Active learning on the ward: outcomes from a comparative trial with traditional methods

Medical Education 2011: 45 : 273–279 Context Academic activity during internship is essentially practical and ward rounds are traditionally considered the cornerstone of clinical education. However, the efficacy and effectiveness of ward rounds for learning purposes have been under‐investigated and it is necessary to assess alternative educational paradigms for this activity. Objectives This study aimed to compare the educational effectiveness of ward rounds conducted with two different learning methodologies. Methods Student subjects were first tested on 30 true/false questions to assess their initial degree of knowledge on pneumonia and diarrhoea. Afterwards, they attended ward rounds conducted using an active and a traditional learning methodology. The participants were submitted to a second test 48 hours later in order to assess knowledge acquisition and were asked to answer two questions about self‐directed learning and their opinions on the two learning methodologies used. Results Seventy‐two medical students taking part in a paediatric clinic rotation were enrolled. The active methodology proved to be more effective than the traditional methodology for the three outcomes considered: knowledge acquisition (33 students [45.8%] versus 21 students [29.2%]; p = 0.03); self‐directed learning (38 students [52.8%] versus 11 students [15.3%]; p < 0.001), and student opinion on the methods (61 students [84.7%] versus 38 students [52.8%]; p < 0.001). Conclusions The active methodology produced better results than the traditional methodology in a ward‐based context. This study seems to be valuable in terms of the new evidence it demonstrates on learning methodologies in the context of the ward round.     

Divergence in student and educator conceptual structures during auscultation training

Context Simulation‐based medical education allows trainees to engage in self‐regulated learning (SRL), yet research aimed at elucidating the mechanisms of SRL in this context is relatively absent. We compared ‘unguided’ SRL with ‘directed’ SRL (DSRL), wherein learners followed an expert‐designed booklet. Methods Year 1 medical students (n = 37) were randomly assigned to practise identifying seven cardiac murmurs using a simulator and video only (SRL group) or a simulator and video plus the booklet (DSRL group). All participants completed a 22‐item test 3 weeks later. To compare interventions, we analysed students’ diagnostic accuracy. As a novel source of evidence, we documented how participants autonomously sequenced the seven murmurs during initial and delayed practice sessions. In addition, we surveyed clinical educators (n = 17) to find out how they would sequence their teaching of these murmurs. Results The DSRL group used 50% more training time than the SRL group (p < 0.001). The groups’ diagnostic accuracy, however, did not differ significantly on the post‐test, retention test or transfer test items (p > 0.12). Despite practising with the expert‐defined ‘timing‐based’ approach to murmur diagnosis (i.e. systolic versus diastolic), 84% of DSRL participants implemented a location‐based approach (i.e. practising aortic murmurs separately from mitral murmurs) during a second, unguided practice session. Notably, most SRL participants used that same approach spontaneously. By contrast, clinical educators were split in their use of the timing‐based (n = 10) and the location‐based (n = 6) approaches. Chi‐squared analyses suggested educators’ conceptions for organising murmurs differed significantly from students’ conceptions. Conclusions Contrary to our predictions, directing students’ SRL produced no additional benefit and increased their practice time. Our findings suggest one potential source of these results was a divergence between student and educator conceptions for structuring the practice of cardiac auscultation skills. This phenomenon has not been well articulated in the medical education literature, and may have important implications in many (especially technology‐mediated) educational contexts.     

Consumers’ knowledge of healthy diets and its correlation with dietary behaviour

Background: Procedural nutrition knowledge is knowledge of how to eat a healthy diet. This type of knowledge potentially plays an important role in dietary behaviour. Previous studies of consumers' nutrition knowledge did not systematically assess procedural nutrition knowledge. Thus, we administered a survey of procedural nutrition knowledge to Swiss consumers to assess the prevalence of misconceptions about healthy eating. Methods: We developed 13 procedural nutrition knowledge items. Nine items were based on qualitative consumer interviews and four items were derived from expert guidelines. The items had a true/false format. We administered the items to a random population sample in a written postal survey (n = 1,043). The survey also assessed the consumers' self‐reported food consumption. For each respondent, we computed the number of correctly answered knowledge items and we correlated this number with food consumption frequencies. Results: The procedural nutrition knowledge items received between 3% and 38% incorrect answers. Individuals with a higher number of correctly answered items consumed more vegetables (r = 0.29). Higher knowledge was associated with the female gender, younger age, higher education, nutrition‐related qualifications and not being on a diet (P < 0.001). Conclusions: Our findings indicate that misconceptions exist in the general population about healthy eating. These misconceptions are associated with a decreased consumption of foods usually defined as healthy. Some population sub‐groups seem particularly susceptible to holding such misconceptions. The implications for nutrition education, particularly concerning the role of fruit and vegetable consumption as well as the food pyramid are discussed.     

Nutrition knowledge and attitudes of New Zealand registered midwives

Aim: The importance of nutrition for a healthy pregnancy is well established. In New Zealand, the majority of women choose midwives as their maternity provider. Therefore, it is important that midwives have an understanding of nutrition issues related to pregnancy. The purpose of the present study was to determine the nutrition knowledge of New Zealand midwives, and to assess the importance they place on nutrition during pregnancy. Methods: An 18‐question postal survey was sent to all members of the New Zealand College of Midwives (n = 1340). Results: A total of 370 questionnaires were returned (response rate of 27.6%). Less than 40% of midwives reported that they had formal nutrition education; however, nearly 75% of respondents indicated that they had received nutrition information through their midwifery education. Most midwives indicated that nutrition was important or very important during pregnancy (98.4%), and that they had a significant or very significant role in educating pregnant women (94.9%) about nutrition. Midwives generally reported a high level of confidence in dealing with nutrition‐related issues. Midwives answered most of the nutrition knowledge questions correctly. However, 64.6% of midwives (n = 369) incorrectly identified spirulina as a good source of iron for vegetarians, 28.1% (n = 104) incorrectly answered that maternal intake of cabbage and beans are often responsible for colic in breastfed infants, and 40.0% (n = 128) incorrectly answered that to reduce food allergies all lactating women should avoid peanuts and shellfish. Conclusion: Overall, midwives were knowledgeable on nutrition issues related to pregnancy and reported a high level of confidence on educating women about nutrition.     

Directed self-regulated learning versus instructor-regulated learning in simulation training

Medical Education 2012: 46: 648–656 Objectives Simulation training offers opportunities for unsupervised, self‐regulated learning, yet little evidence is available to indicate the efficacy of this approach in the learning of procedural skills. We evaluated the effectiveness of directed self‐regulated learning (DSRL) and instructor‐regulated learning (IRL), respectively, for teaching lumbar puncture (LP) using simulation. Methods We randomly assigned internal medicine residents in postgraduate year 1 to either DSRL (‘directed’ to progress from easy to difficult LP simulators during self‐regulated learning) or IRL (in groups of four led by an instructor). All participants practised for up to 50 minutes and completed a pre‐test, post‐test and delayed (by 3 months) retention test on the simulator. Pairs of blinded trained experts independently rated all videotaped performances using a validated global rating scale and a modified version of a validated checklist. Participants provided measures of LP experience and self‐reported confidence. We analysed the pre–post (n = 42) and pre–post–retention performance scores (n = 23) using two separate repeated‐measures analyses of variance (anova s) and computed Pearson correlation coefficients between participants’ confidence and performance scores. Results Inter‐rater agreement was strong for both performance measures (intra‐class correlation coefficient > 0.81). The groups achieved similar pre‐test and post‐test scores (p > 0.05) and scores in both groups improved significantly from the pre‐ to the post‐test (p < 0.05). On retention, a significant interaction (F_2,42 = 3.92, p = 0.03) suggests the DSRL group maintained its post‐test performance, whereas that in the IRL group dropped significantly (p < 0.05). Correlations between self‐reported confidence and post‐test performance were positive and significant for the DSRL group, and negative and non‐significant for the IRL group. Conclusions Both IRL and DSRL led to improved LP performance immediately after practice. Whereas the IRL group’s skills declined after 3 months, the DSRL group’s performance was maintained, suggesting a potential long‐term benefit of this training. Participants in the DSRL group also developed a more accurate relationship between confidence and competence following practice. Further research is needed to clarify the mechanisms of self‐regulated learning and its role in simulation contexts.     

The role of collaborative interactivity in the observational practice of clinical skills

Medical Education 2012: 46 : 409–416 Context Video‐based observational practice can extend simulation‐based learning outside the training space. This study explores the value of collaborative feedback provided during observational practice to the acquisition of clinical skills. Methods Nursing students viewed a video demonstrating the proper ventrogluteal injection technique before performing a videotaped pre‐test trial on a simulator. They were then assigned randomly to one of three observational practice groups: a group that observed the expert demonstration (EO group); a group that viewed the expert demonstration, self‐assessed their individual pre‐test and contrasted their self‐assessments with expert feedback (ESO group), and a group that observed the expert demonstration, self‐assessed and contrasted their assessments with those of an expert, and formed a community that engaged in peer‐to‐peer feedback (ESPO group). The observation of all videos, the provision of assessments and all networking occurred via an Internet‐mediated network. After 2 weeks, participants returned for post‐tests and transfer tests. Results The pre‐test–post‐test analyses revealed significant interactions (global rating scale: F_(2,22) = 4.00 [p = 0.033]; checklist: F_(2,22) = 4.31 [p = 0.026]), which indicated that post‐test performance in the ESPO group was significantly better than pre‐test performance. The transfer analyses revealed main effects for both the global rating scale (F_(2,23) = 6.73; p = 0.005) and validated checklist (F_(2,23) = 7.04; p = 0.004) measures. Participants in the ESPO group performed better on the transfer test than those in the EO group. Conclusions The results suggest that video‐based observational practice can be effective in extending simulation‐based learning, but its effectiveness is mediated by the amount of time the learner spends engaged in the practice and the type of learning activities the learner performs in the observational practice environment. We speculate that increasing collaborative interactivity supports observational learning by increasing the extent to which the educational environment can accommodate learners’ specific needs.     

Patient participation in decision‐making on the introduction of home respiratory care: who does not participate?

Objectives In this study we examined home respiratory patients' participation in decision‐making on whether to begin home respiratory care therapy, and this participation in decision‐making during the latest visit to the clinic. Subjects and methods The target population consisted of patients who were using home respiratory care devices and who were visiting the outpatient clinics. Postal questionnaires were sent to 4159 patients (40% of respiratory care device users in Finland). A total of 3336 answered (response rate 80%) and 3153 were eligible for analysis. Odds ratios, chi‐square tests, Mann–Whitney U‐test and stepwise logistic regression analysis were used in the data analyses. Results Patients who did not participate in decision‐making were more frequently older people, women and had lower income than the other patients. While these results parallel those of previous studies, in contrast we found more women with high education to be non‐participants. Non‐participants were not participating in decision‐making during their latest visit to the clinic in spite of the fact that they considered participation almost as important as did the other patients. Non‐participants were less satisfied with the quality of care given and felt that their life had improved less than did the other patients. Conclusion The ethical principle of equal opportunities to participate in care decisions was not applied among home respiratory care patients in this study. The results challenge health‐care professionals to notice inequalities and improve their practices. The results can be generalized to all home respiratory care patients in Finland.     

A tailored intervention to promote breast cancer screening among South Asian immigrant women

This study developed and evaluated a socioculturally tailored intervention to improve knowledge, beliefs and clinical breast examination (CBE) among South Asian (SA) immigrant women. The intervention comprised a series of socioculturally tailored breast-health articles published in Urdu and Hindi community newspapers. A pre- and post-intervention design evaluated the impact of the mailed articles among 74 participants. The mean age of participants was 37 years (SD 9.7) and they had lived 6 years (SD 6.6) in Canada. After the intervention, there was a significant increase in self-reporting 'ever had' routine physical checkup (46.4-70.8%; p < 0.01) and CBE (33.3-59.7%; p < 0.001). Also, the total summed scores of accurate answers to 12 knowledge items increased (3.3-7.0; p < 0.001). For constructs of health belief model, participants rated their level of agreement for a number of items on a scale of 1-4 (disagree to agree). After the intervention the following decreased: misperception of low susceptibility to breast cancer among SA immigrant women (3.0-2.4; p < 0.001); misperception of short survival after diagnosis (2.7-1.8; p < 0.001); and perceived barriers to CBE (2.5-2.1; p < 0.001). Self-efficacy to have CBE increased (3.1-3.6; p < 0.001). The change scores of five predictor variables were entered in a direct logistic regression to predict the uptake of CBE among participants who never had it prior to the intervention. The model, as a set, was statistically reliable [chi2(5, n = 48) = 14.2 , p < 0.01] and explained 35% of variance in the outcome; perceived barriers remained an independently significant predictor. The results support the effectiveness of written socioculturally tailored language-specific health education materials in promoting breast cancer screening within the targeted population. Future research should test the intervention in other vulnerable populations.     

Peer influence on students’ estimates of performance: social comparison in clinical rotations

Context During clinical rotations, students move from one clinical situation to another. Questions exist about students’ strategies for coping with these transitions. These strategies may include a process of social comparison because in this context it offers the student an opportunity to estimate his or her abilities to master a novel rotation. These estimates are relevant for learning and performance because they are related to self‐efficacy. We investigated whether student estimates of their own future performance are influenced by the performance level and gender of the peer with whom the student compares him‐ or herself. Methods We designed an experimental study in which participating students (n = 321) were divided into groups assigned to 12 different conditions. Each condition entailed a written comparison situation in which a peer student had completed the rotation the participant was required to undertake next. Differences between conditions were determined by the performance level (worse, similar or better) and gender of the comparison peer. The overall grade achieved by the comparison peer remained the same in all conditions. We asked participants to estimate their own future performance in that novel rotation. Differences between their estimates were analysed using analysis of variance (anova) . Results Students’ estimates of their future performance were highest when the comparison peer was presented as performing less well and lowest when the comparison peer was presented as performing better (p < 0.001). Estimates of male and female students in same‐gender comparison conditions did not differ. In two of three opposite‐gender conditions, male students’ estimates were higher than those of females (p < 0.001 and p < 0.05, respectively). Conclusions Social comparison influences students’ estimates of their future performance in a novel rotation. The effect depends on the performance level and gender of the comparison peer. This indicates that comparisons against particular peers may strengthen or diminish a student’s self‐efficacy, which, in turn, may ease or hamper the student’s learning during clinical rotations. The study is limited by its experimental design. Future research should focus on students’ comparison behaviour in real transitions.     

General performance on a numeracy scale among highly educated samples.

BACKGROUND: Numeracy, how facile people are with basic probability and mathematical concepts, is associated with how people perceive health risks. Performance on simple numeracy problems has been poor among populations with little as well as more formal education. Here, we examine how highly educated participants performed on a general and an expanded numeracy scale. The latter was designed within the context of health risks. METHOD: A total of 463 men and women aged 40 and older completed a 3-item general and an expanded 7-item numeracy scale. The expanded scale assessed how well people 1) differentiate and perform simple mathematical operations on risk magnitudes using percentages and proportions, 2) convert percentages to proportions, 3) convert proportions to percentages, and 4) convert probabilities to proportions. RESULTS: On average, 18% and 32% of participants correctly answered all of the general and expanded numeracy scale items, respectively. Approximately 16% to 20% incorrectly answered the most straightforward questions pertaining to risk magnitudes (e.g., Which represents the larger risk: 1%, 5%, or 10%?). A factor analysis revealed that the general and expanded risk numeracy items tapped the construct of global numeracy. CONCLUSIONS: These results suggest that even highly educated participants have difficulty with relatively simple numeracy questions, thus replicating in part earlier studies. The implication is that usual strategies for communicating numerical risk may be flawed. Methods and consequences of communicating health risk information tailored to a person's level of numeracy should be explored further.     

Using electronic flashcards to promote learning in medical students: retesting versus restudying

Medical Education 2011: 45 : 1101–1110 Context The superiority of retesting over restudying in terms of knowledge retention and skills acquisition has been proven in both laboratory and classroom settings, as well as in doctors’ practice. However, it is still unclear how important retesting strategies are to the learning of relevant factual knowledge in undergraduate medical education. Methods Eighty students in Years 3–5 of medical school in Munich participated in a prospective, randomised, double‐blinded, controlled study in which they were exposed to 30 electronic flashcards designed to help them memorise key factual knowledge in the domain of clinical nephrology. The flashcards were presented in four successive learning cycles, each consisting of a study period and a subsequent test period. Half of all participants were randomised to repetitive studying (restudy group) and half were randomised to repetitive testing (retest group) of successfully memorised flashcards. Knowledge retention was assessed after 1 week and 6 months. Additionally, personal data, self‐reflection on the efficacy of the learning strategies and judgements of learning were obtained by questionnaires. Results Repetitive testing promoted better recall than repetitive studying after 1 week (p < 0.001). However, after 6 months general recall was poor and no difference between the restudy and retest groups was observed. Time on task and number of trials, in addition to sex, age, performance and psycho‐social background, did not vary between the groups. Self‐predictions of student performance did not correlate with actual performance. Conclusions In the context of using electronic flashcards, repetitive testing is a more potent learning strategy than repetitive studying for short‐term but not long‐term knowledge retention in clinical medical students. Although students use testing as a learning strategy, they seem to be unaware of its superiority in supporting short‐term knowledge retention.     

Techniques for teaching electrocardiogram interpretation: self-directed learning is less effective than a workshop or lecture

Medical Education 2011: 45 : 347–353 Context Teaching 12‐lead electrocardiogram (ECG) interpretation to students and residents is a challenge for medical educators. To date, few studies have compared the effectiveness of different techniques used for ECG teaching. Objectives This study aimed to determine if common teaching techniques, such as those involving workshops, lectures and self‐directed learning (SDL), increase medical students’ ability to correctly interpret ECGs. It also aimed to compare the effectiveness of these formats. Methods This was a prospective randomised study conducted over a 28‐month period. Year 4 medical students were randomised to receive teaching in ECG interpretation using one of three teaching formats: workshop, lecture or SDL. All three formats covered the same content. Students were administered three tests: a pre‐test (before teaching); a post‐test (immediately after teaching), and a retention test (1 week after teaching). Each tested the same content using 25 questions worth 1 point each. A mixed‐model repeated‐measures analysis of variance (anova ) with least squares post hoc analysis was conducted to determine if differences in test scores between the formats were statistically significant. Results Of the 223 students for whom data were analysed, 79 were randomised to a workshop, 82 to a lecture‐based format and 62 to SDL. All three teaching formats resulted in a statistically significant improvement in individual test scores (p < 0.001). Comparison of the lecture‐ and workshop‐based formats demonstrated no difference in test scores (marginal mean [MM] for both formats = 12.4, 95% confidence interval [95% CI] 11.7–13.2]; p = 0.99). Test scores of students using SDL (MM = 10.7, 95% CI 9.8–11.5) were lower than those of students in the workshop (p = 0.003) and lecture (p = 0.002) groups. Conclusions Compared with those taught using workshop‐ and lecture‐based formats, medical students learning ECG interpretation by SDL had lower test scores.     

Literacy and retention of information after a multimedia diabetes education program and teach-back

Few studies have examined the effectiveness of teaching strategies to improve patients' recall and retention of information. As a next step in implementing a literacy-appropriate, multimedia diabetes education program (MDEP), the present study reports the results of two experiments designed to answer (a) how much knowledge is retained 2 weeks after viewing the MDEP, (b) does knowledge retention differ across literacy levels, and (c) does adding a teach-back protocol after the MDEP improve knowledge retention at 2-weeks' follow-up? In Experiment 1, adult primary care patients (n = 113) watched the MDEP and answered knowledge-based questions about diabetes before and after viewing the MDEP. Two weeks later, participants completed the knowledge assessment a third time. Methods and procedures for Experiment 2 (n = 58) were exactly the same, except that if participants answered a question incorrectly after watching the MDEP, they received teach-back, wherein the information was reviewed and the question was asked again, up to two times. Two weeks later, Experiment 2 participants completed the knowledge assessment again. Literacy was measured using the S-TOFHLA. After 2 weeks, all participants, regardless of their literacy levels, forgot approximately half the new information they had learned from the MDEP. In regression models, adding a teach-back protocol did not improve knowledge retention among participants and literacy was not associated with knowledge retention at 2 weeks. Health education interventions must incorporate strategies that can improve retention of health information and actively engage patients in long-term learning.     

Characteristics of tobacco smoking in schools in Andorra]

1600 schoolchildren aged 13 to 18 answered an anonimus, self administered questionnaire, in a cross sectional study to estimate the prevalence of cigarette smoking in the high grades schools in Andorra. 46.6% answered they did smoke cigarettes, either daily (11.2%) or occasionally (35.4%). Ten per cent of actual smokers did already smoke at age 10, and 50% at age 13. More girls (48.8%) than boys (44.4%) smoked (p less than 0.05) but boys smoked a greater number of cigarettes (p less than 0.001). Ninety five percent smoked Virginia tobacco, and little more than 50% used filter tipped cigarettes. Two thirds of smokers inhaled the smoke of cigarettes; this was more common among daily smokers. Again two thirds of smokers answered they would be prepared to quit smoking. 31% of those who had tried smoking said they believed they would smoke in the future, while only 5.6% of those that never smoked previously said so (p less than 0.001). Actual smokers answered they believed that they would not smoke in the future much less often than non smokers. Parents let boys smoke more than girls when the children started doing so, particularly before age thirteen and after age fifteen. These are the first available data about the community studied describing some features of its cigarette smoking habit. Their knowledge may well help to plan disease protection and health promotion developments addressed to youngsters in Andorra.     

Should we teach using schemas? Evidence from a randomised trial

Medical Education 2012: 46: 815–822 Context Schema‐based instruction may alter knowledge organisation and diagnostic reasoning strategies through the provision of structured knowledge to novice trainees. The effects of schema‐based instruction on diagnostic accuracy and knowledge organisation have not been rigorously tested. Methods Year 2 medical students were randomised to learn four cardiac diagnoses using schema‐based instruction (n = 26) or traditional instruction (n = 27) on a high‐fidelity cardiopulmonary simulator (CPS). Students completed case‐based learning in groups of two to five and underwent individual written and practical tests. The written test consisted of questions testing features that linked or distinguished diagnoses (structured knowledge) and questions testing features of individual diagnoses (factual knowledge). A practical test of diagnostic accuracy on the CPS was performed for two diagnoses present in the learning phase (taught lesions) and two untaught lesions. A majority of students (n = 37, 70%) voluntarily returned for follow‐up written testing 2–4 weeks later. Results Learning time and accuracy did not differ between students on schema‐based and those on traditional instruction. Students receiving schema‐based instruction performed better on structured knowledge questions (p < 0.001) and no differently on factual knowledge questions (p = 0.7). Relative differences between groups remained unchanged on follow‐up testing. Diagnostic success was higher in the schema‐based instruction group for taught lesions (mean difference = 38%, 95% confidence interval [CI] 20–56; p < 0.001) and untaught lesions (mean difference = 31%, 95% CI 15–48; p < 0.001). Conclusions Schema‐based instruction was associated with improved retention of structured knowledge and diagnostic performance among novices. This study provides important proof‐of‐concept for a schema‐based approach and suggests there is substantial benefit to using this approach with novice trainees.     

Nutrition knowledge among Navy recruits

The Navy wants to incorporate nutrition education programs into basic training to teach Navy personnel fundamental principles of good nutrition. This study was undertaken to: determine deficits in recruits' nutrition knowledge, identify recruits with above-average need for nutrition education, and compare recruits' nutrition knowledge with that of typical U.S. school students. Demographic information and responses to a shortened version (36 items) of the National Dairy Council's Nutrition Achievement Test 4, developed for junior and senior high school students, were obtained from 205 male recruits. Although nutrition knowledge among Navy recruits was relatively comparable with that of U.S. school students, findings indicated that nutrition education is indeed needed. Only 2% of recruits answered 90% of the questions correctly. Forty percent answered half or more of the nutrition questions incorrectly. Questions answered incorrectly by more than 50% of recruits involved: (a) how one assesses nutrient needs and whether those needs are being met, (b) the four major food groups and recommended servings, and (c) effects of alcohol and drugs on nutritional status. Recruits who received higher grades in high school, got into less trouble in high school, were older, and were Caucasian had higher nutrition knowledge. Detailed information regarding nutrition misconceptions should help the Navy develop focused nutrition education materials.     

Medical tests: women's reported and preferred decision-making roles and preferences for information on benefits, side-effects and false results

Objective To determine women's preferences for and reported experience with medical test decision‐making. Design Computer‐assisted telephone survey. Setting and participants Six hundred and fifty‐two women resident in households randomly selected from the New South Wales electronic white pages. Main outcome measures Reported and preferred test and treatment (for comparison) decision‐making, satisfaction with and anxiety about information on false results and side‐effects; and effect of anxiety on desire for such information. Results Overall most women preferred to share test (94.6%) and treatment (91.2%) decision‐making equally with their doctor, or to take a more active role, with only 5.4–8.9% reporting they wanted the doctor to make these decisions on their behalf. This pattern was consistent across all age groups. In general, women reported experiencing a decision‐making role that was consistent with their preference. Women who had a usual doctor were more likely to report experiencing an active role in decision‐making. More women reported receiving as much information as they wanted about the benefits of tests and treatment than about the side‐effects of tests and treatment. Most women wanted information about the possibility of false test results (91.5%) and test side‐effects (95.6%), but many reported the doctor never provided this information (false results = 40.0% and side‐effects = 31.3%). A substantial proportion said this information would make them anxious (false results = 56.6% and side‐effects = 43.1%), but reported they wanted the information anyway (false results = 77.6% and side‐effects = 88.1%). Conclusions Women prefer an active role in test and treatment decision‐making. Many women reported receiving inadequate information. If so, this may jeopardize informed decision‐making.     

Intraindividual change and interindividual differences in factors influencing older women's health‐seeking behavior

Our primary purpose in conducting this study was to examine the factor structure of older women's health‐seeking behavior, which we assessed over 100 occasions. This was accomplished with a daily self‐report of nutritional, exercise, and adherence behaviors. A secondary purpose was to determine differences in the stability and lability of health‐seeking behavior factors. The sample consisted of 4 women in their 60s and 4 women in their 80s. By using P‐technique factor analysis, in which the sample size is determined by number of occasions rather than participants, we examined individual factors of health‐seeking behavior for variability over time. Both activity and dietary items made up the health‐seeking behavior factors of participants who were in their 60s, whereas for participants in their 80s factors comprised only activity items. The stability of most of these health‐seeking behaviors indicated that these behaviors may be more trait‐like than state‐like in these older women.