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Dyspnea during hospitalizations for acute phase of illness as recalled by patients with chronic obstructive pulmonary disease.

With use of a qualitative research approach, a study was conducted to explore the phenomenon of dyspnea from the point of view of patients with chronic obstructive pulmonary disease. During a nonacute phase of their illness, 96 adults with chronic bronchitis or emphysema were asked in semistructured interviews to recall their feelings associated with sensations of shortness of breath during hospitalizations for the acute phase. Through content analysis, accounts of different subjects were compared, and several themes were isolated that dominated the dyspneic experience. The themes were fear, helplessness, loss of vitality, preoccupation, and legitimacy. Each theme was expanded by integrating accounts of dyspnea previously reported in the literature with the field study data. Substantiated descriptions of the five themes are presented to sensitize nurses to patients' perceptions of dyspnea and nursing behaviors during hospitalization for the acute phase of chronic obstructive pulmonary disease.

Consumer Behavior↗

Outcome-based doctor-patient interaction anaylsis: I. Comparison of techniques.

Interactional analysis (IA) systems have been devised and applied to doctor-patient dialogues to describe encounters and to relate process to outcomes. Prior work in this area has been typified by the use of a single taxonomy for classifying verbal behaviors and limited outcomes (compliance and/or satisfaction). We applied three different IA systems (Bales, Roter's modified Bales with affective ratings, and Stiles' "Verbal Response Modes") to 101 new-patient visits to a general medical clinic for which multiple outcomes had been determined: several measures of patient knowledge of problems at conclusion of visit; patient compliance with drugs (over the ensuing three months); and patient satisfaction with the visit (perceived technical, interpersonal and communication quality). Within IA systems, cross tabulations and multiple regressions were performed to relate encounter events to outcomes. Across IA systems, multiple regression R2 and R2 adjusted (R2a) for the number of independent variables entering were used to characterize strength of relationships. Roter's IA system showed stronger relationships to outcomes of knowledge (41% R2, 27% R2a) and compliance (44% R2, 28% R2a) than did Bales' or Stiles' systems. R2 for patient satisfaction was identical for Bales and Roter (35%), and greater than R2 for Stiles (14%). We conclude that choice of IA system for research or teaching purposes should be based on behaviors and outcomes of particular interest and importance to the user. Based on audioreview of tapes, Roter's approach is less time-consuming and may perform as well as more complex systems requiring transcript analysis.

Communication↗

Dietary behaviour of pregnant versus non-pregnant women.

This study investigates dietary behaviour and the perceived role of food for health of pregnant versus non-pregnant women. Data were collected between 15 January 2003 and 15 March 2003 in Belgium. One hundred and forty-eight pregnant and 130 non-pregnant women aged between 20 and 40 years completed a self-administered questionnaire about their dietary behaviour and nutritional attitudes. Both sub-samples match with respect to individual factors such as relevant socio-demographics and general food perceptions. Pregnant women report higher consumption of fruits, which results in a better score for fibre intake. They also report higher consumption of beef and dairy products, as well as a higher fat intake. No difference in fish consumption between pregnant and non-pregnant women is observed. In line with recommendations, pregnant women report reduced consumption of food products with heightened safety-related risks, lower use of alcohol and tobacco, and safer food handling practices. Reduced intake of raw vegetables for food safety reasons is not compensated by higher intake of cooked vegetables. Pregnant women also report a lower frequency of moderate physical activity. Most differences in food choice by pregnant versus non-pregnant women pertain to the avoidance of specific, potentially harmful food groups. A substantial share of pregnant women does not follow upon recommendations with respect to alcohol use and exposure to tobacco. Personal medical sources for pregnant women and personal social sources for non-pregnant women are reported as the most attended sources of diet-related information. The perceived role of food for health is not different between pregnant and non-pregnant women, and there were no significant interaction effects between pregnancy and presence of children, which indicates that the observed differences in dietary behaviour can be attributed to the state of being pregnant.

Adult↗

Satisfaction with medical care: replications and theoretic reevaluation.

Satisfaction with medical care is frequently measured in health services research but for many different reasons. The widening conceptualizations and uses of satisfaction reported make comparisons between studies difficult. Questions regarding the structure and dimensionality of satisfaction remain. The relation of satisfaction with utilization still requires theoretic and empiric clarification. This article reports on several surveys containing measures of satisfaction conducted in a research program in community pediatrics. Using multidimensional scaling techniques, the stability of the structure of satisfaction and patients' preferences for care is examined across several samples. The different structures that emerged seem to reflect unique patient experience. Several multivariate approaches were applied to study the relation between satisfaction and utilization. A regulatory self-equilibrating model was offered. Satisfaction is seen as a multifaceted concept related to short-term and long-term processes. Specific models are required to link satisfaction to the various health and illness behaviors.

Blue Cross Blue Shield Insurance Plans↗

The relative effects of classwide peer tutoring and peer coaching on the positive social behaviors of children with ADHD.

This study investigates the effects of Classwide Peer Tutoring (CWPT) and peer coaching on the peer social behaviors of children with ADHD. A single-subject, multiple-baseline design is used with three elementary-school students in Grades 3 and 4. Following a baseline period, CWPT is implemented in each student's classroom. During the second intervention phase, CWPT is continued and peer coaching is added. Peer social behaviors are observed in both academic and social settings, with a primary focus on intervention effects on the latter setting. Results suggest that students participating in CWPT are actively and positively engaged with their peers while carrying out the CWPT program in the academic setting. However, when only CWPT is implemented, increases in positive peer social behaviors are not observed in social settings. The addition of peer coaching results in enhanced social behaviors during recess and lunch.

Attention Deficit Disorder with Hyperactivity↗

Web-based tailored lifestyle programs: exploration of the target group's interests and implications for practice.

An important challenge in Web-based health promotion is to increase the reach of the target audience by taking the target groups' desires into consideration. Data from 505 members of a Dutch Internet panel (representative for Dutch Internet users) were used to asses the target group's interests and needs. 28% participated in Web-based tailored lifestyle programs, 57% expressed an interest in such programs, and 15% expressed no interest. Interest in Web-based programs was predominantly caused by a general interest in lifestyle and online tests. Participation in Web-based tailored lifestyle programs should not take more than 17 minutes per occasion. 84% were interested in follow-up testing after the initial participation. Responders were particularly interested in physical activity and nutrition. Hardly anyone was willing to pay for participation. The results from this study support the use of Web-based tailored lifestyle programs in behavior change efforts.

Adolescent↗

Doctor-patient communication and outcomes among diabetic patients.

This study reports on 242 diabetic patients from the practices of 42 physicians. Communication from physician to patient was studied to determine the effect of communication on subsequent patient outcomes. Patients and physicians were questioned on instructions provided for diabetic management and self-care. The average level of effective communication for all patients in the study was 67 percent. Insulin-dependent diabetics had the best communication scores, those controlled on diet alone the poorest, while oral medication patients were intermediate. Although overall communication scores showed no significant correlation with diabetic control status, patient satisfaction, compliance in taking prescribed medication, or frequency of hospitalization, specific communication items were highly correlated with corresponding behavioral outcomes.

Administration, Oral↗

Relations between physicians' behaviors and analogue patients' satisfaction, recall, and impressions.

This paper investigates associations between physicians' task-oriented and socioemotional behaviors, on the one hand, and analogue patients' satisfaction, recall of information, and global impressions. The study is based on role-playing subjects' responses to interactions between physicians and simulated patients. Audiotapes of two standardized patient cases presented by trained patient simulators to 43 primary care physicians were rated by role-playing patients (N = 258), and electronically filtered excerpts from the encounters were rated for vocal affect by 37 independent judges. Content analysis was made of the visits' transcripts to assess interaction process and to identify all medical information communicated. Finally, speech error rate was calculated from a combination of audiotape and transcript. Findings revealed that role-playing patients clearly distinguished task from socioemotional behaviors of the physicians, and a consistent pattern of association emerged between physicians' task behaviors and role-playing patients' satisfaction, recall, and impressions. Within the task domain, patient-centered skills (i.e., giving information and counseling) were consistently related to patient effects in a positive direction, but physician-centered behaviors (i.e., giving directions and asking questions) demonstrated the opposite relationship. A negative pattern of association was also evident between physicians' socioemotional behaviors and patient effects.

Affect↗

Social support and pain behavior.

Research has shown that social support is generally associated with better adaptation to chronic disease. However, the role that social support plays in adjustment to chronic pain syndromes has received less research attention. The present study was designed to examine the relation of high versus low levels of social support to pain behavior in chronic pain patients. Fifty-one patients with chronic pain completed the Social Support Questionnaire (SSQ) and the McGill Pain Questionnaire. Patients were also observed using a standard observation system to assess pain behaviors. In order to compare pain behaviors displayed by subjects with high versus low levels of social support, a median split was performed on the 2 dimensions of the SSQ: satisfaction with support, and availability of people for support. The results indicated that pain behavior varied as a function of level of satisfaction with social support. Individuals reporting high satisfaction with social support exhibited significantly higher levels of total pain behavior and higher levels of individual pain behaviors such as guarding, rubbing, and bracing. There was no significant difference in total pain behaviors between those high versus low in terms of level of availability of support. There also were no differences between high versus low social support groups in total pain ratings as measured by the McGill Pain Questionnaire. The results are discussed in terms of an operant conditioning perspective on social support. Individuals who are satisfied with the quality of their social support may be satisfied because they receive positive reinforcement from the social environment when they engage in pain behavior.

Adaptation, Psychological↗

Dynamics of contraceptive failures.

The purpose of this study was to explore the vicissitudes of contraceptive efforts and practice, and human behavior contributing to contraceptive failure. A consecutive sample of 481 women, who visited various gynecological out-patient clinics of a New York City municipal hospital between August 1974 and August 1975, served as the study population. There were 181 women with planned pregnancies and 300 women with unplanned pregnancies. The data were gathered in personal interviews. By comparison of both groups it was discovered that the women with unplanned pregnancies, because of their lower frustration tolerance level, had been led by successive difficulties related to contraceptive efforts and practice to episodic, faulty, or nonuse of technically effective contraceptive methods. Thereafter, psychological processes and mechanisms gave rise to a false sense of security, which virtually prevented them from resuming contraceptive practice. These psychological processes and mechanisms also govern other spheres of human behavior and merit systematic investigation.

Adult↗

Dentists' management of patients' fear and anxiety.

Dentists participating in a health screening at the 1983 ADA annual session were asked to complete a brief questionnaire concerning their attitudes and methods of managing anxious patients. Most dentists see patient fear as an extremely important dimension of their practice and believe it to be the most important impediment to patient satisfaction. Behavioral methods such as "talking" appear to be the most frequently used methods of dealing with fearful patients. Finally, most dentists appear to learn their behavioral management methods through informal means.

Anxiety↗

Remote Web usability testing.

Recently, various techniques for and approaches to extending usability testing beyond the traditional laboratories and technologies have emerged. Remote usability testing allows researchers to evaluate the usability of websites by gathering information from remote users. Several different approaches have been proposed, but they often require that the user perform particular installations or configurations. We introduce OpenWebSurvey, a software system for remote usability testing that can remotely record users' behavior while they surf the Internet and that requires no program installation or configuration.

Consumer Behavior↗

Assessment of health risk behaviors. A tool to inform consumers, providers, health care organizations, and purchasers.

INTRODUCTION: Tobacco use, diet and physical activity patterns, and alcohol use are the leading causes of death in the United States. To make major improvements in the health status of the population, behavioral risk factors for disease must be addressed. METHODS: We propose a brief survey of behavioral risk factors for enrollees of health care organizations, employer groups, or other adult populations that can be used to profile the health risk behaviors of a population, assess performance of prevention and risk reduction programs, or make comparisons with other populations. The survey contains questions about tobacco, diet, physical activity, alcohol, firearms, motor vehicle safety, sexual behavior, and drugs. RESULTS: Recommendations for survey items, implementation, and calculation of performance measures are given. CONCLUSIONS: Widespread adoption of this type of survey would be a major step forward in acknowledging the impact that behavior has on health and in furthering individual and organizational accountability for improving health risk behaviors.

Adult↗

Teaching the medical interview: an intervention study.

To study the effects of teaching specific interviewing techniques on verbal behaviors and on health outcomes, internal medicine residents working in a screening clinic were assigned to either an experimental or a control group. The entire clinic visit was audiotaped, transcribed, and coded according to the Verbal Response Mode (VRM) system. Residents in the experimental group were taught interviewing behaviors (patient exposition and physician explanation) that had been found in previous studies to be associated with patient outcomes. Through telephone interviews, patient satisfaction, compliance, and symptom status were determined for all patients. Two hundred and sixty-eight interviews (156 in the experimental group and 112 in the control group) were included in the study. Training did increase patient exposition and physician explanation, but did not affect health outcomes. Residents' attitudes and behaviors during the training are described.

Communication↗

Quality assurance versus QP(4)--the missing link.

First, quality is not easy. Second, basic process understanding, simplification and continuous improvement are equally difficult. We are vertically organized, yet our basic processes are horizontal with cross-functional boundaries. This recognition is the key to continued quality progress. Third, quality cascading is a key concept for progress. It is the most important factor in convincing the work force that we are serious about quality. Last, the concept of ownership is the most powerful force at work in our quality programs. Quality is not a destination, but a never-ending journey. We need to do things better today than yesterday. We need to be constantly on the lookout for ways to correct problems, prevent problems, and make improvements. Even when the customers' needs have been completely and precisely met, a better, more efficient approach may be possible. We need to take a broader view of the role that quality can play in achieving organizational and individual goals. We need to recognize that quality needn't cost more, yet it will improve customer satisfaction. Furthermore, quality involves more dimensions than just product or service; it applies to internal as well as external customers. We must recognize that everything the organization does has a quality component, and that everyone has a responsibility for quality. Accepting a new definition--and a new priority--for quality is essential, but not enough. For quality to become "the way we do business" in our organizations requires a break-through in action. We have to break out of established ways of thinking and acting. We have to learn new behaviors, and we need the skills to mandate and practice them.(ABSTRACT TRUNCATED AT 250 WORDS)

Consumer Behavior↗