Patient Adherence With Medical Treatment Regimens: An Interactive Approach

Inadequate patient adherence to treatment regimens is a ubiquitous problem in health care and carries a profound personal, societal, and economic cost. This article illustrates a general theoretical framework we believe to be useful for the interpretation, conception, and design of adherence research. The core tenet of this framework is that factors that influence adherence can be better understood by considering the interactive effects of patients' characteristics, type of adherence intervention, and characteristics of the illness and medical treatment context. This framework represents an extension and application of previous theory and research from personality, social, and clinical psychology concerning the value of an interactionalist perspective. We illustrate the framework using some of our past work involving treatment adherence among patients with chronic renal failure.     

Effects of Organizational Level and Gender on Stress in the Workplace

Occupational stress adversely affects productivity, absenteeism, and job turnover, and contributes to health-related problems. The effects of organizational level and gender on the specific sources of occupational stress assessed by the Job Stress Survey (JSS) were evaluated for a heterogeneous sample of 1,791 working adults (860 males, 931 females) employed in 2 industrial companies and a large state university. Significant main or interactive effects of organizational level and/or gender were found for the JSS Item Index, Severity and/or Frequency scores of 29 of the 30 JSS items. Organizational level effects were both more numerous and larger in magnitude than gender effects. Employees at higher organizational levels reported that they experienced stress more often while making critical decisions and dealing with crisis situations than did workers at lower levels, for whom inadequate salary and lack of opportunity for advancement were more stressful. For males, work stress was more strongly related to concerns about their role in the power structure of an organization, whereas female employees reported experiencing more severe stress when there was a conflict between job requirements and family relationships.     

Personality Dysfunction and the Management of Chronic Medical Illness: A Community Health Sample

The purpose of this study was to determine the influence of personality disorders on perceived health status, self-efficacy for management of the chronic illness, and physician perception of patient health. A total of 607 patients with self-identified chronicillness(es) volunteered to participate in the study. Out of this sample, 147 had collaborative physician data indicating a chronic illness. The final sample was 143 due to incomplete data. Results suggested that maladaptive personality characteristics, as measured by the Short-Form of the Coolidge Axis II Inventory (SCATI), were related to a number of important factors that influence self-management of chronic illnesses. When the personality constellations were broken into 3 groups (normal, subclinical, and clinical) significant differences were found on the 3 groups of dependent variables (Subjective Health, Self-Efficacy, Physician Appraisal) for the different personality disorders. These data provide useful information on several factors that influence effective disease management. Clinical implications and directions for future research are provided.     

The Scholarship of Teaching in Theology and Religion: A Wabash Center Advisory Committee Conversation

The article is a reflection on what I perceive to be a confusion about the relation between theoretical judgments and judgments of pedagogical efficacy. My interest in the issue originated with my own confusion over persistent student resistance to certain assigned texts that I had initially felt confident would prove valuable in the classroom. The essay unfolds in three segments. In the first, I recount how this concern about the relation between theoretical judgments and judgments of pedagogical efficacy evolved out of my own teaching. I next list three tentative conclusions about the correlation or lack of correlation between theoretical judgments and judgments of pedagogical efficacy. In the concluding segment, I call for concerted resistance to the tendency of pure rationality to colonize the aesthetic and dramatic components of experience so essential to transformative teaching and learning.     

Using MATLAB with the Psychophysics Toolbox to present the heterochromatic fusion nystagmus stimulus

We present a program for MATLAB that generates and presents theheterochromatic fusion nystagmus stimulus. This stimulus allows assessment of isoluminant states through recordings of reflexive eye movements (optokinetic nystagmus). The reflexive nature of the subject’s response makes this stimulus especially useful with nonverbal subjects, such as children and animals. Unfortunately, the stimulus is complex and difficult to program. By presenting the present program, we hope to help those who wish to use this tool in their research. The code of the function can be downloaded at www. dal.ca/~mcmullen/downloads.html.     

Assessing the Readability of Mental Health Internet Brochures for Children and Adolescents

We investigated the readability of seven mental health brochures on mental, emotional, and behavioral disorders in children that were selected from a website developed by the Center for Mental Health Services at http://www.mentalhealth.org. The reading grade levels of the brochures ranged from 11.1 to 14.8 (mean 13.23), considerably higher than the 8th grade level recommended for educational material by the U. S. Department of Education (1986). On other readability variables, assessed using the Readability Assessment Instrument (RAIN; Singh, 1994), all brochures met criterion on most variables but failed on those for new words (audience appropriateness) and print size. This is a favorable result in comparison with other studies that have assessed readability of mental health information on the Internet using the RAIN, although less so with reading grade levels.     

Improving Health Care Utilization, Improving Chronic Disease Utilization, Health Status, and Adjustment in Adolescents and Young Adults with Cystic Fibrosis: A Preliminary Report

We conducted a randomized clinical trial of a 3-session written self-disclosure intervention for patients with cystic fibrosis (CF). Patients (n = 39) who were at least 15 years of age and diagnosed with CF participated in the intervention. Participants in the intervention arm were asked to write in the health care setting about an important emotionally distressing issue of personal significance for a 20-min period of time and two additional 20-min writing episodes at the patient's home, which were prompted by telephone calls. Patients in the control condition received standard care alone. Findings revealed that the intervention resulted in a reduction of the number of days patients spent in the hospital over a 3-month period. The intervention did not have an impact on physiological (Forced Expiratory Volume and Body Mass Index or subjective markers of health status. These findings extend those of Pennebaker's (cf., J. Smyth, 1998) demonstrating an effect of the written-self-disclosure intervention on health care utilization. These preliminary findings are promising and justify further investigation of the modified intervention in other chronic illness populations.     

Cloninger's Temperament and Character Inventory Correlates with Personality Characteristics of Organ Donation Advocates

Temperament and Character Inventory (TCI) and background questionnaire data were collected from a sample of men and women organ donation advocates (N = 362) as part of a national study to investigate their personality characteristics, temperaments, and attitudes about organ donation advocacy. Goals included identifying unique traits for advocates, and response consistency between the TCI and questionnaire. The TCI results included high scores on Cooperativeness and Self-Directedness, and low on Harm Avoidance dimensions. The questionnaire results indicated that most advocates were White, married, college-educated females, who typically spent less than 2 hr with potential donor families, were satisfied with life and job, and believed they would be in a donation position 2 years from the time surveyed. TCI and questionnaire measures were correlated for Self-Transcendence and Spirituality, Helpfulness and Job Satisfaction, and Compassion and Identification variables.