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We developed the Achieving Self-directed Integrated Cancer Aftercare (ASICA) in melanoma app to support monthly total-skin self-examinations (TSSE) by people previously treated for melanoma. A randomized 12-month trial demonstrated ASICA supported optimal monthly TSSE adherence in a third of participants (ClinicalTrials.gov NCT03328247). However, a further third of participants adhered well initially but subsequently dropped off, and a final third did not adhere at all. This follow-up qualitative study investigated trial participants' perceptions of barriers and facilitators to TSSE adherence using the app. Three former trial participants participated in a single focus group and 11 participated in new semistructured telephone interviews. These were analysed thematically alongside secondary analysis of 13 qualitative interviews conducted during the trial. All transcripts were recorded, transcribed and analysed thematically. Five themes encompassing barriers and facilitators to ASICA adherence emerged. These were: technology, role of others, tailoring, disease journey and competing priorities. These data will inform further development of ASICA to increase user adherence.
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Melanoma , Aplicativos Móveis , Humanos , Seguimentos , Melanoma/terapia , Pesquisa Qualitativa , Autoexame , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Antibiotics are over-prescribed for upper respiratory tract infection (URTI). It is unclear how factors known to influence prescribing decisions operate 'in the moment': dual process theories, which propose two systems of thought ('automatic' and 'analytical'), may inform this. OBJECTIVE(S): Investigate cognitive processes underlying antibiotic prescribing for URTI and the factors associated with inappropriate prescribing. METHODS: We conducted a mixed methods study. Primary care physicians in Scotland (n = 158) made prescribing decisions for patient scenarios describing sore throat or otitis media delivered online. Decision difficulty and decision time were recorded. Decisions were categorized as appropriate or inappropriate based on clinical guidelines. Regression analyses explored relationships between scenario and physician characteristics and decision difficulty, time and appropriateness. A subgroup (n = 5) verbalized their thoughts (think aloud) whilst making decisions for a subset of scenarios. Interviews were analysed inductively. RESULTS: Illness duration of 4+ days was associated with greater difficulty. Inappropriate prescribing was associated with clinical factors suggesting viral cause and with patient preference against antibiotics. In interviews, physicians made appropriate decisions quickly for easier cases, with little deliberation, reflecting automatic-type processes. For more difficult cases, physicians deliberated over information in some instances, but not in others, with inappropriate prescribing occurring in both instances. Some interpretations of illness duration and unilateral ear examination findings (for otitis media) were associated with inappropriate prescribing. CONCLUSION: Both automatic and analytical processes may lead to inappropriate prescribing. Interventions to support appropriate prescribing may benefit from targeting interpretation of illness duration and otitis media ear exam findings and facilitating appropriate use of both modes of thinking.
Antibiotics are often used to treat the common cold and ear/nose/throat infections but typically do not work for these issues. We explored the reasons why this prescribing may happen and some of the difficulties doctors might experience when making these treatment decisions. Doctors reviewed written descriptions of patients and decided whether or not to prescribe antibiotics. Some of these doctors also took part in an interview where they 'thought aloud' (said what they were thinking as they were thinking it) while considering the patient descriptions. When the patient had been ill for four or more days, this made decisions more difficult. Sometimes decisions to prescribe due to this illness duration and due to findings from an ear exam were not in line with guidelines for prescribing. Some decisions to prescribe seemed to be more related to automatic habits, while others occurred after careful deliberation over the information. Doctors need more support to make decisions involving these factors and may benefit from strategies to help them use their automatic/habitual thinking and their deliberative thinking in the best ways.
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Otite Média , Infecções Respiratórias , Antibacterianos/uso terapêutico , Cognição , Humanos , Prescrição Inadequada , Otite Média/tratamento farmacológico , Padrões de Prática Médica , Infecções Respiratórias/tratamento farmacológicoRESUMO
PURPOSE: Ward rounds play a crucial role in the delivery of patient care in inpatient settings, but involve a complex mix of tasks, skills and challenges for junior doctors to negotiate. This study informs the development of high-quality training by identifying the activities that junior doctors perform, and those associated with stress during real-life ward rounds. MATERIALS AND METHODS: All activities performed by FY1 doctors (n = 60) over 2 ward rounds were coded in real-time by a trained observer using the work observation method by activity timing (WOMBAT). Doctors' heart rate was continuously recorded and non-metabolic peaks in heart rate used as a physiological indicator of stress. RESULTS: During ward rounds, FY1 doctors commonly engaged in indirect patient care, professional communication, documentation and observation. Very little time was spent on direct patient care (6%) or explicit supervision/education (0.01%). Heart rate data indicated that stress was highest during administrative tasks while interacting directly with patients while stepping out of rounds to complete personal tasks, when answering bleeps and while multi-tasking. CONCLUSIONS: Training that specifically covers the activities involved, skills required, and challenges inherent in real-life ward rounds may better prepare FY doctors for this complex area of practice.
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Médicos , Visitas de Preceptoria , Documentação , Hospitais , Humanos , Corpo Clínico HospitalarRESUMO
BACKGROUND: Hospitals offer snacks for sale to patients, staff and visitors. AIM: As food choice is heavily influenced by the options available, the present study (a) audited snack availability and purchase in NHS hospital sites across a large UK city; and (b) tested the potential effects of changes to this availability in an online choice experiment. METHODS: In Study 1 (audit), single-serve snacks (n=376) available in 76 hospital food retail units were audited. Purchasing data were obtained from six food retail units over four weeks (27,989 sales). In Study 2 (online experiment), participants (n=159) chose snacks from pictured ranges containing 25% (minority), 50% (equivalent) or 75% (majority) healthy options. RESULTS: Available single-serve snacks varied markedly in calorie (18-641 kcals), fat (0-39 g), sugar (0.1-76 g) and salt (0-2.9 g). Only 30% of available snacks were healthy options and only 25% of the most commonly purchased snacks were healthy options. In Study 2, snack choice was significantly associated with the availability of healthy options in the choice array (X2 (2)= 59.71, p<.01). More participants made healthy choices when product ranges contained 75% healthy options compared to 50% (p<.01) and 50% healthy options compared with 25% (p<.01). CONCLUSIONS: Healthy snacks are readily available in NHS sites but there is a greater relative variety of unhealthy snack products. Many consumers continue to purchase unhealthy items. Further increasing the availability and variety of healthy options may support consumers to make healthier choices.
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Preferências Alimentares , Lanches , Comércio , Comportamento do Consumidor , Hospitais , HumanosRESUMO
BACKGROUND: Hospitals in the UK offer snacks for sale to patients, staff and visitors. Despite the NHS's health promoting role, and tightening of regulations around which foods can be sold in hospitals, many snacks purchased in this setting are unhealthy. The present project tests the effectiveness of theory-based point of purchase prompts (PPPs; a form of cognitive nudge) designed to make it cognitively easier for consumers to compare available products and choose healthier options. METHODS: Hospital shops in Scotland (n = 30) were recruited into a cluster randomised controlled trial to test whether a PPP could reduce the average calorie, fat and/or sugar content of purchased snacks. Inclusion criteria stated that eligible sites; sold food; were located in a hospital; and were accessible to staff, patients and visitors. The PPP intervention was a theory-based sign (tailored to the available range in each location) designed to cognitively simplify healthier snack choices by facilitating cross-product comparison. Shops were randomised to display PPPs (intervention; n = 15) or not (control; n = 15) using block randomisation controlling for shop size. Data on all snacks purchased from participating shops were obtained from retailers for a 12-week baseline and 12-week follow-up period. Primary outcomes were the average calorie (kcals), fat(g) and sugar(g) content of snacks purchased each day. Secondary outcomes were the average customer spend per item purchased (£,p) and the total number of snacks purchased daily. Shop staff were not blinded to group assignment but data providers were. Data were analysed using mixed effects multi-level regression models. RESULTS: Data from > 1 million snack purchases were analysed. Snacks purchased from intervention sites were on average significantly lower in calorie (γ = - 1.84, p < .001) and sugar (γ = - 0.18, p = .030) at follow up relative to baseline but only the reduction in calories was significantly different to control. Average spend per item also reduced significantly in intervention (but not control) sites (γ = - 0.89, p < .001). The intervention had no effect on the fat content of snacks or the number of snacks sold. CONCLUSIONS: Simple, theory-based point of purchase prompts can produce small but statistically significant reductions in the energy content of snack purchases from hospital shops. TRIAL REGISTRATION: Retrospectively registered (8/Oct/2018) with ISRCTN (ID: ISRCTN90365793 ).
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Comércio/estatística & dados numéricos , Comportamento do Consumidor/estatística & dados numéricos , Dieta Saudável , Preferências Alimentares/psicologia , Lojas no Hospital , Lanches/psicologia , Gorduras na Dieta , Açúcares da Dieta , Ingestão de Energia , Promoção da Saúde , Humanos , Valor Nutritivo , EscóciaRESUMO
BACKGROUND: Long-term future thinking has been associated with a range of favorable health behaviors. However, it is currently unclear whether this translates into an effect on morbidity and mortality. PURPOSE: The goal of this study was to study the relationship between time perspective and all-cause mortality and to examine the role of health behavior in explaining this association. METHODS: Participants (N = 9,949) aged 50 and over from the English Longitudinal Study of Ageing, a representative cohort of older English adults, estimated the length of their time horizon for financial planning (time perspective). Two thousand ninety-two deaths were recorded over a 9-year follow-up period (2002/2003-2012). Smoking, physical activity, and alcohol consumption were examined as factors that may underlie the time perspective-mortality link. RESULTS: Our prospective survival analyses showed that those who tend to plan for longer periods experienced a significantly reduced risk of all-cause mortality (HR = 0.83; 95% confidence interval [CI]: [0.80, 0.87], p < .001 per 1 SD increase in future time perspective). This association remained after adjusting for baseline socioeconomic status and health (HR = 0.92; 95% CI: [0.88, 0.97], p < .001). The link between time perspective and mortality was observed across the gradient of financial circumstances and did not appear to be due to reverse causality. Healthy behavior among the more future orientated explained 34% of the link between time perspective and mortality. CONCLUSIONS: Using a simply administered indicator of time perspective, this study suggests that a future-orientated time perspective may be an important predictor of reduced risk of death.
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Envelhecimento , Comportamentos Relacionados com a Saúde , Mortalidade , Pensamento , Idoso , Inglaterra/epidemiologia , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Classe Social , Fatores de TempoRESUMO
BACKGROUND: One of the striking regularities of human behavior is that a prolonged physical, cognitive, or emotional activity leads to feelings of fatigue. Fatigue could be due to (1) depletion of a finite resource of physical and/or psychological energy or (2) changes in motivation, attention, and goal-directed effort (e.g. motivational control theory). PURPOSE: To contrast predictions from these two views in a real-time study of subjective fatigue in nurses while working. METHODS: One hundred nurses provided 1,453 assessments over two 12-hr shifts. Nurses rated fatigue, demand, control, and reward every 90 min. Physical energy expenditure was measured objectively using Actiheart. Hypotheses were tested using multilevel models to predict fatigue from (a) the accumulated values of physical energy expended, demand, control, and reward over the shift and (b) from distributed lag models of the same variables over the previous 90 min. RESULTS: Virtually all participants showed increasing fatigue over the work period. This increase was slightly greater when working overnight. Fatigue was not dependent on physical energy expended nor perceived work demands. However, it was related to perceived control over work and perceived reward associated with work. CONCLUSIONS: Findings provide little support for a resource depletion model; however, the finding that control and reward both predicted fatigue is consistent with a motivational account of fatigue.
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Fadiga/fisiopatologia , Motivação/fisiologia , Recursos Humanos de Enfermagem Hospitalar , Recompensa , Jornada de Trabalho em Turnos , Tolerância ao Trabalho Programado/fisiologia , Adulto , Avaliação Momentânea Ecológica , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Physical activity is associated with greater independence in old age. However, little is known about the effect of physical activity level and activity type on activities of daily living (ADL). This review systematically analyzed the effects of physical activity level and activity type on ADL in older adults (mean age, 60+). Electronic search methods (up to March 2015) identified 47 relevant, randomized controlled trials. Random effects meta-analyses revealed significant, beneficial effects of physical activity on ADL physical performance (SMD = 0.72, 95% CI [0.45, 1.00]; p < .01), with the largest effects found for moderate physical activity levels, and for activity types with high levels of mental (e.g., memory, attention), physical (e.g., coordination, balance) and social (e.g., social interaction) demands. Inconsistent effects were observed on self-reported ADL measures. Interventions that include moderate physical activity levels with high mental, physical, and social demands may produce the greatest benefits on ADL physical performance.
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Atividades Cotidianas , Envelhecimento , Exercício Físico/psicologia , Qualidade de Vida , Idoso , Envelhecimento/fisiologia , Envelhecimento/psicologia , HumanosRESUMO
BACKGROUND: The cognitive processes responsible for effortful behavioural regulation are known as the executive functions, and are implicated in several factors associated with behaviour control, including focussing on tasks, resisting temptations, planning future actions, and inhibiting prepotent responses. Similar to muscles, the executive functions become fatigued following intensive use (e.g. stressful situations, when tired or busy, and when regulating behaviour such as quitting smoking). Therefore, an individual may be more susceptible to engaging in unhealthy behaviours when their executive functions are depleted. In the present study we investigate associations between the executive functions, snack food consumption, and sedentary behaviour in real time. We hypothesise that individuals may be more susceptible to unhealthy snacking and sedentary behaviours during periods when their executive functions are depleted. We test this hypothesis using real-time objective within-person measurements. METHODS/DESIGN: A sample of approximately 50 Scottish adults from varied socio-economic, working, and cultural backgrounds will participate in the three phases of the SNAcking, Physical activity, Self-regulation, and Heart rate Over Time (SNAPSHOT) study. Phase one will require participants to complete home-based questionnaires concerned with diet, eating behaviour, and physical activity (≈1.5 hours to complete). Phase two will constitute a 2-3 hour psychological laboratory testing session during which trait-level executive function, general intelligence, and diet and physical activity intentions, past behaviour, and automaticity will be measured. The final phase will involve a 7-day ambulatory protocol during which objective repeated assessments of executive function, snacking behaviour, physical activity, mood, heart rate, perceived energy level, current context and location will be measured during participants' daily routines. Multi-level regression analysis, accounting for observations nested within participants, will be used to investigate associations between fluctuations in the executive functions and health behaviours. DISCUSSION: Data from the SNAPSHOT study will provide ecologically valid information to help better understand the temporal associations between self-regulatory resources (executive functions) and deleterious health behaviours such as snacking and sedentary behaviour. If we can identify particular periods of the day or locations where self-regulatory resources become depleted and produce suboptimal health behaviour, then interventions can be designed and targeted accordingly.
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Função Executiva , Comportamento Alimentar/psicologia , Comportamento Sedentário , Adulto , Afeto , Dieta , Exercício Físico , Feminino , Comportamentos Relacionados com a Saúde , Frequência Cardíaca , Humanos , Intenção , Masculino , Pessoa de Meia-Idade , Projetos de Pesquisa , Escócia , Lanches , Controles Informais da Sociedade , Fatores SocioeconômicosRESUMO
BACKGROUND: General practitioners (GPs) make numerous care decisions throughout their workdays. Extended periods of decision making can result in decision fatigue, a gradual shift toward decisions that are less cognitively effortful. This study examines whether observed patterns in GPs' prescribing decisions are consistent with the decision fatigue phenomenon. We hypothesized that the likelihood of prescribing frequently overprescribed medications (antibiotics, benzodiazepines, opioids; less effortful to prescribe) will increase and the likelihood of prescribing frequently underprescribed medications (statins, osteoporosis medications; more effortful to prescribe) will decrease over the workday. METHODS: This study used nationally representative primary care data on GP-patient encounters from the Bettering the Evaluation and Care of Health program from Australia. The association between prescribing decisions and order of patient encounters over a GP's workday was assessed with generalized linear mixed models accounting for clustering and adjusting for patient, provider, and encounter characteristics. RESULTS: Among 262,456 encounters recorded by 2,909 GPs, the odds of prescribing antibiotics significantly increased by 8.7% with 15 additional patient encounters (odds ratio [OR] = 1.087; confidence interval [CI] = 1.059-1.116). The odds of prescribing decreased significantly with 15 additional patient encounters by 6.3% for benzodiazepines (OR = 0.937; CI = 0.893-0.983), 21.9% for statins (OR = 0.791; CI = 0.753-0.831), and 25.0% for osteoporosis medications (OR = 0.750; CI = 0.690-0.814). No significant effects were observed for opioids. All findings were replicated in confirmatory analyses except the effect of benzodiazepines. CONCLUSIONS: GPs were increasingly likely to prescribe antibiotics and were less likely to prescribe statins and osteoporosis medications as the workday wore on, which was consistent with decision fatigue. There was no convincing evidence of decision fatigue effects in the prescribing of opioids or benzodiazepines. These findings establish decision fatigue as a promising target for optimizing prescribing behavior. HIGHLIGHTS: We found that as general practitioners progress through their workday, they become more likely to prescribe antibiotics that are reportedly overprescribed and less likely to prescribe statins and osteoporosis medications that are reportedly underprescribed.This change in decision making over time is consistent with the decision fatigue phenomenon. Decision fatigue occurs when we make many decisions without taking a rest break. As we make those decisions, we become gradually more likely to make decisions that are less difficult.The findings of this study show that decision fatigue is a possible target for improving guideline-compliant prescribing of pharmacologic medications.
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Background: Executive Function (EF) is a potential mechanism linking physical activity (PA) and mental health. However, evidence regarding the association between free-living PA and EF is limited with mixed results. Across two studies, we examined associations between accelerometer-assessed moderate-to-vigorous PA (MVPA) and facets of EF in different age groups (Study 1) and at different times of day (Study 2). Method: In Study 1, we tested the association between MVPA and verbal fluency across seven days in 285 participants (children, adults, older adults). In Study 2, we tested between- and within-person associations between MVPA and working memory (afternoon, evening, next morning) across three 18-day bursts in 64 preadolescents. Results: Study 1 showed no association between MVPA and verbal fluency overall, but there was an interaction by age group: a positive association was evident in older adults only. In Study 2, we observed a positive between-person association between MVPA and subsequent afternoon and next morning working memory, but not within-person. In the evening, MVPA was not related to working memory. Conclusions: The association between free-living PA and EF differs between age groups and times of day. Future research should consider these factors when examining the association and its role for mental health.
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BACKGROUND: Theories of action control emphasise the importance of planning, but plans are not universally beneficial. PURPOSE: The present study investigates whether the effectiveness of plans depends upon the skill of the planner. METHODS: Study 1 prospectively predicted changes in unhealthy snacking behaviour over 1 week from intentions, action planning and performance on a standardised cognitive test of planning skill (n = 72). Study 2 experimentally randomised skilled and poor planners to receive (or not) a planning intervention before completing an online food diary (n = 144) RESULTS: Spontaneously generated action plans about snacking explained significantly more variance in subsequent snacking if produced by a skilled rather than a poor planner. The planning intervention (implementation intention) significantly improved goal attainment but only in poor planners. CONCLUSIONS: Plans are only as good as the people who make them. Poor planners' plans do not help achieve goals. Planning interventions can compensate for a lack of planning skill.
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Comportamento Alimentar/psicologia , Comportamentos Relacionados com a Saúde , Intenção , Adolescente , Registros de Dieta , Feminino , Objetivos , Humanos , Masculino , Testes Neuropsicológicos , Estudos Prospectivos , Adulto JovemRESUMO
OBJECTIVES: To describe trajectories in melanoma survivors' adherence to monthly total skin self-examination (TSSE) over 12 months, and to investigate whether adherence trajectories can be predicted from demographic, cognitive or emotional factors at baseline. DESIGN: A longitudinal observational study nested within the intervention arm of the ASICA (Achieving Self-Directed Integrated Cancer Aftercare) randomised controlled trial. SETTING: Follow-up secondary care in Aberdeen and Cambridge UK. PARTICIPANTS: n=104 adults (48 men/56 women; mean age 58.83 years, SD 13.47, range 28-85 years; mean Scottish Index of Multiple Deprivation score 8.03, SD 1.73, range 2-10) who had been treated for stage 0-IIC primary cutaneous melanoma in the preceding 60 months and were actively participating in the intervention arm of the ASICA trial. INTERVENTIONS: All participants were using the ASICA intervention-a tablet-based intervention designed to support monthly TSSE. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was adherence to guideline recommended (monthly) TSSE over 12 months. This was determined from time-stamped TSSE data recorded by the ASICA intervention app. RESULTS: Latent growth mixture models identified three TSSE adherence trajectories (adherent -41%; drop-off -35%; non-adherent -24%). People who were non-adherent were less likely to intend to perform TSSE as recommended, intending to do it more frequently (OR=0.21, 95% CI 0.06 to 0.81, p=0.023) and were more depressed (OR=1.31, 95% CI 1.06 to 1.61, p=0.011) than people who were adherent. People whose adherence dropped off over time had less well-developed action plans (OR=0.78, 95% CI 0.63 to 0.96, p=0.016) and lower self-efficacy about TSSE (OR=0.92, 95% CI 0.86 to 0.99, p=0.028) than people who were adherent. CONCLUSIONS: Adherence to monthly TSSE in people treated for melanoma can be differentiated into adherent, drop-off and non-adherent trajectories. Collecting information about intentions to engage in TSSE, depression, self-efficacy and/or action planning at outset may help to identify those who would benefit from additional intervention. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT03328247).
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Melanoma , Neoplasias Cutâneas , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Estudos Longitudinais , Masculino , Melanoma/diagnóstico , Autoexame , Neoplasias Cutâneas/diagnóstico , Melanoma Maligno CutâneoRESUMO
BACKGROUND: There is a critical need for an intervention to improve nurses' eating and physical activity behaviours. As nurses spend a substantial proportion of their waking hours at work, concerted efforts to deliver such interventions in the workplace is growing. This study formed part of a multiphase programme of research that aimed to systematically develop an evidence-based and theory-informed workplace intervention to promote changes in eating and physical activity among nurses. METHODS: The intervention was developed iteratively, in line with Medical Research Council complex intervention guidelines. It involved four activities: (1) identifying the evidence base, (2) understanding the determinants of nurses' eating and physical activity behaviour change through theory-based qualitative interviews and survey, (3) identifying intervention options using the Behaviour Change Wheel, and (4) specifying intervention content and implementation options using a taxonomy of behaviour change techniques. RESULTS: Data from 13 randomised controlled trials indicated that workplace-based behaviour change interventions targeted to this population are effective in changing behaviour. The evidence base was, however, limited in quantity and quality. Nurses' beliefs about important factors determining their eating and physical activity behaviour were identified across 16 qualitative interviews and 245 survey responses, and key determinants included environmental context and resources, behavioural regulation, emotion, beliefs about consequences, knowledge and optimism. Based on these findings, 22 behaviour change techniques suitable for targeting the identified determinants were identified and combined into a potential workplace intervention. CONCLUSIONS: An evidence-based and theory-informed intervention tailored to the target population and setting has been explicitly conceptualised using a systematic approach. The proposed intervention addresses previous evidence gaps for the user population of nurses. Further to this, such an intervention, if implemented, has the potential to impact nurses' eating and physical activity behaviours and in turn, the health of nurses and the quality of healthcare delivery.
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Overeating can be automatically triggered by the presence of palatable food. When presented with an opportunity to consume unlimited chocolate under the guise of a consumer study, chocolate consumption in individuals (n=62) with healthy dietary intentions could be predicted from a psychological measure of cognitive inhibition. Individuals who were less able to suppress goal-incongruent responses in an established inhibitory task: (a) ate more chocolate and (b) had a higher body mass index than others suggesting that these individuals were less able to exert dietary control in the presence of palatable but intention-incongruent foods.
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Cacau , Doces , Ingestão de Alimentos/psicologia , Comportamento Alimentar/psicologia , Inibição Psicológica , Intenção , Índice de Massa Corporal , Feminino , Preferências Alimentares/psicologia , Objetivos , Humanos , Controle Interno-Externo , Masculino , Adulto JovemRESUMO
BACKGROUND: Although recent economics literature suggests a link between performance-related pay (PRP) and ill health, this finding is contested on the grounds that this link is plagued by endogeneity between the two variables of interest. OBJECTIVE: This study investigates the adverse effects of performance-related pay on stress which is an important determinant of physical health. METHODS: Forty subjects were randomly assigned to two equal groups: either being paid by performance or being paid a flat fee. Both objective (saliva samples to measure cortisol elevation) and subjective (self-reported stress level) measures of stress were obtained before and after participation in the experiment. This experimental methodology purges the effects of self-selection into performance pay and identifies the direction of causation from performance-related pay to stress which is measured by cortisol levels. RESULTS: Those who were paid for their performance experienced higher levels of stress, both in terms of perceived stress and in terms of objectively measured cortisol levels, compared to those who were paid a flat fee for minimum performance. CONCLUSIONS: Performance-related pay induces objectively measurable stress. Self-reported stress levels and the objective stress measure obtained by measuring cortisol move in a similar direction for the PRP and non-PRP groups, but only the cortisol group shows statistically significant differences between the PRP and non-PRP. This also suggests that individuals underestimate the stress caused by performance pay.
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Hidrocortisona , Saliva , Humanos , Salários e Benefícios , Estresse Psicológico/etiologiaRESUMO
OBJECTIVE: To test the dimensionality of Type-D personality, using taxometric procedures, to assess if Type-D personality is taxonic or dimensional. Type-D personality is treated as a categorical variable and caseness has been shown to be a risk factor for poor prognosis in coronary heart disease. However, at present, there is no direct evidence to support the assumption that Type D is categorical and able to differentiate true cases from noncases. METHODS: In total, 1012 healthy young adults from across the United Kingdom and Ireland completed the DS14, the standard index of Type D, and scores were submitted to two taxometric procedures MAMBAC and MAXCOV. RESULTS: Graphical representations (comparing actual with simulated data) and fit indices indicated that Type D is more accurately represented as a dimensional rather than categorical construct. CONCLUSION: Type D is better represented as a dimensional construct. Implications for theory development and clinical practice with respect to Type D are examined as well as the wider use of taxometrics within psychosomatic medicine (e.g., to investigate if there are medically unexplained syndrome taxons, such as a Gulf War Syndrome taxon).
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Personalidade/classificação , Adolescente , Adulto , Classificação/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Determinação da Personalidade/estatística & dados numéricos , Estatística como Assunto/métodosRESUMO
OBJECTIVE: Between-participant research has shown that high negative affectivity predicts greater activity limitations and vice versa. This study examined both between- and within-participant associations of negative and positive affectivity with activity levels using ecological momentary assessment. METHOD: Participants were 25 people who had undergone joint replacement surgery 12 months previously. Participants made multiple reports of their activity and positive and negative affectivity over a single day using a computerized diary. Activity was also objectively recorded using an activity monitor. The following day, participants made a self-report of their activity over the measurement day and general positive and negative affectivity levels were recorded. RESULTS: Higher self-reported walking time over the whole measurement day was associated with higher general positive affectivity but not negative affectivity. However, using ecological momentary assessment, higher diary reports of negative affectivity predicted increased activity levels while positive affectivity neither predicted nor was predicted by activity. CONCLUSION: These findings demonstrate the importance of within-participant methodology in detecting subtle and immediate effects of individuals' mood on behavior that may differ from findings investigating between-participant effects over longer time periods.
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Atividades Cotidianas/psicologia , Afeto , Artroplastia de Quadril/psicologia , Artroplastia de Quadril/reabilitação , Artroplastia do Joelho/psicologia , Artroplastia do Joelho/reabilitação , Atividade Motora , Idoso , Idoso de 80 Anos ou mais , Ansiedade/diagnóstico , Ansiedade/psicologia , Estudos de Coortes , Computadores de Mão , Depressão/diagnóstico , Depressão/psicologia , Feminino , Seguimentos , Frustração , Humanos , Humor Irritável , Masculino , Pessoa de Meia-Idade , Motivação , Dor/psicologia , Dor/reabilitação , Estatística como Assunto , Caminhada/psicologiaRESUMO
OBJECTIVE: The present study investigates whether nurses working for a national medical telephone helpline show evidence of "decision fatigue," as measured by a shift from effortful to easier and more conservative decisions as the time since their last rest break increases. METHOD: In an observational, repeated-measures study, data from approximately 4,000 calls to 150 nurses working for the Scottish NHS 24 medical helpline (37% of the national workforce) were modeled to determine whether the likelihood of a nurse's decision to refer a patient to another health professional the same day (the clinically safest but most conservative and resource inefficient decision) varied according to the number of calls taken/time elapsed since a nurse's last rest break and/or since the start of shift. Analyses used mixed-effect logistic regression. RESULTS: For every consecutive call taken since last rest break, the odds of nurses making a conservative management decision (i.e., arranging for callers to see another health professional the same day) increased by 5.5% (p = .001, 95% confidence interval [CI: 2.2, 8.8]), an increase in odds of 20.5% per work hour (p < .001, 95% CI [9.1, 33.2]) or 49.0% (on average) from immediately after 1 break to immediately before the next. Decision-making was not significantly related to general or cumulative workload (calls or time elapsed since start of shift). CONCLUSIONS: Every consecutive decision that nurses make since their last break produces a predictable shift toward more conservative, and less resource-efficient, decisions. Theoretical models of cognitive fatigue can elucidate how and why this shift occurs, helping to identify potentially modifiable determinants of patient care. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Assuntos
Tomada de Decisões/ética , Fadiga/diagnóstico , Adulto , Feminino , Humanos , Masculino , Enfermeiras e EnfermeirosRESUMO
BACKGROUND: Despite the significant health benefits associated with eating healthily, diet is extremely difficult to change, with the majority of people who intend to eat more healthily failing to do so. Recent evidence has suggested that the ability to turn intentions into actions may be related to individual differences in one facet of executive control - cognitive inhibition (i.e. the ability to inhibit irrelevant information and suppress prepotent responses). The present study investigates the role of this and other executive processes (inhibition, task switching, planning and cognitive flexibility) in the translation of dietary intentions into action. In addition, as the literature suggests that weak executive control may be associated with hyper-responsivity to cues to action, the role of executive processes in susceptibility to environmental food cues and responses to If-Then plans designed to cue intended behaviour are investigated. METHODS: Future intentions about consumption of fruits and vegetables and snack foods will be measured in a sample of young adults. Actual consumption of the target foods will be recorded with computerised diaries over a subsequent 3-day period. Performance on a battery of established executive control tasks (Go-NoGo, Tower task, Verbal Fluency task and Trail-Making) will be used to predict the discrepancy between intended and actual dietary behaviour. In addition, executive control scores will be used to predict reported susceptibility to environmental food cues and benefit derived from the use of 'If-Then plans' designed to cue intended behaviour. DISCUSSION: Our findings will add to understanding about the role of executive control in translating intentions into actions and may demonstrate potential for future public health interventions. If participants with weak executive control are found to be less likely to eat as they intend than those with strong executive control, then interventions that reduce the load on these executive processes may increase chances of successful intention-behaviour translation. If those with weak executive control are found to be more responsive to cues to action they may also benefit more from the use of If-Then plans designed to cue intended behaviour.