"Good Care Is Slow Enough to Be Able to Pay Attention": Primary Care Time Scarcity and Patient Safety.

BACKGROUND: There is growing, widespread recognition that expectations of US primary care vastly exceed the time and resources allocated to it. Little research has directly examined how time scarcity contributes to harm or patient safety incidents not readily capturable by population-based quality metrics. OBJECTIVE: To examine near-miss events identified by primary care physicians in which taking additional time improved patient care or prevented harm. DESIGN: Qualitative study based on semi-structured interviews. PARTICIPANTS: Twenty-five primary care physicians practicing in the USA. APPROACH: Participants completed a survey that included demographic questions, the Ballard Organizational Temporality Scale and the Mini-Z scale, followed by a one hour qualitative interview over video-conference (Zoom). Iterative thematic qualitative data analysis was conducted. KEY RESULTS: Primary care physicians identified several types of near-miss events in which taking extra time during visits changed their clinical management. These were evident in five types of patient care episodes: high-risk social situations, high-risk medication regimens requiring patient education, high acuity conditions requiring immediate workup or treatment, interactions of physical and mental health, and investigating more subtle clinical suspicions. These near-miss events highlight the ways in which unreasonably large patient panels and packed schedules impede adequate responses to patient care episodes that are time sensitive and intensive or require flexibility. CONCLUSIONS: Primary care physicians identify and address patient safety issues and high-risk situations by spending more time than allotted for a given patient encounter. Current quality metrics do not account for this critical aspect of primary care work. Current healthcare policy and organization create time scarcity. Interventions to address time scarcity and to measure its prevalence and implications for care quality and safety are urgently needed.

Uncovering physical activity trade-offs in transportation policy: A spatial agent-based model of Bogotá, Colombia.

BACKGROUND: Transportation policies can impact health outcomes while simultaneously promoting social equity and environmental sustainability. We developed an agent-based model (ABM) to simulate the impacts of fare subsidies and congestion taxes on commuter decision-making and travel patterns. We report effects on mode share, travel time and transport-related physical activity (PA), including the variability of effects by socioeconomic strata (SES), and the trade-offs that may need to be considered in the implementation of these policies in a context with high levels of necessity-based physical activity. METHODS: The ABM design was informed by local stakeholder engagement. The demographic and spatial characteristics of the in-silico city, and its residents, were informed by local surveys and empirical studies. We used ridership and travel time data from the 2019 Bogotá Household Travel Survey to calibrate and validate the model by SES. We then explored the impacts of fare subsidy and congestion tax policy scenarios. RESULTS: Our model reproduced commuting patterns observed in Bogotá, including substantial necessity-based walking for transportation. At the city-level, congestion taxes fractionally reduced car use, including among mid-to-high SES groups but not among low SES commuters. Neither travel times nor physical activity levels were impacted at the city level or by SES. Comparatively, fare subsidies promoted city-level public transportation (PT) ridership, particularly under a 'free-fare' scenario, largely through reductions in walking trips. 'Free fare' policies also led to a large reduction in very long walking times and an overall reduction in the commuting-based attainment of physical activity guidelines. Differential effects were observed by SES, with free fares promoting PT ridership primarily among low-and-middle SES groups. These shifts to PT reduced median walking times among all SES groups, particularly low-SES groups. Moreover, the proportion of low-to-mid SES commuters meeting weekly physical activity recommendations decreased under the 'freefare' policy, with no change observed among high-SES groups. CONCLUSIONS: Transport policies can differentially impact SES-level disparities in necessity-based walking and travel times. Understanding these impacts is critical in shaping transportation policies that balance the dual aims of reducing SES-level disparities in travel time (and time poverty) and the promotion of choice-based physical activity.

"I don't have time": an exploration of the role of time pressures in acceptance of internet interventions for mental health.

BACKGROUND: Internet interventions for common mental disorders are widely available, effective, and economical, yet community uptake remains low. One consistently cited reason for not engaging in mental health interventions is lack of time. AIMS: This research examined whether lack of time as a rationale for not using online interventions reflects real time scarcity, and whether time availability impacts intention to use interventions. METHODS: A nationally representative sample (N = 1094, 51% women) reported their time use in activity categories for a typical week. Participants rated their acceptance and likelihood of use of mental health internet interventions, and completed mental health symptom, help-seeking and stigma measures. RESULTS: Amount of leisure time reported by participants was not associated with acceptance or likelihood of use of internet interventions for mental health. However, respondents who worked longer hours ranked time and effort factors as more influential in their intention to use internet-based mental health programs. Younger respondents and those with greater help-seeking attitudes reported higher acceptance of use. CONCLUSION: These findings suggest lack of time is not a direct barrier to use of internet interventions, and that perceived time scarcity may be masking real barriers to uptake.

The association between time scarcity, sociodemographic correlates and consumption of ultra-processed foods among parents in Norway: a cross-sectional study.

BACKGROUND: Use of ultra-processed foods has expanded rapidly over the last decades and high consumption has been positively associated with risk of e.g. overweight, obesity and type 2 diabetes. Ultra-processed foods offer convenience as they require minimal time for preparation. It is therefore reasonable to assume that such foods are consumed more often among people who experience time scarcity. The main aim of this study was to investigate the association between time scarcity and consumption of ultra-processed foods among parents of 2-year olds in Norway. A secondary aim was to investigate the association between sociodemographic correlates, weight status and consumption of ultra-processed foods. METHODS: This cross-sectional study included 497 participants. Chi-square and cross tabulations were used to calculate proportions of high vs. low consumption of ultra-processed foods in relation to time scarcity, sociodemographic correlates and weight status. Binary logistic regression analyses were performed to test the relationship between independent variables and consumption of ultra-processed foods. RESULTS: Participants reporting medium and high time scarcity were more likely to have a high consumption of ultra-processed dinner products (OR = 3. 68, 95% CI = 2. 32-5.84 and OR = 3.10, 1.80-5.35, respectively) and fast foods (OR = 2.60, 1.62-4.18 and OR = 1.90, 1.08-3.32, respectively) compared to those with low time scarcity. Further, participants with medium time scarcity were more likely to have a high consumption of snacks and soft drinks compared to participants with low time scarcity (OR = 1.63, 1.06-2.49). Finally, gender, ethnicity, educational level, number of children in the household and weight status were identified as important factors associated with the consumption of certain types of ultra-processed foods. CONCLUSIONS: Results from the present study showed that time scarcity, various sociodemographic factors and weight status was associated with consumption of processed foods. Future studies with a longitudinal design are needed to further explore these patterns over a longer period of time.

Dietary intake of working women with children does not appear to be influenced by hours of employment: A secondary analysis of the Australian Health Survey (2011-2013).

UNLABELLED: Women with children often fulfil multiple roles of running a household, raising a family and working outside the home. Good nutrition during this time is important to optimise their performance and prevent lifestyle diseases. Women also act as nutritional gatekeepers for their family. The dual burden of paid employment and unpaid family work may be associated with time scarcity in mothers which can impact food preparation and therefore nutritional adequacy. The aim of this study was to examine the diet of women who lived with children by comparison of hours worked. METHODS: This was a secondary analysis of the Australian National Nutrition and Physical Activity Survey 2011-12. Subjects were women aged 18-65 years who resided with ≥1 child (<18 years). Women were grouped according to hours of employment: not working; working <25 h a week; and working ≥25 hours a week. Data from two 24-h dietary recalls were used to compare differences between groups in nutrient intake and proportion of energy from discretionary foods. Covariates included were age, education, smoker status, Socio-Economic Indexes for Areas (SEIFA), number of persons in household, week or weekend day of the survey and the sequence of recalls. RESULTS: Analyses included 1869 women. Dietary intakes varied minimally between groups with intakes of fibre, vitamin C, and calcium lowest in the group not working. Overall diet quality was poor with >30% of energy coming from discretionary foods in all groups. CONCLUSIONS: Usual hours of employment per week have a minimal effect on diet quality in women with children. It is likely that different factors specific to each group contribute to the poor dietary intakes and should be further investigated.

Work-family conflict, lack of time for personal care and leisure, and job strain in migraine: Results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

BACKGROUND: Work-family conflict and time scarcity may affect health. We investigated the association between these issues and migraine, taking into account job strain. METHODS: Baseline data from ELSA-Brasil (6,183 women; 5,664 men) included four indicators of work-family conflict: time- and strain-based interference of work with family (TB-WFC, SB-WFC), interference of family with work (FWC) and lack of time for personal care and leisure (LOT). Migraine was classified according to International Headache Society criteria. RESULTS: Among women, definite migraine was associated with SB-WFC (odds ratio [OR] = 1.28; 95% confidence interval [CI] 1.06-1.55), FWC (OR = 1.32; 1.00-1.75), and LOT (OR = 1.30; 1.08-1.58). Probable migraine was associated with SB-WFC (OR = 1.17; 1.00-1.36). High psychological job demands and low social support interacted with LOT in association with definite migraine. Among men, probable migraine was associated with LOT (OR = 1.34; 1.09-1.64), and there were interactions between job strain and WFC for probable migraine. CONCLUSIONS: Balancing the demands of professional and domestic spheres could be highly relevant in the management of migraines. Am. J. Ind. Med. 59:987-1000, 2016. © 2016 Wiley Periodicals, Inc.

Scarcity makes people short-sighted? Evidence from intertemporal decision-making.

With the acceleration of the pace of society, the problem of scarcity of time resources is becoming more prominent, which may lead to short-sighted behavior. This study aimed to examine the impact of time scarcity on intertemporal choice and its underlying mechanisms through three experiments. Study 1 aimed to investigate the causal relationship between time scarcity and intertemporal choice and the mediating role of anxiety between time scarcity and intertemporal choice. The results showed that participants with a stronger perception of time scarcity were more likely to choose smaller and sooner gains, and that the mediating role of anxiety was significant. In Study 2, the control of time was introduced to explore whether the sense of control could alleviate the negative emotion caused by time scarcity. The results showed that individuals with high levels of control had significantly less anxiety under higher time-scarcity conditions than those with low levels of control. In Study 3, we manipulated time scarcity and found that the sense of control moderated the mediating effect of anxiety in time scarcity and intertemporal choice. Overall, these findings suggest that the sense of control over time is associated with less anxiety from time scarcity, which in turn fosters preferences for delayed gains.

Being pressed for time leads to treating others as things: Exploring the relationships among time scarcity, agentic and communal orientation and objectification.

Time scarcity has become one of the most ubiquitous phenomena in daily life worldwide. Five studies (total valid N = 1332) examined whether time scarcity elicits people's agentic orientation and dampens their communal orientation, thus increasing the likelihood of objectification towards others. Results suggested that people who perceived time scarcity were more likely to exhibit objectification towards others regardless of whether time scarcity was measured (Studies 1 and 3) or manipulated using either a scenario (Study 2a) or a recall task (Studies 2b and 4). Furthermore, agentic and communal orientations mediated the link between time scarcity and objectification (Studies 3 and 4). Additionally, the current research provided a nuanced understanding of these effects by differentiating the people being objectified into acquaintances and close friends (Study 2b) and by taking into consideration the trait-level prosociality of participants (Study 4). Results suggested that the effect persisted when people interacted with others who were close to them, and it was also applicable to people who were highly prosocial by nature. Overall, our findings highlighted the serious interpersonal consequence of time scarcity and highlighted the crucial role of value orientation in understanding this effect.