization
Academic journals
Fig. 5 Relative credibility of sources of information and frequency of use
Page 11 of 14
Zoharetal. Israel Journal of Health Policy Research (2022) 11:20
context of the COVID-19 crisis, there is a high willing-
ness to comply with government guidelines and direc-
tives in this regard [29]. Further research is warranted on
the contribution of trust, conformism, and other factors
to compliance with guidelines among professionals and
the public.
Involvement indecision-making processes
ese results suggest that professionals with a higher
level of involvement in decision-making processes have
a higher level of trust in policy than professionals with
a lower level of involvement. Decision making dur-
ing emergencies requires a non-traditional and flexible
approach [30], and an effective response depends on trust
and ongoing collaboration between stakeholders [31].
Trust is one of the most important elements for suc-
cessful collaboration among stakeholders [32]. For exam-
ple, collaboration during emergencies has been found
to raise trust among various governmental levels and
between governments [31]. Furthermore, collaboration
between researchers and decision makers can lead to
improved decision making, policies, practice, and health
care outcomes [32]. In these contexts, previous studies
have emphasized the positive relationships between pub-
lic participation in decision-making processes and public
trust and confidence both in these processes [33, 34] and
in the government [3537].
e success of public health interventions during the
pandemic depends on public trust in experts and on pub-
lic belief that these experts are involved in the decision
making processes for policy development [22]. In order
to increase public support on health policy it is critical
that the policy is proposed by experts in the relevant field
[33, 38]. erefore, it is critical to involve professionals
from relevant fields in the decision-making process [22,
23] during pandemics and other types of emergencies.
e literature emphasizes the critical role of trust in
government policy and transparency in decision mak-
ing in order to obtain an effective crisis response [39,
40] e decision-making process and the internal dis-
course in the committees should be transparent [41,
42], and based on scientific and epidemiological data
[43]. Transparency during the decision-making pro-
cess allows professionals and other stakeholders who
may not be involved in the decision-making process
to access the evidence being used to inform manage-
ment, policy, and decisions [44]. e results of this
study indicate that essential aspects of trust in policy
include transparency and evaluation of the scientific
quality of guidelines adopted to maintain public health.
Indeed, a recent study found that during the first wave
of COVID-19 Israel managed the pandemic through a
centralized and limited team and without satisfactory
sharing of information with professionals [42].
e present study found that participants with a low
level of involvement in decision making had a lower level
of trust in policy compared to those with high level of
involvement. Research shows that engaging profession-
als or their representatives in the policy-making process
can increase trust and improve policies and their imple-
mentation [22, 23, 32]. erefore, we recommend and
recommended in the past, that the Ministry of Health
considers methods to involve professionals in order to
improve health policies. However, it should be noted that
this study was limited due to its relatively small sample.
Furthermore, participants who demonstrated low levels
of confidence in policy during the first wave of the pan-
demic may not have been invited to participate in dis-
cussions and decision-making in the first place. Further
research is warranted on the contribution of involvement
and participation in decision making process on trust in
policy.
Indeed, the Ministry of Health and the government
made some changes in the decision-making process and
professionals’ involvement after the first wave of COVID-
19. Such measures included: a. More involvement of
advisory committees which included governmental and
non-governmental professionals, such action was taken
to establish the "Magen Israel" (Israel Defender) program,
which is a multi-disciplinary plan for management of the
COVID-19 health crisis. As part of this program, various
mechanisms were established, including the professional
Corona Cabinet that involved public health professionals
and other experts [45, 46] b. More transparency of advi-
sory committees, which published their protocols, includ-
ing a public open discussion on COVID-19 vaccination for
children, enabling external professional to comment [47]
c. Sharing date with professionals and the public, through
dashboard and other modes [48]. eir potential impact
on trust and on decisions is the subject of a future study.
Level oftrust inCOVID-19 policy andits correlations
Our study did not find a correlation between the level of
trust in policy and professionals’ socio-demographic fac-
tors, such as seniority, age, gender, and level of religiosity.
However, there was a difference by profession in trust in
policy and the level of trust in policy was correlated with
trust in the Ministry of Health, the Prime Minister, and
the Minister of Health.
ese results suggest that trust in policy is connected
to trust in government agencies, and particularly in spe-
cific individual officials. A recent paper highlighted that
during emergencies, measures adopted to maintain pub-
lic health require public trust of the information pub-
lished, which depends on public trust in the authorities
Page 12 of 14
Zoharetal. Israel Journal of Health Policy Research (2022) 11:20
as the source of this information [44]. Moreover, trust
in the government is a key element required to achieve
compliance among citizens regarding measures adopted
as public health policies [49]. In addition, a study con-
ducted during the first wave of COVID-19 in Israel found
that participants who evaluated the Prime Minister as the
most credible spokesperson evaluated the crisis manage-
ment in a more positive light than did other participants
[8]. A recent report found a similar intermediate level
of public trust in policy, in the context of evaluating the
agencies dealing with the crisis, during the first wave of
COVID-19 in Israel; this report also demonstrated a fur-
ther decline in trust with respect to the second wave [29].
Although there was only initially an intermediate level
of trust in policy, Israel’s rollout of COVID-19 vaccina-
tions has been very effective; this gap may reflect high
public trust in the safety and efficacy of vaccines and may
also reflect high trust in the health system and the gov-
ernment among people over 60 [50]. In addition, despite
grave concern about the measures taken to enforce emer-
gency orders, the Israeli Police, whose role is to enforce
these orders, has enjoyed a rise in public trust during the
COVID-19 pandemic [51]. Our research findings sup-
port the current literature and expand the understanding
of the relationship between trust in policy and trust in
authorities and governments.
Level oftrust inthevarious agencies dealing
withtheCOVID-19 crisis
Levels of public confidence in politicians and decision-
makers were particularly low around the world even
before the outbreak of the COVID-19 pandemic [22], and
in Israel particularly [24]. With the research showing a
very high level of trust in the Association of Public Health
Physicians and in hospitals, increased involvement of
these leaders (assisting with decision making and vaccine
recommendations) could have been used as leverage to
increase the level of trust among professionals towards
the policy [23]. Moreover, particularly in countries with
a diverse population such as Israel, it is extremely impor-
tant that the health policy information system includes
relevant representatives who are highly trusted by the
populations they represent, in order to increase the level
of trust in policy [43]. Indeed, corrective action was taken
during management of the crisis to include public health
professionals at a higher level of management, following
the establishment of Magen Israel, which included lead-
ers of the Israeli Association of Public Health Physicians
and managers of leading hospitals [39].
is study found an association between levels of trust
in the various agencies and their leaders and levels of
trust in policy. us, for example, participants with the
highest level of trust in the Prime Minister had higher
levels of trust in policy, than those with lower levels of
trust in the Prime Minister. Similarly, another Israeli
study focusing on public perception of COVID-19 gov-
ernment policy found that participants who regarded the
Prime Minister as the most credible spokesman rated the
crisis management at a higher level than the other groups
[8]. ese results are probably related to political person-
alization that has become a central concept both around
the world and in Israel; this is reflected in findings that
show that the media’s focus has increased the personal
activity of politicians and leaders rather than that of par-
ties and organizations [52, 53].
Study limitations
e study sample was obtained using purposive sam-
pling. is method does not guarantee a general repre-
sentation of the target population; however, it was chosen
due to the subject of the study and in order to reach the
widest possible representation of professionals in the
field. Indeed, there was broad participation in terms of
public health professionals (physicians, nurses, research-
ers, lab workers, veterinarians, nutritionists, etc.), educa-
tion, seniority, and age. e study was small and limited
by the response percentage and by the diversity of partic-
ipants, including those who are not involved in decision-
making processes for policy development.
e study was rapidly distributed during the first wave
of the COVID-19 pandemic and was conducted accord-
ing to the COVID-19 restrictions in place at that time.
erefore, it may be assumed that some profession-
als were engaged in management of the outbreak and
therefore did not have the time to answer the survey. To
maintain a high level of anonymity and avoid possible
identification of the respondents to the questionnaire,
the survey did not contain any questions about the actual
workplace or affiliation with any organization.
Potential conflicts may be assumed due to the fact that
some questions in the survey may have touched on topics
within the remit or influence of some of the respondents.
Because the entire survey was delivered online and in a
completely anonymous manner, no biases related to the
interviewees is expected to have occurred.
Conclusions
e COVID-19 pandemic has placed professionals at the
forefront of decision making and highlighted the criti-
cal role of their expertise in decision making. is study
demonstrates moderate levels of trust among Israeli pro-
fessionals in national policy and in government agencies
during the first wave during March–May 2020, with a
higher proportion of public health physicians who had
low trust in policy and lower levels of trust among those
Page 13 of 14
Zoharetal. Israel Journal of Health Policy Research (2022) 11:20
not involved in decision making. ese findings are wor-
risome, because a low level of trust among professionals
may harm cooperation, professional response, and public
trust. Actions to increase trust among professionals are
essential. Such measures include involving professionals
in the decision-making process, increasing the transpar-
ency of the process, and basing policy on scientific and
epidemiological evidence. Indeed, after the first wave,
professionals were greater involved, including partici-
pating in, and advising the Corona Cabinet; Increase
transparency of advisory committees published their
protocols, including a public open discussion on covid-19
vaccination for children as well as sharing data. Further
research is needed to examine whether these measure-
ments contributed to increased trust.
e intermediate level of trust in COVID-19 national
public health policy among professionals has important
implications for future public health emergencies and
should be monitored. We recommend conducting peri-
odic surveys of professionals and other groups, to con-
tinue to examine the level of trust in policy, particularly
during periods of ongoing health crises.
Emergency decision making should be more transpar-
ent and inclusive, especially for professionals, in order to
increase trust, produce evidence-based policy, and better
protect public health.
Abbreviation
ISA: Israeli Security Agency.
Supplementary Information
The online version contains supplementary material available at https:// doi.
org/ 10. 1186/ s13584- 022- 00529-6.
Additional le1. Study framework.
Additional le2. Survey of trust in COVID-19 policy among public health
professionals in Israel.
Acknowledgements
We thank Carly Golodets for language editing. We acknowledge the contribu-
tion of the study participants, and of all public health professionals who saved
many lives during the COVID-19 pandemic.
Author contributions
HL and MN conceived the study. TZ, MN and HL designed and conducted the
survey. TZ and MS conducted the literature review. TZ conducted the data
analysis and wrote the first draft of the paper. All authors edited the paper and
approved the final version. All authors read and approved the final manuscript.
Funding
This work was supported by the National Knowledge and Research Center for
Emergency Readiness, University of Haifa.
Availability of data and materials
The datasets used and/or analyzed during the current study are available from
the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
The survey was approved by the Ethics Committee of the Faculty of Social
Welfare and Health Sciences, University of Haifa (approval #177/20).
Consent for publication
Not applicable.
Competing interests
HL served as the Chairman of the Israeli Association of Public Health Physi-
cians and as a member of the "Magen Israel" experts’ cabinet during the study
period.
Author details
1 School of Public Health, University of Haifa, Haifa, Israel. 2 School of Public
Health, Hebrew University-Hadassah, Jerusalem, Israel.
Received: 15 March 2021 Accepted: 22 March 2022
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... Almost half of the nurses replied that confidence had decreased during the pandemic, and 28% of respondents said that trust had improved slightly. Despite the results of their own research, other authors emphasize that the public's trust towards health care workers has significantly improved [22]. It should be emphasized that trust is the most important element of cooperation in every team, and work in critical situations increases trust among colleagues [23,24]. ...
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Introduction: The COVID-19 pandemic as well as the rate of spread of this particular pathogen around the world have caused the number of patients requiring medical attention and intensive care to exceed the capacity of even the best organized health care systems. This resulted in the need to hire employees who had not previously worked in intensive care units. Experience and knowledge have become particularly important in the context of mutual trust in the ICU team. At the same time, it could affect the level of professional autonomy of nurses, understood as the freedom to perform work based on knowledge, skills and competence without the need to submit to other medical professions. The pandemic status has required that nurses are always involved in their work by participating in training. Faced with the dangers of COVID-19, there is no doubt that by the end of the pandemic, both nursing and healthcare will be better equipped to face future challenges. Methods: The study lasted from July to September 2021. The data collection procedure started with the consent of the heads of the institutions where the data was collected. The study was conducted using the Dempster Practice Behavior Scale (DPBS), which examines work autonomy. The survey using the proprietary questionnaire was conducted among 225 nurses working in eleven ICUs in five voivodeships in Poland. Results: The autonomy of nurses during the COVID-19 pandemic was assessed at a high level. Younger respondents rated autonomy as being higher. Almost half of the respondents assessed the level of professional independence as high, including 52% of nurses, and significantly less, including 34% of doctors. A group of 47% of respondents assessed that trust had decreased and 28% said that trust had improved slightly. Conclusions: Professional independence allows you to perform work independently on others, taking responsibility for decisions and actions. The COVID-19 pandemic, through the influx of new staff members into treatment teams, had an impact on both nursing autonomy and the level of trust in a team, as shown in this study.
... 33 During the pandemic, HCWs, primarily those in frontline roles and local response coordinators, have often been challenged to become credible spokespersons for pandemic information. 34 Such credibility directly influences public confidence and decision-making, which ultimately determines the success or failure of a public health intervention. 33 Failures in risk communication could also explain the presence of uncertainty and negative feelings associated with school regulations. ...
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Aims: With a social media analysis of the discourse surrounding the prevalence of Long COVID in children and young people (CYP), this study aims to explore healthcare workers' perceptions concerning Long COVID in CYP in the UK between January 2021 and January 2022. This will allow to contribute to the emerging knowledge on Long COVID and identify critical areas and future directions for researchers and policymakers. Design: A mixed methods approach with a discourse, keywords, sentiment, and image analysis, using PulsarTM and Infranodus. Setting: A discussion of the experience of Long COVID in CYP in the UK shared on Twitter between 1 January 2021 and 31 January 2022. Participants: A sample of health workers with Twitter accounts whose bio has them identifying themselves as HCWs. Results: We obtained 2588 tweets. HCW were responsive to announcements issued by authorities regarding the management of COVID-19 in the UK. The most frequent feelings were negative. The main themes were uncertainty about the future, policies and regulations, managing and addressing COVID-19 and Long COVID in CYP, vaccination, using Twitter to share scientific literature and management strategies, and clinical and personal experiences. Conclusions: The perceptions described on Twitter by HCW concerning the presence of Long COVID in CYP appear to be a relevant and timely issue and responsive to the declarations and guidelines issued by health authorities over time. We recommend further support and training strategies for health workers and school staff regarding the manifestations and treatment of Long COVID in CYP. Keywords: COVID-19, PASC, Long COVID, children, kids, social media, social network analysis, Twitter
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Governments and citizens need to work together to fight and win the war against the coronavirus and coproduce better health outcomes. However, information asymmetries exist between the two parties and influence coproduction adversely. Effective communication by satisfying different types of citizens’ information needs can reduce the degree of information asymmetry and improve coproduction. When citizens distrust governments, governments can use credible information intermediaries, such as experts and volunteers, to increase information credibility. Increasing information credibility could further reduce information asymmetry, increase public trust, and motivate citizens to comply with health policies and coproduce better health outcomes.
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During 2018–2019 Israel saw some 4300 measles cases in a country-wide epidemic. Increased measles incidence rates and considerable disease burden have been observed in under-vaccinated communities, predominantly Jewish ultraorthodox. The measles epidemic, despite proper public health handling, revealed susceptible population subgroups as well as gaps and lacking resources in the Israeli public health systems. In the COVID-19 pandemic in Israel, as of December 2020, the number of COVID-19 cases reported nationally was over 300,000 with approximately 3000 fatalities. Notably, minority groups such as the ultraorthodox Jewish community and the Arab community in Israel has been profoundly affected by the COVID-19 pandemic. We believe it is still possible to implement the key lessons from the measles outbreak in Israel that could aid in the COVID-19 response in Israel and elsewhere. These conceptions should include a social-based approach, investment in public health human resources and infrastructure, tackling root causes of inequalities, emphasis on trust and solidarity, proactive communication, need for political will, and proper use of epidemiological data as a basis for decision-making. In parallel to proper use of COVID-19 vaccines, when available, a ‘social vaccine’ is crucial as well as preparedness and response according to public health principles.
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While degraded trust and cohesion within a country are often shown to have large socio-economic impacts, they can also have dramatic consequences when compliance is required for collective survival. We illustrate this point in the context of the COVID-19 crisis. Policy responses all over the world aim to reduce social interaction and limit contagion. Using data on human mobility and political trust at regional level in Europe, we examine whether the compliance to these containment policies depends on the level of trust in policy makers prior to the crisis. Using a double difference approach around the time of lockdown announcements, we find that high-trust regions decrease their mobility related to non-necessary activities significantly more than low-trust regions. We also exploit country and time variation in treatment using the daily strictness of national policies. The efficiency of policy stringency in terms of mobility reduction significantly increases with trust. The trust effect is nonlinear and increases with the degree of stringency. We assess how the impact of trust on mobility potentially translates in terms of mortality growth rate.
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The COVID-19 pandemic significantly affected the work of police agencies worldwide. Within a short period of time, the police were assigned new responsibilities and were required to change their priorities and focus on enforcing unusual emergency orders. These new tasks, as well as the emergency atmosphere and its socio-psychological implications, raise a series of questions about public expectations from and trust in the police during the pandemic period. In this article, we report the views of majority communities in Israel (non-Orthodox Jews), as expressed in a survey carried out in the midst of the pandemic. We find that this population supports police enforcement of the new orders and trusts them to do so with integrity, believes the police have been successful in this arena, and is willing to report violations of emergency regulations. Overall, responses indicate more favourable attitudes towards the police, echoing previous findings on policing emergencies.