Rethinking the biopsychosocial model of health: Understanding health as a dynamic system

The biopsychosocial model has dominated research and theory in health psychology. This article expands the biopsychosocial model by applying systems theories proposed by developmental scholars, including Bronfenbrenner's ecological models and Sameroff's transactional model, as well as contemporary philosophical work on dynamic systems. The proposed dynamic biopsychosocial model construes human health as a product of the reciprocal influences of biological, psychological, interpersonal, and macrosystem contextual dynamics that unfold over personal and historical time. The importance, or centrality, of these influences varies within a person over time. The model is explicated using two hypothetical case studies derived from existing interdisciplinary health research. Implications for health, theory, research, and policy are discussed.     

Computer aids in teaching statistics and methodology

Detailed information is provided on the use of a computer as an aid in the teaching of statistics. A review of the state of the art is included.     

How do Physicians Decide to Refer Their Patients for Psychiatric Genetic Counseling? A Qualitative Study of Physicians’ Practice

Psychiatric genetic counseling (PGC) is an emerging specialty discipline within the genetic counseling profession. A specialist PGC service was founded in 2012 in Vancouver, Canada, and though patient benefits have been demonstrated, many physicians do not regularly refer patients to the service despite awareness of its availability. We conducted a qualitative study involving semi-structured telephone interviews with Vancouver-based physicians who were aware of the PGC service to explore this phenomenon. Interviews were audio-recorded, transcribed verbatim, coded, and analysed for emergent themes. Consistent with a grounded theory approach, constant comparison was employed throughout data collection and analysis. Analyses of interviews conducted with 12 physicians revealed that referral practices were informed by perceptions about the purpose of PGC and interpretation of patient cues. Physicians perceived PGC as an information-focused intervention, and considered referral when patients explicitly expressed desire for information about recurrence risk or etiology that they felt unable to adequately address themselves. Even when physicians identified psychotherapeutic benefits of PGC, patient needs of this nature were not perceived as cues prompting referral to PGC. These data suggest that further work is necessary to position PGC in physicians’ minds as a service that could potentially benefit most individuals with psychiatric disorders and their families, and that it encompasses more than information provision. It is important to increase physicians’ awareness of the complementary role that genetic counselors can play to that of the physician in providing psychotherapeutically oriented counselling about illness etiology.     

DECIDE: a Decision Support Tool to Facilitate Parents’ Choices Regarding Genome-Wide Sequencing

We describe the rationale, development, and usability testing for an integrated e-learning tool and decision aid for parents facing decisions about genome-wide sequencing (GWS) for their children with a suspected genetic condition. The online tool, DECIDE, is designed to provide decision-support and to promote high quality decisions about undergoing GWS with or without return of optional incidental finding results. DECIDE works by integrating educational material with decision aids. Users may tailor their learning by controlling both the amount of information and its format – text and diagrams and/or short videos. The decision aid guides users to weigh the importance of various relevant factors in their own lives and circumstances. After considering the pros and cons of GWS and return of incidental findings, DECIDE summarizes the user’s responses and apparent preferred choices. In a usability study of 16 parents who had already chosen GWS after conventional genetic counselling, all participants found DECIDE to be helpful. Many would have been satisfied to use it alone to guide their GWS decisions, but most would prefer to have the option of consulting a health care professional as well to aid their decision. Further testing is necessary to establish the effectiveness of using DECIDE as an adjunct to or instead of conventional pre-test genetic counselling for clinical genome-wide sequencing.     

Goals and Learning in Microworlds

We explored the consequences for learning through interaction with an educational microworld called Electric Field Hockey (EFH). Like many microworlds, EFH is intended to help students develop a qualitative understanding of the target domain, in this case, the physics of electrical interactions. Through the development and use of a computer model that learns to play EFH, we analyzed the knowledge the model acquired as it applied the game-oriented strategies we observed physics students using. Through learning-by-doing on the standard sequence of tasks, the model substantially improved its EFH playing ability; however, it did so without acquiring any new qualitative physics knowledge. This surprising result led to an experiment that compared students' use of EFH with standard-goal tasks against two alternative instructional conditions, specific-path and no-goal, each justified from a different learning theory. Students in the standard-goal condition learned less qualitative physics than did those in the two alternative conditions, which was consistent with the model. The implication for instructional practice is that careful selection and analysis of the tasks that frame microworld use is essential if these programs are to lead to the learning outcomes imagined for them. Theoretically, these results suggest a new interpretation for numerous empirical findings on the effectiveness of no-goal instructional tasks. The standing “reduced cognitive load” interpretation is contradicted by the success of the specific-path condition, and we offer an alternative knowledge-dependent interpretation.     

Long-term retention of information about presentation modality by children and adults

A mixed-modality continuous recognition task followed by a final recognition test after 0 h, 4 h, 1 day, or 7 days was administered to third- and fourth-grade children and adults. Subjects gave recognition responses and reported presentation modalities. Forgetting rates for both words and input mode were invariant with age. The decay functions for presentation modality were affected, however, by the initial input mode, with modality identification declining more rapidly for words heard first than for words seen first. Information about whether a word was seen or heard remained in memory for at least 4 h. The results demonstrate that long-term-memory representations contain a great deal of information about input mode and suggest that the theoretical distinction between automatic and effortful processing may be a useful one.     

Dichoptic interaction of visual structure and light flashes

Perceptual interaction between monocular flashes and different amounts of continuously visible target structure shown to the other eye was investigated. A response variable called dominance of the flashes is defined and found to be a direct function of flash intensity and an inverse function of contraocular target structure. The dominance variable is distinguished from subjective brightness of the flashes and subjective complexity of the targets. The observed effects are attributed to limited central processing capacity with increased informational load.