Using vignettes to assess the contribution of goal adjustment in the adaptation to chronic musculoskeletal pain

Quality of Life Research - The quality of life of individuals with chronic musculoskeletal pain partly depends on their capacity to adjust their personal goals. Vignettes have been rarely used to...     

Using Vignettes to Tap Into Moral Reasoning in Public Health Policy: Practical Advice and Design Principles From a Study on Food Advertising to Children

In this article, we describe a process for designing and applying vignettes in public health policy research and practice. We developed this methodology for a study on moral reasoning underpinning policy debate on food advertising to children.Using vignettes prompted policy actors who were relatively entrenched in particular ways of speaking professionally about a controversial and ethically challenging issue to converse in a more authentic and reflective way.Vignettes hold benefits and complexities. They can focus attention on moral conflicts, draw out different types of evidence to support moral reasoning, and enable simultaneous consideration of real and ideal worlds. We suggest a process and recommendations on design features for crafting vignettes for public health policy.Vignettes have been identified as a useful device to elicit discussion on beliefs, values, and norms.1–3 They are short stories based on fictional or fictionalized (hypothetical) scenarios, in which respondents are asked to draw upon their own experience to predict how characters will—or should—behave.4–7 Vignettes have a long history in social inquiry, including psychology, social work, and health education. Vignettes are useful for several qualitative data collection functions: to set a tone for an encounter by serving as ice-breaker or concluding device (for example, at the opening or closing of an interview or focus group, where shifts between concrete and abstract concepts need to be made),8 to capture complexity in the operationalization of concepts through their representation of real-world situations,9 to place potential actions in specific situational contexts,8 to facilitate expression of personal or subjective experiences and beliefs,1,2,10 and to analyze judgments in response to moral dilemmas.8We outline a process for designing and applying vignettes in public health policy research and practice that we developed for a study on the moral reasoning underpinning policy debate on food advertising to children. Vignettes prompted policy actors, who were relatively entrenched in particular ways of speaking professionally about the issue, to converse in a more authentic and reflective way. First, we describe the issue of food and beverage advertising to children, focusing on how it presents specific challenges for qualitative policy research. Second, we include an in-depth illustrative look at our study methodology. Third, we have included a brief selection of results from the study, focusing on themes that highlight the function of the vignettes. Fourth, we conclude with lessons learned on the practical application of vignettes, from conception to implementation, and how they can serve as a useful tool for public health policy deliberation.     

Development and reliability of a self-report questionnaire to examine children's perceptions of the physical activity environment at home and in the neighbourhood

Background  

Environmental factors are increasingly being implicated as key influences on children's physical activity. Few studies have comprehensively examined children's perceptions of their environment, and there is a paucity of literature on acceptable and reliable scales for measuring these. This study aimed to develop and test the acceptability and reliability of a scale which examined a broad range of environmental perceptions among children.     

Interprofessional Clinical Supervision in Mental Health and Addiction: Toward Identifying Common Elements

This study explores the experiences and perceptions of clinicians from a range of professions to articulate general principles for clinical supervision in mental health. Seventy-seven volunteer clinicians participated in 14 focus groups in 2008–2009. They discussed their perceptions about clinical supervision, facilitators, and barriers. Discussions were digitally recorded and transcribed verbatim, and qualitative analytic methods were used to identify themes and exceptions. The study found frontline clinicians identified interacting factors they associated with quality clinical supervision. Themes related to the structure, content, and process of supervision and contained common elements across professions and those that were specific to nursing. Considerable agreement exists regarding principles for interprofessional supervision in mental health; that it is available on a regular and crisis-responsive basis, and that supervisors are expert in clinical interventions for specific populations and have the skills for teaching and supporting staff. Some nurse participants expressed unique perceptions about clinical supervision based on their professional traditions and approaches, which requires further study before advancing a common model of supervision across professions.     

The Relationships Between Socioeconomic Status,COVID-19 Risk Perceptions,and the Adoption of Protective Measures in a Mid-Western City in the United States

An individual's perception of risk plays an influential role in the behaviors they engage in, which could reduce or increase exposure or transmission of a certain disease. Since risk perceptions vary by social identities (e.g., gender, race/ethnicity, age) they are believed to influence the interpretation and likelihood of following guidance from risk-communication efforts. This study aims to understand how COVID-19 risk perceptions vary by social identity (with an emphasis upon socioeconomic factors), how such identities influence behavior adoption through risk-communication pathways, and how findings can be practically applied in messaging. Previous studies have investigated the role of social factors on risk perceptions, but SES has not been modeled as the main factor. Guided by the Health Belief Model and Social Determinant of Health Frameworks, findings from our 326 participants suggest those with high-risk COVID-19 perceptions identified as higher income and held more advanced educational degrees, suggesting a positive relationship between risk perceptions and SES. Individuals with high-risk perceptions more frequently reported practicing protective behaviors against COVID-19 and reported greater severity, susceptibility, barriers, benefits, trust, confidence, and health literacy in adopting behavior changes against the virus. When applying such findings to create a local risk-communication plan (logic model), it was found that messaging should be culturally relevant, in-plain language, and consistent to improve health literacy. In addition to using the most trusted and frequently used communication sources self-identified by residents, we recommend uniting trusted formal and informal community leaders to provide information in diverse pathways and formats.

     

Employee experience of structural change in two Norwegian hospitals.

Advances in medical and technological procedures, together with changes in demography, demand structural changes in the Nordic health care systems. Few studies have focused on employee perceptions of these structural changes. This study aims to describe employee reactions following a merger between two Norwegian hospitals. A Grounded theory approach has been used in this study. The theoretical model is based on empirical data collected from employees directly affected by the structural change process. Employee resistance was found to be the core category. Three categories were found in relation to this core category; goal uncertainty, organizational culture and individual insecurity. Different perceptions and interpretations of vaguely formulated goals lead to employee resistance. The difference between the organizational cultures in the two hospitals impeded the merger according to the project plan, and very few positive results could be seen. Individual insecurity regarding the future was experienced in connection with the implementation of structural change. The authors propose a strategy to counteract resistance in similar mergers.     

Tangible evidence, trust and power: public perceptions of community environmental health studies

Communities with environmental health concerns in the USA frequently request studies from their local or state departments of public health. This paper presents findings from three focus groups conducted in communities north of Boston that have been the subject of two different environmental health studies. The focus groups were designed to elicit residents' perceptions of environmental health, and of the particular studies conducted in their communities. In all focus groups, participants had difficulty accepting the findings of health studies that contradicted their own experiences of environmental exposures and illness. Our results suggest that lay knowledge, informed in varying degrees by the experience of what we term "tangible evidence," creates a lens through which communities interpret a health study's findings. The differences in reliance on tangible evidence were related to participants' sense of trust in public officials, and the institutions responsible for conducting health studies. Participants from the wealthier, predominantly white communities discussed trust in study design and methodologies used. In contrast, participants from the lower-income, higher-minority communities assessed health studies with reference to their trust (or lack thereof) in study sponsors and public health institutions. Participants' experience of tangible evidence, trust or distrust in health agencies and research institutions, and a sense of relative community power, influence how they assess the findings of environmental health studies and may have implications for pubic health.     

Microtomographic and morphometric characterization of a bioceramic bone substitute in dental implantology

In recent years, bone tissue regeneration studies have led to a deeper knowledge of chemical and structural features of the best biomaterials to be used as replacements for lost bone structures, with the autologus bone still today the only graft material able to ostegenerate, osteinduct and/or osteoconduct. The difficulties of the small available amount of autologus bone, together with morbidity of a second surgical operation on the same patient, have been overcome using both synthetic and biologic substitute bones. The possibility of investigating morphometric characteristics of substitute bones makes it possible to evaluate the predictability of regenerative processes and, so far, a range of different methods have been used for the purpose. X-ray microtomography (micro-CT) is a miniaturized form of conventional tomography, able to analyze the internal structure of small objects, performing three-dimensional images with high spatial resolution (< 10 micron pixel size). For a correct analysis, samples need not be altered or treated in any way, as micro-CT is a non-invasive and non-destructive technique. It shows promising results in biomaterial studies and tissue engineering. This work shows the potential applications of this microtomographic technique by means of an in vitro analysis system, in characterizing morphometric features of human bone tissue, and contributes to the use of this technique in studies concerning biomaterials and bioscaffolds inserted in bone tissue.     

Perceptions by patients and families towards treatment outcomes in mental health services

The need to evaluate treatment outcomes in mental health services from the user's perspective has been highlighted in the literature. The objective of this study was to compare the perceptions of patients and their families regarding treatment outcomes, in terms of perceived changes in the patient's life. The Perception of Change Scale was applied to 100 psychiatric patients that used public mental health services and 100 family members. The results showed a high percentage of agreement between patients' and families' perceptions of change on most items in the scale and on the open-ended questions. The results confirmed previous studies comparing patients' and families' satisfaction with other aspects of services. They also attest to the validity of patients' responses in the evaluation of treatment outcomes in mental health services.     

Interpretations of healthy and unhealthy eating, and implications for dietary change

Central to many considerations of health-related dietary change is the interpretation given to 'healthy' and 'unhealthy' eating. Results are reported from two studies which investigated people's understanding of these concepts. The first study involved structured interviews with 48 respondents: a wide range of interpretations of healthy and unhealthy eating was found using content analysis techniques. The second study (n = 242) used questionnaires to assess the extent to which different interpretations were endorsed. The extent to which different eating behaviours were perceived as healthy or unhealthy varied greatly. A principal components analysis of perceptions of healthy and unhealthy eating produced five separate factors. Some differences in perceptions were found for people of different age, gender and educational level. Objectively assessed dietary intake and perceived intake were found to be two distinct quantities. 'Healthy' eaters were found to perceive 'healthy eating' slightly differently to 'unhealthy' eaters. The results suggest that lay understanding of healthy eating does generally conform with dietary guidelines, and therefore health promotion priorities should focus on physical and psychological constraints to healthy eating, rather than attempting to increase the public's knowledge as a whole.     

A comparison of the clinical effectiveness and costs of mental health nurse supplementary prescribing and independent medical prescribing: a post-test control group study

Background  

Supplementary prescribing for mental health nurses was first introduced in the UK in 2003. Since then, a number of studies have reported stakeholders' perceptions of the success of the initiative. However, there has been little experimental research conducted into its effectiveness. This paper reports findings from the first known study to compare the cost and clinical impact of mental health nurse supplementary prescribing to independent medical prescribing.     

Lay Meanings of Health Among Rural Older Adults in Appalachia

Purpose: Self‐perceptions of health vary depending on one's social and cultural context. Rural residents have been characterized as having a distinct culture, and health differences by residence have been well documented. While there is evidence of poor health among rural older adults, little research has examined how they perceive and define health. Qualitative methods may help capture these lay meanings of health. The purpose of our study was to use a qualitative approach to examine what perceptions community‐dwelling rural older adults have regarding their health. Methods: The study involved thirteen 90‐minute focus groups and short self‐administered surveys with community‐dwelling persons aged 60 years or older residing in 6 rural West Virginia communities. A total of 101 participants were asked questions about their personal definitions of health. With professional transcribed tapes from the focus group discussions, we used a systematic text analysis approach. Findings: Discussions included 4 themes on the meaning of health: (1) health as a value, (2) dimensions of life, (3) holistic nature of health, and (4) health care use and adherence. Conclusion: Our results expand on previous studies and demonstrate that health is a subjective, multidimensional construct deeply embedded in the everyday experience of rural older adults. We found that older adults’ perceptions about health contain components which most medical professionals would not take into account. Health care providers may consider supplementing traditional medical approaches with a more contextually sensitive recognition of rural elders’ desired health goals and outcomes.     

Assessment of environmental correlates of physical activity: development of a European questionnaire

Background  

Research on the influence of the physical environment on physical activity is rapidly expanding and different measures of environmental perceptions have been developed, mostly in the US and Australia. The purpose of this paper is to (i) provide a literature review of measures of environmental perceptions recently used in European studies and (ii) develop a questionnaire for population monitoring purposes in the European countries.     

The influence of socio-cultural factors on breast cancer screening behaviors in Lagos,Nigeria

Culture has been shown to influence health beliefs and health-related behaviors by influencing the type of health information to which women have been exposed and shapes health and illness perceptions and practices. To increase screening rates, cultural influences should be considered as important correlates of screening behaviors for breast cancer. This study used semi-structured interviews of women attending a cancer screening facility in Lagos, Nigeria guided by the PEN-3 model to describe culturally relevant factors that shape attitudes toward breast cancer and breast cancer screening. Religion was the most prominent theme and was shown to have positive, negative and existential effect on breast cancer perceptions. Other major themes observed were related to family and traditional beliefs. The results from this study could be used to develop and implement culturally relevant cancer prevention interventions, strategies, and recommendations to overcome screening barriers in an effort to increase breast cancer participation and awareness among Nigerian women.     

Preschool teachers’ perceptions and pedagogical practices: young children’s use of ICT

ICT has been widely introduced to early childhood programs for young children to learn and play, but the meaningful integration of ICT into early learning and development is not strongly evident. While studies reveal that teachers are the key to the effective use of ICT in the classroom, there is to date limited research investigating how early childhood teachers perceive and support young childrens use of ICT. This paper reports on a survey study examining Chinese preschool teachers perspectives and pedagogical practices. Although there was a level of correspondence between the teachers perceptions and pedagogical practices, the teachers high positive perceptions of ICT benefits conflicted with their low frequencies of using pedagogies to facilitate the childrens ICT use. The results point to the importance of providing effective professional learning and development programs so teachers can employ a wider range of pedagogical strategies to support the childrens use of ICT.     

Perceived causes of sporadic cryptosporidiosis and their relation to sources of information

BACKGROUND: The importance of a person's perceptions about the causes of their disease has been emphasised by research on various diseases. Several studies have found perception may be linked to protective behaviours. OBJECTIVE: This study intends to identify the main perceived causes of sporadic cryptosporidiosis, and to analyse some of the factors that may influence respondent's perception. The role of respondents' attributions, the scientific plausibility of perceptions, and the importance of specific information sources are also explored. DESIGN: Quantitative and qualitative analyses of data from a case-control study. SETTING: General population in Wales and north west England. PARTICIPANTS: The study is based on a sample of 411 respondents from Wales and north west of England, whose cryptosporidiosis diagnosis was confirmed by a laboratory. RESULTS: The results show that the most frequent perceived causes are water (by drinking it or swimming), contagion (mostly from children), and contaminated food. Perceived causes are qualitatively similar to the ones described in scientific literature, but some quantitative differences are evident. Respondents' certainty in relation to the cause of illness is directly related with plausibility. The most frequent information sources used by respondents were test stool results, environmental health officers, and doctors or nurses. Results suggest that information sources may influence the perception of the causes of cryptosporidiosis. Qualitative data provided a few clues about situations where sporadic and outbreak cases may be confused. CONCLUSION: In contrast with outbreaks, various information sources in addition to the media are used by people with sporadic cryptosporidiosis that in turn affects the perception of aetiology. This has implications for the dissemination of information about control measures for cryptosporidiosis and surveillance activities.     

Co-teaching: a faculty development strategy

It has been stated that faculty development programmes which are closely linked to particular teaching contexts are most likely to be effective. Over the past 10 years we have developed a model of 'co-teaching' for faculty development which is based upon this premise and which can be applied to any clinical rotation. In this paper we describe our model, in which paired physicians focus on developing their teaching skills while sharing the clinical supervision of residents and medical students. Through iterative phases of teaching, debriefing and planning, co-teachers gain experience in analysing teaching encounters and develop skills in self-evaluation. Teaching occurs in the usual clinical settings such as attending (consultant) teaching rounds, clinic precepting, and case conferences. We discuss our model in the context of educational theory and related literature. We support our positive assessment of the co-teaching model through the precepts of collaborative inquiry and case study methodology. Vignettes, taken from the experiences of the authors, are used to demonstrate how the model is used to develop effective solutions to problems and to help in the maturation of one's skill as an educator. Successful implementation of the model is predicated on the development of a truly collaborative process between co-teachers. We share lessons we have learned from our experience of implementing the model in different clinical venues, such as the contrast between teaching on a hospital ward or in the clinic. This collaborative process has been well received by junior and senior faculty participants in our institution for more than a decade.     

Genre-specific media and perceptions of personal and social risk of smoking among South Korean college students

The smoking rate among adult men in South Korea is one of the highest in the world, standing at about 53%. Although various mass media-based educational initiatives have been taken to reduce this rate, their contribution toward the smoking risk perceptions of South Koreans has not been investigated. This study examined the association between genre-specific media exposure and personal and social risk perceptions of smokers and nonsmokers. Data from a survey of 558 South Korean college students (39% smokers) show that genre-specific media exposure differentially predicts personal and social risk perceptions of smokers and nonsmokers. News media exposure predicted smokers' personal risk perceptions, whereas entertainment media exposure predicted nonsmokers' personal risk perceptions. Exposure to a hybrid genre, health infotainment, predicted social risk perceptions, but not personal risk perceptions, of both smokers and nonsmokers. High rates of exposure to medical documentary were associated with low personal risk perceptions of nonsmokers, but not smokers. These results collectively suggest that mixed-media strategies may effectively address perceptions of personal and social risk of smoking. Suggestions for future research, and theoretical and practical implications, are offered.     

Assessing Perceptions of Stress in Diabetic Children

Stress is an issue often addressed in the literature, yet few systematic investgations of stress have been attempted with children, particularly those with chronic illnesses Based upon studies associating stress and illness in adults, a similar relationship between stress and illness is assumed in children, if adult values of stress are used rather than an assessment of children's own stress values This study examined diabetic children's perceptions of stress by (a) asking them to compile a list of stresses and rank them, and (b) administering Goddington's list of stress items to determine its ability to predict children's own perceptions of stress Results indicated poor agreement between Goddington's rankings and those of diabetic children Lists of items suggested spontaneously by diabetic children appear most relevant for health providers to evaluate the impact of psychosocial stress on chronic illness.