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Determinants of adolescents' satisfaction with health care providers and intentions to keep follow-up appointments.

OBJECTIVE: To better understand the determinants of adolescents' satisfaction with their health care providers and to examine the relationship among satisfaction, intention to return for follow-up, and appointment-keeping behavior. METHODS: One hundred and twenty-four adolescent patients attending a university-based general adolescent medicine clinic were surveyed prior to the visit about their attitudes regarding provider behavior. After the visit, subjects completed a questionnaire on provider behavior during the visit, satisfaction with the visit, and intention to keep their follow-up appointment. RESULTS: Multivariate regression analysis revealed that pre-visit attitudes about providers' style of behavior predicted satisfaction (beta = 0.252; p < 0.01). After controlling for pre-visit attitudes, perceptions about providers' style of behavior proved to be a strong predictor of visit satisfaction (beta = 0.512; p < 0.01). Visit satisfaction was associated with intention to keep scheduled follow-up appointments (r = 0.327; p < 0.01). However, subjects with greater intention to return were not more likely to keep their follow-up appointments. CONCLUSION: Provider behavior is an important determinant of adolescents' satisfaction with their health care.

Adolescent↗

Does intentional weight loss affect mortality rate?

Short-term studies indicate that intentional weight loss among obese persons significantly improves physiologic variables. Hence, it is logical to conjecture that intentional weight loss would lead to long-term benefits and increased longevity. Herein, we review recent epidemiologic studies that investigate the weight loss-mortality association using a conservative analytic approach that included distinguishing between intentional and unintentional weight loss, adjusting for potential confounders, and excluding unhealthy subjects. On balance, results indicate that intentional weight loss appears to neither increase nor decrease mortality rate. Discussion focuses on the problems of addressing this important public health question with observational data.

Journal Article↗

Psychosocial and demographic variables associated with consumer intention to purchase sustainably produced foods as defined by the Midwest Food Alliance.

OBJECTIVE: To examine psychosocial and demographic variables associated with consumer intention to purchase sustainably produced foods using an expanded Theory of Planned Behavior. DESIGN: Consumers were approached at the store entrance and asked to complete a self-administered survey. SETTING: Three metropolitan Minnesota grocery stores. PARTICIPANTS: Participants (n = 550) were adults who shopped at the store: the majority were white, female, and highly educated and earned >or= 50,000 dollars/year. Participation rates averaged 62%. MAIN OUTCOME MEASURES: The major domain investigated was consumer support for sustainably produced foods. Demographics, beliefs, attitudes, subjective norm, and self-identity and perceived behavioral control were evaluated as predictors of intention to purchase them. ANALYSIS: Descriptive statistics, independent t tests, one-way analysis of variance, Pearson product moment correlation coefficients, and stepwise multiple regression analyses (P <.05). RESULTS: Consumers were supportive of sustainably produced foods but not highly confident in their ability to purchase them. Independent predictors of intention to purchase them included attitudes, beliefs, perceived behavioral control, subjective norm, past buying behavior, and marital status. CONCLUSIONS AND IMPLICATIONS: Beliefs, attitudes, and confidence level may influence intention to purchase sustainably produced foods. Nutrition educators could increase consumers' awareness of sustainably produced foods by understanding their beliefs, attitudes, and confidence levels.

Adolescent↗

The value of assessing intent in attempted suicide.

Suicidal intent was assessed in a sample of 151 admissions to a general hospital for self-poisoning or self-inflicted injury. Severity of intent was associated with the act's medical seriousness and with the risk of suicide derived from a validated risk scale. Although high and low intent cases were comparable in respect of precipitating factors, patients rated high on suicidal intent were more likely to have experienced depressive symptoms in the previous month.

Adolescent↗

Pregnancy intention and pregnancy happiness: are they different?

OBJECTIVES: This study examines the relationship among pregnancy intention and attitudes, inconsistent contraceptive use, and plans for potential pregnancy among 311 women who presented at local health departments to seek a pregnancy test and for whom a pregnancy would be unintended. METHODS: Women were surveyed prior to receiving pregnancy tests. Pregnancy intention was measured using traditional classifications of mistimed and unwanted pregnancies. Frequency distributions and chi-square tests were computed to examine and compare rates of happiness about the pregnancy among women with mistimed or unwanted pregnancy and to compare rates of inconsistent contraceptive use and plans for the pregnancy by intention and level of happiness. RESULTS: Although all of the women selected for our sample stated that their pregnancies would be unintended, almost half (46%) were inconsistent contraceptive users. Further, 48% reported that they would be somewhat or very happy about a pregnancy. The proportion of women who were uncertain about the future of a pregnancy and who considered adoption or abortion was highest among those for whom a potential pregnancy was mistimed and who were unhappy about the pregnancy. CONCLUSIONS: Differentiating between pregnancy intention and happiness has practice implications for family planning and prenatal providers. Additional research should further elaborate these distinctions.

Abortion, Induced↗

Children's attitudes and behavioral intentions toward a peer with autistic behaviors: does a brief educational intervention have an effect?

This study examined children's ratings of attitudes and behavioral intentions toward a peer presented with or without autistic behaviors. The impact of information about autism on these ratings was investigated as well as age and gender effects. Third- and sixth-grade children (N = 233) were randomly assigned to view a video of the same boy in one of three conditions: No Autism, Autism, or Autism/Information. Children at both grade levels showed less positive attitudes toward the child in the two autism conditions. In rating their own behavioral intentions, children showed no differences between conditions. However, in attributing intentions to their classmates, older children and girls gave lower ratings to the child in the autism conditions. Information about autism did not affect ratings of either attitudes or behavioral intentions as ascribed to self or others.

Age Factors↗

The relationship between ethical ideology and ethical behavior intentions: an exploratory look at physicians' responses to managed care dilemmas.

Within the past few years, managed care health insurance programs have become commonplace. With managed care programs, however, physicians are facing increasing ethical pressures. This paper examines the relationship between physicians' behavior intentions with respect to four managed care ethical scenarios and their responses to Forsyth's (1980) Ethics Position Questionnaire (EPQ). This is one of the first papers to compare this scale to behavioral intentions in the workplace. We provide a literature review of the ethical dilemmas that doctors face under a managed care system and conduct a national random sample of general practitioners and surgeons regarding the four managed care ethical dilemmas. The results show that the doctors surveyed are significantly more idealistic than relativistic. In relating the EPQ to the ethical scenarios, however, there was no support for the proposition that ethical ideology was related to the ethical behavioral intentions. This suggests more research is needed to establish the links between ethical positions, attitudes, and behavioral intentions. Finally, there were little differences in EPQ scores by practice or demographic variables, the only significant result being that general surgeons are significantly more idealistic than family practitioners.

Confidentiality↗

Intentional and unintentional nonadherence: a study of decision making.

Nonadherence to medical regimens is a major problem in health care. Distinguishing between intentional nonadherence (missing/altering doses to suit one's needs) and unintentional nonadherence (forgetting to take medication) may help in understanding nonadherence. Participants with respiratory conditions completed an anonymous questionnaire about (i) nonadherence; (ii) reasons for and against taking medications; and (iii) perceived style of the consultation in which their medication was first prescribed, as well as demographic and clinical variables. Consistent with the hypotheses, intentional nonadherence is predicted by the balance of individuals' reasons for and against taking medication as suggested by the Utility Theory, where these reasons include only those which the individual considers relevant and on which he/she focuses. Unintentional nonadherence is less strongly associated with decision balance, and more so with demographics. The research highlights the importance of (a) treating intentional and unintentional nonadherence as separate entities and (b) assessing individuals' idiosyncratic beliefs when considering intentional nonadherence.

Adult↗

Psychometric evaluation of measures of organizational commitment and intention to quit among pharmaceutical scientists.

This study utilized different statistical techniques to evaluate the reliability (internal consistency) and the discriminant validity of the most widely used measures of organizational commitment and intention to quit (the employing organization). Data were obtained from a national mail survey of members of the American Association of Pharmaceutical Scientists (AAPS) working in the pharmaceutical industry. Both instruments had high Cronbach alpha values in this sample of pharmaceutical scientists. There was a substantial correlation between the scale designed to measure organizational commitment and that for intention to quit. Factor analysis revealed that there was only one common factor underlying the 20 items that were originally designed to measure two distinct constructs. The findings in this study suggested that the most widely used instruments designed to measure organizational commitment and intention to quit may be actually measuring one construct, or the theoretical constructs named as organizational commitment and intention to quit may not be empirically distinct.

Adult↗

Pregnancy intentions, pregnancy attitudes, and the use of prenatal care in Missouri.

OBJECTIVES: This study uses data from 2378 mothers of live-born infants from the NICHD/Missouri Maternal and Infant Health Survey to examine the relationship between pregnancy intention and adequacy of prenatal care. METHODS: Pregnancy intention was measured using traditional classifications of mistimed and unwanted pregnancies as well as additional measures of women's attitudes about their pregnancies. Odds ratios for inadequate prenatal care and its component parts (initiation of care and receipt of services) were calculated using multiple logistic regression in separate models and in a combined model for the measures of intention and attitude. RESULTS: Women's attitudes about their pregnancies were associated with inadequate prenatal care, including both inadequate initiation of care and inadequate receipt of services. Traditional measures of intendedness were significantly related only to inadequate initiation of care. Women who were unhappy about the pregnancy (OR = 1.44), unsure that they wanted to be pregnant (OR = 2.81), or denied their pregnancies (OR = 4.82) were more likely to have inadequate prenatal care than women who did not have these attitudes. Women who were unhappy about being pregnant (OR = 1.86), unsure that they wanted to be pregnant (OR = 3.44), or who denied the pregnancy (OR = 6.69) were more likely to have inadequate initiation of care. Women who were unsure that they wanted to be pregnant (OR = 1.95) or who denied their pregnancies (OR = 2.47) were more likely to have received inadequate care once they had entered care. CONCLUSIONS: This study suggests that attitudes about pregnancy may be a psychosocial barrier to women obtaining early and continuous prenatal care. Pregnancy attitudes should be assessed and appropriate services provided to improve women's utilization of prenatal care. New measures of pregnancy attitude, beyond the traditional intention measures, can be useful in assessing pregnancy wantedness and identifying women to target for these services.

Adolescent↗

Effects of a preventive intervention on adolescent substance use initiation, expectancies, and refusal intentions.

This study evaluated the effects of a school-based preventive intervention (Botvin, G. J. 1996, 2000) on growth trajectories of substance initiation (alcohol, tobacco, and marijuana), expectancies, and refusal intentions. A rural midwestern sample (N=847) provided three waves of data from middle school students. Growth curve analyses demonstrated that the intervention significantly slowed the rate of increase in substance initiation and significantly slowed the rate of decrease in refusal intentions. The intervention also slowed the rate of decrease in negative outcome expectancies, although the significance level was only marginal. A multiple group comparison showed that the impact of initial levels of substance initiation on growth trajectories of refusal intentions differed between conditions, suggesting that the intervention decreased the effect of early substance initiation on the rate of change over time for refusal intentions. Gender differences also were found, although the intervention was effective in slowing the rate of increase in initiation for both genders.

Adolescent↗

Intentional and unintentional injuries across health regions in Alberta, Canada: an implication for policy.

The growing practice of including intentional injuries (suicide and interpersonal violence) under the injury control umbrella has produced some controversy. The present study was designed to determine whether or not there might be an empirical basis for this initiative from an ecological point of view by examining the associations among unintentional and intentional injuries across 17 geographically defined health regions. The study was set in the Province of Alberta, Canada, where health services were delivered to a population of 2.96 million persons in 1999 through 17 regional health authorities. The results of a principal components analysis showed that nearly all causes of injury-hospitalization loaded on a single factor. It was not possible to produce separate factors for intentional and unintentional injuries. The strong intercorrelation among all measures suggests that there is an empirical basis for the view that intentional and unintentional injuries belong under the same conceptual umbrella, at least at the ecological level.

Accident Prevention↗

Periodontal healing after intentional auto-alloplastic reimplantation of injured immature upper front teeth.

BACKGROUND/AIMS: Conventional endodontic treatment results in high complication quota when performed in immature teeth. Intentional reimplantation with extraoral insertion of an endodontic implant (auto-alloplastic reimplantation) is an alternative. METHOD: In a retrospective study, the healing of 40 teeth reimplanted intentionally according to this method in patients aged 7 to 15 years was evaluated. Clinical tests (palpation, percussion sound, periotest values) and radiographical examinations were used to determine the type of periodontal healing (inflammatory resorption/periodontitis apicalis; replacement resorption/ankylosis; normal healing). RESULTS: Mean lifetime of the replanted teeth was 59.2+/-42.5 months, estimated survival time on the basis of the Kaplan-Meier analysis was 99.5 months. 17 teeth (42.5%) were classified as failures, mostly due to inflammatory resorption or periodontitis apicalis. Further investigations demonstrated that success rate and retention period of intentionally replanted teeth depend on the preoperative condition of the pulp. Teeth with preoperative infection suffered frequently from inflammatory resorption or periodontitis apicalis after being replanted (14 of 28 teeth). Estimated survival time according to Kaplan-Meier was 75.5 months. In contrast, inflammations or progressive resorptions were not observed in teeth without preoperative infection of the pulp. All these 12 teeth showed normal periodontal healing and regular tooth mobility. In the absence of any pathology in clinical or radiological findings after an average functional period of 72.3 months, the prognosis can be presumed excellent. Estimated survival time of 148.3 months according to Kaplan-Meier differs significantly from survival time of teeth infected preoperatively. CONCLUSIONS: From the results of this investigation, it may be concluded that an infection of the pulp - due to delay of treatment or attempts at endodontic therapy - should be avoided before intentional replantation of immature front teeth with pulp necrosis. Periodontal healing of the autologous root is not impaired by the insertion of posts made of Al2O3-ceramics or titanium. The inserted posts do not ankylose. Orthodontic movement of auto-alloplastically replanted teeth is possible.

Adolescent↗

Attributing negative intent to wife behavior: the attributions of maritally violent versus nonviolent men.

This study compared attributions for negative wife behavior offered by three groups of husbands: 22 maritally violent and distressed, 17 nonviolent but maritally distressed, and 17 nonviolent and nondistressed. Husbands rated wife behaviors presented in nine hypothetical problematic marital situation vignettes. On a measure of responsibility attributions, violent husbands were more likely than nondistressed husbands to attribute negative intentions, selfish motivation, and blame to the wife. On a measure of possible negative wife intentions, violent husbands were more likely than either distressed or nondistressed men to attribute negative intentions to the wife. Exploratory analyses suggested that certain types of marital situations (e.g., jealousy and rejection from wife) were particularly likely to elicit attributions of negative intent from violent husbands.

Adult↗

Therapists' intentional use of metaphor: memorability, clinical impact, and possible epistemic/motivational functions.

The memorability, clinical impact, and possible epistemic and motivational functions of therapists' intentional use of therapeutic metaphor were examined in 4 dyads of experiential psychotherapy. Clients tended to recall therapists' intentional metaphors approximately two thirds of the time, especially when these metaphors were developed collaboratively and repetitively. Clients rated therapy sessions in which they recalled therapists' intentional use of metaphors as more helpful than sessions in which they recalled therapeutic events other than therapists' intentional metaphors. Four distinctive epistemic and motivational functions of therapeutic metaphor were observed.

Adaptation, Psychological↗

Estimating individual influences of behavioral intentions: an application of random-effects modeling to the theory of reasoned action.

Methods are proposed and described for estimating the degree to which relations among variables vary at the individual level. As an example of the methods, M. Fishbein and I. Ajzen's (1975; I. Ajzen & M. Fishbein, 1980) theory of reasoned action is examined, which posits first that an individual's behavioral intentions are a function of 2 components: the individual's attitudes toward the behavior and the subjective norms as perceived by the individual. A second component of their theory is that individuals may weight these 2 components differently in assessing their behavioral intentions. This article illustrates the use of empirical Bayes methods based on a random-effects regression model to estimate these individual influences, estimating an individual's weighting of both of these components (attitudes toward the behavior and subjective norms) in relation to their behavioral intentions. This method can be used when an individual's behavioral intentions, subjective norms, and attitudes toward the behavior are all repeatedly measured. In this case, the empirical Bayes estimates are derived as a function of the data from the individual, strengthened by the overall sample data.

Adolescent↗

Intentionality in human gait control: modifying the frequency-to-amplitude relationship.

Tight frequency-to-amplitude relationships are observed in spontaneous human steady gait. If required, however, they can be modified. The following experiments were aimed at the processes underlying this flexibility, which forms the fundamental basis of the intentional adaptive capabilities of locomotion. In Experiment 1, Ss had to intentionally modify the frequency-to-amplitude relationship (leading to preferred or nonpreferred steady states). In Experiment 2, they had to temporarily perturbate the stride-frequency-to-amplitude relationship to intentionally shorten or lengthen 1 stride. Within the important constraints exerted by the head-arm-trunk system on leg movement, the results pointed out 2 main strategies that allow the S to intentionally adapt stride organization on-line: adjustment of the tonic properties of the oscillating leg to achieve nonpreferred steady states and phasic action to ensure temporary movement away from a steady state.

Acceleration↗

Using implementation intentions to increase attendance for cervical cancer screening.

This article evaluates an intervention based on P. M. Gollwitzer's (1993) concept of implementation intentions. Women registered at a medical practice in rural England (N = 114) completed measures of the theory of planned behavior variables before a manipulation that induced one half of the sample to form implementation intentions specifying when, where, and how they would make the appointment. Subsequent attendance was determined from medical records. Findings show that the theory of planned behavior variables and previous delay behavior provided good prediction of attendance. However, despite equivalent motivation to attend, participants who formed implementation intentions were much more likely to attend for screening compared with controls (92% vs. 69%). Evidence also suggests that implementation intentions attenuated the relationship between previous delay behavior and subsequent attendance.

Adult↗