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Lupine Publishers | Public Health Followership During Covid19: Are followers more dangerous than their leaders?

 Lupine Publishers | Scholarly Journal Of Psychology And Behavioral Sciences

Introduction

The Covid19 pandemic has been a hybrid of 3 components, a highly contagious virus SARSCov2 [1], a culture of fear leading to risk aversion [2], and an escalating sovereign debt overhang [3] risking austerity and loss of ‘non-viable’ jobs. Currently a ‘second wave’ involving all three components is underway. Followership is a recent notion within the leadership genre [4], with recent literature emphasising the effect followers have on moderating behaviour of leaders, through a combination of stable and dynamic factors, in keeping with the social impact theory [5]. Followers are expected to cultivate aptitudes to function in a subordinate role, whilst assisting ‘the Leader’ in enacting his or her wishes. Historically followers were volunteers to a cause, for example ‘people of the way’ who followed the teachings of Jesus, accepting the task of persuading others towards ‘God’s kingdom on earth’ There was no expectation of monetary or social gain, but a real risk of martyrdom [6]. However, over the last century followership has become professionalised, for example in medicine [7], with followers seeking employment in public services, charities or academia; motivated by monetary and career ambitions including the prospect of civic honours. Despite senior followers often having specialist expertise, which leaders have to depend on, they can suffer reputational damage on being demoted or transferred from their post if found wanting. In return, it is [or at least was], expected for leaders to ‘carry the can’ when actions by followers caused unfortunate outcomes. Consequently, relationships between leaders and their followers can be tense or ambivalent [8].

Known Knowns

Prior to Covid19, western governments had developed elaborate plans to manage pandemics. Early intervention was seen as crucial for avoiding exponential contagion and associated economic losses. Furthermore, ‘event 201’ - a scenario-based exercise was conducted in October 2019 organised by the World Economic Forum, the Gates Foundation and the Johns Hopkins University. This meeting concluded that robust organisational links should be created between public health agencies, universities and private logistics firms [9]. However, despite attendance of senior bureaucrats from all relevant stakeholders, no follow-through occurred; perhaps due to recent pandemics [SARS and EBOLA] petering out with negligible western deaths, probably compounded by public health bodies undergoing ‘restructuring’ with associated job insecurity.

Unknown Knowns [Pre-Covid19]

Leadership training in public services have tended to involve ‘in house’ expertise, rarely utilising insights from the financial sector. One key market risk analyst is Nasim Taleb; who coined the term ‘black swan’; events which are completely unpredictable but highly consequential, bursting bubbles of irrational investment; leading to major restructuring of businesses and public sector organisations. Taleb went on to write a follow up book; ‘Antifragilie; the things that gain from disorder’ [10]; the idea being that unexpected disruption revels fragile teams and organisations; which typically fold at an early stage during a black swan event, whereas other teams and organisations survive and thrive. Public services, charities and academia have largely ignored Taleb’s work, perhaps considering themselves protected from market forces, with posts guaranteed through public funding. Although these organisations have repeatedly discussed the need for ‘transformation’, this has not involved building antifragility. Furthermore, there is limited recognition that talented staff move jobs, to work with antifragilie minded teams and leaders.

On selection of senior followers, Warren Buffet [Berkshire Hathaway Investments] described his strategy in recruiting senior staff being based on 3 values; energy, intelligence and, most of all, integrity [11], suggesting that recruits without integrity could ‘kill’ organisations. Integrity, defined by C.S. Lewis as ‘doing the right thing when no one is watching’, is arguably not necessarily a quality foremost in public sector recruitment, where a talent to cut costs and capacity to remain ‘on message’ perhaps being more sought after. The other book relevant to followership is by Paul Babiac and Robert Hare; ‘Snakes in suits; when psychopaths go to work’ [12]. They describe 2 types of damaging followers, firstly those who use the organisational hierarchy to maximise power, and secondly, ‘enablers’ who enforce instructions of their leaders using bullying [13]. The consequences of these individuals include loss of trust between employees, loss of productivity and litigation when evidence of malfeasance comes to light.

Known Unknowns [Post Covid First Wave]

The main observation within the first 2 months of the pandemic was the failure by western public health bodies to communicate risks and safeguards to the public [14]. Perhaps they were awaiting guidance from the World Health Organisation [WHO], which delayed calling the pandemic, having ignored warnings on human-to-human transmission for a crucial 3 week period in January. These bodies were perhaps also awaiting orders from their political leaders, despite these individuals being conflicted on economic preservation and maintaining public popularity. However, public health bodies in the east, with experience of the original SARS pandemic, reacted promptly warning the public on the emerging problem alongside organising testing, contact tracing and quarantining of the vulnerable [15]. The other finding has been the gap between promises made by western politicians on testing and contact tracing compared to actual delivery of these targets. Despite the pre-pandemic protocols, public health has been unable to rapidly organise testing for the virus, alongside failures of contact tracing [16]. Early involvement of firms with track records on logistics was absent, alongside not involving private labs to increase testing capacity. It appears politicians were not aware of practical problems with delivery either due to subordinates not advising them of facts on the ground or due to followers wanting to please their masters with good news [including cost minimisation]. The decision by NHS England to discharge around 25,000 elderly hospital patients in April to care home beds before routine testing for SARSCOv2 was available [17] probably resulted in 50% of care homes contracting Covid19, with around 15,000 elderly deaths. This decision is awaiting legal review as there was no attempt to separate potentially infective people from the other residents, for example by setting up separate care home floors with dedicated staffing. The rationale for bed clearance was to ‘protect the NHS’ although in reality NHS hospitals did not come close to becoming overwhelmed [18]. Nevertheless, over 90% of care home residents were promptly placed on a combination of ‘Do not resuscitate’ orders and ‘Emergency health care’ plans, both reducing the possibility for active treatment of acute illness episodes. NHS England have denied influencing GP practices to carry this action and the government has ordered the Care Quality Commission to investigate blanket imposition of these orders in England [19].

Unknown Unknowns [Post ‘Second Wave’]

The main unknown pertains to how the virus will exert its effects on the population through continuing mutation, partly caused by attempts to degrade it by the immune system. There is concern that infectivity will increase [20], with long term disability affecting the heart, brain and lungs among Covid19 survivors, including those with ‘sub clinical’ initial symptoms [21]. Furthermore, uncertainty remains on effectiveness of the current crop of 11 vaccines undergoing human trials, especially on preventing community spread of infection, as viral carriage in the upper respiratory tract post vaccination is not guaranteed [22]. It is anticipated that spikes of infection will continue for the next 12 months resulting in local ‘circuit braking’ restrictions, although uncertainty remains as to the efficacy of these measures, partly due to less than full public adherence. Partially tested vaccines can be authorized for emergency use, but continuing concerns about delivery, storage and public uptake remain [23]. An evidence-based case for population wide prophylaxis using Vitamin D and Zinc supplementation has been made to public health bodies [24,25] in the face of commercial interests of vaccine and drug manufacturers.

Conclusion

Covid19 has cast a harsh light on weaknesses of public health bodies in the west and the resulting risk to populations they were meant to protect. It seems unfair to solely blame their political masters, as they are highly dependent on competent civil servant followers, who monitor situations on a week-to-week basis and take operational decisions. Differential roles of elected leaders and their subordinate followers needs redrawing, to avoid loss of public trust due to failures in delivering on promises. Followers must speak ‘truth to power’ on realities on the ground, whilst focusing on building ‘anti-fragility’ within organisational teams, utilising scenario planning and stress testing, thereafter by updating and simplifying practice algorithms. This would free up leaders to communicate with the public with confidence, whilst formulating the future direction of travel [‘the vision’]. This demarcation of roles would produce less conflict and better service delivery going forward, despite recurring ‘black swan’ events. Furthermore, ethical responsibilities of followers need redefining; with an emphasis on duty of care and candour towards the public who ultimately fund them through taxation. This includes admission of mistakes and the courage to ‘whistle blow’ if concerns on public safety are not being acted on by their political masters. Furthermore, capacity for integrity - described as essential by Warren Buffett - will need to be prioritised in recruitment post Covid19.

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Lupine Publishers | The Associations Between Fear of COVID-19 and Preventive Behaviors Among People in Gaza Strip, Palestine

 Lupine Publishers | Scholarly Journal Of Psychology And Behavioral Sciences

Abstract

The COVID-19 pandemic is a global health emergency that could severely impact mental health. Fear of COVID-19 or its risk perceptions is strongly associated with COVID-19 preventive behaviors. This study aimed to examine the associations between the anxiety of COVID-19 and preventive behaviors among People in the Gaza Strip. The sample consists of 682 participants. A cross-sectional online survey design was used; all participants completed the Fear of COVID-19 Scale (FCV-19S) and preventive behavior scale. The required data were collected and analyzed. The mean fear of COVID-19 score was 2.51 (SD = 0.83, range: 7–35), while the mean score for preventive behavior was 2.48 (SD = 0.38, range: 3–30). Besides, results showed participants from the North Gaza governorates and those with low educated levels had the highest level of fear of COVID-19. In contrast, females and highly educated participants were more likely to engage in preventive behaviors than other participants. Our findings show no significant associations between fear of COVID-19 and adherence to preventive behaviors. It is essential to continue monitoring the psychological reactions of people during the outbreak.

Keywords: COVID-19; Fear; Preventive Behaviors; Palestine; Gaza Strip.

Introduction

The COVID-19 pandemic is a global health emergency that could severely impact public health [1]. The outbreak was first revealed in late December 2019 when clusters of pneumonia cases of unknown etiology were found in the city of Wuhan of Hubei Province, in China [2]. Ever since the coronavirus disease 2019 (COVID 19) attained a pandemic status [3], there have been strenuous efforts by health experts and authorities worldwide to mitigate the spread of the virus [4]. This includes installing health protocols such as washing hands regularly, wearing a face mask and keeping at least a physical distancing meter from each other during a social gathering [5]. Toward prevention of COVID-19, the Ministry of Health (MOH) declared a state of emergency and recommend that several safety protocols such as hand washing, wearing of face mask, physical distancing, and quarantining, all travellers coming through Rafah and Beit Hanon (Erez) crossings had undergone a compulsory quarantine at one of the MOH designated facilities, isolation hospitals, and health quarantine centers. People stay for 21 days in quarantine centers. On 26 August 2020, MOH in Gaza confirmed the first COVID-19 spread through the Gaza strip community. The total number of confirmed cases is 63428, of which 6614 are still active cases, 56211 cases fully recovered and were discharged, while the number of deaths reached 603 deaths. However, reliance on government action alone is insufficient to control COVID-19 disease totally (WHO) proposed several personal preventive behaviors for individuals to engage in to prevent COVID-19 infection. Therefore, understanding the factors associated with individuals’ preventive behaviors is an important topic during the COVID-19 pandemic [6- 10].

One psychological aspect of the COVID-19 pandemic is fear. Fear is an unpleasant emotional state triggered by the perception of threatening stimuli [11]. Also, fear of COVID-19 or its risk perceptions is strongly associated with COVID-19 preventive behaviors [8]. After reviewing the literature, the authors found that fear of COVID-19 are associated with preventive COVID-19 infection behaviors. Some accurate COVID-19 information (e.g., the death rate and numbers of confirmed cases) may trigger an individual’s fear of COVID-19 and induce psychological distress [12]. The authors believe that trust in COVID-19 information sources may improve awareness of preventive behavior; on the other hand, it may affect mental health, including an increase in fear of COVID-19 and induce psychological distress. A study aimed to assess the prevalence and predictors of depression among the Palestinian community during this pandemic found that the prevalence of depression was 57.5% [13-17]. As well known, life in Gaza is so tricky due to the unusual circumstances that the Palestinian people are living under the continuing Israeli blockade. There are many forms of suffering that the Palestinian people experience, such as unemployment, poverty, security instability, siege, and finally impact of the COVID-19 pandemic. All of these factors, when combined, increase mental health problems [18-20]. A recent study aimed to examine the psychological distress among healthcare providers during the COVID-19 Pandemic in Gaza Strip, which found that depression level 68%, anxiety 69%, stress 67% [21]. In Gaza, no studies were conducted to examine the associations between fear of COVID-19 and preventive behaviors according to the authors’ knowledge. This study will provide information and data for all concerned people. On the other hand, this study will increase the mental health body knowledge in Palestine; this study seeks to examine the associations between fear of COVID-19 and preventive behaviors among People in the Gaza Strip.

Methods

Study population, sample, and setting

The target population comprises all 18 years or older people and currently living in the Gaza Strip. The sample consists of 682 participants. We adopted a cross-sectional survey design to measure fear COVID-19 and to assess how individuals perform preventive COVID-19 infection behaviors among the study sample by using an online survey. A snowball sampling method focused on recruiting the general public living in Gaza Strip during the pandemic was conducted. The online survey was first disseminated on Facebook and WhatsApp applications to friends, and they were encouraged to pass it on to others.

Procedure

Since the MOH recommended the public to minimize face-toface interaction and isolate themselves at their homes, potential respondents were electronically invited. All of them completed the questionnaires in Arabic through an online survey. Ethics approval was obtained from the Helsinki Ethical Committee in the Gaza Strip, Palestine (Code: PHRC/HC/735/20). Privacy was strictly protected during the procedure. The purposes of the study and information about it were posted on the first page of the questionnaire. To protect data and preserve privacy, the authors contacted the participants by phone and electronically and explained the objectives of the study and the content of the questionnaires and thanked them for participating in the study. The questionnaire was sent to a specialist in English translation. After that, the Arabic version was sent to a specialist in Arabic for accreditation, and then finally, back translation to Arabic was done. All respondents provided online informed consent before starting the questionnaire. Data collection took place over seven days (28 September to 5 October 2020).

Instrument

Demographic information

The demographic variables explored included the age, gender, marital status, governorate region where the participant resided, and education level.

Fear of COVID-19 scale

(FCV-19S) includes seven items with a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree) to assess how an individual fears COVID-19. The validity and reliability of the tool were verified. The Arabic Version of (FCV-19S) has excellent psychometric properties; internal consistency (Cronbach’s alpha=.88), with concurrent validity indicated by significant and positive correlations with HADS (r = .66).

COVID-19 preventive behavior scale

It consists of 10 items formulated based on WHO measures to prevent the spread of COVID-19. Items were assessed on a 3-point Likert scale (always=3, sometimes=2, rarely=1). A higher score indicates a more outstanding commitment to protective behaviors COVID-19. The validity of the questionnaire was confirmed using the viewpoints of nine public health and psychology experts. The reliability of the questionnaire was investigated by calculating internal consistency (Cronbach’s alpha=.825) [22].

Results

Characteristics of the study sample

In this study, 682 participants completed and returned the questionnaire, 46.5% were male, and 53.5% were female, the age group between 21 and 40, represented 68% of the participants, 49.6 % are single, most of the participants (70.7%) were currently studying in college, and On the other hand, 10.7% of them are studying a master or doctorate (Table 1).

Table 1: Sociodemographic characteristics (n = 682).

Fear of COVID-19 and preventive behaviors scales

The highest score item was item 2, “It makes me uncomfortable to think about coronavirus,” by 52% of participants. While item 3, “My hands become clammy when I think about coronavirus,” is considered the lowest item with (7.8%). Result shows (58.5%) of the participants disagree that they have a fear of COVID-19. The most preventive behaviors were Cover the nose and mouth when coughing or sneezing, where 90.67% of respondents always said, “I place a tissue paper or bending elbow in front of my mouth and nose when coughing or sneezing.” According to the concerned authorities, they always told: “I adhere to the instructions when leaving the house” by 85.67%. While washing hands regularly with soap and water for at least 20 seconds came thirdly 85.33%.

On the other hand, the lowest prevention behaviors keeping a safe space between themselves and other people were just 74.67% of the sample said: “keep a distance of at least 1.5 m. from others” (Table 2).

Table 2: Fear of COVID-19 and preventive behaviors scales.

Correlation between fear of Covid-19 and preventive behaviors

Using Pearson correlation, the correlation coefficient was low and not significant (r = 0.006, P = 0.875).

Variations of fears and preventive measures concerning socio-demographic characteristics

Significant differences are shown between fears of COVID-19 and preventive behaviors with education level and residence place (P < 0.001). Post-Hoc Sheffie’s test revealed fear of COVID-19 is more in the northern part of the Gaza strip and among low educated participants. In contrast, preventive behaviors are more adopted in Gaza city and among the highly educated. Concerning gender, the significance is reported with preventive behaviors favoring females (P = 0.004) (Table 3).

Table 3: Comparison between fears of COVID-19 and preventive behaviors concerning socio-demographic characteristics.

Discussion

This current study examined the associations between fear of COVID-19 and Preventive behaviors among people in the Gaza Strip. Contrary to expectation, there were no significant associations between fear of COVID-19 and adherence to preventive behaviors. Participants’ commitment can be attributed to factors other than fear, such as their autonomous motivation and government legislation; this is in line with the findings [23]. These disagree with the findings of previous studies that there exists an association between fear of COVID-19, mental health, and COVID-19 preventive behaviors [4,24]. There are no statistically significant differences at a substantial level (α ≤ 0.05) between demographic factors, age, gender, marital status, and fear of COVID-19. This is inconsistent with other reports showing greater psychological vulnerability in women than men during the COVID-19 pandemic [2,5,9]. On the other hand, there is a statistically significant difference at a substantial level (α ≤ 0.05) between the place of residence favoring the North Gaza Governorate, low educational level, and the fear of COVID-19. This can be explained due to a vast outbreak of COVID-19 in the North Gaza Governorate; lockdown measures were implemented, leading to amplifying adverse psychological reactions to COVID-19. This finding is consistent with [17]. The entirety conclusions suggest that fear of COVID19 may play an integral role in the health and preventive behaviors among low educated participants.

There are no statistically significant differences concerning the preventive behavior results at a significant level (α≤0.05) between demographic factors, age, marital status, and preventive behavior. In contrast, there is a statistically significant difference at a considerable level (α ≤ 0.05) between the place of residence in favor of Gaza city, high educational level, gender in favor of female and preventive behavior. This is due to the high level of fear among females, which motivates them to adhere to preventive behaviors. Urban residents like Gaza Governorate can buy the necessary health equipment for prevention. Their work can be performed from home; unlike in other areas staying at home would imply dropping their primary source of livelihood; this finding is in line with the Rossi. Participants reported high adherence to preventive behaviors, and those with high education levels were associated with more commitment to preventive behaviors. This may be due to participants’ characteristics, as (81.4%) have a bachelor’s degree or higher, these results were found in line with previous studies [15,19].

Conclusion

Our findings show that there were no significant associations between fear of COVID-19 and adherence to preventive behaviors. This study demonstrated a statistically significant difference at a significant level (α ≤ 0.05) between the place of residence in favor of the North Gaza Governorate, low educational level, and the fear of COVID-19. On the other hand, there is a statistically significant difference at a significant level (α ≤ 0.05) between the place of residence in favor of Gaza city, high educational level, gender in favor of female and preventive behavior. The current study indicated a lower-than-average level of fear of COVID-19 and an increased commitment to preventive behaviors among participants. Education level and gender have an essential role in the management of people’s health and preventive behaviors. Health experts and communicators may capitalize on these findings to educate people on COVID-19. It is crucial to continue monitoring the psychological reactions of people during the outbreak.

 

https://lupinepublishers.com/psychology-behavioral-science-journal/pdf/SJPBS.MS.ID.000208.pdf

https://lupinepublishers.com/psychology-behavioral-science-journal/fulltext/the-associations-between-fear-of-covid-19-and-preventive-behaviors-among-people-in-gaza-strip-palestine.ID.000208.php

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