Ecological analysis of the first generation of community clinical oncology programs.

OBJECTIVE: An ecological framework is proposed for assessing factors important to consider in allocating funds to promote sound performance of interorganizational programs. DATA SOURCE/STUDY SETTING: This framework is used to examine the first generation of Community Clinical Oncology Programs (CCOPs) funded by the National Cancer Institute (NCI) from 1983-1986 to coordinate clinical research activity at the local level. The research reported is based on secondary data collected for the Community Cancer Care Evaluation at the Fred Hutchinson Cancer Center. STUDY DESIGN: A repeated measures design was used to analyze differences in the level and patterns of CCOP productivity, a measure of the number of patients enrolled on NCI-approved Phase III trials. The predictive dimensions include (1) measures of environmental inputs (population density, organizational dominance, professional support, NCI funding); (2) measures of organizational inputs (number of hospitals, number of staff, number of physicians, NCI experience, clinical research experience); and (3) structural measures (functional specialization, administrative concentration). Predicted relationships were assessed using general linear models procedures. DATA COLLECTION/EXTRACTION METHODS: Data obtained from NCI files were supplemented by interviews with NCI personnel and published statistics. PRINCIPAL FINDINGS: Funding level, clinical research experience, and number of staff are the most important predictors of patient enrollment. Clinical research experience has a positive relationship with patient enrollment and a negative association with changes in enrollment. The reversal is explained by the influence of the CCOPs that had the greatest amount of clinical research experience at the beginning of the program. CONCLUSIONS: The ecological approach provides a useful framework for understanding factors that should be considered in funding interorganizational programs and promoting their development. Most importantly, results suggest that a somewhat different approach is needed to initiate programs rather than to expand existing programs.

Memory for and experience of differential competitive behavior of individuals and groups.

Four experiments investigated whether differential experiences with groups and individuals led to previously obtained results of greater competitive expectations in intergroup than interindividual relations. In Experiment 1, participants rated their recalled instances of intergroup relations as more competitive than their interindividual relations. In Experiment 2, a relatively greater proportion of competitive to cooperative intergroup relations were recalled compared with interindividual relations. In Experiment 3, participants recorded relevant interactions for 7 days, and rated their intergroup relations as more competitive than their interindividual relations. In Experiment 4, participants recorded a relatively greater number of cooperative than competitive relations with individuals than with groups. These results can be interpreted as a demonstration in a nonlaboratory context that intergroup relations are more competitive than interindividual relations.

Effects of resource availability and importance of behavior on the experience of crowding.

According to the interference formulation, participants in a crowded setting will experience interference to the extent that behavioral goals conflict with environmental conditions. The importance of the behavioral goals directly affects not only the magnitude of the interference but also the mechanism by which people cope with interference. It was reasoned that important goals would induce a more active coping strategy in a crowded setting than in an uncrowded setting and would maintain task performance at the price of increasing crowding stress. When the behavioral goal is unimportant, decrements in task performance preclude a rise in stress. A laboratory study manipulated group size, in order to vary the availability of resources, and the importance of the task behavior. The predictions were confirmed, and partial confirmation was obtained for predictions involving the effects of the internal-external personality dimension. The meaning of the results is discussed in terms of other findings in the literature on crowding and the mediating role of the type of mechanism used to cope with interference.

Interindividual-intergroup discontinuity reduction through the anticipation of future interaction.

Consistent with the role of a long-term perspective in reducing the tendency of intergroup relations to be more competitive than interindividual relations in the context of noncorrespondent outcomes, an experiment demonstrated that anticipated future interaction reduced intergroup but not interindividual competitiveness. Further results indicated that the effect was present only for groups composed of members high in abstractness (Openness-Intellect on the Big 5 Inventory and Intuition on the Myers-Briggs Type Inventory) who trusted their opponents.

Long-term outcome maximization and the reduction of interindividual-intergroup discontinuity.

Two experiments demonstrated that different procedures can be used to reduce the tendency for intergroup relations to be more competitive than interindividual relations. Experiment 1 revealed that this tendency was reduced when individual or group participants interacted with individual or group confederates who followed a tit-for-tat strategy as opposed to a Pavlov strategy or a standard control condition that did not involve confederates. Experiment 2 revealed that the tendency for groups to be more competitive than individuals was less pronounced with successive responding than with simultaneous responding. Further results indicated that the higher the total session score on the Consideration of Future Consequences Scale, the less the competition between groups. The results from both experiments were interpreted as indicating that intergroup competitiveness can be reduced by inducing a concern with long-term outcomes.

When groups are more competitive than individuals: the domain of the discontinuity effect.

The related goals of the research were to delineate the domain of discontinuity, 1st by demonstrating its occurrence in a nonmatrix situation and, 2nd, by establishing the antecedent outcome conditions necessary for producing a discontinuity effect. The 1st goal was met by designing a mixed motive situation involving the production of origami products. Under these conditions, the magnitude of the discontinuity effect did not significantly differ from that in a matrix-only condition. The 2nd goal was met by a separate experiment that used H. H. Kelley and J. W. Thibaut's (1978) analysis of degree of noncorrespondence of outcomes. This experiment demonstrated that as noncorrespondence increased, so did the rate of competitive responding by groups but not by individuals. This pattern was qualified by an interaction with gender such that competitiveness was more markedly affected by noncorrespondence for groups of women than for groups of men.

Support groups as open systems: a model for practice and research.

Despite the increasing of use of support groups to respond to the needs of people dealing with crises, life transitions, and chronic conditions, there is no conceptual framework to guide practice and research. On the basis of a review of the literature, this article distinguishes support groups from self-help and treatment groups. It then proposes an open systems model for understanding the factors that affect support groups, for guiding interventions, and for evaluating their outcomes. Four conceptual dimensions are described: (1) environmental conditions (resources and constraints), (2) participant group characteristics (size, composition, and technology), (3) group conditions (goals, structural form, and development), and (4) outcomes (positive and negative effects for members, leaders, and organizations; group problems; and ethical and legal issues). Findings from a pilot study of support group practice based on this framework are presented and discussed.

Negative experiences in support groups.

Although the benefits of support groups are well documented in the literature, little attention has been given to possible negative effects. A review of the literature related to support groups, negative experiences in groups, and social support, as well as personal accounts of members and practitioners, affirm the importance of considering the negative experiences in support groups. In addition, this material provides a base for the specification of potential problematic group conditions and negative outcomes and points to issues in obtaining information from respondents about negative factors. Findings from mailed questionnaires given to practitioners leading cancer support groups indicate the nature of the negative experiences in groups that these practitioners had led or heard about. Implications of these findings for prevention and intervention are discussed.

Connecting group members through telephone and computer groups.

Telephone conference calls and computer-assisted groups are innovative means of offering health and mental health services. This article reviews the practice literature on the use of technology-based groups and presents the results of a survey of group practitioners that focused on their experiences with telephone and computer groups, their knowledge and comfort levels with these groups, and their perspectives on the benefits and problems of using technology in group practice. Benefits of using this technology included increased accessibility, convenience, and anonymity; problems were decreased cues, technological issues, and group process difficulties. Implications of using telephone and computer technology for group practice, particularly in health settings, are discussed.

Promoting breast cancer screening in rural, African American communities: the "science and art" of community health promotion.

Implementing community health promotion programs can be a daunting task for social workers. Aside from the practical skills necessary for engaging diverse groups, it requires an understanding of the complex interplay of several theoretical constructs. Using an eight-year breast cancer prevention project, the North Carolina Breast Cancer Screening Program, as a case study, this article describes both the "science and art" of community health promotion. The article provides examples illustrating the "art" of generating participation by both lay and professional communities and concludes with guidelines for social workers who plan to conduct their own community health promotion programs.