Measuring young adolescent perceptions of relationships: A vignette-based approach to exploring gender equality.

This paper reports the development and baseline data of a vignettes-based measure of gender equality. METHODS: Vignettes were developed through 3-day long focus groups. After piloting in 13 sites and repiloting a revised version in 6 countries, responses were categorized by the construct tapped and a scoring system developed. Finalized vignettes were then tested in DR Congo, Ecuador and China. RESULTS: Young adolescents can successfully respond to vignettes; and can differentiate self from hypothetical protagonists of same and opposite sex. Response differences by sex of respondent and protagonist were statistically significant across a range of scenarios and settings. CONCLUSION: This is the first vignettes-based measure for young adolescents assessing young adolescent perceptions of relationships differentiated by sex of the protagonist.

A standardized low-cost peer role-playing training intervention improves medical student competency in communicating bad news to patients in Botswana.

OBJECTIVE: The purpose of this study was to demonstrate effectiveness of an educational training workshop using role-playing to teach medical students in Botswana to deliver bad news. METHOD: A 3-hour small group workshop for University of Botswana medical students rotating at the Princess Marina Hospital in Gaborone was developed. The curriculum included an overview of communication basics and introduction of the validated (SPIKES) protocol for breaking bad news. Education strategies included didactic lecture, handouts, role-playing cases, and open forum discussion. Pre- and posttraining surveys assessed prior exposure and approach to breaking bad news using multiple-choice questions and perception of skill about breaking bad news using a 5-point Likert scale. An objective structured clinical examination (OSCE) with a standardized breaking bad news skills assessment was conducted; scores compared two medical student classes before and after the workshop was implemented.ResultForty-two medical students attended the workshop and 83% (35/42) completed the survey. Medical students reported exposure to delivering bad news on average 6.9 (SD = 13.7) times monthly, with 71% (25/35) having delivered bad news themselves without supervision. Self-perceived skill and confidence increased from 23% (8/35) to 86% (30/35) of those who reported feeling "good" or "very good" with their ability to break bad news after the workshop. Feedback after the workshop demonstrated that 100% found the SPIKES approach helpful and planned to use it in clinical practice, found role-playing helpful, and requested more sessions. Competency for delivering bad news increased from a mean score of 14/25 (56%, SD = 3.3) at baseline to 18/25 (72%, SD = 3.6) after the workshop (p = 0.0002).Significance of resultsThis workshop was effective in increasing medical student skill and confidence in delivering bad news. Standardized role-playing communication workshops integrated into medical school curricula could be a low-cost, effective, and easily implementable strategy to improve communication skills of doctors.

Management simulations for Lean healthcare: exploiting the potentials of role-playing.

Purpose The purpose of this paper is to investigate the potentials of role-playing (RP) both in training healthcare (HC) professionals to implement tools and improvement actions based on Lean principles, and in supporting group discussion and the sharing of different competencies for the development of Lean HC. Design/methodology/approach The paper presents the case study of an RP simulation called LEAN HEALTHCARE LAB, which is used to train HC professionals at Siena University Hospital. The paper reports and discusses the results of a specific two-day simulation session and of a questionnaire that was distributed to gather feedback from the participants. Findings The paper verifies the potentials of RP to be a powerful educational and training tool that is able to stimulate the HC participants to apply Lean thinking principles and share their competencies in collaborative decision-making processes. Research limitations/implications The study provides data in reference to one single simulation session, although the game has already been applied several times in different HC organizations with very similar outcomes. Moreover, a more in-depth analysis of players' perceptions and decisions could be performed using different tools in addition to the adopted questionnaire. Practical implications RP games (RPGs) are effective training and educational tools for HC professionals. They offer benefits and learning conditions which are definitely different if compared with more conventional education programs for HC professionals. Originality/value While previous studies have extensively discussed the potentialities of RPG and simulations in training programs, only a few articles have discussed the RP adoption for Lean thinking and even less to educate HC professionals on Lean principles and tools.

Impact of Performance Feedback in Family-Centered and Culturally Responsive Interview Instruction.

PURPOSE: Conducting culturally responsive and family-centered diagnostic interviews is an important part of speech and language services. However, there is limited information on the effective ways to teach speech-language pathology graduate students to acquire these skills. The purpose of this study was to examine the effect of performance feedback on graduate students' use of ethnographic principles, open-ended questions, and restating and summarizing comments in caregiver interviews. METHOD: A randomized controlled crossover design (n = 26) was used to examine the differential effects of students receiving performance feedback or general feedback on role-play interviews. Ethnographic principles, open-ended questions, and restating and summarizing comments were measured at 3 time points: after class instruction (Groups 1 and 2), after the first feedback type allocation (Group 1: performance feedback; Group 2: general feedback), and after the second feedback type allocation (Group 1: general feedback; Group 2: performance feedback). RESULTS: Statistically significant increases, with large effect sizes, were found in students' use of ethnographic principles, open-ended questions, and restating and summarizing comments following the performance feedback conditions. CONCLUSION: These findings suggest that performance feedback is an effective and efficient instructional procedure to increase culturally responsive and family-centered interview skills through an ethnographic interview approach in preservice speech-language pathology students.

Enhancement of Pulmonary Tuberculosis Prevention Behavior With Role Play Among Elementary School Students.

Tuberculosis as an infectious disease is increasing in both the number of cases and severity of impact, and the number of cases among school-aged children is also increasing. Health promotion campaigns in schools have not been intensive, and there is poor behavior in tuberculosis prevention. Role play-playing roles actively with provided materials-is one health education method that can empower school-aged children to understand tuberculosis prevention. The purpose of this research is to identify the influence of role playing on tuberculosis transmission prevention in school-aged children. Study participants were 100 school-aged children. The study used quasi-experimental types of pre-test and post-test, with a control group. The t test results showed that improvement of tuberculosis prevention behaviors in the intervention group was higher than the control group (p value = .000). The role play method is recommended for health education for at least 6 sessions in school-aged children.

Enhancing Dental Students' Understanding of Poverty Through Simulation.

Dental students should develop an understanding of the barriers to and frustrations with accessing dental care and maintaining optimal oral health experienced by persons with limited resources rather than blaming the patient or caregiver. Developing this understanding may be aided by helping students learn about the lives of underserved and vulnerable patients they will encounter not only in extramural rotations, but throughout their careers. The aim of this study was to determine if dental students' understanding of daily challenges faced by families with low income changed as a result of a poverty simulation. In 2015 and 2016, an experiential poverty simulation was used to prepare third-year dental students at one U.S. dental school for their upcoming required community-based rotations. In 2015, United Way staff conducted the simulation using the Missouri Community Action Poverty Simulation (CAPS); in 2016, faculty members trained in CAPS conducted the simulation using a modified version of the tool. In the simulation, students were assigned to family units experiencing various types of hardship and were given specific identities for role-playing. A retrospective pretest and a posttest were used to assess change in levels of student understanding after the simulation. Students assessed their level of understanding in five domains: financial pressures, difficult choices, difficulties in improving one's situation, emotional stressors, and impact of community resources for those living in poverty. The survey response rates in 2015 and 2016 were 86% and 74%, respectively. For each of the five domains, students' understanding increased from 58% to 74% per domain. The majority reported that the exercise was very valuable or somewhat valuable (74% in 2015, 88% in 2016). This study found that a poverty simulation was effective in raising dental students' understanding of the challenges faced by low-income families. It also discovered that framing the issues in the context of accessing dental care was important.

[Health Statistics in Senegal: between political stakes and role playing]. / Production des statistiques sanitaires au Sénégal : entre enjeux politiques et jeux d'acteurs.

INTRODUCTION: Many countries have developed disease surveillance systems to deal with epidemics, but although health information systems have existed for more than two decades, constraints and biases in data collection limit the relevance of policy decisions and strategies in the field of health, as priority has been given to education and health in developing countries. Donor support has led to the development of systems for the production of statistics, designed, among other things, to more clearly target interventions in terms of educational objectives, action and credibility and enable health systems to continue to benefit from external funding. METHODS: We used a classical anthropology approach based on observations and in-depth interviews with local and national health system actors. RESULTS: The aim of this article is to analyse the real effects of the production of health statistics in health care systems and to determine the relevance of these figures in the context in which they apply. DISCUSSIONS: Health priorities defined by international organizations and technical and financial partners focus on diseases considered to be ?priorities? to the detriment of neglected diseases, which are perceived as being more important at the local level due to their impact on the already limited health systems. We describe how health actors within healthcare structures adjust and adapt to public health requirements.

Arts-based HIV and STI prevention intervention with Northern and Indigenous youth in the Northwest Territories: study protocol for a non-randomised cohort pilot study.

INTRODUCTION: Indigenous youth are disproportionately represented in new HIV infection rates in Canada. Current and historical contexts of colonisation and racism, disconnection from culture and land, as well as intergenerational trauma resulting from the legacy of residential schools are social drivers that elevate exposure to HIV among Indigenous peoples. Peer-education and arts-based interventions are increasingly used for HIV prevention with youth. Yet limited studies have evaluated longitudinal effects of arts-based approaches to HIV prevention with youth. The authors present a rationale and study protocol for an arts-based HIV prevention intervention with Northern and Indigenous youth in the Northwest Territories (NWT), Canada. METHODS AND ANALYSIS: This is a multicentre non-randomised cohort pilot study using a pretest/post-test design with a 12-month follow-up. The target population is Northern and Indigenous youth in 18 communities in the NWT. The aim is to recruit 150 youth using venue-based sampling at secondary schools. Participants will be involved in an arts-based intervention, Fostering Open eXpression among Youth (FOXY). Participants will complete a pretest, post-test survey directly following the intervention, and a 12-month follow-up. The primary outcome is new or enhanced HIV knowledge, and secondary outcomes to include: new or enhanced sexually transmitted infections knowledge, and increased self-esteem, resilience, empowerment, safer sex self-efficacy and cultural connectedness. Mixed effects regression analyses will be conducted to evaluate pretest and post-test differences in outcome measurement scores. ETHICS AND DISSEMINATION: This study has received approval from the HIV Research Ethics Board at the University of Toronto (REB: 31602). In addition, the project is currently registered in the NWT with the Aurora Research Institute (Licence: 15741). Trial results will be published according to the Transparent Reporting of Evaluations with Nonrandomised Designs statement. TRIAL REGISTRATION NUMBER: NCT02743026; Pre-results.

Development of a Communication Intervention for Older Adults With Limited Health Literacy: Photo Stories to Support Doctor-Patient Communication.

Successful doctor-patient communication relies on appropriate levels of communicative health literacy, the ability to deal with and communicate about health information. This article aims to describe the development of a narrative- and picture-based health literacy intervention intended to support older patients with limited health literacy when communicating during their primary care consultations. We performed a formative evaluation that included a review of the literature and interviews with stakeholders on relevant health literacy issues, qualitative studies with the target group, intervention planning, and a small-scale evaluation. Cocreation with the target group was a major component. Seven photo stories were developed incorporating principles from narrative and social learning theory and covering communication themes and strategies identified during focus group discussions and role-play exercises. The intervention was developed in 3 different formats: 1-page photo stories, narrated video clips using the original photo story pictures, and interactive video clips covering participation and communication during primary care consultations. In our small-scale evaluation, older adults considered the cocreated intervention appealing and comprehensible. The intervention shows promise for improving the health of older adults but needs further evaluation. This study provides a rigorous template for the participatory development of health literacy interventions.

The Role of Self- and Peer Assessment in Dental Students' Reflective Practice Using Standardized Patient Encounters.

The aim of this study was to gain insight into the nature of the role played by self- and peer assessment in the development of dental students' reflective practice skills and the value gained through structured encounters with standardized patients. Four standardized patient encounters in an objective structured clinical exam (OSCE) format served as a learning experience for students to demonstrate decision making and communication skills in complex scenarios regarding issues of ethics. Self- and peer assessment and peer-to-peer discourse were used to enhance student reflection. A sample of 16 peer pairs was randomly selected from the population of 108 fourth-year students who participated in the 2014 Clinical Dental Ethics OSCE. Data were collected from self- and peer assessment forms. Five overall performance themes (personal affect, verbal communication, professional demeanor, relationship-building, and patient management) and three student learning themes (application and knowledge, ways to change, and impressed with peer/increased confidence in self) were identified. The results showed that peer assessment ratings were consistently higher than those in the self-assessments, but overall the students deemed both their peers' and their own decision making and communication skills to be quite good. These students rated their experience with the OSCE and self- and peer assessments as positive, appreciating the importance of reflection and learning from their peers. These results provide support for the continued formative use of standardized patient OSCEs and self- and peer assessment to help students develop skills in decision making, communication, professionalism, and reflection.

Assessing program sustainability in an eating disorder prevention effectiveness trial delivered by college clinicians.

Sustainability of the Body Project, a dissonance-based selective eating disorder prevention program supported by efficacy and effectiveness trials, has not previously been examined. This mixed-methods study collected qualitative and quantitative data on training, supervision, and the intervention from 27 mental health clinicians from eight US universities who participated in an effectiveness trial and quantitative data on 2-year sustainability of program delivery. Clinicians, who were primarily masters-level mental health providers, had limited experience delivering manualized interventions. They rated the training and manual favorably, noting that they particularly liked the role-plays of session activities and intervention rationale, but requested more discussion of processes and group management issues. Clinicians were satisfied receiving emailed supervision based on videotape review. They reported enjoying delivering the Body Project but reported some challenges with the manualized format and time constraints. Most clinicians anticipated running more groups after the study ended but only four universities (50%) reported providing additional Body Project groups at the 1-year follow-up assessment and sustained delivery of the groups decreased substantially two years after study completion, with only one university (12%) continuing to deliver groups. The most commonly reported barriers for conducting additional groups were limited time and high staff turnover.

Teaching clinical interviewing skills using role-playing: conveying empathy to performing a suicide assessment: a primer for individual role-playing and scripted group role-playing.

This article provides a useful introduction to the art of role-playing in both the individual format and the group format using scripted group role-playing (SGRP). Role-playing can provide powerful learning opportunities, but to do so it must be done well. This article imparts guidance toward this goal. SGRP may greatly enhance the acquisition of critical complex interviewing skills, such as suicide assessment and uncovering domestic violence, in health care providers across all disciplines, an educational goal that has not been achievable to date. Although research is at an early stage of development, the hope represented by SGRP is tangible.

The validity of a regression-based procedure for detecting concealed psychopathology in structured personality assessment.

Positive Impression Management (PIM) predicted scoring of the Personality Assessment Inventory (PAI; Morey, 2007) is a regression-based procedure designed to inform diagnostic hypotheses when respondents engage in positive response distortion (PRD). Observed scores that deviate above the PIM-predicted score are proposed to indicate areas of true psychopathology that are being concealed by the respondent. To test this proposition, the PAI was administered twice to 334 undergraduate students, using standard instructions and job applicant role-play instructions. For most PAI scales and subscales, the PIM-predicted deviation scores from the role-play condition were significantly correlated with scores on the corresponding scale obtained from the standard administration condition. Exceptions to the general findings are noted for some scales, and recommendations are offered for further research and clinical application of PIM-predicted scores.

An assessment of student satisfaction with peer teaching of clinical communication skills.

BACKGROUND: Peer teaching is now used in medical education with its value increasingly being recognised. It is not yet established whether students differ in their satisfaction with teaching by peer-teachers compared to those taught by academic or clinical staff. This study aimed to establish satisfaction with communication skills teaching between these three teaching groups. METHODS: Students participated in a role-play practical facilitated either by clinicians, peer-teachers or non-clinical staff. A questionnaire was administered to first-year medical students after participating in a communication skills role-play session asking students to evaluate their satisfaction with the session. Data were analysed in SPSS 20. RESULTS: One hundred and ninety eight students out of 239 (83%) responded. Students were highly satisfied with the teaching session with no difference in satisfaction scores found between those sessions taught by peers, clinical and non-clinical staff members. 158 (80%) considered the session useful and 139 (69%) strongly agreed tutors facilitated their development. There was no significant difference in satisfaction scores based on tutor background. CONCLUSIONS: Satisfaction is as high when tutored by peer-teachers compared to clinicians or non-clinical staff. Constructive feedback is welcomed from a range of personnel. Final-year students could play an increasing role in the teaching of pre-clinical medical students.

Os papéis ocupacionais de pessoas hospitalizadas em decorrência da Síndrome da Imunodeficiência Adquirida / The occupational roles of hospitalized people due to Acquired Immune Deficiency Syndrome

Pessoas com o Vírus da Imunodeficiência Humana (HIV) e doentes com Síndrome da Imunodeficiência Adquirida (AIDS)vivenciam alterações de papéis ocupacionais. O objetivo deste estudo foi conhecer a configuração desses papéis em pessoashospitalizadas em decorrência da AIDS, nos diferentes estágios da patologia. A casuística foi composta por 40 pessoasHIV positivas internadas, subdivididas em três grupos por tempo de diagnóstico; o grupo controle foi composto por12 pessoas, não infectadas e não internadas. Os dados quantitativos foram coletados por meio da aplicação do protocolo“Lista de Identificação de Papéis Ocupacionais”, validado no Brasil, e analisados pelo Teste Exato de Fisher. Foram realizadasentrevistas com 20% das pessoas do grupo de estudo, para coleta de dados qualitativos, analisados de acordo como método de análise de conteúdo. Constatou-se que as pessoas do grupo de estudo apresentaram mais perdas de papéisocupacionais do que as do grupo controle, sendo a diferença estatisticamente significativa para o papel de “trabalhador”.Concluiu-se que pessoas com HIV/AIDS perdem papéis ocupacionais devido ao adoecimento e hospitalização, o que trazimpactos psicossociais e compromete sua vida ocupacional.(AU)

Persons hosting Human Immunodeficiency Virus (HIV) and patients having Acquired Immunodeficiency Syndrome (AIDS)suffer from alterations of occupational roles. The aim of this study was to know the configuration of these roles in personshospitalized as a result of AIDS, in the different stages of the pathology. The casuistry was composed by 40 HIV-positivepersons interned, subdivided in three groups considering diagnosis time; the control group was composed by 12 persons,not infected and not interned. Quantitative data were collected by means of the application of the protocol “List of Identificationof Occupational Roles”, validated in Brazil, and analyzed by Fisher Exact Test. Interviews were carried out with20% of the persons of the group of study, for collection of qualitative data, and analyzed according to the content analysismethod. We observed that the persons of the group of study presented more losses in occupational roles than those in thecontrol group, and we identified a statistically significant difference for the role of “worker”. We concluded that personshaving HIV/AIDS lose occupational roles due to the diseases and hospitalization, something which brings psychosocialand compromises their occupational life.(AU)

The use of narrative sampling in the assessment of social cognition: the Narrative of Emotions Task (NET).

Social cognitive deficits in schizophrenia are well documented and related to functional outcome. Current social cognition measures are often not psychometrically validated, too heterogeneous for standardization, and focus principally on one domain of social cognition rather than the simultaneous activation of multiple domains. Also, few if any allow for personalization of stimuli and interpretation of personally evocative events. An alternative methodology that addresses these limitations is the analysis of samples of personal narratives. The present study evaluates the psychometric properties of a measure called the Narrative of Emotions Task (NET). The NET was used to assess the performance of participants with a diagnosis of schizophrenia or schizoaffective disorder and nonclinical controls. Use of the NET revealed significant impairments in the emotional narratives of participants with schizophrenia. Various NET indices were significantly related to current measures of theory of mind and emotion perception, as well as a social skills role-play, but were not related to measures of attributional style or clinician-rated functioning scales. Overall, the NET׳s psychometric properties justify further use of the narrative sampling method of social cognition assessment in this population.

Activating older adults with serious mental illness for collaborative primary care visits.

OBJECTIVE: Persons with serious mental illness frequently receive inadequate medical care and are more likely to experience difficulty navigating the health care system compared with the general population. To address this gap in quality, we developed a program of peer co-led collaborative activation training for primary care (CAT-PC) designed to improve "patient activation" and person-centered care in primary care visits for middle-aged and older adults with serious mental illness and cardiovascular risk. This report presents pilot study feasibility and participant outcomes for CAT-PC. METHOD: A pre-post pilot evaluation of CAT-PC included N = 17 adults (age ≥ 50) with serious mental illness and cardiovascular health risk conditions, and N = 6 primary care providers. CAT-PC consists of 9 weekly peer co-led patient education and skills training sessions and a 45-min video-based training for primary care providers. Pre-post measures included the Patient Activation Measure (PAM), Perceived Efficacy in Patient-Physician Interactions (PEPPI), Autonomy Preference Index (API) for preferred role in primary care encounters, and Social Skills Performance Assessment (SSPA) role-play test for medical visits. RESULTS: All 17 participants attended 5 or more sessions. Post-intervention improvement was found for patient activation and simulated performance of medical visit communication skills. Trends were observed for improved self-efficacy in provider interactions and greater preference for a more collaborative role in decision-making. CONCLUSIONS AND IMPLICATIONS: CAT-PC is a brief, peer co-led education and skills training intervention potentially improving patient activation in primary care encounters and providing an important missing component in emerging models of "patient-centered behavioral health homes" for this high-risk group.

Adaptive role switching promotes fairness in networked ultimatum game.

In recent years, mechanisms favoring fair split in the ultimatum game have attracted growing interests because of its practical implications for international bargains. In this game, two players are randomly assigned two different roles respectively to split an offer: the proposer suggests how to split and the responder decides whether or not to accept it. Only when both agree is the offer successfully split; otherwise both get nothing. It is of importance and interest to break the symmetry in role assignment especially when the game is repeatedly played in a heterogeneous population. Here we consider an adaptive role assignment: whenever the split fails, the two players switch their roles probabilistically. The results show that this simple feedback mechanism proves much more effective at promoting fairness than other alternatives (where, for example, the role assignment is based on the number of neighbors).