Patients' compliance: the problem and directions for psychological research

The problem of patients' noncompliance with prescribed medications is discussed, to include prevalence and suspected variables of influence. This article seeks to sensitize psychological researchers to the problem, cites research on nonspecific drug factors which could affect noncompliance, and suggests directions for needed research efforts. Variables suggested for study include perceptual qualities of medications and associated expectations and preferences. It is suggested that a psychological research perspective could broaden understanding of noncompliance and possibly lead to "engineering" of medications which could enhance compliance.     

Listening to Different Voices: Formation of Sanction Beliefs and Taxpaying Norms1

How do people form beliefs about sanctions and norms toward the legal system? Using data from a telephone survey with 1,200 Minnesota adult residents, we examine how income sources that provide an opportunity to avoid official detection shape the amount and sources of communication about IRS enforcement effectiveness. Individuals with economic exchanges that provide the opportunity to cheat without detection received significantly more information about tax issues and IRS enforcement, especially from co-workers. Although both family members and co-workers were major sources of tax information, individuals received more information about IRS enforcement effectiveness from co-workers than from family members. Communication with co-workers lowered the perceived likelihood of IRS detections for overstating deductions, lowered the perceived severity of informal sanctions for tax cheatings, and lowered the perceived fairness of tax laws and positive personal norms toward compliance with tax laws. In contrast, communication with family members enhanced the perceived fairness of tax laws and positive personal norms toward compliance with tax laws. These findings are interpreted in the framework of social comparison theory (Festinger, 1954). We discuss implications for the theory and research on the development of beliefs about enforcement systems and compliance with laws.     

Exposure to national flags reduces tax evasion: Evidence from the United States,Australia, and Britain

There have been numerous theories from numerous academic fields explaining why individuals engage in tax evasion. Drawing broadly on Social Identity Theory, we predict that exposure to one's national flag can reduce tax evasion by making salient one's national identity, motivating one to sacrifice one's self-interests for one's country—which would presumably include paying one's fair share of taxes. In three experiments, we found that exposure to American, Australian, and British flags reduced Americans', Australians', and Britons' tax evasion in financially incentivized tasks (Experiments 1, 3) and increased tax-paying attitudes (Experiment 2). The effects arose because flag primes made salient participants' national identities that then motivated them to help their country. We ruled out social norms and trust in authorities as alternative explanations. As such, flag primes might reduce tax evasion and in doing so improve the economic and societal welfare of a country.     

An Argument for Compulsory Vaccination: The Taxation Analogy

I argue that there are significant moral reasons in addition to harm prevention for making vaccination against certain common infectious diseases compulsory. My argument is based on an analogy between vaccine refusal and tax evasion. First, I discuss some of the arguments for compulsory vaccination that are based on considerations of the risk of harm that the non-vaccinated would pose on others; I will suggest that the strength of such arguments is contingent upon circumstances and that in order to provide the strongest defence possible of compulsory vaccination, such arguments need to be supplemented by additional arguments. I will then offer my additional argument for compulsory vaccination: I will argue that in both cases of vaccine refusal and of tax evasion individuals fail to make their fair contribution to important social and public goods, regardless of whether each individual contribution ‘makes a difference’. While fairness considerations have sometimes been used to support a moral duty to vaccinate, they have not been appealed to in order to argue for a legal duty to vaccinate. I will suggest that this is due, among other things, to a misapplication of the principle of the least restrictive alternative in public health. Finally, I will address nine possible objections to my argument.     

Legal Innovation for Social Change: Exploring Change and Resistance to Different Types of Sustainability Laws

In this article I argue that a desirable future direction for political psychology would be to pay more attention to social‐psychological processes involved in the response to innovative laws, in particular those devised with sustainability and environmental protection aims. This involves taking into account the following premises: (1) innovation and change are not unitary phenomena; instead there are different types of innovation; (2) legal and policy innovation is a specific type and is highly central in an era when global challenges are increasingly dealt with by global treaties which are then translated into national laws with a call to transform local practices; (3) offering attention to the reception of such innovation involves developing specific conceptual tools; (4) devising a typology of legal innovation is one step in this direction; (5) furthering our comprehension of how people, groups, and institutions receive—i.e., accept, contest—legal innovation for sustainability is important for helping to push forward sustainability goals, which are legislated but far from attained. The present article outlines theoretical tools for addressing psychosocial processes involved in the reception of legal innovation, drawing mostly on the approach of social representations and the literature of environmental psychology, and offers three criteria for a typology of laws. Finally I present some examples of responses to subtypes of legal innovation from the sustainability domain, taken as an illustrative case, and discuss differences and commonalities in the processes of acceptance and resistance that each mobilizes.     

A Note on Tax Evasion as a Function of the Quality of Information about the Magnitude and Credibility of Threatened Fines: Some Preliminary Research

In a pame-simulation context, tax evasion behavior of 13 subjects was observed. The probability that tax evasion will be detected and fined appears to be a more effective deterrent than the size of such fines, although both the magnitude of finm and their probability affect tax evasion. Vague information about the probability that fines will be imposed enhances the deterrent power of low probability audits and small fines.     

一名宗教信仰者输血引发的思考

输血挽救了无数危重患者的生命,但少数宗教信仰者在自己或其家属急需输血时却拒绝输血治疗,而目前我国的法律法规在这一方面尚无明确规定,在此种情况下是否输血,医师处于两难的选择,也较易引起医患纠纷,为此建议我国卫生及其司法部门尽快制定相关法律法规,使医务工作者,在遇到此类问题时有章可循,有法可依。     

Do Our Psychological Laws Apply Only to College Students?: External Validity Revisited

That most psychological research is conducted with students led to concerns that psychological laws apply only to this population. These fears are based on Campbell and Stanley’s concept of external validity that specifies the extent to which research findings can be generalized. This concept is based on an inductivist philosophy. As philosophers of science have argued since Hume, one cannot derive general laws from singular observations. Instead, one develops theories and uses empirical studies to test these theories. This solves the problem of generalization because the domain of applicability is specified by the theory. Reports that studies result in different findings when conducted in different cultures are unproblematic as long as these differences can be explained with psychological theories.     

Gender,Status, and Tax Offenses

Current literature on tax evasion finds that compared to women, men are more likely to engage in tax evasion. This study examines how expectation states theory helps explain this gender difference by investigating the relationship between status and compliance to authority using a secondary analysis of ICPSR data on the Monitoring of Federal Criminal Sentences. We hypothesize that the effect of gender on the odds of being convicted for a tax offense compared to any other white collar crime will decrease when controlling for other diffuse status characteristics. Results from a series of multivariate regression models support this hypothesis.     

Psychological Laws (Revisited)

It has been suggested that a functionalist understanding of the metaphysics of psychological typing eliminates the prospect for psychological laws. Kim, Millikan, and Shapiro have each separately argued that, if psychological types as functional types are multiply realized, then the diversity of realizing mechanisms demonstrates that there can be no laws of psychology. Additionally, Millikan has argued that the role of functional attribution in the explanation of historical kinds limits the formulation of psychological principles to particular taxa; hence, psychological laws applicable to any cognitive being are not possible. Both arguments against the possibility of psychological laws, I want to suggest, only succeed at showing that certain types of empirical principles will not be laws. I will suggest that a further type of empirical principle, grounded in the general constraints on the sustainability of population types, remains in the running as a candidate law. Importantly, the formulation of these principles presupposes a functionalist understanding of psychological typing.     

An assessment of antecedent events influencing noncompliance in an outpatient clinic

Several studies have shown that various factors can influence noncompliance, including task novelty, rate of presentation, and task preference. This study examined the impact of selected antecedent variables on noncompliance in an outpatient clinic setting. In two experiments involving 6 typically developing children, the consequences for noncompliance remained constant. During Experiment 1, demands that included noncontingent access to adult attention were contrasted with the same demands that did not include attention within a multielement design. In Experiment 2, demands were altered by decreasing the difficulty or amount of work or providing access to attention. In both experiments, results indicated idiosyncratic responses to the manipulated variables, with decreases in noncompliance observed following introduction of one or more antecedent variables with 5 of the 6 participants. These results suggested that noncompliance can be reduced via changes in antecedent variables, including adding potential positive reinforcers to the task situation, and that it is possible to probe variables that alter noncompliance in an outpatient clinic setting.     

REDUCING NONCOMPLIANCE TO FOLLOW-UP APPOINTMENT KEEPING AT A FAMILY PRACTICE CENTER

In this study, we evaluated follow-up appointment keeping at a family practice center. To determine if noncompliance could be reduced, four treatments were implemented: no-treatment control, modified appointment card, free follow-up, and a reduced rate follow-up. Thereafter, the reduced rate follow-up was implemented again to determine the extent noncompliance could be reduced for all eligible patients. Incentives significantly increased follow-up appointment keeping, whereas the modified appointment card was ineffective. A cost analysis suggested that the no-treatment control and modified appointment card conditions were the least expensive, but also the least effective. The incentive conditions were more expensive, but the reduced rate condition generated the most net revenue. Questionnaire data suggested that the incentive conditions had an effect on noncompliance and may be considered for use in other medical settings.     

Note on functional measurement and data analysis

The guiding idea of functional measurement is that measurement theory and substantive theory form an organic unity. Psychological scales are inherent in the statement of quantitative psychological laws, and these laws themselves form the base and frame for psychological measurement. Valid scales thus depend on empirically valid laws. But establishing empirical validity of any law requires appropriate data analysis. Several statistical problems are discussed with respect to simple algebraic laws. To illustrate the necessity for proper tests of goodness of fit for algebraic models, five sets of experimental data are reanalyzed. In each case, the factorial plot and the analysis of variance showed that the data were nonadditive. Nevertheless, an additive model was fit to the data. The correlations between the data and the predictions from the additive model were extremely high, ranging from .964 to .9997. The corresponding observed-predicted scatterplots also gave little sign of the deviations from additivity. These correlation-scatterplot analyses conceal and obscure what the factorial plot and the analysis of variance reveal and make clear. Other topics discussed are accepting and rejecting the null hypothesis, the use of nonmetric smoothing for parameter estimation, and problems of stimulus-response-model generality. An extension of functional measurement is suggested for a practicable error theory for nonmetric analysis.     

Assessing Parental Response Patterns in the Treatment of Noncompliance in Children

Child noncompliance is one of the most frequently reported behavior problems in clinic-referred children. One difficulty with treating noncompliance in the clinic is that the demand characteristics of the situation may alter the rates of child compliance. The observation of parent-child interactions, with an emphasis on parent behaviors, may be a more meaningful way to assess parent training programs. In the current study, the parents of three children each showed a distinctive pattern in their responding to their children's compliant and noncompliant behaviors. An in vivo direct instruction procedure, that involved the therapist working directly with the parent to provide immediate consequences was used. Following training, improvements in correct responding were evident for al parents. Particularly noteworthy was that child compliance was not an accurate indicator when assessing parents' initial skill levels.     

抢救一例Rh阴性稀有血型危重孕妇的体会与思考

Rh阴性稀有血型危重患者的临床救治相当棘手。本文通过回顾对一名Rh阴性血型危重孕妇的临床救治经过,探讨了应急情况下Rh阴性血型危重患者的临床救治策略和采供血应急措施,建议我国尽快建立稀有血型血库和制定相关法律法规,为应急情况下抢救Rh阴性血型患者提供依据和保障。     

Analogical transfer and expertise in legal reasoning

Analogical transfer and its relation to expertise is examined in a legal context. Three experiments were conducted comparing the performance of novices (introductory tax students) and of experts (experienced tax practitioners from multinational public accounting firms) on tasks involving the application of tax laws. In Experiment 1 subjects completed a target problem after reading a decided case that was either analogous or not analogous to a target problem. A limited amount of transfer was observed, with no differential rate of transfer across experience levels. In Experiments 2 and 3 attempts were made to facilitate transfer of knowledge by inducing transfer-appropriate processing of the source analog and by providing multiple source analogs. The results of both experiments indicate an interaction between treatment and expertise. Unexpectedly, the facilitating treatments reduced the transfer of knowledge for experts while increasing the transfer for novices. Subsequent analysis of the responses of the expert subjects indicates that for the more experienced expert subjects a highly proceduralized rule interfered with the knowledge transfer when that rule was made salient by the facilitating treatments. The less experienced expert subjects behaved in a manner consistent with the hypotheses. This poor performance of the more experienced experts results from the inflexibility in expert problem solving due to the proceduralization of information processing. Frensch and Sternberg (1989) demonstrate that this type of inflexibility is one of the costs of expertise and results from the development of a large and highly complex knowledge base containing numerous well developed strategies.     

The interstate delivery of psychological services: opportunities and obstacles

An analysis of the psychology licensing laws of the 50 states and the District of Columbia reveals that these laws pose serious obstacles to practicing outside of the state in which one is licensed. Eleven states do not allow any interstate practice. Twenty-three states allow an out-of-state psychologist to practice in that state but require some type of prior permission of the board. Only 17 states allow some interstate practice without prior approval, but several of these impose a variety of limitations. All 41 states that do allow an out-of-state psychologist to practice limit the number of days that such practice is allowed. These laws seem to be aimed more at protecting the psychologists who are licensed in that state than in protecting the potential consumers of psychological service. The need for reform of these laws is discussed, and a potential model-the interstate Mutual Recognition Compact-developed for nursing is a promising solution.     

One hundred years of laws in psychology

Mainstream psychology in the 20th century has been conceived as a nomothetic science, but few psychological "laws" have been proposed. A PsycLit search of journal abstracts from 1900 to 1999 yielded a total of 3,093 "law" citations, or 22 per 10,000 entries, with two psychophysical laws (Weber's law and Stevens's power law) and two learning laws (Herrnstein's matching law and Thorndike's law of effect) as the most frequently cited. The number of law citations has been decreasing throughout the century, to 10 per 10,000 entries in the last decade, with few references to laws of recent origin. This could be the result of increasing doubts about the lawfulness of psychological processes coupled with a general preference for less ambitious terms (such as effects, principles, models, or functions).     

Multiple Realizability,Constraints, and Identity

Shapiro has suggested that the empirical plausibility of the multiple realizability of human‐like minds is dubious, because a contrary thesis, the Mental Constraint Thesis, enjoys positive empirical evidence. The Mental Constraint Thesis states that, given the actual physical laws, there is only one way to realize a human‐like mind. I will suggest, however, that the Mental Constraint Thesis is not a contrary to the empirical multiple realizability thesis relevant to psychological reduction or autonomy and, as a consequence, has no bearing on those classificatory issues.     

The essentialist aspect of naive theories

Recent work on children's inferences concerning biological and chemical categories has suggested that children (and perhaps adults) are essentialists - a view known as psychological essentialism. I distinguish three varieties of psychological essentialism and investigate the ways in which essentialism explains the inferences for which it is supposed to account. Essentialism succeeds in explaining the inferences, I argue, because it attributes to the child belief in causal laws connecting category membership and the possession of certain characteristic appearances and behavior. This suggests that the data will be equally well explained by a non-essentialist hypothesis that attributes belief in the appropriate causal laws to the child, but makes no claim as to whether or not the child represents essences. I provide several reasons to think that this non-essentialist hypothesis is in fact superior to any version of the essentialist hypothesis.