Healthcare provider cultural competency: development and initial validation of a patient report measure.

OBJECTIVE: Health researchers have proposed that provider cultural competency may contribute to health disparities. Yet, this belief continues to lack empirical support, and this is due in part to measurement issues that have plagued the cultural competency construct. In the present research, we report on the development of a theoretically grounded, generally applicable, and patient report measure of provider cultural competency. DESIGN: Samples of predominantly African American patients (N=310) were recruited from three urban medical clinics to complete a survey about their relationship with their physician. MAIN OUTCOME MEASURES: We examined the factor structure, validity and other psychometric characteristics of a newly proposed patient report measure of provider cultural competency. RESULTS: Psychometric analyses supported a tripartite model of cultural competency that was comprised of patient judgments of their physician's cultural knowledge, awareness, and skill. In addition, this result was replicated across multiple clinical contexts, while also demonstrating convergent and incremental validity when correlated with measures of trust, satisfaction and discrimination. CONCLUSION: This newly proposed measure addresses prior limitations in cultural competency measurement and may enhance future research by providing a standardized tool for use in multiple clinical and cultural contexts.     

The effects of gender,long-term need for recovery and trait inhibition-rumination on morning and evening saliva cortisol secretion

Abstract

The aim of this study was to investigate the long-term effects of need for recovery from work and trait rumination on saliva cortisol secretion. The sample consisted of 76 white-collar workers, 52 men and 24 women who had previously provided baseline data four years earlier and volunteered to participate in the present study. In the present study, saliva cortisol secretion was measured over seven consecutive days, on awakening, and at 10 p.m. No relationships were found between the independent variables and morning saliva cortisol levels. High trait rumination at baseline, however, was significantly related to higher evening cortisol levels for both women and men. Baseline need for recovery from work was strongly related to evening cortisol secretion for women, but in the opposite direction than expected. The present results add to the small but equivocal body of literature that has examined the long-term effects of work strain on cortisol secretion.     

Executive Functioning and Gambling: Performance on the Trail Making Test is Associated with Gambling Problems in Older Adult Gamblers

ABSTRACT

Rates of gambling problems in older adults have risen with increased accessibility of gambling venues. One possible contributor to problem gambling among older adults is decreased self-control brought about by diminished executive functioning. Consistent with this possibility, Study 1 revealed that older adults recruited from gambling venues reported greater gambling problems if they also experienced deficits in executive functioning, measured via the Trail Making Test. Study 2 replicated this finding and demonstrated that problem gambling is associated with increased depression among older adults, mediated by increased financial distress. These studies provide support for the hypothesis that older adult gamblers who have executive functioning problems are also likely to have gambling problems.     

The Relationship Between Childhood Onset Obesity and Psychopathology in Adulthood

We administered the Symptom Checklist (Derogatis, 1975; SCL-90-R) to 37 obese subjects in outpatient treatment for obesity. Patients with early onset obesity demonstrated a greater frequency and higher levels of emotional distress and psychiatric symptomatology than patients with late onset obesity. Individuals who developed obesity in childhood showed more psychopathology than those who developed obesity later in life. Overall, these findings support the belief that obesity is characteristically associated with greater internal psychological conflict. These findings further suggest that childhood obesity could serve as a predictor variable for possible future psychological disturbance in obese populations.     

Couples with Intimate Partner Violence Seeking Relationship Help: Associations and Implications for Self‐Help and Online Interventions

In‐person conjoint treatments for relationship distress are effective at increasing relationship satisfaction, and newly developed online programs are showing promising results. However, couples reporting even low levels intimate partner violence (IPV) are traditionally excluded from these interventions. To improve the availability of couple‐based treatment for couples with IPV, the present study sought to determine whether associations with IPV found in community samples generalized to couples seeking help for their relationship and whether web‐based interventions for relationship distressed worked equally well for couples with IPV. In the first aim, in a sample of 2,797 individuals who were seeking online help for their relationship, the levels and correlates of both low‐intensity and clinically significant IPV largely matched what is found in community samples. In the second aim, in a sample of 300 couples who were randomly assigned to a web‐based intervention or a waitlist control group, low‐impact IPV did not moderate the effects of the intervention for relationship distress. Therefore, web‐based interventions may be an effective (and easily accessible) intervention for relationship distress for couples with low‐intensity IPV.     

Sudden gains in treatment-as-usual couple therapy for military veterans

Previous studies of couple therapy have conceptualized change as a gradual process. However, there is growing evidence that, for many clients, the majority of gains in other treatment modalities are often achieved between just 2 sessions. Isolating the frequency, nature, and predictors of these sudden gains (SGs) in couple therapy can add to a growing understanding of how and why couple therapy works. In a sample of 67 couples receiving treatment-as-usual couple therapy in two Veterans Affairs hospitals, 25% of individuals experienced a SG in relationship satisfaction. The magnitude of these SGs were large (d = 1.62) and fully explained the total pre-post change for individuals who experienced them. Individuals with SGs showed significantly greater satisfaction gains during therapy; however SGs were not related to relationship satisfaction or relationship status at 18-month follow-up. SGs were predicted by the content of the previous session, putative change mechanisms of communication, intimacy, and behavior, as well as the partner's SGs during the same period. Results suggest that SGs are an important component of change during couple therapy for some individuals, challenging the assumption of continuous change in previous studies. In addition, predictors of SGs were generally consistent with theoretical and empirical examinations of mechanisms of change in couple therapy.     

Searching for the “Big Five” in a Greek context: the NEO-FFI under the microscope

The five-factor inventory (FFI) is a commonly used personality test based on the NEO-personality inventory revised. It has been translated into several languages and validated in a number of countries. Using a sample of 1204 individuals, the present study evaluates the psychometric properties and factor structure of the Greek FFI and provides normative information for its use with Greek populations. Convergent validity is also assessed by studying the relationship between the five scales of the FFI and the Brief Symptom Inventory. Results show that although the factor scales had acceptable internal consistency, they were highly intercorrelated. Exploratory factor analyses failed to reproduce the appropriate factor structure, yielding instead numerous fragments of the five dimensions. Confirmatory factor analyses also failed to lend support to the five factor model of personality as measured by this instrument. Based on these results, the use of the instrument is recommended only with serious caution in this cultural context. Further research ought to decipher whether the failures to reproduce the five factor model using the FFI in this and other cultures represents a challenge to the universality of the theory, or merely a shortcoming of the specific instrument.     

Evidence of Poor Planning in Children with Attention Deficits

This study examined the planning performance of children with attention deficits, and also investigated the possible interactions between inattention and anxiety in the performance of executive function tasks. A group of 98 children (grades 4 and 6), derived from an initial group of 550, were assigned to an attention difficulties group (AD) and a control group (n = 49 each) based on their scores on a variety of cognitive attention measures and teacher scales of attention and hyperactivity. The two groups were matched on age, gender, parental education, non-verbal and verbal ability. They were compared on Crack-the-Code (C-t-C) action-planning task, embedded and ambiguous figures and Theory of Mind tasks. Analyses indicated that the failure of AD children on cognitive performance measures is linked to planning impairments. The co-occurrence of anxiety, in turn, did not interact with inattention to affect planning performance differentially. Implications of these findings for the current discussion about the cognitive and emotional processes underlying impaired performance among children with attention deficits on executive control tasks are discussed.