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Results for “Utility Theory”

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PubMed2005

A procedural model for planning and evaluating behavioral interventions.

OBJECTIVE: A model for planning, implementing and evaluating health behavior change strategies is proposed. Variables are presented which can be used in the model or serve as examples for how the model is utilized once a theory of health behavior is adopted. RESULTS: Examples of three innovative strategies designed to influence behavior change are presented so that the proposed model can be modified for use following comprehensive screening and baseline measurements. Three measurement priorities: clients, methods and agency are subjected to three phases of assessment: goals, implementation and effects. CONCLUSION: Lifestyles account for the majority of variability in quality-of-life and premature morbidity and mortality. Interventions designed to influence healthy behavior changes must be driven by theory and carefully planned and evaluated. The proposed model is offered as a useful tool for the behavior change strategist.

Behavior Therapy↗

PubMed1991

Holding death at bay: the experience of the spouses of patients undergoing cardiovascular surgery.

This study utilized a grounded theory design to investigate the experiences related to being the spouse of a cardiovascular surgical patient during five subject-identified phases: a) finding out the surgery was necessary, b) waiting for surgery, c) waiting during surgery, d) the intensive care unit (ICU) experience, and e) the recovery period before hospital discharge. Data were collected from each of eight subjects via three unstructured, tape-recorded interviews conducted a) on the day of the patients' hospital admission, b) during the first 48 hours of the patients' ICU stay and c) just before the patients' hospital discharge. Holding Death at Bay was identified as the core category. Three main categories: uncertainty, helping commitment and reorganization emerged from the data and were apparent in each of the five subject-identified phases of the spouses' experience. Main categories and subcategories of the core category emerging from the data are described. Implications of this research for nursing practice and further nursing research are discussed.

Adaptation, Psychological↗

PubMedDate not supplied

Planning change in scheduling practices: a theoretical perspective.

The dynamic nature of today's health care environment requires innovation and creativity in organizational structure and management style. Some of the most essential concerns of nursing staff today are related to quality of working life, and perhaps a central focus for most nurse employees is a scheduling system which offers the flexibility necessary for them to respond to an active personal and professional life. This paper describes the utilization of change theory in operationalizing new scheduling practices with four unique nursing groups. The self designed master rotation and a self scheduling process are two examples of innovative change implemented by four nurse managers. Each participative management approach is presented in relation to the phases of Lewin's change process. Strategies include a needs assessment survey, facilitating staff participation in the design, implementation and evaluation of a new scheduling practice and encouraging group responsibility for the process and outcome of the planned change.

Decision Making, Organizational↗

PubMed1989

[Study on "massage to activate the meridian" apparatus in the treatment of cholecystolithiasis].

This apparatus is designed in accordance with the doctrine and principles of traditional Chinese medicine and based on the theory of meridian and specific massage procedure in conjunction with the "Information Theory" and electron utilizing technique. It utilizes a programmed induction "Special Wave" to stimulate a series of acupuncture points, combined with administration of western drugs from a regime of "General Attack" treatment on the gallbladder stones, to enhance their evacuation. By stimulating the specific acupuncture points with this apparatus through the action of "Special Wave" strong contraction of the gallbladder can be elicitated. Experiments on dogs showed that under such stimulation the intra-gallbladder pressure can be increased 26 times, producing a jet of bile flow which facilitates the expulsion and evacuation of stones in the gallbladder. Method of use: first place a conductive rubber pad on the acupuncture point to be stimulated, then use a hand-held electrode to massage-stimulate the meridian. It is carried out forward and backward along the direction of meridian. The whole procedure is carried out under direct visualization with the help of ultrasonic B-scan. When dilatation of the common bile duct is observed, the hand-help electrode is used to perform push-compress massage on the meridian, and acupuncture points making the stones enter the common bile duct B-scan give proper orientation for the manipulation. This method has been tested clinically on 410 patients with good results. The evacuation rate of the gallbladder stones was 92.7% with complete evacuation achieved in 17.3%.(ABSTRACT TRUNCATED AT 250 WORDS)

Acupuncture Therapy↗

PubMed1979

Parent-peer influence as a predictor of marijuana use.

Although there is some literature which discusses adolescent reference groups, none have utilized reference group theory to examine the relative impact of the parent and peer reference groups and to attempt to predict behavior among teenagers from this knowledge. This study attempts to correct this deficiency by examining the frequency of marijuana use in a nonrandom sample of college students from a large southwestern university. Ordinal type scales and tau-b provide a statistically strong degree of association between the type of reference group orientation and marijuana use. The results of this study show that the influence of the most salient reference group appears to be an important predictor of whether or not an individual may engage in the use of marijuana.

Adolescent↗

PubMedDate not supplied

Compliance: an interactionist approach.

Compliance is central to health care, but by its very nature it remains problematic to health care providers and health care receivers. In this article an interactional approach, the utilization of role theory, in the study of compliance is proposed. Rationale for the need for such a framework is provided through the presentation and critique of currently used models and theories, such as the medical model, the health belief model, control theory, and learning theory. Assumptions of the proposed framework are presented, and four components are identified when considering compliance enactment from an interactional perspective. These are: self-concept, role enactment, complementary roles, and periodic evaluation of role enactment by self and others. Several theoretical propositions evolve as central to the development of a unified framework for compliance. The propositions can be considered potential hypotheses. This article demonstrates one approach to theory development in nursing.

Attitude to Health↗

PubMed1996

Folk medicine and health beliefs: an Appalachian perspective.

This article examines Appalachian folk medicine and considers the importance of utilizing an integrative theory, the Health Belief Model, to understand the use of alternative medicine in the United States. The author examines the need for social workers and other health care providers to further assess the roles of folk medicine in an Appalachian client population. The author creates linkages among the limited writings in the literature regarding folk medical practices of Appalachians and also draws examples of folk medicine usage from qualitative research and professional intervention with this client group. The author focuses on how mainstream health care professionals may assess the role of folk medicine in the lives of their clients by approaching folk medicine as a focal and culturally-imbedded component of their clients' overall health care. Moreover, the author addresses the need for health care professionals to become not only aware of folk medical practices, but to act as advocates for culturally competent health care within the larger health care delivery system which largely overlooks or downplays the significance of folk medicine. In an age of expensive and constricted mainstream health care services and the implementation of managed care, the author examines how folk medical practices factor into primary health care.

Appalachian Region↗

PubMed1998

[Choice and disclosure of preferences, towards sharing the therapeutic decision in cancerology: from economic theory to medical practice].

Today, as it is often difficult to demonstrate the superiority of a new molecule or a therapeutic strategy in term of plain efficacy on disease, the incitement is strong to provide some complementary argument of assessment, we are assisting to the emergence of a new concept: shared therapeutic decision making. Is the application of this concept--with make the paternalistic model questionnable--adapted to all cases? What are the different levels of participation that could be envisaged? Are there favourable methods for this participations? This shared decision making--direct (patients' choice between treatment options) or indirect (integration of elicited preferences in the decision process)--if it has to be efficient, must surround with care: to define its application limitation, to protect itself of manipulation. It shall require to consider information transmission difficulties, to establish some elicitation preference method. Some technical, such as time trade off, standard gamble or willingness to pay, supported by economic theory of expected utility, permit to help eliciting patients' preferences and to structure the therapeutic choice. Some empirical study of preference elicitation shall permit to get clear the complexity of trade off between the different choice element that could enter in the acceptability of the treatment for patients.

Age Factors↗

PubMed1999

Associations between health status and utilities implications for policy.

BACKGROUND: If shape of a person's utility function is associated with his health status, as is predicted by Prospect Theory, the use of utilities from the healthy could result in 'de facto' discrimination against the sick. OBJECTIVES: To determine if patients' utilities for hypothetical states and for their current health were associated with their health status. DESIGN: A cross-sectional study of the health and values of patients with depressive illnesses. SETTING: Patients from three large primary care practices with various medical illnesses complicated by symptoms of depression. MEASURES: Short-Form 12 health status measurements, standard gamble, and visual analog scale preference measurements for patients' current health and for three hypothetical states. RESULTS: One hundred and forty nine patients enrolled in the study and 139 patients completed the survey. Utilities for the best and worst states were similar across different levels of health status; however, standard gamble utilities for intermediate health states were higher for patients in poorer health than patients in better health (P = 0.019,) suggesting utility functions with radically different shapes. Utilities for patients' current health were also associated with their health status. Patients in poor health tended to overvalue their current health relative to the most similar hypothetical state; whereas, patients in good health tended undervalue their current health state (P = 0.036). CONCLUSIONS: In patients with depressive illnesses, there were significant interactions between health and values, that were consistent with the predictions of Prospect Theory, and that could result in systematic under valuation of the health effects of treatments that primarily benefit more severely patients ill.

Adult↗

PubMed2000

Methodological issues in grounded theory.

Examination of the qualitative methodological literature shows that there appear to be conflicting opinions and unresolved issues regarding the nature and process of grounded theory. Researchers proposing to utilize this method would therefore be wise to consider these conflicting opinions. This paper therefore identifies and attempts to address four key issues, namely, sampling, creativity and reflexivity, the use of literature, and precision within grounded theory. The following recommendations are made. When utilizing a grounded method researchers need to consider their research question, clarify what level of theory is likely to be induced from their study, and then decide when they intend to access and introduce the second body of literature. They should acknowledge that in the early stages of data collection, some purposeful sampling appears to occur. In their search for conceptually dense theory, grounded theory researchers may wish to free themselves from the constraints that limit their use of creativity and tacit knowledge. Furthermore, the interests of researchers might be served by attention to issues of precision including, avoiding method slurring, ensuring theoretical coding occurs, and using predominantly one method of grounded theory while explaining and describing any deviation away from this chosen method. Such mindfulness and the resulting methodological rigour is likely to increase the overall quality of the inquiry and enhance the credibility of the findings.

Humans↗

PubMed1990

Seeking safe passage: utilizing health care during pregnancy.

This grounded theory study was conducted to explore how women utilize health care during pregnancy. The 27 women who were interviewed had sought prenatal care early, late or not at all. Transcriptions from the interviews were subjected to constant comparative analysis. The major concern of the women was seeking safe passage through pregnancy and childbirth. Processes used to achieve safe passage were searching for care, consulting, transferring, waiting, contingency planning and self-care. Discussed in this paper is the role that choice plays in utilizing care and transferring some elements of prenatal care to women to manage themselves.

Choice Behavior↗

PubMed1995

The chemistry of defense: theory and practice.

Defensive chemicals used by organisms for protection against potential consumers are generally products of secondary metabolism. Such chemicals are characteristic of free-living organisms with a limited range of movement or limited control over their movements. Despite the fact that chemical defense is widespread among animals as well as plants, the vast majority of theories advanced to account for patterns of allocation of energy and materials to defensive chemistry derive exclusively from studies of plant-herbivore interactions. Many such theories place an undue emphasis on primary physiological processes that are unique to plants (e.g., photosynthesis), rendering such theories limited in their utility or predictive power. The general failure of any single all-encompassing theory to gain acceptance to date may indicate that such a theory might not be a biologically realistic expectation. In lieu of refining theory, focusing attention on the genetic and biochemical mechanisms that underlie chemical defense allocation is likely to provide greater insights into understanding patterns across taxa. In particular, generalizations derived from understanding such mechanisms in natural systems have immediate applications in altering patterns of human use of natural and synthetic chemicals for pest control.

Animals↗

PubMed2006

Using functional theory to promote HIV testing: the impact of value-expressive messages, uncertainty, and fear.

This study tests the utility of the functional theory of attitudes and arousal of fear in motivating college students to get tested for HIV. It is argued from the perspective of functional theory that value-expressive appeals to get tested for the purpose of taking care of one's own health could be effective if that goal is desired by message targets who are sexually active and unaware of their sexually transmitted disease status. As part of the process, the effectiveness of these appeals is increased by the arousal of uncertainty and fear. A model detailing the mediating processes is proposed and found to be consistent with the data. Overall, messages advocating testing for the self-interested reason of one's own health were more effective than messages advocating testing for the goal of protecting one's partners.

AIDS Serodiagnosis↗

PubMed1992

Chaos, an omen of transcendence in the psychotherapeutic process.

Here some of the basic ideas assembled under the recently coined term chaos theory are applied to the process of psychotherapy. Utilizing some ideas from chaos theory, "chaos" is defined in psychological terms as a state of overwhelming anxiety and is interpreted as the first indication of potential psychological growth. The concepts of Analytical Psychology and the modality of sandtray therapy are used to illustrate the type of therapeutic approach this theoretical work proposes in the transcendent cycle. Psychotherapy simply facilitates a transformation, wherein clients are guided through the chaos they are experiencing so that they may grow beyond their current psychological limitations.

Adaptation, Psychological↗

PubMed1994

The use of spectral analysis to determine regional cerebral glucose utilization with positron emission tomography and [18F]fluorodeoxyglucose: theory, implementation, and optimization procedures.

A method for kinetic analysis of dynamic positron emission tomography (PET) data by linear programming that allows identification of the components of a measured PET signal without predefining a compartmental model has recently been proposed by Cunningham and co-workers. The method identifies a small subset of functions from a large input set of feasible functions that best fits the time course of total radioactivity measured by PET. To investigate in detail the properties of this technique, we applied it to PET studies with [18F]fluorodeoxyglucose, a tracer with well-characterized kinetic properties. We examined dynamically acquired data over various time intervals in many brain regions and found that the number of components identified by the method is stable and consistent with the presence of kinetic heterogeneity in every region. We optimized the method for determination of regional rates of glucose utilization; calculated rates were found to be somewhat dependent upon the treatment of noise in the measured tissue data and upon the time interval in which the data were collected. The application of a numerical filter to remove noise in the data resulted in values for regional cerebral glucose utilization that were stable with time and consistent with rates determined by the other established techniques. Based on the results of the current study, we expect that the spectral analysis technique will prove to be a highly flexible tool for kinetic analysis of other tracer compounds; it is capable of producing low-variance, time-stable estimates of physiological parameters when optimized for time interval of application, input spectrum of components, and processing of noise in the data.

Adult↗

PubMed1989

Technological innovation and the labour process in health care.

The process of technological innovation in health care is explored in this paper using labour process theory. Taking the specific case study of diagnostic imaging technology it argues for the utility of labour process theory for analysing the professional labour process as a means of delineating the social contexts in which technological innovation provides a means of empowering workers.

Health Policy↗

PubMed2000

Exercise participation decisions of Jordanian myocardial infarction patients: application of the decisional conflict theory.

This study examined the utility of Janis and Mann's [Janis, I. L. & Mann, L. (1977). Decision making: a psychological analysis conflict, choice and commitment. New York, NY: Free press.] decisional conflict theory (DCT) in predicting decisions to exercise following hospitalization for a myocardial infarction (MI). A structured interview of operationalized DCT variables was conducted with 88 MI patients attending cardiology clinics in two Jordanian military hospitals. Stress was viewed as an indicator of exercise benefits-barriers decisional conflict. The findings revealed that the benefits-barriers interaction significantly predicted stress for the 48 patients who did not exercise. Rehospitalization for cardiac events was a significant predictor of stress for the 40 exercisers. Preinfarction exercise behavior, stress and gender were significant predictors of MI patients' decisions to exercise. Results of this study indicated that decisional conflict and stress were characteristics of MI patients who delayed or avoided exercising.

Adaptation, Psychological↗

PubMed2004

How can Health Behavior Theory be made more useful for intervention research?

BACKGROUND: The present paper expresses the author's views about the practical utility of Health Behavior Theory for health behavior intervention research. The views are skeptical and perhaps even a bit exaggerated. They are, however, also based on 20-plus years of in-the-trenches research focused on improving health behavior practice through research. DISCUSSION: The author's research has been theoretically driven and has involved measurement of varying variables considered to be important theoretical mediators and moderators of health behavior. Regretfully, much of this work has found these variables wanting in basic scientific merit. Health Behavior Theory as we have known it over the last 25 years or so has been dominated by conceptualizations of behavior change processes that highlight cognitive decision-making. Although much of health behavior practice targets what people do rather than what they think, the logic of focusing on thoughts is that what people think about is the key to what they will do in the future, and that interventions that can measure and harness those processes will succeed to a greater extent than those that do not. Unfortunately, in the author's experience, the premise of cognitive theories has fallen short empirically in a number of ways. The cognitive schemata favored by most health behavior theories are difficult to measure, they do not predict behavioral outcomes very well, there is little evidence that they cause behavior, and they are hard to change directly. SUMMARY: It is suggested that health behavior researchers reconsider their use of these theories in favor of models whose variables are more accessible to observation and experimental manipulation and that most importantly have strong empirical support.

Journal Article↗