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.
Issue The National Health Plan (PNS) 2012-2016 (extended until 2020) is the Portuguese strategic health document that presents the direction of intervention within the Health System. A final evaluation of PNS was foreseen, with National Institute of Health Dr Ricardo Jorge (INSA) being responsible for carrying out this task. The experience gained by INSA in defining a roadmap to be used in this process can be important in steering other actors to policy evaluation. Description of the problem In order to analyze the impact of policies, it is necessary to collect evidence that can evaluate the results achieved, and more importantly, identify gaps in implementation and evaluation issues. Herein, we aim to present the methodological approach developed to pave the way to the final assessment of PNS. Results As part of the Biennial Collaborative Agreement 2016-2017, WHO sponsored a high-level technical consultative process with relevant experts to address the condition for defining the work plan. It was devised to undertake: i) A scoping review based upon data collected from PNS implementation evidence mapping; ii) A qualitative analysis of the perception from main stakeholders on PNS impact and their expectations. Thus, a matrix of evidence was built to analyze the alignment of PNS at national and local levels, and with the main health framework targets and indicators. Also, online surveys and face-to-face interviews were done with key stakeholders in order to identify evidence gaps and critical factors for the successful PNS implementation, among others. Lessons To characterize its implementation and impact on citizens' health, a sound PNS evaluation should be guided by clear assessment questions, supported by validated tools and complemented by international guidance. In addition, a long-term consultative process with key stakeholder support is required to properly identify opportunities, priorities, and outcomes. Key messages Institutionalization of an evaluation process as part of public policies life cycle is a powerfull tool to foster learning and crucial to achievement of proposed goals. A clear structure to support the policy evaluation approach is mandatory to guarantee impartiality, independence and transparency on the overall process.
Background Evidence shows that individuals can engage in maladaptive behaviours as a response to a pandemic context, which can compromise their health and wellbeing. This project aims to characterize self-reported changes in addiction-related behaviours and associated factors in the adult population during the first COVID-19 lockdown, in Portugal. Methods Cross-sectional study, with an online survey conducted between May 22 and July 20, 2020, targeting a non-probabilistic sample of adults (18 years of age or more) dwelling in Portugal (mainland and autonomous regions). The following data were collected: alcohol drinking, smoking, use of cannabis and other substances, gambling, and sugar-sweetened food intake, work-related variables, and sociodemographics. After data cleaning and weighting (by sex, age group, NUTS II and educational level), logistic regression models were conducted to assess potential determinants of addiction-related behaviours. Results Overall, 3.982 individuals participated in the study (79.1% women; mean age of 45.15 years). Women, young adults (18-34 years) and individuals with difficulties in work-life balance had higher odds for self-reported increase of sweets intake. Men, young adults (18-34 years) and those with work-life balance difficulties presented higher odds for alcohol drinking increase. Those unemployed (or with suspended activity or in layoff) and those with lower income had higher odds for gambling behaviour increase. Conclusions Some segments of the Portuguese population reported to have increased their engagement in addictive-related behaviours, during the COVID-19 lockdown, which can have negative consequences for mental health. The study of the correlates of maladaptive responses under this scenario is pivotal to inform public health interventions and alleviate the potential deleterious impacts of this pandemic. Key messages COVID-19 pandemic can increase maladaptive coping behaviours in some segments of the population. Public health interventions are needed to mitigate the negative consequences of this pandemic.
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.
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