The presence of accountability in digital interventions targeting non-adherence: A review.

OBJECTIVES: Provider-centered accountability, defined as the anticipation of a social interaction between a patient and their provider, increases patients' adherence to prescribed treatment. Digital adherence interventions based on accountability may be especially effective at promoting adherence. The current study aimed to assess whether publications on digital adherence interventions discuss accountability, include intervention components related to accountability, and measure feelings of patient accountability as an outcome. METHODS: PubMed was queried between January 2010 and March 2021 to identify randomized controlled trials incorporating digital adherence interventions. Full-text articles were assessed for participant demographics, interventions utilized, outcomes, and intervention effectiveness. RESULTS: A total of 131 publications met inclusion criteria. Only four publications discussed accountability as a potential factor influencing patient adherence. Although 11% of publications included an intervention with direct accountability, only one did so by design. None of the included studies assessed feelings of accountability as an outcome. CONCLUSIONS: While provider-centered accountability has the potential to boost the efficacy of digital adherence interventions, accountability is rarely incorporated in studies of such interventions. PRACTICE IMPLICATIONS: Additional investigation into the influence of accountability on adherence interventions will allow for the development of these interventions as effective tools applicable to the full range of patients.

Comparing the affective and social effects of positive reappraisal and minimising reappraisal.

Negative interpersonal events, such as close relationship conflicts, can threaten one's affective and social well-being. To improve affect and to maintain valuable relationships, individuals could select different reappraisal tactics. One could use positive reappraisal to find potential benefits of the event (e.g. "This conflict helps our relationship grow."), or use minimising reappraisal to decrease the perceived impact of event (e.g. "This is no big deal."). These two tactics target distinct appraisal dimensions: valence versus significance. We investigated whether these two reappraisals would show similar or different profiles of affective and social effects in the context of close relationship conflicts. Study 1 was based on a sample of 90 Chinese younger adults. Study 2 was based on a sample of 237 American adults (156 MTurk workers and 81 undergraduates combined). Across two studies, both reappraisals effectively improved affect in response to a recalled conflict. Minimising reappraisal group showed significantly increased affect and relationship satisfaction (Study 1&2), but decreased conflict resolution motivation (Study 2) across time. Positive reappraisal group, on the other hand, showed less pronounced increases in positive affect but increased conflict resolution self-efficacy across time (Study 1&2). We discuss these findings by highlighting within-reappraisal variation and potential trade-offs in pursuing affective and social regulation goals.

Anecdote Increases Patient Willingness to Take a Biologic Medication for Psoriasis.

Patients often are apprehensive about starting biologic medications for their psoriasis. Typical fears include anxiety regarding possible side effects and reluctance in accepting their proven efficacy. In this study, we aimed to evaluate patients' willingness to take a biologic medication for their psoriasis if presented with clinical trial evidence, an anecdote, or both. A prospective online survey study was performed in 222 patients with psoriasis. Patients were randomized to receive clinical trial evidence of a biologic medication's efficacy and safety, an anecdote of a single patient's positive experience, or both. Responses were recorded on a 10-point Likert scale and evaluated using the Kruskal-Wallis test followed by Dunn test. Results indicated that presenting an anecdote-alone or in combination with clinical trial evidence-may be an effective way to improve patients' willingness to take a biologic medication for psoriasis.

Tolerability of and Adherence to Topical Treatments in Atopic Dermatitis: A Narrative Review.

Atopic dermatitis (AD) is a common, chronic inflammatory skin disease that oftentimes requires complex therapy. Poor adherence is a major barrier to AD treatment success. An interspecialty, virtual roundtable panel was held, through which clinical dermatologists, allergists, and behavioral and social psychologists discussed AD management and adherence. Relevant literature was reviewed, and the content of this article was organized based on the roundtable discussion. Current guidelines for AD treatment include maintenance and acute therapy for mild-to-severe AD. Therapy is often complex and requires significant patient involvement, which may contribute to poor treatment adherence. Behavioral and social psychology strategies that may help improve adherence include scheduling timely follow-up appointments, using a clearly written eczema action plan (EAP), reducing perceived treatment burden, utilizing anchoring techniques, sharing anecdotes, and rewarding children using positive reinforcement and stickers. There are multiple practical ways by which providers can improve both the management and treatment adherence of patients with AD.

What predicts who we approach for social support? Tests of the attachment figure and strong ties hypotheses.

Before people seek support for an issue, they must choose whom in their support network to approach. Two prominent supporter-selection hypotheses are the attachment figure hypothesis and the strong ties hypothesis, housed in psychology and sociology, respectively. People are expected to have a special preference for attachment figures and also for strong ties and to seek them more frequently than others. Despite the widespread acceptance of these hypotheses, neither has ever been tested, we argue, with the most appropriate methods for their claims. Moreover, no one has ever tested whether the 2 theories might not be independent, that is, whether one might subsume the other. To properly test the theories, one requires intranetwork, enacted support-seeking data, and the theories must be modeled not just separately but also simultaneously. The present article reports 3 such studies. In Studies 1 and 3, a sample of adults reported their supporter-selection decisions for a single stressful event, and in Study 2, a sample of emerging adults reported their supporter-selection decisions for a period of 2 weeks. Evidence showed that each theory uniquely predicted supporter-selection decisions. For each theory the data revealed both expected and unexpected findings. Attachment figures were selectively sought for support, but this preference did not get stronger as issues became more severe. Stronger ties were selected more often than weaker ties; however, the strong tie effect emerged as 2 independent effects rather than one (closeness and interaction frequency). Taken together, the studies supported both theories, but also suggest the need for further theoretical development. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Comparing psoriasis advertisement methods with patient willingness to initiate treatment.

Background: Many patients with psoriasis struggle with taking biologic agents. The way in which providers present medications could enhance treatment adherence.Objectives: To determine how fear appeals, personal appeals, and social appeals influence psoriasis patients' willingness to use a biologic.Methods: A randomized online survey study was used to assess subjects with a self-reported diagnosis of psoriasis and their willingness to initiate treatment. Subjects were randomized in a 1:1:1 ratio to receive an online survey with the following emotional appeals: social, fear, or personal (n = 315). Subject-reported willingness to take treatment was recorded on a 10-point Likert scale and analyzed via single-factor ANOVA, two-group t-tests, chi-squared analysis, and multiple linear regression analysis.Results: A total of 315 subjects with a reported diagnosis of psoriasis completed the survey. Patient demographic information includes the following: mean age of 35 years ± 11.2; 67% female. Compared to subjects presented with a social appeal (M = 6.2, SD = 2.9), subjects presented with a fear appeal (M = 7.1, SD = 2.5, p = .01) and personal appeal (M = 7.0, SD = 2.7, p = .03) reported a greater average willingness to take treatment.Conclusions: Presenting biologic agents using fear or personal appeals may be a simple and effective technique to improve patients' willingness to take treatment.

Accountability in patient adherence.

BACKGROUND: The accountability inherent in the social interaction between a patient and healthcare provider affects patients' motivation to adhere to treatment. To characterize the role of accountability as a tool to improve self-efficacy and self-management and thereby promote patients' adherence to treatment, a measure of accountability is needed. AIMS: To develop and test the validity, reliability, and sensitivity of a new outcome measure designed to assess accountability. METHODS: The accountability measurement tool was developed from the literature, expert consultation, and focus groups. A focus group and three pilot studies were performed both in clinic and through an online crowdsourcing platform. Principal Component Analysis evaluated constructs, and Cronbach's alpha measured internal consistency. Validity was established using convergent and divergent correlations to other validated scales. RESULTS: A total of 292 participants took part in this study. The 12-item accountability scale demonstrated very good internal consistency (Cronbach's α=0.92). Components of the accountability measurement tool correlated with predicted validated measures, including the Treatment Self-Regulation Questionnaire. Divergent validity was established with no significant difference noted between age, sex, race, and education level. CONCLUSION: Future use of this questionnaire will allow for the assessment of the interaction between accountability and adherence to treatment and lead to the development of new interventions to promote better adherence.

Accountability: a missing construct in models of adherence behavior and in clinical practice.

Piano lessons, weekly laboratory meetings, and visits to health care providers have in common an accountability that encourages people to follow a specified course of action. The accountability inherent in the social interaction between a patient and a health care provider affects patients' motivation to adhere to treatment. Nevertheless, accountability is a concept not found in adherence models, and is rarely employed in typical medical practice, where patients may be prescribed a treatment and not seen again until a return appointment 8-12 weeks later. The purpose of this paper is to describe the concept of accountability and to incorporate accountability into an existing adherence model framework. Based on the Self-Determination Theory, accountability can be considered in a spectrum from a paternalistic use of duress to comply with instructions (controlled accountability) to patients' autonomous internal desire to please a respected health care provider (autonomous accountability), the latter expected to best enhance long-term adherence behavior. Existing adherence models were reviewed with a panel of experts, and an accountability construct was incorporated into a modified version of Bandura's Social Cognitive Theory. Defining accountability and incorporating it into an adherence model will facilitate the development of measures of accountability as well as the testing and refinement of adherence interventions that make use of this critical determinant of human behavior.

It's a matter of time: The effect of depletion on communal action in romantic relationships is moderated by relationship length.

Researchers have only begun to turn their attention to the role of self-control in communal action (rather than communal restraint) in relationships. Conflicting results from early studies indicate that the association between self-control and communal action may be quite complex, and potentially moderated by many variables. Here we investigate how relationship length may moderate the extent to which communal actions require self-control resources. In 5 studies, we investigated the role of self-control resources in implementing (Studies 1 and 2) and in choosing (Studies 3-5) communal actions for a romantic partner, as a function of the length of time partners had been together. The data supported the hypothesis that as relationships mature over time, communal actions may require less self-control to implement and may become a decisional default. These findings suggest that communal actions may be a more deliberative response in newer romantic relationships but a more reflexive response in more established relationships.

Self-regulating the effortful "social dos".

In the current research, we explored differences in the self-regulation of the personal dos (i.e., engaging in active and effortful behaviors that benefit the self) and in the self-regulation of the social dos (engaging in those same effortful behaviors to benefit someone else). In 6 studies, we examined whether the same trait self-control abilities that predict task persistence on personal dos would also predict task persistence on social dos. That is, would the same behavior, such as persisting through a tedious and attentionally demanding task, show different associations with trait self-control when it is framed as benefitting the self versus someone else? In Studies 1-3, we directly compared the personal and social dos and found that trait self-control predicted self-reported and behavioral personal dos but not social dos, even when the behaviors were identical and when the incentives were matched. Instead, trait agreeableness--a trait linked to successful self-regulation within the social domain--predicted the social dos. Trait self-control did not predict the social dos even when task difficulty increased (Study 4), but it did predict the social don'ts, consistent with past research (Studies 5-6). The current studies provide support for the importance of distinguishing different domains of self-regulated behaviors and suggest that social dos can be successfully performed through routes other than traditional self-control abilities.

What we think we do (to each other): how personality can bias behavior schemas through the projection of if-then profiles.

People's knowledge about others includes not only person schemas about the typical traits of others but also behavior schemas about the likely interpersonal consequences of different behaviors. In this article, it is argued that perceiver effects can be interactive at the level of behavior schemas. A person's own personality configuration of if-then responses in social interactions (Mischel & Shoda, 1995) may contribute to that person's beliefs about the meaning and impact of relational behaviors more generally. In consequence, people who experience strong (or weak) responses to behaviors that vary along a particular trait dimension, such as warmth-coldness, may expect others to experience similarly strong (or weak) responses to those same kinds of behaviors. In 3 studies, people who were high in trait communion expected others to respond more strongly to behaviors that varied in warmth-coldness than did people who were low in trait communion, and people who were low in trait agency expected others to respond more strongly to behaviors that varied in assertiveness-unassertiveness than did people who were high in trait agency. Studies 2 and 3 provided evidence that participants' behavior schemas were based on assumptions derived from their own if-then personality profiles.

The Pollyanna myth: how highly agreeable people judge positive and negative relational acts.

Although people high in agreeableness have often been shown to be positively biased toward others, four studies provide evidence that agreeableness is associated with extremity effects, not simple positivity effects, in social judgment. Across studies, agreeable participants judged prosocial behaviors more favorably, but antisocial behaviors more unfavorably, than did disagreeable participants. In support of a goal-congruence mechanism, Study 1 showed that communal goals, rather than perceived similarity, mediated the effects, and Studies 2-4 demonstrated that agreeable perceivers were particularly sensitive to communal (vs. agentic) violations. A longitudinal study of real-life impressions supported the laboratory evidence that agreeable people are highly sensitive to both the prosocial and antisocial behavior of others (Study 4). We discuss how the current account complements and extends existing theories of agreeableness.

What it pays to know about a close other: the value of if-then personality knowledge in close relationships.

Researchers have debated the benefits of having accurate knowledge about a close other's personality. However, the existing research has examined personality knowledge solely in terms of traits. Although trait knowledge may be useful during relationship selection, we hypothesize that once a relationship becomes established, accurate personality knowledge about the other person's if-then profiles--the person's characteristic patterns of responses to situations--may be particularly beneficial. We conducted the first study of if-then accuracy in close relationships. To do so, we developed the If-Then Trigger Profile Questionnaire, which consists of 72 descriptions of potentially bothersome interpersonal behaviors. Participants in this study selected a friend to participate with them. Both friends then rated how much each behavior tended to trigger a negative emotional reaction in themselves personally and how much each behavior might trigger a negative emotional reaction in their friend. Findings demonstrated that accurate knowledge about a friend's if-then trigger profile is associated with reduced feelings of conflict and increased feelings of depth in the relationship.

Only because I love you: why people make and why they break promises in romantic relationships.

People make and break promises frequently in interpersonal relationships. In this article, we investigate the processes leading up to making promises and the processes involved in keeping them. Across 4 studies, we demonstrate that people who had the most positive relationship feelings and who were most motivated to be responsive to the partner's needs made bigger promises than did other people but were not any better at keeping them. Instead, promisers' self-regulation skills, such as trait conscientiousness, predicted the extent to which promises were kept or broken. In a causal test of our hypotheses, participants who were focused on their feelings for their partner promised more, whereas participants who generated a plan of self-regulation followed through more on their promises. Thus, people were making promises for very different reasons (positive relationship feelings, responsiveness motivation) than what made them keep these promises (self-regulation skills). Ironically, then, those who are most motivated to be responsive may be most likely to break their romantic promises, as they are making ambitious commitments they will later be unable to keep.

Not so fast: the (not-quite-complete) dissociation between accuracy and confidence in thin-slice impressions.

After decades of research highlighting the fallibility of first impressions, recent years have featured reports of valid impressions based on surprisingly limited information, such as photos and short videos.Yet beneath mean levels of accuracy lies tremendous variance-some snap judgments are well-founded, others wrongheaded. An essential question for perceivers, therefore, is whether and when to trust their initial intuitions about others. In three studies of first impressions based on photos and videos, the authors examined accuracy for Big Five trait judgments as well as corresponding reports of confidence. Overall, perceivers showed a limited ability to intuit which of their impressions were more accurate than others, although a curvilinear effect emerged: In the relatively few cases where perceivers reported an absolute lack of confidence, their accuracy was indeed comparatively low. Across the studies, judgment confidence was shaped by sources at the judgment level and the judge level that were unrelated to accuracy.

Voicing conflict: preferred conflict strategies among incremental and entity theorists.

The way individuals choose to handle their feelings during interpersonal conflicts has important consequences for relationship outcomes. In this article, the authors predict and find evidence that people's implicit theory of personality is an important predictor of conflict behavior following a relationship transgression. Incremental theorists, who believe personality can change and improve, were likely to voice their displeasure with others openly and constructively during conflicts. Entity theorists, who believe personality is fundamentally fixed, were less likely to voice their dissatisfactions directly. These patterns were observed in both a retrospective study of conflict in dating relationships (Study 1) and a prospective study of daily conflict experiences (Study 2). Study 2 revealed that the divergence between incremental and entity theorists was increasingly pronounced as conflicts increased in severity: the higher the stakes the stronger the effect.

Incorporating if...then...personality signatures in person perception: beyond the person-situation dichotomy.

Three studies investigated conditions in which perceivers view dispositions and situations as interactive, rather than independent, causal forces when making judgments about another's personality. Study 1 showed that perceivers associated 5 common trait terms (e.g., friendly and shy) with characteristic if...then... (if situation a, then the person does x, but if situation b, then the person does y) personality signatures. Study 2 demonstrated that perceivers used information about a target's stable if...then... signature to infer the target's motives and traits; dispositional judgments were mediated by inferences about the target's motivations. Study 3 tested whether perceivers draw on if...then... signatures when making judgments about Big Five trait dimensions. Together, the findings indicate that perceivers take account of person-situation interactions (reflected in if...then... signatures) in everyday explanations of social behavior and personality dispositions. Boundary conditions are also discussed.