Measuring desire for control of health care processes

We conducted three known-groups studies to obtain discriminant validity information among potential self-report measures of the construct desire for control over health care processes. In the first study we looked at types of preparation for childbirth; in Studies 2 and 3 we investigated choice of a place in which to die and signing a Living Will. With none of the measures could we adequately distinguish those who had signed a Living Will (or intended to) from those who did not intend to sign one. The best discriminator of a choice of a place to die (hospital vs. home or hospice) and type of preparation for childbirth (Lamaze vs. other types of classes vs. no classes) was the Information subscale of Krantz's Health Opinion Survey (KHOS; Krantz, Baum, & Wideman, 1980). With the Behavioral Involvement subscale of the KHOS and our newly designed situation-specific measure of desire for control, we could only inconsistently discriminate among the groups. The generalized measure, Burger and Cooper's (1979) Desire for Control Scale, did not help us to discriminate among these groups. Correlations of these measures with demographic variables are provided and discussed.     

Effects of Contract Framing,Motivation to Quit,and Self-Efficacy on Smoking Reduction1

Social learning theorists (SLT) have advocated that individual's cognitive beliefs about perceived behavioral ability and outcome expectancies are predictive of behavior change. SLT's also propose that the threat of losing positive rewards may result in greater behavior change than gaining rewards for altering behaviors such as smoking. Specifically, presenting behavioral outcomes in a loss frame context has proven more influential under certain conditions than presenting outcomes in a gain frame context. The present study evaluated the relationship between smoking cessation self-efficacy motivation to quit, and contract framing on smoking reduction. The majority of cognitive and behavioral changes occurred between baseline and 3 months into a 12-month treatment program. An interaction between contract framing and motivation to quit suggested that, for subjects with low motivation, receiving combined (gain plus loss) frame contracts resulted in smoking fewer cigarettes posttreatment than receiving gain frame only contracts. An interaction between framing and self-efficacy also indicated that subjects who received combined frame contracts smoked fewer cigarettes if they had high rather than low self-efficacy beliefs.     

Social Support and Depression in Rheumatoid Arthritis: A One-Year Prospective Study1

Previous research on patients with rheumatoid arthritis (RA) has suggested that social support is beneficial for helping patients to adjust psychologically to the chronic and unpredictable episodes of pain. This study addresses whether support buffers the adverse effects of arthritis pain or whether support results in a decrease in the severity of pain regardless of pain levels in 233 RA patients. The results indicated that patients who reported higher satisfaction with their emotional support when experiencing higher levels of pain were less likely to be depressed than patients who do not perceive such support. The results were obtained after controlling the effects of demographic variables, functional disability variables, and the direct effects of pain and social support. However, moderating effects of emotional support were not found when this relationship was examined over a 6-month period. Rather, causal modeling suggested that both pain and emotional support contributed to a change in depression over two 6-month intervals. The results also suggested that depression may have an adverse effect on change in emotional support over a similar time frame.     

The development and psychometric evaluation of the Brief Resilient Coping Scale

This article introduces the Brief Resilient Coping Scale (BRCS), a 4-item measure designed to capture tendencies to cope with stress in a highly adaptive manner. Two samples of individuals with rheumatoid arthritis (ns = 90 and 140) provide evidence for the reliability and validity of the BRCS. The BRCS has adequate internal consistency and test-retest reliability. Convergent validity of the scale is demonstrated by predictable correlations with measures of personal coping resources (e.g., optimism, helplessness, self-efficacy), pain coping behaviors, and psychological well-being. Resilient coping, as assessed by the BRCS, also buffers the effects of high levels of arthritis-related and non-arthritis-related stressors on depressive symptoms. The sensitivity of the BRCS to changes associated with a cognitive-behavioral intervention is also demonstrated. The BCRS may be useful for identifying individuals in need of interventions designed to enhance resilient coping skills.     

The effects of sex-role ideology,self-esteem,and expected future interactions with an audience on male help seeking

Male subjects, purportedly being observed by an audience, received failure feedback while working on a task (rating dialogues for neuroticism). Help was readily available, from a male or female assistant, and the primary dependent variable was whether or not subjects requested help. Embarrassment was postulated as the major inhibitor of help seeking in this situation. Self-report measures of embarrassment and perceived accuracy were taken throughout the session. The independent variables were: task centrality (sex-role appropriateness), sex of assistant, expectation of future interaction with the audience, self-esteem, and sex-role ideology (“traditional” vs “feminist” beliefs). The principal results for help seeking were: high esteem traditional subjects sought help less frequently on the central (male) task and more frequently sought help on the peripheral (female) task; feminists did not differ in help seeking according to sex of task. Increased embarrassment was not generally associated with inhibition of help seeking. In fact, there was a trend for high embarrassment to be reported immediately before help was sought. To explain these results, two forms of embarrassment are distinguished — the embarrassment due to continued failure, which should result in seeking help to bring about success, and anticipated embarrassment involved in the act of seeking help, which should inhibit help-seeking behavior.     

Adaptation in patients with chronic rheumatoid arthritis: application of a general model.

We derived a model of appraisal, coping, and adaptation in patients with rheumatoid arthritis (RA) from the more general theory of Lazarus and Folkman (1984) and examined this model using a longitudinal data set spanning 4 years and involving 239 RA patients (of whom 157 contributed to the primary analyses, with the remainder contributing to various follow-up analyses). This model attempted to identify the short- and long-term adaptational consequences of coping as well as the antecedents (appraisals, beliefs, social support, disease activity, etc.) that promote particular coping styles. Interrelations among the variables were examined using path-analytic techniques. Many observed relations were consistent with the model. Significant relations were subjected to more stringent analyses examining the ability of hypothesized causal variables to predict changes in outcome variables 1 year later. These analyses provided additional support for many observed relations and suggested the existence of a vicious cycle involving helplessness appraisals, passive coping with pain, and psychosocial impairment that promotes maladaptation in the face of RA. Theoretical implications, strengths, and limitations of the study are discussed.     

Age and health care beliefs: self-efficacy as a mediator of low desire for control

The relation between individuals' age, desire for control, information, and perceived self-efficacy was examined using a cross-sectional comparison of 116 noninstitutionalized adults, ages 20 to 99. We found that individuals over 60 years of age desired less health-related control than did younger adults, and preferred that health professionals make decisions for them. Differences in desire for health-related information were in the same direction but were not significant. Older adults also desired less control in general day-to-day living. Perceived self-efficacy was also lower for individuals over 60 years of age. Results suggested that perceived self-efficacy mediated the age differences in health-related desire for control. Mediation of general desire for control, however, was not strong. Cohort and developmental explanations are provided for these findings. It is suggested that those individuals most at risk for chronic illnesses and hospitalization are also those who are most likely to fail to take an active role in their health care.