Breaking Difficult News in a Cross-cultural Setting: a Qualitative Study about Latina Mothers of Children with Down Syndrome

Giving difficult news to patients represents a common dilemma for health care professionals. Based on three decades of research, various authors have proposed guidelines outlining the ideal setting, delivery, and timing. Existing publications focus on patients of European descent and may not be applicable in cross-cultural settings. We explored perceptions of Spanish-speaking mothers who have a child with Down syndrome and how they preferred to receive the news of their child's diagnosis. We conducted semi-structured qualitative interviews (n?=?14), which were coded and analyzed by thematic networks to identify common themes. Six significant themes emerged: Cultural Belief System, Communication, Support/Lack of Support, Feelings Engendered, Medical Issues, and Medical System. One overarching theme of mother-child bonding encompassed all sub-themes. The mothers desired the news in a more positive, balanced light and with more complete explanations about the condition. Mothers felt excluded from the diagnostic process and wanted to be better informed about the need for diagnostic studies. Participants used religious beliefs to explain the reason for their child's condition. Many factors influenced Latina mothers' ability to bond initially with their children with Down syndrome. Ideally, these factors should be acknowledged during informing interviews to assist Latino families in adjustment.     

The theory of planned behaviour and breast self-examination: Assessing the impact of past behaviour,context stability and habit strength

This study applied the theory of planned behaviour (TPB) to the prediction of breast self-examination (BSE) intentions and behaviour, and tested whether the frequency of past behaviour and context stability moderates intention–behaviour and habit–behaviour relations. Seventy-seven females completed measures of the TPB, frequency of past behaviour, context stability and habit strength (Self-Report Habit Index). BSE behaviour was assessed at 1-month follow-up (n?=?66). The TPB explained 33% of the variance in BSE intentions and 11% of the variance in time 2 BSE. The frequency of past behaviour moderated the intention–behaviour relationship such that the intention was only positively related to time 2 BSE behaviour when the frequency of past behaviour was low. Context stability and the combination of the frequency of past behaviour?×?context stability moderated the habit–behaviour relationship such that habit strength was only positively related to time 2 BSE behaviour when context stability and the combination of frequency of past behaviour?×?context stability were high. The results are consistent with the proposal that behaviours that are performed frequently in stable contexts are predominantly under the control of habitual processes, whereas behaviours that are performed infrequently in unstable contexts are predominantly under the control of intentional processes.     

Reviews

Gorbachev, Glasnost and The Gospel by Michael Bourdeaux. Hodder and Stoughton, 1990. 226 pp. Hardback, £13.95. Paperback, £8.99.

The Lutheran Church and the East German State: Political Conflict and Change under Ulbricht andHonecker by Robert F. Goeckel. Cornell University Press, 1990. 328 pp.

With God, For the People by Laszlo Tokes with David Porter. London: Hodder and Stoughton, 1990. Paperback, 226 pp., £3.50.

In the Eye of the Romanian Storm by Felix Corley and John Eibner. Old Tappan, New Jersey: Fleming H. Revell Company, 1990. Paperback, 272 pp., $6.95.     

The Interim Service Preferences of Parents Waiting for Children’s Mental Health Treatment: A Discrete Choice Conjoint Experiment

Parents seeking help for children with mental health problems are often assigned to a waiting list. We used a discrete choice conjoint experiment to model preferences for interim services that might be used while waiting for the formal assessment and treatment process to begin. A sample of 1,059 parents (92 % mothers) seeking mental health services for 4 to 16 year olds chose between hypothetical interim services composed by experimentally varying combinations of the levels of 13 interim service attributes. Latent Class analysis yielded a four–segment solution. All segments preferred interim options helping them understand how agencies work, enhancing their parenting knowledge and skill, and providing an opportunity to understand or begin dealing with their own difficulties. The Group Contact segment (35.1 %) preferred interim services in meetings with other parents, supported by phone contacts, frequent checkup calls, and wait–time updates. Virtual Contact parents (29.2 %) preferred to meet other parents in small internet chat groups supported by e–mail contact. Membership in this segment was linked to higher education and computer skills. Frequent Contact parents (24.4 %) preferred face–to–face interim services supported by weekly progress checks and wait time updates. Limited Contact parents (11.3 %) were less intent on using interim services. They preferred to pursue interim services alone, with contacts by phone, supported by fewer check–up calls and less frequent wait time updates. All segments were more likely to enroll in interim services involving their child.     

A Mutually Facilitative Relationship Between Learning Names and Learning Concepts in Preschool Children: The Case of Artifacts

Two studies investigated the relationship between learning names and learning concepts in preschool children. More specifically, we focused on the relationship between learning the names and learning the intended functions of artifacts, given that the intended function of an artifact is generally thought to constitute core conceptual information about an artifact's category. We asked whether learning the intended function of a novel artifact facilitates retention of its name and whether learning the name of a novel artifact prompts the search for information about its intended function. In Experiment 1, 3- and 4-year-old children better retained the names of novel artifacts when the intended functions of these artifacts were revealed. The comparison condition involved providing perceptually relevant and conceptually irrelevant information about the objects. In Experiment 2, 4-year-old children who were provided with the names of novel artifacts were more likely to seek out information about the objects' functions than children provided with conceptually irrelevant information about the artifacts. Together, the studies demonstrate the intimate and mutually facilitative relationship between names and concepts in young children.     

Match-Action: The Role of Motion and Audio in Creating Global Change Blindness in Film

An everyday example of change blindness is our difficulty to detect cuts in an edited moving-image. Edit blindness (Smith & Henderson, 2008) is created by adhering to the continuity editing conventions of Hollywood, for example, coinciding a cut with a sudden onset of motion (match-action). In this study, we isolated the roles motion and audio play in limiting awareness of match-action cuts by removing motion before and/or after cuts in existing Hollywood film clips and presenting the clips with or without the original soundtrack whilst participants tried to detect cuts. Removing post-cut motion significantly decreased cut detection time and the probability of missing the cut. By comparison, removing pre-cut motion had no effect suggesting, contrary to the editing literature, that the onset of motion before a cut may not be as critical for creating edit blindness as the motion after a cut. Analysis of eye movements indicated that viewers reoriented less to new content across intact match-action cuts than shots with motion removed. Audio played a surprisingly large part in creating edit blindness with edit blindness mostly disappearing without audio. These results extend film editor intuitions and are discussed in the context of the Attentional Theory of Cinematic Continuity (Smith, 2012a).     

Asian American college students' suicide ideation: a mixed-methods study

The purpose of this mixed-methods study was to explore the phenomenon of suicide ideation among 293 Asian American college students. Guided by T. Joiner's (2005) interpersonal-psychological theory of suicidal behavior, the authors examined the relationships among perceived burdensomeness, thwarted belongingness, self-construals, and suicide ideation. Compared with thwarted belongingness, perceived burdensomeness was a more robust predictor of suicide ideation. However, thwarted belongingness moderated the positive association between perceived burdensomeness and suicide ideation. Furthermore, interdependent self-construal and independent self-construal both weakened the link between perceived burdensomeness and suicide ideation and between thwarted belongingness and suicide ideation. The authors also conducted a qualitative analysis of participants' open-ended responses about their perceptions of why Asian American college students might consider suicide. The authors identified a core phenomenon of unfulfilled expectations as well as 2 broad themes related to this core phenomenon: unfulfilled intrapersonal expectations and unfulfilled interpersonal expectations, comprising the subthemes of (a) family, (b) relationship, (c) cultural differences, and (d) racism. These findings are discussed in terms of implications for suicide-related clinical interventions and primary prevention efforts among Asian American college students.     

Anger toward God: social-cognitive predictors, prevalence, and links with adjustment to bereavement and cancer

A recent model of collective action distinguishes 2 distinct pathways: an emotional pathway whereby anger in response to injustice motivates action and an efficacy pathway where the belief that issues can be solved collectively increases the likelihood that group members take action (van Zomeren, Spears, Fischer, & Leach, 2004). Research supporting this model has, however, focused entirely on relatively normative actions such as participating in demonstrations. We argue that the relations between emotions, efficacy, and action differ for more extreme, nonnormative actions and propose (a) that nonnormative actions are often driven by a sense of low efficacy and (b) that contempt, which, unlike anger, entails psychological distancing and a lack of reconciliatory intentions, predicts nonnormative action. These ideas were tested in 3 survey studies examining student protests against tuition fees in Germany (N = 332), Indian Muslims' action support in relation to ingroup disadvantage (N = 156), and British Muslims' responses to British foreign policy (N = 466). Results were generally supportive of predictions and indicated that (a) anger was strongly related to normative action but overall unrelated or less strongly related to nonnormative action, (b) contempt was either unrelated or negatively related to normative action but significantly positively predicted nonnormative action, and (c) efficacy was positively related to normative action and negatively related to nonnormative action. The implications of these findings for understanding and dealing with extreme intergroup phenomena such as terrorism are discussed.     

The FAD-Plus: measuring lay beliefs regarding free will and related constructs

We describe the development of FAD-Plus, a 27-item measure of lay beliefs in free will and 3 closely related constructs: scientific determinism, fatalistic determinism, and unpredictability. Previously published measures included only a subset of these variables and tended to assume an a priori pattern of relations among these 4 beliefs. In Study 1, exploratory factor analyses suggested relatively independent factors. This independence was sustained in Study 2, using a confirmatory analysis. Each of the 4 subscales (Free Will, Scientific Determinism, Fatalistic Determinism, and Unpredictability) showed acceptable internal consistencies. Study 2 also mapped out associations with the Big Five personality traits and showed that believing in free will is not synonymous with having an internal locus of control. Study 3 replicated the instrument's structure and subscale reliabilities in a community sample. Preliminary applications are described.     

Possible disagreements and defeat

Conciliatory views about disagreement with one’s epistemic peers lead to a somewhat troubling skeptical conclusion: that often, when we know others disagree, we ought to be (perhaps much) less sure of our beliefs than we typically are. One might attempt to extend this skeptical conclusion by arguing that disagreement with merely possible epistemic agents should be epistemically significant to the same degree as disagreement with actual agents, and that, since for any belief we have, it is possible that someone should disagree in the appropriate way, we ought to be much less sure of all of our beliefs than we typically are. In this paper, I identify what I take to be the main motivation for thinking that actual disagreement is epistemically significant and argue that it does not also motivate the epistemic significance of merely possible disagreement.