Encouraging patient participation in general practice consultations: Effect on consultation length and content,patient satisfaction and health

Abstract

Following the evidence from earlier research that one-to-one interventions can increase the patient's contribution to the consultation, this paper reports the results from a randomised control trial which assessed the effects of a leaflet designed to enhance patient participation in consultations. A random sample of patients (aged 16 to 74) waiting to see a general practitioner were given either an intervention leaflet, which encouraged the patient to take an active role in the consultation, or a control leaflet which gave dietary advice. The effects of the intervention were assessed by measuring length of consultation, number of questions asked by the patient, patient satisfaction score, doctor's feelings about the consultation, the change in patients' health in the 4 weeks following the consultation (measured by the SF-36 Health Survey) and the number of patient visits to a GP in the following year. The results showed that patients in the intervention group had significantly longer consultations than those in the control group and tended to ask more questions but there was no significant effect on patient satisfaction. The doctor tended to feel that he had a better understanding of patients in the intervention group. Overall there was no significant effect on SF-36 scores but, for patients under the age of 40, and for those in higher social classes the scores of patients in the intervention group improved to a significantly greater degree than did those for the control group. The intervention did not have any effect on the number of GP visits made by patients in the subsequent year. The study results show that a relatively simple leaflet can have an impact on patients' behaviour during the consultation, even though there were no effects on patient satisfaction with the consultation or in the number of GP visits in the following year.     

Book Review

Performance-based measures and ratings of executive functions were examined in a sample of adolescents with attention deficit/hyperactivity disorder (ADHD) and comparison controls. Performance-based measures of executive function included inhibition, working memory, set shifting, and planning, and ratings of these same executive functions were completed by parents and teachers. Adolescents with ADHD demonstrated lower executive function performance than controls and displayed elevated ratings on the executive function ratings by parents and teachers. Significant associations were obtained between the performance-based measures and the parent and teacher ratings, but each measure was not uniquely associated with its respective scale on the rating scales. When performance-based measures and ratings were examined as predictors of ADHD status, the parent and teacher ratings entered as significant predictors of ADHD status. Further commonality analyses indicated that performance-based measures accounted for little unique variance in predicting ADHD status and also displayed little overlap with the behavioral ratings. These findings highlight the diagnostic utility of behavioral ratings of executive function in predicting ADHD status; however, behavioral ratings should not be assumed to be a proxy for performance on measures of executive function in clinical practice.     

The Dark Triad and animal cruelty: Dark personalities,dark attitudes,and dark behaviors

Research examining the interpersonal interactions of those high on the Dark Triad has proliferated in recent years. Extant research, however, has not examined other types of relationships such as attitudes and behaviors towards animals. Further, there has been limited research examining the associations between personality and attitudes and behaviors towards animals generally. In this study, participants (N = 227) completed an online survey measuring the Dark Triad, attitudes towards animals, and acts of animal cruelty. The results revealed that individuals with higher levels of the Dark Triad demonstrated less positive attitudes towards animals and reported engaging in more acts of animal cruelty. Age and sex were found to be significant predictors of less positive attitudes and behaviors towards animals, independent of the Dark Triad. These results suggest that those callous and manipulative behaviors and attitudes that have come to be associated with the Dark Triad are not just limited to human-to-human interactions, but are also consistent across other interactions.     

Parent predictors of changes in child behavior problems

The present study examined whether ineffective discipline, single parent status, social support, parent involvement, and parent depression predicted changes in preschoolers' (N = 129) behavior problems. This study also evaluated whether child sex and ethnicity moderated the relations between these variables and changes in problem behavior. Parents completed questionnaires at the beginning of the study, and parent, teacher, and observational ratings of children's behavior problems were collected twice during the school year. Parents' own social support predicted improvement for boys and parent depression was associated with worsening symptoms for girls. Single parenthood and parent involvement predicted changes in behavior problems for the sample as a whole. Several significant ethnic differences emerged, highlighting the importance of considering cultural context in studies of parenting and child externalizing behavior.     

AN INTEGRAL APPROACH TO SUSTAINABLE CONSUMPTION AND WASTE REDUCTION

This article aims to demonstrate how the Integral approach can be utilized to understand and potentially resolve a particular human-ecological issue. It arises out of a research project that involved examining the factors inhibiting sustainable consumption and waste reduction in the community of Calgary. The Integral approach aims to ensure that no fundamental dimensions of the problem are neglected. It beckons us to consider body, mind, and spirit in the personal, cultural, and social realms of reality.     

Training School Psychologists in Behavior Support Consultation

SUMMARY

Although school consultation began as a means of providing assistance to individual teachers on a voluntary basis, it has evolved into a stand-alone service regulated by state and federal law. In order to meet the demand for increased accountability in the services they provide, school psychologists and other prereferral intervention team members have expressed a need to develop skills in two key areas: (a) selecting interventions that are conceptually relevant and therefore likely to be effective in responding to children's behavior problems, and (b) providing teachers with the resources and support needed to ensure successful plan implementation. In this paper, we describe various strategies that have been shown to be effective at addressing each of these issues by drawing on recent research in school consultation and applied behavior analysis. Considerations surrounding the use of these strategies by school consultants are discussed, as are implications for increasing the effectiveness and accountability of school consultation services.     

Intergenerational occupational transmission: Do offspring walk in the footsteps of mom or dad,or both?

The purpose of this research was to apply the Theory of Planned Behavior (TPB) in order to investigate intergenerational occupational transmission between parents and their children. A sample of 260 undergraduate students completed a questionnaire measuring TPB variables, and congruence was calculated between the parents' occupations and their offspring's chosen profession. Intention to work in the parents' occupations was predicted by attitude, subjective norm and perceived behavioral control. Congruence between parents' and their children's occupational choice was predicted by intention and perceived behavioral control. The findings provide support to the relational approach in career choice. Implications of the findings for career counselors and young people's career choices are discussed.     

A Systemic Framework for Trauma-Informed Schooling: Complex but Necessary!

In most classrooms in most schools, there are students who have suffered complex trauma who would benefit from a system-wide, trauma-informed approach to schooling. Despite growth in Australian schools adopting trauma-informed practice, education systems are yet to embrace a whole-of-organization approach, unlike other systems supporting children and adolescents. This is likely due to multifarious complexities inherent in, and specific to, the schooling system. This article reviews early findings from current research in Queensland, Australia that is exploring requirements for a system-wide approach to trauma-informed schooling. Findings highlight that achieving systemic, trauma-informed schooling is complex but necessary and has potential to improve outcomes for students and those aiming to educate them. Findings have implications for schooling and education systems worldwide.     

Job Stress and Dyadic Synchrony in Police Marriages: A Preliminary Investigation

Despite reports documenting adverse effects of stress on police marriages, few empirical studies focus on actual emotional behaviors of officers and spouses. In this preliminary investigation, 17 male police officers and their nonpolice wives completed daily stress diaries for 1 week and then participated in a laboratory‐based discussion about their respective days. Conversations were video‐recorded and coded for specific emotional behaviors reflecting hostility and affection, which are strong predictors of marital outcomes. We examined associations between officers' job stress (per diaries and the Police Stress Survey) and couples' emotional behavior (mean levels and behavioral synchrony) using a dyadic repeated measures design capitalizing on the large number of observations available for each couple (1020 observations). When officers reported more job stress, they showed less hostility, less synchrony with their wives' hostility, and more synchrony with their wives' affection; their wives showed greater synchrony with officers' hostility and less synchrony with officers' affection. Therefore, for officers, greater job stress was associated with less behavioral negativity, potentially less attunement to wives' negativity, but potentially greater attunement to wives' affection—perhaps a compensatory strategy or attempt to buffer their marriage from stress. These attempts may be less effective, however, if, as our synchrony findings may suggest, wives are focusing on officers' hostility rather than affection. Although it will be important to replicate these results given the small sample, our findings reveal that patterns of behavioral synchrony may be a key means to better understand how job stress exacts a toll on police marriages.     

Implementation of Parent Management Training—Oregon Model (PMTOTM) in Iceland: Building Sustained Fidelity

Bringing empirically supported treatments (ESTs) into community settings is a challenge because of threats to therapy adherence. The nationwide implementation of Parent Management Training—the Oregon Model (PMTO) in Iceland was studied by comparing therapists' competent adherence to PMTO across three generations of therapists. To assess therapists' competence and adherence to the PMTO method, the Fidelity of Implementation Rating System (FIMP) was used as the measuring device. Of 16 therapists across three generations who entered training, 12 completed with certification. As expected, each of the three generations obtained adequate FIMP scores. Generations 1 and 3 showed equivalent levels of performance on FIMP scores at certification. A small drop in FIMP scores for Generation 2 was explained in terms of translating and culturally adjusting materials and strengthening training procedures. Results are parallel to earlier findings from the nationwide PMTO implementation in Norway and support the idea that PMTO can be implemented in community settings with high fidelity even when resources are scarce.