Babyface effects: A double‐edged sword in healthcare service evaluations

We examine how a doctor's baby‐like facial appearance affects people's perceptions and judgments before and after a medical fraud occurs. A 2 (face type: babyfaced vs maturefaced) × 2 (doctor's gender: male vs female) × 2 (doctor's specialty: internal medicine vs surgery) between‐subjects experiment was conducted. The results indicate that a babyfaced doctor fares better than a maturefaced doctor in terms of patients' expectations, satisfaction and intended loyalty. However, having baby‐like facial features may work against a doctor who is involved in a medical fraud. The severity of a medical fraud is perceived to be greater when it involves either a babyfaced female doctor of internal medicine or a babyfaced male surgeon. After the medical fraud, this altered perception of the fraud's severity leads to reduced patient loyalty. Service evaluations based on the doctor‐patient relationship show that the doctor's baby face is a double‐edged sword.     

Observer Perceptions of Chronic Low Back Pain1

This study examined the effects of three variables on perceptions of symptoms associated with chronic low back pain: (a) the presence or absence of supporting medical evidence, (b) the valence (positive/negative) of the relationship of an observer to the person in pain, (c) the degree of control (present/absent) of the person in pain over the circumstances of pain onset. The independent variables were manipulated in a (2 × 2 × 2) within-subjects design. Forty-eight undergraduate subjects were asked to estimate levels of pain intensity, emotional distress, and disability for the person in pain described in each of eight vignettes. Significant main effects, a two-way interaction, and a three-way interaction emerged, indicating that these contextual variables exerted substantial and complex effects on observer perceptions. The implications of these findings are discussed for matters such as pain assessment and disability determination.     

Synergistic effects of pain and alcohol use in relation to depressive and anxiety symptoms among Latinos in primary care

Although past work has shown that alcohol use co-occurs with anxiety/depression among Latinos, little work has examined the variables that qualify such associations. The present investigation sought to address whether pain severity (i.e. pain intensity and/or pain-related disability, respectively) moderated relations between hazardous drinking and depressive/anxious arousal symptoms among an economically disadvantaged Latino sample recruited from a primary care medical setting. Participants included 253 adult Latinos (M_age = 38.5 years, SD = 10.8; 86.6% female) who attended a community-based primary care clinic. There was a significant interaction of hazardous drinking with pain intensity in relation to depressive symptoms and significant interactions of hazardous drinking and pain-related disability in relation to depressive and anxious arousal symptoms. Hazardous drinking was associated with more severe depressive/anxious arousal symptoms only when pain intensity/disability was high. This is the first study to demonstrate the moderating role of pain intensity and disability in associations between hazardous drinking and anxiety/depression among Latinos in a primary care medical setting.     

Exploring patient perspectives of prediabetes and diabetes severity: a qualitative study

Abstract

Objective: This qualitative study sought to identify and describe patients’ variant perceptions of disease severity after receiving a type 2 diabetes (T2DM) or prediabetes (preDM) diagnosis.

Design: Researchers interviewed 29 patients from two US medical centers to ascertain perceptions of severity. We used the constant comparative method from a grounded theory approach to identify themes from patients’ perspectives that inform their disease severity. This approach was used to help translate research to practice and ultimately identify intervention strategies informed by authentic experiences of preDM and T2DM patients.

Results: Perceptions of disease severity fell into two groups: high and low severity. Patients diagnosed with T2DM and preDM emerged in both groups and were comparative in terms of sample size, gender, and ethnic diversity. Several factors contributed to patients’ beliefs, including what they were told about the disease, observations from experiences within their own social network, and information from formal diabetes classes and their own research. The two perspectives diverged when patients described how their belief was informed by three thematic properties or personal factors: (i) fears; (ii) clinician communication; and (iii) social comparisons.

Conclusions: Beliefs about severity are influenced by patients’ fears, interactions with clinicians, and experiences within their social networks. These findings show that when interacting with patients with T2DM or preDM, clinicians should elicit patient perceptions of disease severity so they may then tailor the discussion to address these perceptions and help patients grasp the severity of these conditions.     

Ethnic Differences in Perceived Impairment and Need for Care

Latino children in the U.S. have high rates of unmet need for mental health services, perhaps due to biased perceptions of impairment and need for care by parents and providers. We tested this argument using an experimental vignette design. Vignettes described children with problems that varied on severity (mild vs. serious), nature of the problem (internalizing vs. externalizing), as well as gender and ethnicity (Latino vs. Anglo). Raters were Latino and Anglo parents (N = 185) and providers (N = 189). Vignettes with Latino names were viewed as more impaired by both parents and providers, and this effect was significantly stronger in Latino vignettes with less severe problems. Severity and Latino features of vignettes also interacted with judgments of need for service. At higher severity, vignettes with Anglo names were judged to need service more than vignettes with Latino names, despite the same judged levels of impairment. Results are discussed in the light of the unmet need for Latinos.     

Self‐Enhancement on a Self‐Categorization Leash: Evidence for a Dual‐Process Model of First‐ and Third‐Person Perceptions

Research suggests that first‐ and third‐person perceptions are driven by the motive to self‐enhance and cognitive processes involving the perception of social norms. This article proposes and tests a dual‐process model that predicts an interaction between cognition and motivation. Consistent with the model, Experiment 1 (N = 112) showed that self‐enhancement drove influence judgments when messages were normatively neutral—people reported first‐person perceptions for in‐group‐favoring messages and third‐person perceptions for out‐group‐favoring messages. Experiment 2 (N = 208) showed an additive effect when social norms were also in‐group‐enhancing, but showed a decreased effect when social norms and group‐enhancement were discordant. The findings are hard to reconcile with pure motivational or cognitive explanations, but are consistent with the proposed dual‐process model.     

Parallels in Preschoolers' and Adults' Judgments About Ownership Rights and Bodily Rights

Understanding ownership rights is necessary for socially appropriate behavior. We provide evidence that preschoolers' and adults' judgments of ownership rights are related to their judgments of bodily rights. Four‐year‐olds (n = 70) and adults (n = 89) evaluated the acceptability of harmless actions targeting owned property and body parts. At both ages, evaluations did not vary for owned property or body parts. Instead, evaluations were influenced by two other manipulations—whether the target belonged to the agent or another person, and whether that other person approved of the action. Moreover, these manipulations influenced judgments for owned objects and body parts in the same way: When the other person approved of the action, participants' judgments were positive regardless of who the target belonged to. In contrast, when that person disapproved, judgments depended on who the target belonged to. These findings show that young children grasp the importance of approval or consent for ownership rights and bodily rights, and likewise suggest that people's notions of ownership rights are related to their appreciation of bodily rights.     

Medical help-seeking by different types of chronic pain patients

Abstract

This paper reports on a study of the use of health services by different types of patients with chronic benign pain. The purpose of the study was to identify differences in medical consumption between different types of pain patients. In the course of one year 586 patients were selected by 45 general practitioners: they included patients who had had almost daily chronic pain symptoms for at least six months, without a medical diagnosis (such as cancer or arthritis) to explain the pain. Patients were categorized according to the Multidimensional Pain Inventory which distinguishes four categories: the dysfunctional, who perceive severe pain and gain social support; the interpersonally distressed, who combine pain with affective and relational distress; adaptive copers, who cope with their pain in a number of ways; the average type, with characteristics of all three other types. It was hypothesised that adaptive copers would make less use of health services and would be more involved in self-help activities than dysfunctional or interpersonally distressed patients. Frequent use of psychological services by the interpersonally distressed group was expected. It was predicted that difference in health services use would continue during the subsequent year.

No differences were found between the four groups in location, temporal characteristics, or possible medical causes of the pain symptoms. Dysfunctional patients used more services than the others. Adaptive copers used the least. The four groups did not differ in self-care activities. Group-membership as well as pain severity are related to the use of health services. None of the groups showed a significant decline in the use of health services during the year. It is concluded that chronic pain is invalidating, but that not all patients are equally excessive in their use of medical services.     

Comparative effectiveness of CBT interventions for co-morbid chronic pain & insomnia: A pilot study

IntroductionChronic pain is difficult to treat and often precedes or exacerbates sleep disturbances such as insomnia. Insomnia, in turn, can amplify the pain experience. Both conditions are associated with inflammatory processes, which may be involved in the bi-directional relationship between pain and sleep. Cognitive behavioral therapy (CBT) for pain and CBT for insomnia are evidence based interventions for, respectively, chronic pain and insomnia. The study objectives were to determine the feasibility of combining CBT for pain and for insomnia and to assess the effects of the combined intervention and the stand alone interventions on pain, sleep, and mood outcomes compared to a control condition.MethodsTwenty-one adults with co-occurring chronic pain and chronic insomnia were randomized to either CBT for pain, CBT for insomnia, combined CBT for pain and insomnia, or a wait-list control condition.ResultsThe combined CBT intervention was feasible to deliver and produced significant improvements in sleep, disability from pain, depression and fatigue compared to the control condition. Overall, the combined intervention appeared to have a strong advantage over CBT for pain on most outcomes, modest advantage over both CBT for insomnia in reducing insomnia severity in chronic pain patients.DiscussionCBT for pain and CBT for insomnia may be combined with good results for patients with co-occurring chronic pain and insomnia.     

A comparison of race‐related pain stereotypes held by White and Black individuals

Pain judgments are the basis for pain management. The purpose of this study was to assess Black and White participants' race‐related pain stereotypes. Undergraduates (n = 551) rated the pain sensitivity and willingness to report pain for the typical Black person, White person, and themselves. Participants, regardless of race, rated the typical White person as being more pain sensitive and more willing to report pain than the typical Black person. White participants rated themselves as less sensitive and less willing to report pain than same‐race peers; however, Black participants rated themselves as more pain sensitive and more willing to report pain than same‐race peers. These findings highlight similarities and differences in racial stereotypic pain beliefs held by Black and White individuals.     

Attitudes of Health Care Trainees About Genetics and Disability: Issues of Access, Health Care Communication, and Decision Making

Prior studies suggest that knowledge and attitudes of health care professionals influence patient communication and medical decision making. To study this dynamic in the context of genetic disability, we developed a survey on health professionals' attitudes regarding disability and genetic screening and pilot-tested it on a sample of medical students, residents, and genetic counseling students (N = 85). Despite minimal experience with disability or genetics, most respondents reported feeling comfortable dealing with genetics (59%) and disability (75%). The majority felt that disability caused significant suffering for both the person (51%) and family (64%), and that research should be directed toward preventing genetic disability (62%). Similar to prior literature, perceived Quality of Life was most often based on degrees of physical and cognitive functioning, pain, and social support. However, differences were found between genetic counseling trainees and other medical trainees in their relative emphasis of social versus medical issues in questions of disability and genetic testing, and these response patterns were associated with differences in the groups' priorities for offering information about social resources. Respondents agreed that access to genetic testing and information is personal and that testing should be available upon request for oneself (68%) and to a lesser degree for one's fetus (55%) or child (41%). However, the same individuals frequently stated that society should regulate access to such technologies. Although most felt that the patient and professional should jointly make such decisions on a case-by-case basis, it was also seen as appropriate for the health care professional to occasionally decline genetic testing. It seems apparent that training and experience influence knowledge and attitudes. Therefore, it is critical to document knowledge and attitudes of various health care providers and trainees, including differences between various specialties, to improve educational interventions geared to this area.     

Truthiness and law: Nonprobative photos bias perceived credibility in forensic contexts

Nonprobative but related photos can increase the perceived truth value of statements relative to when no photo is presented (truthiness). In two experiments, we tested whether truthiness generalizes to credibility judgments in a forensic context. Participants read short vignettes in which a witness viewed an offence. The vignettes were presented with or without a nonprobative, but related photo. In both experiments, participants gave higher witness credibility ratings to photo-present vignettes compared to photo-absent vignettes. In Experiment 2, half the vignettes included additional nonprobative information in the form of text. We replicated the photo presence effect in Experiment 2, but the nonprobative text did not significantly alter witness credibility. The results suggest that nonprobative photos can increase the perceived credibility of witnesses in legal contexts.     

Self-conscious emotions in patients suffering from chronic musculoskeletal pain: A brief report

Objective: The role of self-conscious emotions (SCEs) including shame, guilt, humiliation and embarrassment are of increasing interest within health. Yet, little is known about SCEs in the experience of chronic pain. This study explored prevalence and experience of SCEs in chronic pain patients compared to controls and assessed the relationship between SCEs and disability in pain patients.

Design and measures: Questionnaire assessment comparing musculoskeletal pain patients (n = 64) and pain-free control participants (n = 63). Pain was assessed using the McGill Pain Questionnaire; disability, using the Roland–Morris Disability Questionnaire; and six SCEs derived from three measures (i) Test of Self-Conscious Affect-3 yielding subscales of shame, guilt, externalisation and detachment (ii) The Brief Fear of Negative Evaluation Scale and (iii) The Pain Self-Perception Scale assessing mental defeat.

Results: Significantly greater levels of shame, guilt, fear of negative evaluation and mental defeat were observed in chronic pain patients compared to controls. In the pain group, SCE variables significantly predicted affective pain intensity; only mental defeat was significantly related to disability.

Conclusion: Findings highlight the prevalence of negative SCEs and their importance in assessment and management of chronic pain. The role of mood in this relationship is yet to be explored.     

Stories that move? Peer athlete mentors' responses to mentee disability and sport narratives

BackgroundHow people respond to the stories people tell matters. Past research demonstrates that there are varied responses to the narratives individuals with spinal cord injury (SCI) use. Yet, no research has explored how peer athlete mentors with SCI respond to their mentees' stories about sport participation that are framed in different disability narratives.PurposeTo explore how peer athlete mentors respond to four mentees' vignettes representing various attitudes towards adapted sport.MethodsThirteen peer athlete mentors discussed these vignettes in hour-long interviews; their responses were analysed using a dual narrative analysis.ResultsPeer athlete mentors tailored their responses to each individual vignette. Specifically, responses to the most open vignettes were tailored to the mentees' disability narratives and provided a variety of resources and sport information. This type of response to mentees' stories can support and validate these mentees' experiences and increase the likelihood that mentees will try sport. In contrast, peer athlete mentors' responses to the heavily resistant vignettes contained limited information about sport. These responses also challenged the mentees' disability narratives. These types of responses may be counter-productive as they invalidate the mentees' experiences with sport and SCI and may further deter sport participation.ConclusionWhile peer athlete mentors tailored the information they would provide to mentees who use different disability narratives, they expressed difficulties responding to the heavily resistant narrative. Future peer athlete mentor training should address this difficulty by providing practice around how to communicate with individuals expressing resistant narratives.     

Development of clinical vignettes to assess healthcare decision-making capacity in elderly with mild cognitive impairment and Alzheimer's disease

IntroductionCognitive impairment can constrict healthcare decision-making capacity, as it affects the ability to understand, appreciate, and reason with information, as well as communication abilities. Therefore, decision-making capacity of elders with mild cognitive impairment or Alzheimer's disease should be carefully assessed when patients are asked to make decisions regarding their health. Vignettes are particularly relevant to assess healthcare decision capacity, since they can come close to real life situations and improve statistical reliability of capacity assessment instruments.ObjectiveThis paper describes the construction and development process of three hypothetical vignettes, to be included in a new Portuguese assessment tool of healthcare decision-making capacity (CAI-Health).MethodFor vignettes’ development, examples from other assessment tools were first reviewed to summarize their text length, language complexity and health information contained. Most prevalent causes of mortality and morbidity in Portuguese elders were then identified, in order to select the health issues to include in CAI-Health’ vignettes. Seven vignettes were developed, and three were selected to be included in CAI-Health. After vignette's selection, these were reviewed by three experienced medical experts, during a focus group.ConclusionVignettes final version include cases of increased complexity, presenting situations of mild cognitive impairment, lung tumor and knee arthrosis.     

Social Distance,Framing, and Judgment: A Construal Level Perspective

Drawing upon construal level theory, this research investigates the influence of social distance on individuals’ responses to persuasive messages. Experiment 1 (N= 133) demonstrates that the persuasive impact of a gain frame becomes stronger when people make judgments for socially distant (e.g., others) versus proximal entities (e.g., selves). On the other hand, the persuasive impact of a loss frame remains the same across different levels of social distance. Experiment 2 (N= 135) shows that the persuasiveness of a societal frame becomes stronger when people make judgments for socially distant versus proximal entities, whereas the persuasiveness of an individual frame is unaffected by social distance. Experiment 3 (N= 80) provides evidence that mental salience of positive and societal outcomes of an action increases as social distance increases, whereas mental salience of negative and individual outcomes remains the same across different levels of social distance.     

When seeking influences believing and promotes posttraumatic adaptation

Background: Theory and evidence link social support processes and self-efficacy appraisals in the promotion of adaptation following traumatic events. Dynamic causal processes, however, have not been examined longitudinally or in the context of mass-violence. This study tested whether quantity of social support seeking indirectly reduced distress severity among student survivors of mass university shootings. Hypotheses specified that the indirect effects of social support seeking on distress severity would occur through positively influencing perceived social support and self-efficacy, and that these effects would emerge and become stronger as posttraumatic stress symptom severity increased. Design: Path analysis via Mplus 7.2 was used to test the hypothesized moderated-serial-mediation model (conditional indirect effects). Methods: The sample (N = 1191) consisted of students enrolled at Virginia Tech during the 16 April 2007 shootings. Data were collected via online surveys at two time points, 3–4 months and 1-year post-shootings. Results: Hypotheses were supported, showing that the indirect effects of social support seeking on distress reduction occurred through perceived social support, which in turn influenced self-efficacy. These effects emerged and grew in strength as PTS severity increased. Conclusions: Clinical implications, including the need to consider contextual determinants of posttraumatic recovery, are discussed.     

Social Beliefs and Visual Attention: How the Social Relevance of a Cue Influences Spatial Orienting

We are highly tuned to each other's visual attention. Perceiving the eye or hand movements of another person can influence the timing of a saccade or the reach of our own. However, the explanation for such spatial orienting in interpersonal contexts remains disputed. Is it due to the social appearance of the cue—a hand or an eye—or due to its social relevance—a cue that is connected to another person with attentional and intentional states? We developed an interpersonal version of the Posner spatial cueing paradigm. Participants saw a cue and detected a target at the same or a different location, while interacting with an unseen partner. Participants were led to believe that the cue was either connected to the gaze location of their partner or was generated randomly by a computer (Experiment 1), and that their partner had higher or lower social rank while engaged in the same or a different task (Experiment 2). We found that spatial cue‐target compatibility effects were greater when the cue related to a partner's gaze. This effect was amplified by the partner's social rank, but only when participants believed their partner was engaged in the same task. Taken together, this is strong evidence in support of the idea that spatial orienting is interpersonally attuned to the social relevance of the cue—whether the cue is connected to another person, who this person is, and what this person is doing—and does not exclusively rely on the social appearance of the cue. Visual attention is not only guided by the physical salience of one's environment but also by the mental representation of its social relevance.     

Multiaxial taxonomy of fibromyalgia syndrome patients

Pain, disability, and depression are present in various degrees in patients with fibromyalgia syndrome. Cluster analysis was used in this research to ascertain the existence of subgroups of patients in a fibromyalgia sample based on these variables. Two clusters were defined: one characterized by high levels of pain, disability, and depression (n=51) and another characterized by low levels of pain, disability, and depression (n=67). Multivariate analysis of variance (MANOVA) confirmed differences between clusters on these health status factors and a second MANOVA revealed that the subgroup with a poorer health status reported greater passive coping, helplessness, and stress, and less satisfaction with social support, than the subgroup with better health status. Logistic regression indicated that the best discriminator of subgroup membership was helplessness. These results suggest that different approaches to patient management, particularly intervention strategies aimed at reducing helplessness, may be beneficial for patients with high levels of pain, disability, and depression.