Satisfaction with care among low-income female outpatients

Patient satisfaction correlates with important health behaviors and outcomes. Little is known about satisfaction in disadvantaged populations of different racial/ethnic backgrounds. The current study evaluated demographic and psychological correlates of patient satisfaction among a low-income, multiethnic sample of female outpatients attending cervical cancer screening. Participants included 338 African American, Latina, and white women ages 18 - 49 years attending University of Texas Medical Branch Regional Maternal & Child Health Clinics. Data were obtained via self-report and chart review. Patient satisfaction was assessed using the Patient Satisfaction Questionnaire (PSQ). Total PSQ scores reflected two distinct underlying subscales (satisfaction and dissatisfaction), which differed from the original factor structure of the PSQ. Satisfaction was predicted by patient beliefs that their health is self-determined, beliefs that doctors control their health, self-esteem, and education. Dissatisfaction was predicted by patient beliefs that good health is a matter of chance/luck, self-esteem, social desirability, and income. Higher self-esteem, education, and beliefs that health is controlled by oneself or doctors correlated with higher satisfaction with care in the clinic setting. Understanding the influence of patient characteristics on perceptions of care is important for physicians to foster relationships with patients that increase feelings of satisfaction, decrease dissatisfaction, and ultimately, improve health outcomes.     

Environmental stress, psychological stress and allostatic load

The mechanism by which chronic caregiving stress results in poor health is not well understood. The objective was to determine whether such a mechanism may be allostatic load, a novel concept specifying physiological systems that may suffer cumulative wear and tear following chronic stress, leading collectively to poor health. The study examines the association of allostatic load with environmental and psychological stress in the contexts of dementia caregiving and relinquishment of care, and is a 2-year longitudinal comparison of three groups: 80 new dementia spouse caregivers, 120 veteran caregivers, and 60 non-caregivers. Data comprised allostatic load markers and environmental and psychological stress measures. Cross-lagged analyses produced a statistically significant association between psychological stress and one allostatic load component (primary mediators). Psychological stress was a better predictor of primary mediators than environmental stress. Primary mediators rose with time for caregivers, but not for non-caregivers. A greater rise was evident for caregivers who had relinquished their role by the second year, although the level of psychological stress actually declined. Primary mediators are a key component of the relationship between allostatic load and prior stress. When allostatic load is treated as an outcome of stress, it is important to distinguish environmental and psychological stress.     

The effects of sexual assault-related intrusion suppression in the laboratory and natural environment

Individuals with a history of sexual victimization often experience enduring intrusive thoughts associated with their assault history. Research suggests that the characteristic ways in which sexually assaulted individuals respond to aversive internal experiences (i.e., thoughts, emotions, etc.) can influence the psychological distress associated with these intrusions. This study investigated the effects of suppressing sexual assault-related intrusions in a sample of 61 female college students with a history of adolescent or adult sexual assault and recent assault-related intrusions. Participants were randomly assigned to suppress or monitor intrusions during a laboratory task and for 48 h outside the laboratory. In contrast to study hypotheses, findings indicated that intrusion monitoring was associated with higher subjective distress than suppression both in the laboratory and in the natural environment. No differences were found for the frequency of intrusions between groups in the laboratory. However, modest evidence for a rebound effect in intrusion frequency was found outside the laboratory.     

Minority influence: the role of the rate of majority defection and persuasive arguments

An experiment employing the Twelve Angry Men paradigm was conducted to determine the role of the rate of majority defection to the minority position and the use of persuasive arguments by the minority on minority influence. Subjects were more influenced by the minority when it provided persuasive arguments by refuting the majority viewpoint than when the minority did not. More minority influence occurred when the minority obtained majority defectors than when the minority did not. Moreover, the rate of majority defection made a difference. Minority influence was not obtained with the initial acquisition of a single defector and the significant influence that occurred with the acquisition of four defectors was not further increased by the acquisition of additional defectors. The results for the number of majority defectors were generally consistent with Tanford and Penrod's social influence model. Finally, the issue of the number of majority defectors versus the speed at which they defect is discussed. © 1998 John Wiley & Sons, Ltd.     

Collective Action as Individual Choice

We argue that conceptual analyses of collective action should be informed by game-theoretic analyses of collective action. In particular, we argue that Ariel Rubenstein’s so-called ‘Electronic Mail Game’ provides a useful model of collective action, and of the formation of collective intentions.     

Too much to count on: impaired very small numbers in corticobasal degeneration

Patients with corticobasal degeneration (CBD) have calculation impairments. This study examined whether impaired number knowledge depends on verbal mediation. We focused particularly on knowledge of very small numbers, where there is a precise relationship between a cardinality and its number concept, but little hypothesized role for verbal mediation. We evaluated accuracy and reaction time (RT) for matching dot arrays and Arabic numerals involving smaller (2-4) and larger (5-9) cardinalities in non-aphasic patients with CBD (n=16), frontotemporal dementia (FTD; n=23), and healthy controls (n=15). CBD were less accurate and slowed at judging smaller Arabic numeral-dot array stimuli compared to FTD patients and controls. Moreover, only CBD showed longer RTs judging successively larger number-dot array pairs among the smaller cardinalities. Difficulty judging very small numbers is impaired in CBD, suggesting degraded representation of precise number knowledge that does not depend on language functioning.     

Android Epistemology For Babies: Relections On Words,Thoughts And Theories

Words, Thoughts and Theories arguesthat infants and children discover the physical and psychological featuresof the world by a process akin to scientific inquiry, more or less asconceived by philosophers of science in the 1960s (the theory theory).This essay discusses some of the philosophical background to analternative, more popular, ``modular' or ``maturational' account ofdevelopment, dismisses an array of philosophical objections to the theorytheory, suggests that the theory theory offers an undeveloped project forartificial intelligence, and, relying on recent psychological work oncausation, offers suggestions about how principles of causal inference mayprovide a developmental solution to the ``frame problem'.     

Change Processes in Residential Cognitive and Interpersonal Psychotherapy for Social Phobia: A Process-Outcome Study

The purpose of this study was to test cognitive and interpersonal models for improving social phobia. Eighty patients with social phobia were randomized to 10-week residential cognitive (RCT) or residential interpersonal psychotherapy (RIPT). They completed process measures every Thursday and a sub-outcome measure every Monday. The ratings were analyzed with mixed models. Weekly changes in the process variables derived from the cognitive model (self-focus, estimated probability and estimated cost of negative social events, safety behaviors) predicted subsequent weekly changes in social anxiety. Changes in the interpersonal variable perceived acceptance by others also predicted subsequent changes in social anxiety. On the other hand, changes in social anxiety predicted changes in the four cognitive variables. There were no interactive effects of process with treatment. The cognitive variables decreased during treatment to a similar degree in both treatments. The results indicate that, to reduce social anxiety, therapy should target self-focus, estimated probability and cost of feared social events, safety behaviors, and perceived acceptance by others. The process of improvement may involve positive cycles in that a reduction of social anxiety, in turn, appeared to impact self-focus, probability, cost, and safety behaviors.     

An Instrumental Variable Estimator for Mixed Indicators: Analytic Derivatives and Alternative Parameterizations

Psychometrika - Methodological development of the model-implied instrumental variable (MIIV) estimation framework has proved fruitful over the last three decades. Major milestones include...     

The role of rapport in satisfying one’s basic psychological needs

Psychological need satisfaction is essential for daily human functioning and one of its sources is high quality interactions. Rapport is essential to high quality interactions and may be one way that various relationships types can provide the nutriments of healthy functioning. We hypothesized that when people perceive interactions to be higher in rapport, they will experience greater satisfaction of their needs for autonomy, competence, and relatedness. We also explored whether this would be a basic process that would be altered by the relationship between interactants, testing this with multiple operationalizations. We conducted an event-contingent diary study in which participants (n_participants?=?124) responded to items at baseline, each time they experienced an interaction (n_interaction?=?1293), and at two-week follow-up. Supporting hypotheses, rapport in interactions was positively associated with need satisfaction within-persons, between-persons, cross-sectionally, and when examining temporal change. Moreover, rapport tended to predict the satisfaction of one’s needs for competence, autonomy, and relatedness independently. Finally, relationships between interactants did not moderate these associations.