Nurit Guttman

What should be given a priority - costly medications for relatively few people or inexpensive ones for many? The Health Parliament public consultation initiative in Israel

Background  In the past two decades, government and civic organizations have been implementing a wide range of deliberative public consultations on health care‐related policy. Drawing on these experiences, a public consultation initiative in Israel called the Health Parliament was established.

The Paradox of Realism and “Authenticity” in Entertainment-Education: A Study of Adolescents' Views About Anti-Drug Abuse Dramas

The successful use of drama as a vehicle to influence health-related attitudes and behaviors is credited to its ability to elicit an emotional experience and identification among audience members. This study investigated the views of adolescents regarding an entertainment-education (EE) component of their schools anti-drug program—a live performance of a professionally produced anti-drug abuse drama. The analysis draws mainly on data collected from 64 focus groups, conducted in 24 schools across Israel, and open-ended responses to questionnaires administered to more than 1,700 adolescents. The adolescents were generally entertained by the anti-drug abuse drama and moved by its “authenticity,” which emerged as a central construct in this study. Yet only a fraction identified with the characters and many remained unwilling to “tell” on a friend who uses drugs. Drawing on these findings, implications to EE theory and practice are discussed, particularly as they relate to the dramas perceived realism or “authenticity,” and its unintended effects.

When the Visit to the Emergency Department is Medically Nonurgent: Provider Ideologies and Patient Advice

It is estimated that more than half of pediatric hospital emergency department (ED) visits are medically nonurgent. Anecdotal impressions suggest that ED providers castigate medically nonurgent visits, yet studies on such visits are scarce. This study explored the perspectives of 26 providers working in the EDs of two urban hospitals regarding medically nonurgent pediatric ED visits and advising parents or guardians on appropriate ED use. Three provider ideologies regarding the appropriateness of medically nonurgent ED use were identified and found to be linked to particular communication strategies that providers employed with ED users: restrictive, pragmatic, and all-inclusive. The analysis resulted in the development of a typology of provider ideological orientations toward ED use, distinguished according to different orientations toward professional dominance.

Laypeople's Ethical Concerns About a New Israeli Organ Transplantation Prioritization Policy Aimed to Encourage Organ Donor Registration among the Public

A new policy recently enacted in Israel promises preferred status in receiving organs for transplantation to individuals who register to be organ donors and to their close family members. Proponents believe it will increase the supply of organs for transplantation from the deceased. Ethical issues were raised in government committees appointed to discuss the policy before its approval, but discussions among laypeople were not solicited. This study aimed to elicit laypeoples views about the policy by conducting thirteen group interviews and thirty-six individual interviews. Participants included religious and nonreligious people, immigrants, and Arabs. Some participants thought the law would contribute to fairness by prioritizing those willing to give, but others articulated ethical concerns that were not emphasized by scholars, in particular that the policy would add to the erosion of social solidarity, increase divisiveness, and enable people to abuse the system. Mistrust in the health care system emerged as a prominent reason for not registering as an organ donor. Implications about the importance of transparency in the organ transplantation system as a basis for an information campaign, social norms regarding organ donation, and the publics involvement in policy issues on organ donation are discussed.

My Son Is Reliable: Young Drivers' Parents' Optimism and Views on the Norms of Parental Involvement in Youth Driving

The high crash rates among teenage drivers are of great concern across nations. Parents’ involvement is known to help increase their young drivers’ driving safety. In particular, parents can place restrictions on their son’s/daughter’s driving (e.g., restrict night time driving), which can enable the young driver to gain driving experience in safer conditions. Yet little is known about what do parents think about parental responsibility regarding young drivers’ driving. This study aimed to address this question. It draws on both quantitative and qualitative data obtained through a phone survey of 906 Israeli parents of young drivers that included both open- and closed-ended items and 20 semistructured interviews with parents. The main findings were that parents tended to be optimistic about their own child’s driving compared with other young drivers and were relatively unconcerned about speeding. Whereas most parents thought restrictions regarding driving at night or talking on the phone should be placed on young drivers, most believed many parents do not enforce them. Most also believed many parents feel they are unable to influence young drivers’ driving. The exception, however, was they believed most parents restrict young drivers driving when they are tired. Two contrasting conceptions of parental responsibility were identified and presented as a model. Potential implications for road safety campaigns from a social norms perspective are discussed.

Parental receptivity to child biomarker testing for tobacco smoke exposure: A qualitative study

OBJECTIVE Widespread tobacco smoke exposure (TSE) of children suggests that parents may be unaware of their childrens exposure. Biomarkers demonstrate exposure and may motivate behavior change, but their acceptability is not well understood. METHODS Sixty-five in-depth interviews were conducted with parents of young children, in smoking families in central Israel. Data were analyzed using thematic analysis. RESULTS Consent to testing was associated with desire for information, for reassurance or to motivate change, and with concerns for long-term health, taking responsibility for ones child, and trust in research. Opposition to testing was associated with preference to avoid knowledge, reluctance to cause short-term discomfort, perceived powerlessness, and mistrust of research. Most parents expressed willingness to allow measurement by urine (83%), hair (88%), or saliva (93%), but not blood samples (43%); and believed that test results could motivate behavior change. CONCLUSIONS Parents were receptive to non-invasive child biomarker testing. Biomarker information could help persuade parents who smoke that their children need protection. PRACTICE IMPLICATIONS Biomarker testing of children in smoking families is an acceptable and promising tool for education, counseling, and motivation of parents to protect their children from TSE. Additionally, biomarker testing allows objective assessment of population-level child TSE.

Educational drama and the dilemma of ‘false catharsis’: lessons for theory and practice from a study of anti-drug plays in Israel

This study, initiated and funded by The Israel Anti-Drug Authority, investigated adolescents’ reactions to professionally produced anti-drug plays, performed in 27 schools across Israel. The study included observations and the analyses of 20 professionally produced anti-drug plays performed during the school year and interviews with theatre personnel. The analysis of the plays’ narratives revealed that most plays had a melodramatic narrative based on a ‘true story’ and most depicted the downfall of a protagonist who became addicted to drugs. By the very choice of a closed, melodramatic structure, that precludes alternatives and a deep discussion of issues, these plays created an undivided hero, devoid of conflicts and ambivalence, who has no personal responsibility for his actions and the people around him and moves in a narrow private world that does not relate to the values and norms surrounding the issue of drugs.

Organ and tissue donor parents’ positive psychological adjustment to grief and bereavement: practical and ethical implications

Abstract Organ transplantation from the deceased typically involves requesting close family members’ consent to procure the deceased’s organs. This raises ethical and clinical concerns whether this difficult decision, taken while they are grieving, might have a long-term impact on their adjustment to bereavement. The study employed five measures of bereavement, adjustment and meaning of life (three developed for this study), administered to 216 bereaved Israeli donor and non-donor parents, mainly of deceased adults. The analysis distinguished between organ/tissue donors and donor/non-donors and determination of death (brain/cardiac). No differences were found according to grief measures or method of diagnosing death but donor parents scored higher on ‘life development’, ‘meaning of life after loss’ and ‘personal growth’. Findings suggest the donation process is not associated with a more negative adjustment to bereavement and might have benefited some donor parents in terms of adjustment to loss or meaning of life and growth, in particular those with higher levels of grief. Methodological and practical implications are discussed.

Public Deliberation on Policy Issues Normative Stipulations and Practical Resolutions

Public deliberation forums on policy issues are increasingly employed as a means to engage citizens in discussions on a wide range of public policy issues that traditionally were entrusted to experts. Philosophically these forums draw on deliberative democracy theory, but their application can be found in diverse social and organizational contexts. This chapter summarizes concerns regarding limitations and pitfalls that can characterize public deliberation and discusses how the broad normative conditions for a democratic public deliberation have been translated to actual procedures in various public deliberation initiatives. Several types of deliberation methods and examples on topics such as planning, nanotechnology, and budgets are presented to illustrate how different public deliberation initiatives aimed to realize these stipulations. The chapter concludes with theoretical and pragmatic challenges.

Protecting Young Children From Tobacco Smoke Exposure: A Pilot Study of Project Zero Exposure

Providing objective evidence of child TSE by using biomarkers and home air quality may persuade parents to protect their children from tobacco smoke. BACKGROUND: Tobacco smoke exposure (TSE) harms children, who are often “captive smokers” in their own homes. Project Zero Exposure is a parent-oriented, theory-based intervention designed to reduce child TSE. This paper reports on findings from the pilot study, which was conducted in Israel from 2013 to 2014. METHODS: The intervention consisted of motivational interviews, child biomarker and home air quality feedback, a Web site, a video, and self-help materials. The primary outcome was child TSE as measured by hair nicotine. Secondary outcome measures were air nicotine and particulate matter, parental reports of TSE, parental smoking behavior, and TSE child protection. A single-group pre- and posttest design was used. RESULTS: Twenty-six of the 29 recruited families completed the study. The intervention was feasible to implement and acceptable to participants. Among the 17 children with reliable hair samples at baseline and follow-up, log hair nicotine dropped significantly after the intervention (P = .04), hair nicotine levels decreased in 64.7% of children, and reductions to levels of nonexposed children were observed in 35.3% of children. The number of cigarettes smoked by parents (P = .001) and parent-reported child TSE declined (P = .01). Logistical issues arose with measurement of all objective measures, including air nicotine, which did not decline; home air particulate matter; and hair nicotine. CONCLUSIONS: A program based on motivational interviewing and demonstrating TSE and contamination to parents in a concrete and easily understandable way is a promising approach to protect children from TSE. Further research is needed to enhance current methods of measurement and assess promising interventions.