Whither dominance? An enduring evolutionary legacy of primate sociality.

This article discusses dominance personality dimensions found in primates, particularly in the great apes, and how they compare to dominance in humans. Dominance traits are seen in virtually all primate species, and these dimensions reflect how adept an individual is at ascending within a social hierarchy. Among great apes, dominance is one of the most prominent personality factors but, in humans, dominance is usually modeled as a facet of extraversion. Social, cultural, and cognitive differences between humans and our closest ape relatives are explored, alongside humanity's hierarchical and egalitarian heritage. The basic characteristics of dominance in humans and nonhuman great apes are then described, alongside the similarities and differences between great apes. African apes live in societies each with its own hierarchical organization. Humans were a possible exception for some of our history, but more recently, hierarchies have dominated. The general characteristics of high-dominance humans, particularly those living in industrialized nations, are described. Dominance itself can be subdivided into correlated subfactors: domineering, prestige, and leadership. Various explanations have been posed for why dominance has declined in prominence within human personality factor structures, and several possibilities are evaluated. The value of dominance in personality research is discussed: dominance has links to, for instance, age, sex, aggression, self-esteem, locus of control, stress, health, and multiple socioeconomic status indicators. The piece concludes with recommendations for researchers who wish to assess dominance in personality.

Development and validation of the Symptomatic Transdiagnostic Test (S2T).

INTRODUCTION: The categorical approach in psychiatry has received many criticisms. Modern research tends to develop a transdiagnostic approach. However, transdiagnostic works lack an overall understanding and focus mainly on anxiety and depression. The aim of the present study was to develop an easy to use tool to evaluate multiple dimensions opening the way for further research in the transdiagnostic approach. This will allow researchers to quickly assess the efficacy of psychotherapeutic interventions on multiple psychopathological dimensions. METHOD: First, we identified the main symptoms of psychopathology in a sample of mental healthcare workers. Second, we developed the Symptomatic Transdiagnostic Test (S2T) to assess the main symptoms of psychopathology. Third, we evaluated its psychometric properties (exploratory and confirmatory factor analysis, internal consistency) in three non-clinical samples and one clinical sample. RESULTS: The 66-item S2T included eleven factors referring to: i) negative thoughts and mood; ii) psycho-traumatic and maladaptive symptoms; iii) addiction symptoms; iv) disturbed eating behavior; v) disturbed perception and behavior; vi) panic and agoraphobia; vii) emotional lability; viii) dejection; ix) neurodevelopmental manifestations; x) anxiety and xi) psychic hyperactivity. We found a high internal consistency for the general scale (α=0.96) and the subscales. We found a good concurrent validity. As expected, we found higher levels of symptoms within the clinical population as compared to the non-clinical samples, except for addiction symptoms and disrupted eating behavior. We found negative associations between the symptomatic dimensions and psychological skills. CONCLUSION: The S2T is a relevant tool for clinicians and researchers to assess the psychopathological profile. The main psychopathological symptoms are negatively related to the psychological skills.

The role of legitimizing the social hierarchy in the impact of status on perceived assertiveness and competence.

The present research aimed to examine how perceivers' system-justifying beliefs moderate the way they evaluate high- versus low-status targets on assertiveness and competence. In three experimental studies, we manipulated a target's hierarchical position within his company's organization. Participants rated the target on traits reflecting assertiveness and competence. Their system-justifying beliefs were assessed in an ostensibly unrelated study. Results consistently showed that participants inferred assertiveness from the target's hierarchical position regardless of system justification, whereas the relationship between social status and competence was consistently moderated by system-justifying beliefs: only participants high in system justification ascribed more competence to the high-status target than to the low-status target. These findings are in line with the hypothesis suggesting that inferring competence from high-status positions could rely on the tendency to justify social inequalities, whereas inferring assertiveness would not.

Voice, silence, perceived impact, psychological safety, and burnout among nurses: A structural equation modeling analysis.

BACKGROUND: The organizational studies' literature suggests that employees' expressions of voice and silence may be distinct concepts with different predictors. Organizational researchers also argue that both employees' voice and silence are related to burnout; however, these relationships have not been adequately examined in the healthcare context. OBJECTIVE: This study aimed to investigate the relationships among nurses' perceived impact, psychological safety, voice behaviors, and burnout using a theoretical model. Voice behaviors were conceptualized as voice and silence. DESIGN: A cross-sectional, correlational study design was employed. SETTINGS: Study data were collected in 34 general hospitals in South Korea. PARTICIPANTS: A total of 1255 registered nurses providing direct care to patients were included in this study. METHODS: Using a convenience sampling method, a web-based survey was conducted to obtain data. All variables were measured using standardized instruments. A structural equation modeling analysis was employed to test a hypothesized model positing that perceived impact and psychological safety have both direct and indirect effects on nurse burnout through voice and silence. The response rate was 72.8 %. RESULTS: The findings supported the hypothesized model. Both perceived impact and psychological safety were positively related to expressions of voice, but both were negatively associated with silence. We also found that perceived impact was more strongly associated with voice than with silence, while psychological safety had a stronger impact on silence than on voice. Furthermore, voice reduced burnout, while silence increased it. Finally, perceived impact reduced burnout through voice (ß = -0.10, 95 % confidence interval [-0.143, -0.059]) and silence (ß = -0.04, 95 % confidence interval [-0.058, -0.014]), and psychological safety also decreased burnout through voice (ß = -0.04, 95 % confidence interval [-0.057, -0.016]) and silence (ß = -0.07, 95 % confidence interval [-0.101, -0.033]). Additional analyses revealed that prohibitive voice and silence significantly mediated the associations between psychological safety and burnout and perceived impact and burnout, but the mediating role of promotive voice was not statistically significant. CONCLUSIONS: It is important to recognize that voice and silence are distinct concepts. Moreover, to reduce nurse burnout, nurse managers and hospital administrators should develop separate strategies for promoting nurses' perceived impact and psychological safety, as their influences on voice and silence differ. REGISTRATION: Not applicable. TWEETABLE ABSTRACT: Voice and silence both influence nurse burnout. Separate strategies should be applied to voice and silence, as they are different concepts.

Data on self-esteem among adolescents in India.

A person's total perception of his or her value or worth is referred to as self-esteem. It may serve as a proxy for how much a person "values, approves of, appreciates, prizes, or likes [him or herself]". The study's major goals were to assess adolescents' levels of self-esteem and examine the impact assertiveness training had on those adolescents' self-esteem. The research design selected for the study was pre-experimental one group pre-test and post-test research design". Anon-probability convenience sampling technique was used to obtain a sample of 60 adolescents who fulfilled the inclusion criteria. Rosenberg Self-Esteem Scale was the study's primary instrument, a 10-item questionnaire that a person fills out and scores on a 0-3 scale, containing both positive and negative items, is used to measure one's degree of self-esteem. In this case, questions 2, 5, 6, 8, and 9 had lower scores than questions 1,3,4,7 and 10. The Likert scale looks like this: Strongly disagree, strongly agree, agree, and disagree. The mean Self-Esteem score prior to the test was 11.33 with a standard deviation of 1.28, whereas the mean Self-Esteem score after the test was 21.16 with a standard deviation of 1.94. The mean difference of 9.83 is significant at 0.001 levels. The 't' value of 33.4 was higher than the table value. This study provides evidence of adolescents' self-esteem has been improved through assertiveness training.

Why the belief in one's equal rights matters: Self-respect, depressive symptoms, and suicidal ideation in Western and non-Western countries.

The present research investigated the relationship between self-respect (i.e., a person's belief of possessing the same rights as others) and depressive symptoms. Based on earlier longitudinal findings that self-respect fosters assertiveness and that assertiveness negatively predicts depressive symptoms, we tested these relationships in Western and non-Western countries. Additionally, we explored associations with suicidal ideation. Across seven countries (N = 2408) we found that self-respect and depressive symptoms were negatively correlated. In addition, we found evidence for an indirect path via assertiveness as well as negative correlations with suicidal ideation in countries with available measures. Finally, within-manuscript meta-analyses confirmed the main path between self-respect and depressive symptoms across all seven countries. This research presents the first evidence for the negative association between self-respect (feeling equal to others) and depressive symptoms and highlights new directions for linking self and self-regard to mental health.

Attitudes toward Patient-Centred Care, Empathy, and Assertiveness among Students in Rehabilitation Areas: A Longitudinal Study.

This study assessed attitudes toward patient-centred care, empathy, assertiveness, and subjective perception of communication skills and technical knowledge among Portuguese undergraduate students in healthcare. These students may develop rehabilitation activities with patients in their person-oriented or technique-oriented professions. Portuguese nursing and allied health students from two public higher education schools completed questionnaires in the first and third academic years: Patient-Practitioner Orientation Scale, Jefferson Scale of Physician Empathy, Scale for Interpersonal Behaviour, and a subjective perception of technical knowledge and communication skills. A total of 183 students completed the surveys. In the first year, students showed moderate to high scores on patient-centredness attitudes, empathy, and assertiveness and perceived themselves as having good communication skills. Students from person-oriented programmes significantly improved their Total and shared patient-centred attitudes in the third year compared with students attending technique-oriented professions. Significant differences in empathy were found between groups in the third year. Distress associated with assertive behaviours increased significantly across time in students from technique-oriented programmes compared with their peers in person-oriented programmes. The results suggest that the health profession's orientation and the programmes' specific curriculum might have a role in how some dimensions evolved in the two groups of students. The increasing assertiveness-related discomfort highlighted the importance of assessing and monitoring students' emotional wellbeing during their initial interactions with patients.

Beyond scientific and technical training: Assessing the relevance of empathy and assertiveness in future physiotherapists: A cross-sectional study.

Background and Aims: Empathy and assertiveness are two essential social skills for a health professional such as a physiotherapist and are necessary for developing moral thinking. Previous studies show that the development of empathy and other social skills improves as students progress in their studies. However, other authors show deterioration of empathy as students progress in their studies and acquire clinical experience. Training in soft skills, such as assertiveness, among health science students will have an impact on the quality of patient care. Effective communication, conflict resolution and the ability to work as part of a team are competencies that have been put to one side as a result of the recent COVID-19 pandemic and it is important to resume training students in soft skills. The objective of this study is to investigate to determine the empathic and assertive state of physiotherapy university students. Methods: A descriptive cross-sectional study of physiotherapy university students was conducted in the 2022/2023 academic year. The Interpersonal Reactivity Index (IRI) scales for empathy and the Rathus test for assertiveness (RAS) were used as study tools. Finally, 127 students participated in the study, 52.91% of the total population of physiotherapy students. The questionnaire was available for 4 weeks in November and December 2022. Results: The empathetic and assertive development of the students was found to be acceptable. Significant differences were also observed according to the gender variable in the students, with female students presenting better results (p = 0.01). Students who are working or have clinical experience in other professions score lower on the empathy personal distress subscale (p < 0.001). Conclusion: Future research should be considered to help improve clinical and professional expertise in physiotherapy students about empathic and assertive development. The findings provide new evidence on the levels of empathy and assertiveness in physiotherapy students.

Young Adult Women and Sexual Awareness in the Digital Age: Examining Pathways Linking Online Dating Debut and Mindfulness with Sexual and Mental Health.

Sexual awareness is an understudied phenomenon, despite its known effects on mental health. Little is known about the predictors of sexual awareness, including how early sexual debut and early engagement with online dating and hookup apps might impact the development of sexual mindfulness. Given the conceptual overlap between mindfulness and sexual awareness, this study tested a model that hypothesized that general mindfulness and early sexual and online dating debuts may be associated with mental health outcomes and sexual behavior through pathways involving sexual awareness (assertiveness, consciousness, appeal, and monitoring). A sample of 2,379 heterosexually active young adult women completed an online survey. Path models indicated that both early sexual debut (prior to age 15) and early online dating debut (prior to age 18) had significant, positive direct associations with anxiety and depression scores. Early online dating was also associated with condomless sex with casual male partners. However, both early sexual debut and early online dating debut were indirectly linked to greater sexual risk through greater appeal, and to lower sexual risk through sexual assertiveness. Additionally, greater monitoring contributed to more depression for those with an earlier sexual debut. These findings point to potential risks associated with early online dating. They also highlight benefits of studying sexual awareness as a multi-dimensional construct, especially as it helps to clarify divergent findings in the existing literature on the long-term consequences associated with early sexual debut. While some domains were associated with risk (monitoring and appeal), others were indicative of resilience (assertiveness).

Comunicación asertiva, estado nutricional y desarrollo físico en adultos mayores / Assertive Communication; Nutritional Status and Physical Development in Aged Adults

Introducción: La asertividad es una herramienta comunicacional que puede contribuir de manera positiva en que los adultos mayores interpreten correctamente la necesidad e importancia de realizar acciones que permitan mantener un adecuado desarrollo físico y estado nutricional durante la tercera edad. Objetivo: Describir cómo la implementación de la comunicación asertiva puede ayudar a la incorporación de los adultos mayores al programa de actividades físicas del adulto mayor. Métodos: Se realizó una investigación básica, no experimental y descriptiva en una población de 157 adultos mayores, de los cuales 113 formaron parte de la muestra de investigación. Se aplicó la comunicación asertiva para lograr la incorporación de estos al programa de actividades físicas del adulto mayor. Resultados: El miedo al contagio con COVID-19 fue la principal causa referida para no participar en las actividades (17,70 por ciento). Predominaron los adultos mayores con nivel de conocimiento bajo sobre la importancia de las actividades físicas en los adultos mayores. Después de aplicar la comunicación asertiva se logró que el 64,60 por ciento de los ancianos se incorporaran al programa. Conclusiones: La asertividad, con sus técnicas y acciones, facilitó la incorporación de adultos mayores al programa de actividades físicas. Su aplicación se basó en la preparación y la capacidad de negociación con las personas de la tercera edad para poder lograr su incorporación a las actividades físicas del programa del adulto mayor(AU)

Introduction: Assertiveness is a communicational tool that can contribute positively to aged adults' correct interpretation of the need and importance of performing actions that allow them to maintain adequate physical development and nutritional status during older age. Objective: To describe how the implementation of assertive communication can help the incorporation of aged adults to the physical activity program for the elderly. Methods: A basic, nonexperimental and descriptive research was conducted with a population of 157 aged adults, of which 113 were part of the research sample. Assertive communication was applied to achieve their incorporation into the physical activity program for the elderly. Results: Fear of infection with COVID-19 was the main reported cause for not participating in the activities (17.70 percent). Aged adults with a low level of knowledge about the importance of physical activities for the elderly predominated. After applying assertive communication, 64.60 percent of the older adults could become part of the program. Conclusions: Assertiveness, with its techniques and actions, facilitated the incorporation of aged adults to the physical activities program. Its application was based on the preparation and the ability to negotiate with older adults in order to achieve their incorporation to the physical activities of the program for the elderly(AU)

"I Just Want to Feel Good Without Making You Feel Bad": Sexual Assertiveness Negotiation in Adolescent Romantic Relationships.

Sexual assertiveness is often conceptualized as an individual's ability to express one's own sexual needs, desires, and limits. Given that sexual assertiveness is embedded in interactions and can affect not only both partners' sexual well-being but also relationship satisfaction, dyadic approaches are needed to investigate sexual assertiveness negotiation within adolescent romantic relationships. This qualitative study aimed to document adolescents' ability to negotiate their sexual needs, desires, and limits with their partners during interactions where they discussed their sexual concerns. A directed content analysis, based on the life positions of the transactional analysis theory, was conducted on the interactions of 40 adolescent romantic dyads aged 14-19 years (M = 16.65; SD = 1.49). The results revealed four categories of strategies: (1) mutual assertiveness: negotiation of one's own sexual needs, desires, and limits with those of the partner; (2) singular passiveness: repression of one's own sexual needs, desires, and limits to privilege those of the partner; (3) singular aggressiveness: prioritization of one's own sexual needs, desires, and limits over those of the partner; and (4) mutual lack of negotiation skills: neglecting both partners' sexual needs, desires, and limits. Among other things, adolescents' ability to be sexually assertive was hindered by anticipations, including assumptions leading to disregarding one's own sexual needs, desires, and limits or fearing to ignore the partner's. To promote mutually rewarding sexual activities and prevent sexual violence, sexual education initiatives should support adolescents' ability to assertively negotiate their sexuality with their partner and avoid passiveness, aggressiveness, and lack of negotiation.

Introverted and yet effective? A faceted approach to the relationship between leadership and extraversion.

Introduction: Extraversion and its facets of assertiveness and sociability were identified as stable predictors for leader emergence and effectiveness. However, recent research suggested that extraversion may lie in the eyes of the beholder; it might not be the leader's possession but their followers' attribution of the trait that shapes these criteria of leader success. Methods: In our study, we reverse-engineered this relationship and assessed the effects of effective leadership behaviors on personality perceptions. More specifically, we created scenarios of a leader responding to coordination challenges with passive-avoidant, transactional, or transformational leadership behaviors. We presented 204 participants with these scenarios and assessed how extraverted, assertive, and sociable they perceived the leader to be. Results: Interestingly, and not fully meeting our expectations, ascriptions of extraversion and its facets of assertiveness and sociability did not directly relate to the effectiveness of the behaviors, as the moderately effective transactional leadership style garnered the highest ascriptions of extraversion and its facets. Further, ascriptions of extraversion to the transformational behavior of intellectual stimulation were remarkably low, matched only by the laissez-faire dimension of the passive-avoidant leadership style. Discussion: We integrate and contrast these unexpected but explainable findings with current research, discuss potential associations between introversion and empowering leadership practices and provide suggestions for future discourse, illustrating the potential of investigating the presence of an introverted leadership advantage in the workplace of tomorrow.

Imagine All the People: A Guided Internet-Based Imagery Training to Increase Assertiveness among University Students-Study Protocol for a Randomized Controlled Trial.

The importance of communication skills for well-being and self-realization is widely accepted. Despite that, research on assertiveness and assertiveness training has declined significantly in recent decades. Consequently, traditional training does not consider the most recent novel technologies used to spread psychological interventions. This study proposes the development of ComunicaBene: a guided Internet-based imagery intervention to promote assertiveness. Moreover, it describes the study protocol for a randomized control trial to investigate the intervention's efficacy and acceptability. Participants will be randomly assigned to an experimental (ComunicaBene) or waitlist control condition. ComunicaBene consists of different online training modules corresponding to three phases: psychoeducation, imaginative exposure, and in vivo-exposure. Each module provides participants with theoretical and practical content about needs, emotions, communication style, and assertiveness. Moreover, during the program, every student is supervised by a Tutor. Participants in the control condition will be included in a waiting list. Primary and secondary outcomes will include changes in assertiveness, well-being, emotional awareness, worry, and rumination. Outcomes will be assessed at pre- and post-intervention, and via a 6-month follow-up. We expect that the results will support the efficacy of ComunicaBene as an innovative, scalable, affordable, and acceptable intervention to spread assertive training through the Internet and among a broad population.

Relationship between assertiveness in community pharmacists and pharmacist-initiated prescription changes.

BACKGROUND: Despite the usefulness of assertiveness by healthcare professionals in improving patient safety, few studies have evaluated the assertiveness of community pharmacists. Community pharmacists' assertiveness might be associated with pharmacist-initiated prescribing changes to improve medication safety. OBJECTIVES: Our objective was to examine which types of assertiveness-related self-expression are associated with community pharmacist-initiated prescribing changes while adjusting for possible confounding factors. METHODS: We conducted a cross-sectional survey in Japan between May and October 2022 in 10 prefectures. Community pharmacists belonging to a large pharmacy chain were recruited. The outcome variable was the frequency of community pharmacist-initiated prescription changes over 1 month. Community pharmacists' assertiveness was assessed using the Interprofessional Assertiveness Scale (IAS) and 3 sub-domains (nonassertive, assertive, and aggressive self-expression). Participants were classified into 1 of 2 categories based on medians. Demographic and clinical characteristics were compared by group with univariate analysis. A generalized linear model (GLM) was used to investigate the association between pharmacist-initiated prescription changes as an ordinal variable and pharmacists' assertiveness. RESULTS: Of 3346 community pharmacists invited, 963 were included in the analysis. Participants with high assertive self-expression scores had a significantly higher frequency of pharmacist-initiated prescription changes. There was no association between nonassertive or aggressive self-expression and pharmacist-initiated prescription changes. After adjustments, high assertive self-expression remained associated with a high frequency of community pharmacist-initiated prescription changes (odds ratio, 1.34; 95% confidence interval, 1.02-1.74; p = 0.032). CONCLUSIONS: Higher assertive self-expression among community pharmacists is associated with higher frequency of pharmacist-initiated prescription changes.

Efficacy of transdiagnostic cognitive-behavioral therapy for assertiveness: A randomized controlled trial.

Assertiveness training has been an essential component in cognitive-behavioral therapy (CBT), for example, in the treatment of social anxiety and in dialectical behavioral therapy. However, the assertiveness construct has garnered little attention in recent clinical research. The objective of this study was to investigate the efficacy of an eight-week transdiagnostic stand-alone internet-based CBT intervention specifically aimed at increasing levels of assertive behavior. Following inclusion, we randomized N = 210 participants into three groups: therapist-guided self-help, unguided self-help, and a wait-list control condition. After a one-year follow-up, we employed a linear mixed model to estimate the effects at both post-test and follow-up for the primary outcome measures of assertiveness, Adaptive and Aggressive Assertiveness Scales, the Rathus Assertiveness Schedule, and secondary outcome measures of anxiety, depression, and general well-being. We also assessed reliable clinical change. Compared to the wait list at the post-treatment, estimated between-group effect sizes on self-rated adaptive assertiveness were statistically equivalent for the two treatment groups both at the post and at the one-year follow-up time points, ranging from ES = 0.95 to 1.73, with reliable clinical recovery proportions from 19 % to 36 %. The increase in aggressive assertiveness ranged from ES = 0.62 to 0.90 compared to the wait-list condition at post. For social anxiety symptoms, the effects compared to the wait list at post-treatment ranged from ES = 0.67 to 0.93, with a reliable clinical recovery rate from 16 % to 26 %. For self-assessed well-being, the effects compared to the wait list at post ranged from ES = 0.70 to 1.05. No effects were observed for generalized anxiety, although within-group evidence was found for a medium effect on depression one year after treatment. Overall, the two treatment conditions produced similar effects. In general, participation increased healthy assertive expressions regardless of treatment condition, all the while reducing self-assessed social anxiety and, over time, possibly also depression. Participation also improved general well-being. The findings demonstrate that the assertiveness construct can be a suitable target for intervention, with reductions of both psychiatric symptoms and non-syndromal problems in daily life. The study was preregistered at ClinicalTrials.gov (NCT04240249).

It Takes Two to Tango: Links Between Traditional Beliefs About both Men's and Women's Gender Roles and Comfort Initiating Sex and Comfort Refusing Sex.

Traditional gender roles dictate rigid rules and standards prescribing which behaviors, thoughts, and feelings are considered masculine and feminine within sexual contexts, and thus internalizing these beliefs (higher traditional gender ideology) may influence sexual attitudes. Prior theorizing has primarily focused on how women's traditional beliefs about women's gender roles (traditional femininity ideology) and men's traditional beliefs about men's gender roles (traditional masculinity ideology) influence their sexual assertiveness. Yet, men can hold traditional beliefs about women, and women can hold traditional beliefs about men, and these beliefs should have important implications for sexual assertiveness. We addressed this gap by testing how both heterosexual women's (n = 389) and men's (n = 393) traditional masculinity and femininity ideologies associate with their reported comfort initiating sex and comfort refusing sex in their relationships. When accounting for both sets of beliefs, women's traditional beliefs about men's and women's roles interacted to predict comfort initiating sex, but not comfort refusing sex. Men's traditional beliefs about men's roles predicted less comfort refusing sex, and their traditional beliefs about women's roles predicted less comfort initiating sex. This novel research underscores the importance of considering beliefs about both sets of traditional gender roles for understanding people's sexual attitudes. Supplementary Information: The online version contains supplementary material available at 10.1007/s11199-023-01366-w.

Measuring women's sexual autonomy: Development and preliminary validation of the women's sexual autonomy scale.

BACKGROUND: Sexual autonomy is an influential component of sexual health risk reduction frameworks, but a universal assessment of sexual autonomy is currently lacking. OBJECTIVES: This study develops and validates the Women's Sexual Autonomy scale (WSA), a comprehensive measure that captures women's perception of their sexual autonomy. DESIGN: Forty-one items were initially created based on current research and in consultation with sexual health experts. In Phase I, a cross-sectional study with 127 women was conducted to finalize the scale. In Phase II, a cross-sectional study with 218 women was conducted to test the stability and validity of the scale. A confirmatory factor analysis was conducted with an independent sample of 218 participants. METHODS: In Phase I, principal component analysis with promax rotation was conducted to examine the factor structure for the sexual autonomy scale. Cronbach's alphas were conducted to assess the internal consistency of the sexual autonomy scale. In Phase II, confirmatory factor analyses were conducted to confirm the factor structure of the scale. Logistic and linear regressions were used to assess validity of the scale. Unwanted condomless sex and coercive sexual risk were used to test construct validity. Intimate partner violence was used to test predictive validity. RESULTS: Exploratory factor analysis identified four factors across 17 items: 4 items on sexual cultural scripting (Factor 1), 5 items on sexual communication (Factor 2), 4 items on sexual empowerment (Factor 3), and 4 items on sexual assertiveness (Factor 4). Internal consistency for the total scale and subscales were adequate. The WSA scale showed construct validity by negatively relating to unwanted condomless sex and coercive sexual risk, and predictive validity by negatively relating to partner violence. CONCLUSION: The results of this study suggest the WSA scale provides a valid, reliable assessment of sexual autonomy for women. This measure can be incorporated into future studies investigating sexual health.

Sexual communication patterns in couples with vulvodynia-a case-control behavioral observation study.

BACKGROUND: Sexual communication is a common target in psychological treatments for vulvodynia, and associations with sexual function and distress, as well as pain intensity, have been demonstrated. However, structured observations of the communication patterns of couples with vulvodynia are lacking, as these are needed to guide treatment efforts. AIM: To explore (1) the sexual communication patterns in couples with vulvodynia in terms of observed communication quality (operationalized as validating and invalidating responses), self-reported sexual assertiveness, and self-disclosure and (2) associations between sexual communication quality and pain intensity. METHODS: In a case-control design with within- and between-group comparisons, 62 couples engaged in videotaped discussions about their sexual relationship. Trained coders assessed the discussions by rating sexual communication (validation and invalidation) according to a structured behavioral coding scheme. Group differences in sexual communication quality were examined with parametric and nonparametric tests. Dyadic associations among observed communication quality, self-rated sexual assertiveness, and self-disclosure were examined within the actor-partner interdependence model. Multiple regression was used to test the predictive value of partners' validation/invalidation on the pain intensity of the women with vulvodynia. OUTCOMES: Observed communication quality (ie, validation and invalidation), self-reported sexual assertiveness, self-disclosure, and pain intensity. RESULTS: Partners of women with vulvodynia were more invalidating toward their partners than those of women without pain. There were no significant differences in validating/invalidating communication between women in the 2 groups or in validation between partners. Partners' validating communication were significantly associated with women's lower pain intensity. The sexual communication patterns differed between couples with and without vulvodynia, and the associations between validating/invalidating responses and sexual assertiveness were stronger in the vulvodynia group than in the group without pain. Results on validation/invalidation and self-disclosure were inconclusive. CLINICAL IMPLICATIONS: The results indicate a need to direct treatment interventions toward couples' sexual communication quality (ie, levels of validation and invalidation). STRENGTHS AND LIMITATIONS: Strengths include systematic behavioral coding and dyadic analyses. Limitations include the cross-sectional design and self-selection of participants. CONCLUSION: This study demonstrated sexual communication patterns specific to couples with vulvodynia, and we conclude that validation and invalidation are important components of the sexual communication of couples with vulvodynia as they relate to sexual assertiveness, women's self-disclosure, and pain intensity.

Technology-based interactive communication simulation for Korean nurses: A randomized controlled repeated-measures design.

BACKGROUND: Effective and standardized technology-based communication simulations addressing diverse clinical situations for novice nurses are limited. OBJECTIVES: This study evaluated the efficacy of the Technology-based Interactive Communication Simulation for Nurses on communication competency (knowledge, self-efficacy, skills, and clarity), compassion, and assertiveness among novice nurses. DESIGN: We used a randomized controlled repeated-measures design. Participants were randomly assigned to either the intervention (Technology-based Interactive Communication Simulation for Nurses) or attention control group and completed the assigned program, the questionnaire thrice (i.e., before, immediately after, and four weeks after the program), and the e-simulation twice (i.e., immediately after and four weeks after the program). SETTINGS AND PARTICIPANTS: Korean nurses with six months to two years of experience recruited from five secondary and tertiary hospitals participated in the study at a private, quiet place of their choice. METHODS: The intervention comprises two simulation cases across different formats: (1) an interactive communication simulation for various clinical situations followed by a tailored debriefing; and (2) a video showing a conflict between a nurse and caregiver and between nurses, followed by a self-reflection activity. Communication skills and clarity were also evaluated by raters. Data analyses included descriptive analyses, t-tests, chi-square tests, and a generalized estimating equation model. RESULTS: In total, 142 nurses (73 in the intervention and 69 in the attention control groups) participated in the programs, and 128 participated through the four-week follow-up. Technology-based Interactive Communication Simulation for Nurses significantly improved communication knowledge and self-efficacy and compassion among novice nurses compared to the attention control program, and its effects were maintained for four weeks. The group difference in communication skills and clarity evaluated by the raters was also significant. CONCLUSION: Technology-based Interactive Communication Simulation for Nurses is effective in enhancing the communication competence of novice nurses. Future studies should analyze assertiveness in Korean healthcare settings.

Healthcare providers and patients: an essay on the importance of professional assertiveness in healthcare today.

Professional assertiveness can enable the healthcare provider to confidently share their expertise without seeming authoritarian to the patient. Professional assertiveness is an interpersonal communication skill that helps express opinions or knowledge while respecting similar competencies in others. For healthcare providers, this compares to sharing scientific or professional knowledge with their patients while respecting their person, ideas, and autonomy. Professional assertiveness also connects the patient's beliefs and values with actual scientific evidence and healthcare system constraints. The definition of professional assertiveness might be easy to understand, but it remains challenging to apply in clinical practice. In this essay, we hypothesize that the practical difficulties healthcare providers encounter with assertive communication stem from their misunderstanding of this style.