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PubMed2006

When computers should remain computers: a qualitative look at the humanization of health care technology.

This article describes users' responses to human-like characteristics of two health promotion IVR systems. We conducted a qualitative evaluation of two systems that promoted physical activity and healthy dietary behavior respectively. Two themes that emerged dealt with favorable responses of the users to the machine's intrinsic qualities of being insentient and non-judgmental, and the users' precarious sensitivity to certain human-like characteristics of the systems, namely, the content of the scripts and the recorded human voice. The article suggests that design factors that are intended to enhance human-like characteristics of these applications elicit both positive and negative responses. Thus, even though many users enjoyed and appreciated the human-like performance of the machine, some who were more sensitive about their exercise or dietary behavior preferred a non-affective response by these systems, i.e. they preferred the system to behave like a 'machine' (without emotions) rather than a 'person'.

Adult↗

PubMed2003

Tools for remote usability evaluation of Web applications through browser logs and task models.

The dissemination of Web applications is extensive and still growing. The great penetration of Web sites raises a number of challenges for usability evaluators. Video-based analysis can be rather expensive and may provide limited results. In this article, we discuss what information can be provided by automatic tools able to process the information contained in browser logs and task models. To this end, we present a tool that can be used to compare log files of user behavior with the task model representing the actual Web site design, in order to identify where users' interactions deviate from those envisioned by the system design.

Consumer Behavior↗

PubMed1991

Employees' perceptions of an on-site cancer screening clinic.

A 14-question survey was mailed to 355 employees examined during a 5-month period in 1989 in a nurse-administered employee cancer screening clinic at The University of Texas M.D. Anderson Cancer Center in Houston. Almost 60% of the study group (209/355) responded to the survey, which was designed to measure employees' attitudes toward the on-site clinic. Overall, respondents viewed the program very positively, and almost all of those still employed by M.D. Anderson Cancer Center at the time of the survey said they would return for an examination the next year. Between 52 and 80% of respondents reported increasing the practice of self-examinations for cancer. Of the quarter of the study group who identified themselves as being smokers at the time of the screening examination, 63% said they were no longer smoking. Finally, the analysis showed that having registered nurse participants present during screening did not significantly affect employees' willingness to return for an examination the next year. The survey results indicate that employees view the screening program favorably, that the education they receive affects their behavior, and that almost all have a positive attitude about returning for an examination the next year.

Adult↗

PubMed1994

The pharmacokinetics of inhaled 1,1,1-trichloroethane following high milk intake in mice.

In the evaluation of lipophilic halocarbons for neurobehavioral toxicity in operant testing, animals often receive large amounts of milk as a behavioral reinforcer over time. If this increase of fat in the diet sufficiently impacted the lipid depots of the animal, the pharmacokinetics of lipophilic test compounds might be significantly affected and thus obscure the accompanying neurobehavioral effects. The effects of milk intake, comparable to what was consumed as behavioral reinforcer during operant behavioral sessions, on the pharmacokinetics of inhaled 1,1,1-trichloroethane (TRI) were therefore examined in the blood and nine organ tissues of mice. Male CD-1 mice were food restricted so that their body weights would be reduced to and maintained at 80% of their original, and received a single gavage dose of 1.0 ml evaporated milk daily for three weeks. A control group with similar food restrictions was dosed with the same volume of water. Inhalation exposures to 3500 ppm TRI for 100 minutes were conducted at the end of the treatment period. Blood and nine organ tissues were sampled at a series of time points, and their TRI contents were analyzed by headspace gas chromatography. The uptake of TRI was rapid, with near steady state approached in blood and most tissues after 40-60 minutes of exposure. All of the tissues except fat had similar TRI time-concentration profiles, while TRI concentrations in fat tissue were about 20-30 times higher than in other tissues. There was no statistically significant difference in the tissue concentrations between the milk-dosed group and water-dosed group at all of the time points for all tissues measured. Therefore, it appears unlikely that this level of milk intake as a reinforcer in behavioral studies will affect the results of operant testing evaluations by altering the pharmacokinetics of lipophilic halocarbons such as TRI.

Administration, Inhalation↗

PubMed2003

The effect of health plan characteristics on Medicare+ Choice enrollment.

OBJECTIVE: To provide national estimates of the effect of out-of-pocket premiums and benefits on Medicare beneficiaries' choice among managed care health plans. DATA SOURCES/STUDY SETTING: The data represent the population of all Medicare+ Choice (M+C) plans offered to Medicare beneficiaries in the United States in 1999. STUDY DESIGN: The dependent variable is the log of the ratio of the market share of the jth health plan to the lowest cost plan in the beneficiary's county of residence. The explanatory variables are measures of premiums and benefits in the jth health plan relative to the premiums and benefits in the lowest cost plan. DATA COLLECTION METHODS: The data are from the 1999 Medicare Compare database, and M+C enrollment data from the Centers for Medicare and Medicaid Services (CMS). PRINCIPAL FINDINGS: A $10 increase in an M+C plan's out-of-pocket premium, relative to its competitors, is associated with a decrease of four percentage points in the jth plan's market share (i.e., from 25 to 21 percent), holding the premiums of competing plans constant. CONCLUSIONS: Although our price elasticity estimates are low, the market share losses associated with small changes in a health plan's premium, relative to its competitors, may be sufficient to discipline premiums in a competitive market. Bidding behavior by plans in the Medicare Competitive Pricing Demonstration supports this conclusion.

Aged↗

PubMedDate not supplied

Female patients and male nursing students.

Male nursing students, just like their female counterparts, are expected to give quality, professional nursing care to all patients. The sex of the patient assignment should not prevent learning opportunities. Cultural attitudes, however, perceive nursing to be a female profession. Role confusion occurs when a female patient and a male nurse are paired. Because of this stereotypical behavior, men in nursing sometimes face barriers in providing quality care to female patients. The cause and possible solutions to this issue are addressed.

Attitude of Health Personnel↗

PubMed2000

The death of the four "P"s: a premature obituary.

To paraphrase Mark Twain the report of the demise of the four "P"s has been greatly exaggerated. While new concepts such as the four "R"s of relevance, response, relationships, and results may add value, the four "P"s remain essential. Moreover, health care marketing can benefit from the addition of a fifth "P," Prompting customers to adopt and repeat behaviors that benefit them, and a fifth "R," Reminding customers of the health and quality-of-life benefits they have gained from health care plans and providers.

Communication↗

PubMed1989

Development and validation of an instrument to measure patient satisfaction with pharmacy services.

A research program was undertaken to develop and validate a multidimensional measure of patient satisfaction with pharmacy services. A self-administered questionnaire consisting of 44 Likert-type attitudinal items was adapted from the Patient Satisfaction Questionnaire developed by Ware et al. In an iterative scale development process, the adapted questionnaire and its revisions were evaluated in three successive studies conducted on convenience samples (n = 30, 313, 489) of individuals in attendance at family practice clinics in a southwestern city. Methods used to construct multi-item scales measuring separate dimensions of service included principal components factor analysis and item analyses. Acquiescent response set (ARS), the tendency to agree with statements of opinion regardless of content, was measured by the method of matched pairs of items. A partial correlation matrix which controlled for ARS was used as the data in a principal components factor analysis in an effort to reduce the biasing effect of ARS on factor analytic outcomes. Dimensions of satisfaction identified were Explanation, Consideration, Technical Competence, Financial Aspects, Accessibility, Drug Efficacy, OTC (over-the-counter) Product Availability, and Quality of the Drug Product. Questionnaire revision is suggested to confirm the validity of the latter two dimensions Future research should examine the relationship between separate dimensions of satisfaction and other patient attitudes and behaviors, and the convergence between this instrument and other measures of patient satisfaction with pharmacy services.

Adolescent↗

PubMed1979

An assessment of a continuing care program.

In mid-1977 the Kern County (Calif.) Department of Mental Health Services undertook a survey of residents and operators of group and family care homes in the county to obtain their views on how services in the homes might be improved and to assess the level of skills of the patients placed there. A total of 139 former patients and 26 operators agreed to be interviewed. The results showed that few of the patients had overt behavioral problems and most were capable of self-care. For the most part the patients were satisfied with the homes, although problems related to finances and lack of outside activities were cited by both patients and operators. The authors emphasize the importance of including such assessment of consumer satisfaction in planning mental health services.

Activities of Daily Living↗

PubMed1990

Exploring perceptions of hospital operations by a modified SERVQUAL approach.

The authors employ a modified SERVQUAL approach to understanding the relationships among patients' perceptions of inpatient, outpatient, and emergency room services and their overall perceptions of service quality, satisfaction with their care, and willingness to recommend the hospital's services to others. Three models of these perceptions and related behavioral variables are developed. Dominating these models is a dimension labeled "patient confidence," which has a significant impact on nearly all measures of patient satisfaction.

Consumer Behavior↗

PubMed2006

Self-prediction of hedonic trajectories for repeated use of body products and foods: poor performance, not improved by a full generation of experience.

This study extends earlier work by [Kahneman, D., and Snell, J. (1992). Predicting a changing taste: Do people know what they will like? Journal of Behavioral Decision Making, 5, 187-200.]. suggesting that people are poor at predicting changes in liking. This is an important issue because an absence of this ability would make it difficult for people to optimize their own choices. Twenty undergraduates and 20 of their parents sampled four relatively unfamiliar consumer products, two foods and two body products, for 8 days. On Day 1, participants rated their initial liking and predicted their liking after seven daily uses of the products. Predictions were compared to actual liking on Day 8. Consistent with prior work, participants were poor at predicting their actual hedonic trajectories because they underestimated the degree to which their preferences would change. Contrary to predictions, parents were no better than students at this task, even though they had some 20-39 years more experience in observing their own hedonic trajectories. There is no evidence for any parent-child resemblance in either liking for the products or ability to accurately predict hedonic trajectory, and no evidence for consistency in ability to predict trajectories across the four different products. In general, participants underestimate the degree to which their preferences will change.

Adolescent↗

PubMed1983

Disenrollment from a prepaid group plan. A multivariate analysis.

Although high annual disenrollments from prepaid group practices (PGPs) present significant problems to the manager, studies on this subject generally have been limited to simple descriptions of the phenomenon. The authors' approach utilizes multivariate techniques--discriminant analysis and logistic regression--to overcome the simplicity of these bivariate studies. It allows an examination of the significant correlates of disenrollment in a stepwise manner that adjusts for the effects of all variables included in the models. Two surveys conducted by the Medical Care Group of St. Louis (MCGSL) provide data for this research. After classifying the sample of 2,402 families as continuous enrollees, voluntary disenrollees, and mandatory disenrollees, the analyses show that these groups represent significantly different member populations. The variables that significantly and independently discriminate among them include sociodemographic characteristics (subscriber age, race, education and occupation, and family size and income), satisfaction level with the plan, and presence of alternatives to the PGP (nonplan family members and coverage by alternative health insurance). These findings suggest that voluntary and mandatory disenrollment behavior may be more complex than previously considered. Moreover, the PGP manager is faced with perplexing problems in attempting to control this troublesome phenomenon.

Analysis of Variance↗

PubMed1988

Meta-analysis of correlates of provider behavior in medical encounters.

This article summarizes the results of 41 independent studies containing correlates of objectively measured provider behaviors in medical encounters. Provider behaviors were grouped a priori into the process categories of information giving, questions, competence, partnership building, and socioemotional behavior. Total amount of communication was also included. All correlations between variables within these categories and external variables (patient outcome variables or patient and provider background variables) were extracted. The most frequently occurring outcome variables were satisfaction, recall, and compliance, and the most frequently occurring background variables were the patient's gender, age, and social class. Average correlations and combined significance levels were calculated for each combination of process category and external variable. Results showed significant relations of small to moderate average magnitude between these external variables and almost all of the provider behavior categories. A theory of provider-patient reciprocation is proposed to account for the pattern of results.

Adult↗

PubMed2004

Perceptions of health care providers' communication: relationships between patient-centered communication and satisfaction.

Specific communication practices of multiple professionals in health care settings can impact patient outcomes. This study, conducted at a large Children's Hospital, sought to determine the extent to which patient-centered communication (PCC) affected satisfaction with communication and with care itself. Parents of child patients (N = 195) reported on the communication practices of physicians, nurses, and hospital staff members during their most recent stay in the hospital. Surveys were completed on site. Health care providers' use of PCC behaviors, especially immediacy and perceived listening, was positively associated with satisfaction with care and with communication. In addition, PCC behaviors were perceived to be used more frequently with children in better health than with children with poorer health status.

Adult↗

PubMed1985

The dentist-patient relationship: perceptions by patients of dentist behavior in relation to satisfaction and anxiety.

This study relates perceived dentist behaviors to anxiety in patients during treatment and to satisfaction during the dental visit. The sample consisted of 231 adult patients, 107 men and 124 women, at a public hospital dental clinic. Immediately after treatment, patients were asked to respond to a list of 21 dentist behaviors thought to be associated with positive dentist-patient interaction. Criterion measures obtained were ratings of anxiety by patients during treatment and measures from the DVSS. None of the dentist behaviors was related to anxiety in patients in a way that would suggest that dentist behavior either reduced or increased anxiety. DAS scores obtained before treatment were the best predictor of anxiety in patients during treatment. Most of the dentist behaviors were significantly related to satisfaction in patients. Stepwise multiple regression analyses using DVSS scores as criterion variables indicated that those variables contributing most to satisfaction in patients were indicative of dentist communication that was accepting and caring. Anxiety in patients during treatment also was an important negative predictor of satisfaction. The results indicate that the dentist behaviors explored in this study were associated with satisfaction in patients, but were not clearly related to anxiety reduction.

Anxiety↗

PubMed1981

Drinking behavior and the development of hypothalamic lesions from aspartame ingestion in water-restricted weanling mice.

Wealing mice that had been deprived overnight of water, or of water and diet, were offered a solution containing L-aspartyl-L-phenylalanine-methylester (APM) or monosodium L-aspartate monohydrate (MSA) as the sole source of drinking water, and/or a diet containing large amounts of APM and/or MSA for 30 min, and were killed subsequently. Only those animals exposed to concentrated (6.64% W/V) MSA solutions developed neuronal lesions in the hypothalamic arcuate nuclei. Those offered MSA in the diet only, or APM either in the diet and/or in solution, failed to develop such lesions. Apparently water-restricted weanling mice lose their ability to regulate subsequent drinking behavior, and consume hyperosmolar MSA or APM solutions whose osmolarity or sweetness would be aversive to humans. Such animals are unsuitable for the safety evaluation of APM.

Animals↗

PubMed2005

To empower or not to empower your sales force? An empirical examination of the influence of leadership empowerment behavior on customer satisfaction and performance.

This research focuses on the impact of leadership empowerment behavior (LEB) on customer service satisfaction and sales performance, as mediated by salespeople's self-efficacy and adaptability. Moreover, the authors propose an interactive relationship whereby LEB will be differentially effective as a function of employees' empowerment readiness. The authors' hypotheses are tested using survey data from a sample of 231 salespeople in the pharmaceutical field, along with external ratings of satisfaction from 864 customers and archival sales performance information. Results indicated that contrary to popular belief, employees with low levels of product/industry knowledge and low experience benefit the most from leadership behaviors that are empowering, whereas high-knowledge and experienced employees reap no clear benefit. The authors conclude with directions for future research and application.

Achievement↗

PubMed2000

Establishing mutual trust--a prerequisite to public partnership.

Establishing mutual trust is the key to establishing workable and sustainable partnerships between the public and service providers, in any part of the world. The experience of utilities in the United Kingdom and United States shows that trust is established through sharing information with the public and improving customer service. Understanding the needs of the public and the service agency are a prerequisite to establishing trust. There is no "magic formula" for the process, as it depends on the current level of knowledge, attitudes and actual practice (behavior) of both the public and the service agency. In Jordan, for example, there is awareness of environmental issues, but trust must be developed to generate public support for programs.

Community Participation↗