Dating couples and their relationships: intimacy and contraceptive use.

Investigations of ineffective contraceptive use have generally focused on individualistic rather than dyadic factors. The present study used a sample of dating couples to investigate four intimacy dimensions in relation to contraceptive use. Fourteen consistent contraceptive use (CCU) couples and 16 inconsistent contraceptive use (ICU) couples participated. It was found that the two groups' expectations of intimacy did not differ significantly. However, the ICU couples reported experiencing significantly lower levels of emotional, social, and intellectual intimacy than did the CCU couples. Significant differences between realized and expected levels of intimacy were found only among ICU couples. The results indicate that partners with mutually dissatisfying levels of intimacy were more likely to use contraceptives inconsistently.

Entry into the health care system: the family's decision-making process.

BACKGROUND AND OBJECTIVES: Prior work has demonstrated the importance of family members in deciding whether or not to consult a physician. This study investigated how such decisions are made and what dimensions are important in the decision-making process. METHODS: Thirty middle-class couples each role-played four hypothetical illness situations. Verbatim transcripts were analyzed according to a negotiation paradigm. RESULTS: If the decision was to wait rather than to consult a physician, the decision was more likely to have been initiated by the person designated as experiencing the signs and symptoms. Conversely, if the decision was to consult a physician, the decision was more likely to have been initiated by the spouse. Subjective views of the meaning, duration, and effect of the signs and symptoms were important dimensions in deciding whether or not to call the physician. CONCLUSION: We suggest that family practice residents be taught to inquire about family members' roles in the patient's decision to seek health care. This would demonstrate in a concrete way, beginning with the initial steps in the doctor-patient interview, the family physician's commitment to the context of the family.

Children's conceptions of AIDS: a developmental analysis.

Examined causal reasoning about AIDS in children representing three major phases of cognitive development: prelogical, concrete logical, and formal logical thinking. 60 Ss (age groups: 5-7 years, 8-10 years, and 11-13 years) were administered the Concepts of AIDS Protocol. Responses were scored using the developmentally ordered Concepts of Illness Category System. The data confirm that, as a group, children's causal thinking about AIDS parallels the ways in which children think about illness in general. More specifically, the data could be organized in terms of 6 major categories or ways in which children conceptualize AIDS and its causes. The findings provide an initial empirical foundation for AIDS education curricula.

Developmentally-based AIDS/HIV education.

A growing number of health and education professionals argue that AIDS/HIV education curricula should be developmentally-based. They suggest the principles of developmental psychology be used to design curricula based on the sequentially ordered ways children of different ages understand AIDS. Relying on findings of research on development of children's conceptions of illness, a specific developmentally-based approach to educating school-age children about AIDS/HIV is presented in this paper. For each of three major age groups, the paper describes general characteristics for children's thought processes, ways in which children assimilate information about various aspects of AIDS, and implications for educating children about causes, prevention, and fear of AIDS. The focus of AIDS/HIV education can move from reducing fear in the younger group, to identifying and differentiating causes and noncauses of AIDS in the intermediate groups, to articulating strategies for AIDS prevention in the older group.

PIP: A growing number of health and education professional argue that AIDS/HIV education curricula should be developmentally-based. They suggest the principles of developmental psychology be use to design curricula based on the sequentially ordered ways children of different ages understand AIDS. Relying on findings of research on development of children's conceptions of illness, a specific developmentally-based approach to educating school-age children about AIDS/HIV is presented in this paper. For each of the 3 major age groups (young, intermediate, and older), the paper describes general characteristics for children's though processes, ways in which children assimilate information about various aspects of AIDs, and implications for educating children about causes, prevention, and fear of AIDS. With maturity, though processes change from an egocentric viewpoint of self to an integration of self and others, from focusing only on external events to distinguishing between external and internal domains, from the inability to differentiate between cause and effect to complex causal reasoning, and from absolute thinking to relativistic thinking. These characteristics are evident in their knowledge about AIDS. While younger children define AIDS on terms of an external event and cannot articulate a cause for AIDS, children at the intermediate age level define AIDS by specific symptoms, attribute its cause to an external agent, and perceive AIDS as occurring in more general groups of people. Older children define a specific illness as a syndrome, perceive the causes of AIDS to include sex and drugs, and have a more complex understanding of the consequences of AIDs. The focus of AIDS/HIV education can move from reducing fear in the younger group thought reassurance from authority figures about their nonvulnerability, to identifying and differentiating causes and noncauses of AIDS in the intermediate groups by providing them with a list of noncauses, and to articulate strategies for AIDS prevention in the older group through detailed explanations of modes of transmission and prevention behavior. (author's modified).

Teaching styles in the faculty-resident relationship.

As part of an effort to train family physicians to be more effective teachers in family medicine, a teaching styles workshop program was developed. The aim of the program is to help physician teachers to become more flexible in matching a teaching style to a particular teaching context. The program consists of three components: (1) a scheme for classifying teaching behaviors as belonging to one of the four basic styles identified, (2) videotaped models of each of the four basic styles, and (3) structured role playing by workshop participants in which the four styles are practiced and critiqued. The program, as used in two different sets of faculty development workshops, is described and recommendations for its use by others given.

Development of children's concepts of illness.

This study examines the development of children's concepts of illness in light of Piaget's and Werner's findings regarding the ontogenesis of causal relations. Six developmentally ordered categories of explanation of illness have been articulated. These categories, which are consistent with Piaget's three major stages of cognitive development, can be useful to pediatricians (1) in explaining illness and providing "reassurance" to children, (2) in developing meaningful health education strategies, and (3) in responding to the degree of control the child feels over the illness.

Case oriented group discussions for family physicians.

Curriculum in family medicine and primary care includes various areas of concern for educators in the behavioral sciences. Most of this concerns the physician-patient relationship as the focus for teaching and learning. This paper outlines the work of a longitudinal, case oriented group of family physicians as it reflects the correlation between the actualities of practice and the curriculum in behavioral science for family practice residents. Also discussed is the issue of potential "typologies" as elaborated in the family physicians' reasons for case presentations. Such groups assist faculty and practitioners in their own awareness of educational and patient care issues in the physician-patient relationship as well as serve as a foundation for building a relevant behavioral science curriculum for residents and students.

Ethical and legal issues in family practice.

The unique goal of family practice, that of caring for the entire family's broadly defined health needs, places the family physician in an especially uncomfortable position when there is intrafamily conflict. In particular, the question of "whose agent (physician) are you?" when a family is in conflict often creates a serious ethical dilemma for the family physician. The roles of three experts who deal with family conflict, the psychotherapist, the lawyer, and the family physician, are compared and contrasted. The physician as expert is a useful approach only insofar as there are clearcut answers to a particular problem. But the ambiguity inherent in ethical problems makes this approach less than satisfactory. The role of the physician as teacher/facilitator is explored as an alternative to resolving the ethical dilemmas of intrafamily conflict.