In the ongoing debate in the area of critical leadership studies, the nature of leader–follower relationships is a thorny issue. The nature of followership has been questioned, especially whether followers can display resistance behaviours while maintaining their follower position. Addressing this issue requires a dialectical approach in which followers and leaders alike are primary elements in leadership co-production. Followers who face destructive leaders are of special interest when leadership is studied as a co-creational process. This context favours the emergence of a full range of behavioural profiles in which passives and colluders will illustrate the destructive leadership co-production process, and those who resist demonstrate that followers may not follow the leader and still keep a followership purpose. A two-step data analysis procedure was conducted based on the behaviour descriptions of 123 followers having a destructive leader. A qualitative analysis (i.e. content analysis) showed a set of behaviours and their antecedents that suggest three main groups of followers: resisters, obedient and mixed behaviour. Treating these data quantitatively (i.e. latent class analysis), six followers’ profiles emerged: active resistance, passive resistance, passive obedience, conflict avoidance, support and mixed. Our findings provide evidence that followers who resist may do it for the sake of the organisation. We discuss our findings in light of followership theory, whereby joining role-based and constructionist approaches allows us to argue that followers may still be followers even when they do not invariably follow their leader.

Issue The COVID-19 pandemic caused profound disruptive changes worldwide. Mental health (MH) and wellbeing (WB) have been particularly affected, namely with increased levels of anxiety, depression, post-traumatic stress disorder and burnout symptoms. Several factors can have contributed to individuals' vulnerability, including perceived uncertainty, the strict measures adopted, the socioeconomic hardship and the direct effects of the virus. Although the pandemic is primarily a public health and a socioeconomic crisis, it could turn into a serious MH crisis with all the associated implications. Description As a Health Observatory, National Institute of Health Doutor Ricardo Jorge, in collaboration with Institute of Environmental Health of Lisbon School of Medicine, and Portuguese Society of Psychiatry and Mental Health, coordinated an observational study to characterize the MH and WB of general population and health professionals residing in Portugal, during pandemic's first wave. Anxiety, depression, post-traumatic stress disorder, burnout and resilience were selected as main outcomes, measured using validated instruments with sound psychometric properties. Results High levels of psychological distress were observed among general population and health professionals. Women, younger, individuals with lower income or unemployed, lower educational level and frontline health professionals were most susceptible to psychological suffering. The research team produced a Policy Brief with a set of 14 recommendations for immediate action to ensure equal access to psychological and emotional support for all citizens, to reduce the impact of mental disorders and to promote MH. Lessons The mitigation of psychological suffering is of paramount importance, from an equitable perspective focus on identified vulnerable sub-groups. Particular attention should also be given to citizens infected with SARS-CoV-2 and patients with COVID-19, who faced direct consequences of the disease. Key messages In a pandemic context, monitorization of population’s mental health is of paramount importance. Health Observatories should have an active and reinforced role in this public health area to mitigate potential negative impacts of pandemics.

PurposeLeadership is a time-dependent process and a recent leadership research trend posits a central role of time-based variables. The dyadic tenure plays a keystone role in understanding leader–follower dynamics, especially as regards leader ethics. In line with this, from a social learning theory perspective, the authors propose a model that explains how and when ethical leaders' behaviors influence subordinates' moral disengagement.Design/methodology/approachWith a sample of 220 employees, the present study tests the conditional indirect effect of ethical leadership on followers' moral disengagement via instrumental ethical climate (IEC), using dyadic tenure as the moderator variable. The analyses were conducted with Hayes PROCESS macro.FindingsResults suggested that IEC fully mediates the relationship between ethical leadership and moral disengagement. Thus, when followers perceive low levels of ethical leadership, they notice higher levels of IEC, which is positively related to moral disengagement. However, IEC perception only influences moral disengagement when dyadic tenure approaches the third year.Originality/valueThis paper answers calls to include time-based variables in leadership studies. Hence, using dyadic tenure, this study gives support to previous propositions that were still awaiting empirical test.

The COVID-19 pandemic poses critical challenges for the health care workers (HCWs) around the world due to the increasing demands imposed on health care systems. This study aims to investigate how risk concern impacts burnout via positive and negative affect. Further, the moderating role of risk exposure (low, medium, and high) in this parallel mediation model is examined. A sample of 257 Portuguese HCWs answered a questionnaire. Structural equation modeling (SEM) analysis was applied. Results showed that risk concern positively influences negative affect – but not positive affect – and, consequently, burnout. Contrary to our expectations, this indirect effect was not greater for individuals in the high-risk group (vs. low-risk group), which can be explained by individual and organizational factors' buffering role. These findings draw healthcare organizations' attention to the hazardous effects of risk concern on HCWs' well-being.

The COVID-19 pandemic increased psychosocial risk factors among healthcare professionals (HCPs). Objective: To characterize Portuguese HCPs mental health (MH), estimate anxiety, depression, post-traumatic stress disorder (PTSD) and burnout symptoms, and identify risk/protective factors. A cross-sectional online survey and a longitudinal assessment were conducted in 2020 (T0) and 2021 (T1). Sociodemographic and occupational variables, COVID-19-related experiences and protective behavior data were collected from a non-probabilistic sample of HCPs in Portugal. Symptoms of anxiety, depression, PTSD, burnout and resilience were assessed using the Portuguese versions of the Generalized Anxiety Disorder Scale (GAD-7), the Patient Health Questionnaire (PHQ-9), the Post-traumatic Stress Disorder Checklist (PCL-5), the Shirom–Melamed Burnout Measure (MBSM) and the Connor–Davidson Resilience Scale (CD-RISC-10), respectively. Risk and protective factors were identified through simple and multiple logistic regression models. Overall, 2027 participants answered the survey in T0 and 1843 in T1. The percentage of moderate-to-severe symptoms decreased from T0 to T1; however, a considerable proportion of HCPs reported symptoms of distress in both years. Being a woman, working in a COVID-19-treatment frontline position and work–life balance increased the odds of distress. High resilience, good social/family support, and hobbies/lifestyle maintenance were found to be protective factors. Globally, our results show that performing as a HCP during the pandemic may result in long-term effects on MH.

PurposeFollower's individual differences have been receiving increased attention in studying destructive leadership because followers may enable or disable it. One of these yet under-researched features is the role of followers' leadership coproduction beliefs (a role construal) in explaining their resistance to destructive leaders. Departing from the proactive motivation theory, this paper explores the robustness of coproduction beliefs by testing its ability to predict followers' resistance to destructive leaders across four situations – abusive supervision, exploitative leadership, organization directed behaviors and laissez-faire.Design/methodology/approachWith a sample of 359 participants that answered a scenario-based survey, the present study tests the relationship between coproduction beliefs and resistance behaviors in the four mentioned groups, while controlling for alternative explanations. A multigroup analysis was conducted with PLS-SEM.FindingsConstructive resistance is always favored by coproduction beliefs independently of the leader's type of destructive behavior. Dysfunctional resistance, however, is sensitive to the leader's type of destructive behavior.Originality/valueThis paper extends knowledge on the role of coproduction beliefs as an individual-based resource against destructive leaders.

Background Bread is one of the main sources of salt intake in Portugal. Based on this evidence, a protocol signed between national Health Sector and the Associations of Industrial Bakeries, in 2017, established gradually decrease salt in bread until 2021. This measure also targets schools’ available bread, this should not exceed 1g salt, to end of 2018. A pilot Health Impact Assessment (HIA) aims to assess the potential impact on salt reduction in bread on the eating habits of children (6-18 years) and their families. Methods A questionnaire is being performed to assess the effect of this measure. The first version was designed by a panel of 11 experts (content validity), following the plain text principles. A external specialist revised it for facial validity. A pilot was tested. Thereafter, a REDCap online survey of “Knowledge and Attitude towards the Gradual Reduction of Salt in Bread” questionnaire was finalized. The target group is the parents or guardians of children and young persons, of School Clusters in the south of Portugal. Results Final online survey totalizes 33 items, divided into four blocks: 1.Knowledge and General literacy data, 2.Domestic Consumption, 3.Scholar consumption and 4.Sociodemographic. An adult responsible for the child/young person should answer the survey. Access is possible through a REDCap link, using computers available in the School Cluster, or other manner suitable for the purpose. Conclusions This survey will contribute to the identification of modifiable behaviors related with salt intake. Such evidence may eventually provide the opportunity for new strategies in this area. Key messages Health Impact Assessment as a procedure to assess the effects of measures and policies on human health. Questionnaires are a rapid tool to access perceptions, attitudes and knowledge.

Background The Portuguese National Health Plan (PNS) 2012-2016, extended to 2020, was the strategic health document shaping the direction of intervention within the Health System. The National Institute of Health Doutor Ricardo Jorge (INSA) is the institution responsible for carrying out its final evaluation. To underpin PNS final evaluation a multistep process was designed. Methods A mixed methods study using a convenience sample was implemented to assess stakeholders’ perception about five PNS dimensions: dissemination, communication, implementation, impact, and evaluation. For this purpose, two different tools were used. Semi-structured interviews with former health policy managers were conducted. In addition, an online survey was designed and widely distributed to additional stakeholders. From October 2019 to February 2020, data was collected using two separate instruments. Integral transcriptions of the interviews were made. Qualitative content analysis and quantitative descriptive analysis were used. Results A total of 12 interviews and 179 valid surveys were obtained. Regarding stakeholders’ perception about PNS implementation process, there was an overall positive recognition about the strategic and operational relevance of the PNS, as a common dialogue platform and a tool for health improvements both for health status and health system function in Portugal. Among pointed implementation barriers, management was mentioned as the major constraint, mainly due to shortage of human and financial resources to carry out the recommended interventions within the PNS timeline. Conclusions As part of the evaluation process the research team found relevant gain knowledge of the wider context in which PNS was developed and implemented, based on stakeholders’ perception. Their considerations are important not only to support the definition of the questions and criteria for PNS final evaluation, but also to highlight key issues for the future policy cycle. Key messages