What it means to be and feel like a "true" American: perceptions and experiences of second-generation Americans.

Through semistructured interviews, the authors investigated the relationships between the definition of a "true" American, the impact of 9/11, and the war in Iraq and their impact on experiences of fitting into and being excluded from the American identity with a sample of 10 2nd-generation young adults. Using consensual qualitative research methods (C. E. Hill et al., 2005; C. E. Hill, B. Thompson, & E. N. Williams, 1997) the authors identified 6 major domains that described participants' experiences, including physical characteristics of true Americans, behavioral characteristics of true Americans, beliefs and values of true Americans, the impact of 9/11 on definitions of true Americans, participants' American identity, and experiences as 2nd-generation Americans.

The physician-patient working alliance.

OBJECTIVE: Cognitive and emotional dimensions of the physician-patient relationship (working alliance) were examined in relation to patients' beliefs about the usefulness of treatment (perceived utility), patients' beliefs about being able to adhere to treatment (adherence self-efficacy beliefs), patients' follow through on their treatment plan (adherence), and patients' satisfaction. METHODS: Participants were 51 men and 67 women who averaged 38.9 years of age (S.D.=12.28). Seventy-two were Euro-American, 23 African-American, 6 Asian-American, 11 Hispanic, and 6 "Other." They reported an average of 7.3 years (S.D.=7.48) since being diagnosed with a chronic medical illness and an average of 7.1 (S.D.=4.88) visits to their doctor within the last year. Patients' conditions included HIV+/AIDS, hypertension, diabetes, asthma, and cancer. RESULTS: Results show moderate to strong relationships between working alliance and perceived utility (r=0.63, P<0.001), self-efficacy (r=0.47, P<0.001), adherence (r=0.53, P<0.001), and satisfaction (r=0.83, P<0.001). Regression analyses showed that ratings of the working alliance (SB=0.25, P<0.005) and self-efficacy beliefs (SB=0.48, P<0.001) predicted patient adherence and that working alliance ratings (SB=0.83, P<0.001) also predicted patient satisfaction. CONCLUSION: The working alliance can be measured in medical care and appears to be strongly associated with patients' adherence to and satisfaction with treatment. PRACTICE IMPLICATIONS: The working alliance is important in medical treatment, as it is associated with patient adherence and satisfaction. Patients' self-efficacy ought to be assessed and promoted as it is also associated with treatment adherence.