Interpreting cross-sectional data on stages of change

Abstract

The vast majority of studies investigating stage theories of health behaviour such as the transtheoretical model have used a cross-sectional research design. Participants are classified into stages and compared on theoretically relevant variables. This paper discusses the proper interpretation of cross-sectional data on stages of change. Linear patterns are not consistent with the stage model assumption that different causal factors are important at different stages but discontinuity patterns (patterns that do not show consistent increments or decrements across stages) can be diagnostic of a stage model. Researchers who use cross-sectional designs should specify predictions concerning the patterns to be expected under a stage model and under possible rival models, and interpret their data accordingly. Wherever possible, they should conduct prospective longitudinal and experimental studies which enable stronger inferences to be drawn.     

Illness perceptions and distress in women at increased risk of breast cancer

Variation in the levels of distress in women at increased risk of breast cancer has been reported, yet there is limited understanding of the factors that are associated with heightened distress in this population. This study took a theoretical approach using Leventhal's Self Regulatory Model (SRM) to understand variation in distress levels. The study examined the associations between perceptions of breast cancer and distress in women at increased risk of breast cancer, and a comparison sample with no experience of the disease in their social environment. Questionnaire data from 117 women at increased risk of breast cancer and 100 comparison women were analysed. Women at increased risk of breast cancer showed comparable levels of general distress but significantly higher levels of cancer specific distress than the comparison group. There were few differences in illness perceptions between the samples, although a number of cognitive perceptions of breast cancer were related to both general and cancer specific distress in the increased risk sample, but not in the comparison sample. The results suggest that the SRM provides a useful framework to explore the psychological response to genetic risk. Further research is required in this population to examine illness perceptions in more detail, validate quantitative measures of illness perceptions, and examine interactions between risk perception and the SRM constructs.     

‘Mundus imago Dei est’: The Spirituality of the Emblematist of the French Renaissance

Abstract

This study explores the constitutive principle of Mundus imago Dei est in the work of emblematists representative of both Catholic and Protestant traditions in France in the late sixteenth- and early seventeenth-centuries. Examples selected have been militant (Georgette de Montenay), philosophical (Jean-Baptiste Chassignet), and devotional (Jean de La Ceppède). The aim is to discover common rhetorical strategies of an aesthetic in the service of faith. Qualities and features derived from the Augustinian tradition are demonstrated. Further, apparent disharmony of images is shown to yield to harmony of thought.     

International Genetic Counseling Students’ Perspective on Their Training Experience in the United States

International students face social, psychological and academic challenges upon moving to a foreign country to pursue higher education. Clinical disciplines such as genetic counseling present additional challenges adapting to an unfamiliar health care system and different interactions and expectations with patients and colleagues. This study used semi-structured interviews to identify challenges that international genetic counseling students face during training in the United States. Eight international genetic counseling alumni who graduated from U.S.-accredited programs were interviewed. Participants stated that the U.S. academic system was unfamiliar—class participation and paper-writing required the greatest adjustment. There was a need for help in understanding social norms in academic settings. Clinically, they were unfamiliar with the dynamics and communication style of U.S. families. Non-native English speakers experienced greater difficulty in all areas. Most participants reported that they were uncomfortable asking for help in transitioning to life, study and work. Participants identified mentorship programs for international students as potentially useful in clarifying expectations in academic and clinical settings. These results may assist international students preparing to study genetic counseling in the U.S. and may help genetic counseling training programs identify the academic and clinical challenges faced by international students.     

Perception of symmetry and repetition within and across visual shapes: Part-descriptions and object-based attention

In five experiments, we investigated the detection of symmetry (i.e., translation plus reflection) or repetition (i.e., translation alone) between two vertical jagged contours. The complexity of the two contours was manipulated, as was their figure-ground assignment; the two contours either belonged to a common object "inside" them, to two separate objects "outside" them, or to two separate objects each to the right of one contour. Replicating Baylis and Driver (1994), symmetry judgements were unaffected by contour complexity when made within a single shape, implying a parallel process operating efficiently across contour discontinuities. However, all the other conditions yielded substantially slower judgements as complexity increased, suggesting either effortful point-by-point comparisons, or a highly inefficient parallel process. In agreement with Baylis and Driver (1995a), symmetry perception was harder when figure-ground assignment turned convexities along one contour into concavities along the other contour; and likewise for repetition detection. However, even when convex parts matched between the two contours, judgements were still affected by complexity unless they belonged to a common object. This supports Baylis and Driver's (1993) proposal that effortless comparisons for the layout of multiple convex parts can only be made within single perceptual objects.     

Assessing knowledge-intensive work environment: General versus situation-specific instruments

The aim of the present study is to examine to what extent general and situation-specific work environment instruments capture the salient work characteristics in a knowledge-intensive context. We conducted qualitative open-ended interviews with 30 employees (24 men and six women) from a Norwegian university department. The information from the interviews was content-analysed and coded on the scales of five work environment instruments; two general instruments (the General Nordic Questionnaire for Psychological and Social Factors at Work [QPSNordic] and the Job Diagnostic Survey [JDS]) and three situation-specific instruments (Assessing the climate for creativity [KEYS], Situational Outlook Questionnaire [SOQ], and the Organizational Climate Measure [OCM]). The results showed that situation-specific work environment instruments covered significantly more statements about the work environment than the general instruments. More statements could be categorized on the organization and individual levels, compared to group and leadership levels. The situation-specific instruments covered more statements than general instruments at the organization level. These statements were mainly related to the organizational context, social and relational characteristics, and encouragement of creativity and organizational impediments to creativity. The findings support the value of situation-specific instruments for assessing the work environment in knowledge-intensive organizations.     

The moral psychology of rationing among physicians: the role of harm and fairness intuitions in physician objections to cost-effectiveness and cost-containment

Introduction

Physicians vary in their moral judgments about health care costs. Social intuitionism posits that moral judgments arise from gut instincts, called “moral foundations.” The objective of this study was to determine if “harm” and “fairness” intuitions can explain physicians’ judgments about cost-containment in U.S. health care and using cost-effectiveness data in practice, as well as the relative importance of those intuitions compared to “purity”, “authority” and “ingroup” in cost-related judgments.

Methods

We mailed an 8-page survey to a random sample of 2000 practicing U.S. physicians. The survey included the MFQ30 and items assessing agreement/disagreement with cost-containment and degree of objection to using cost-effectiveness data to guide care. We used t-tests for pairwise subscale mean comparisons and logistic regression to assess associations with agreement with cost-containment and objection to using cost-effectiveness analysis to guide care.

Results

1032 of 1895 physicians (54%) responded. Most (67%) supported cost-containment, while 54% expressed a strong or moderate objection to the use of cost-effectiveness data in clinical decisions. Physicians who strongly objected to the use of cost-effectiveness data had similar scores in all five of the foundations (all p-values?>?0.05). Agreement with cost-containment was associated with higher mean “harm” (3.6) and “fairness” (3.5) intuitions compared to “in-group” (2.8), “authority” (3.0), and “purity” (2.4) (p?<?0.05). In multivariate models adjusted for age, sex, region, and specialty, both “harm” and “fairness” were significantly associated with judgments about cost-containment (OR?=?1.2 [1.0-1.5]; OR?=?1.7 [1.4-2.1], respectively) but were not associated with degree of objection to cost-effectiveness (OR?=?1.2 [1.0-1.4]; OR?=?0.9 [0.7-1.0]).

Conclusions

Moral intuitions shed light on variation in physician judgments about cost issues in health care.

     

Conference Report: Orthodox Christianity and Contemporary Europe

Studies in East European Thought -     

Healing Rituals for Couples Recovering from Adultery

Recovery from the trauma of adultery is a process that is full of points where the couple can get stuck. We describe an experiential model that utilizes healing rituals. We start with a general exploration of the use of rituals in marriage and family therapy. The key elements of effective rituals are described. We describe stuck points in these relationships including: 1) knowing the details, 2) releasing the anger, 3) showing commitment, 4) rebuilding trust, and 5) rebuilding the relationship. Ritualized interventions are described for each of these stuck points.