Behavioral health coaching for rural-living older adults with diabetes and depression: an open pilot of the HOPE Study.

BACKGROUND: Patients with diabetes are at increased risk for depression, compounding the burden of disease. When comorbid with diabetes, depression leads to poorer health outcomes and often complicates diabetes self-management. Unfortunately, treatment options for these complex patients are limited and comprehensive services are rarely available for patients in rural settings. METHODS: A small open trial was conducted to test the acceptability, feasibility and preliminary outcomes of a telephone-delivered coaching intervention for rural-dwelling older adults with uncontrolled diabetes and comorbid, clinically significant depressive symptoms. A total of eight older adults were enrolled in Healthy Outcomes through Patient Empowerment (HOPE), a 10-session (12-week), telephone-based coaching intervention. Primary study constructs included measures of diabetes control (Hemoglobin [Hb] A1c), depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]), and diabetes-related distress (Problem Areas in Diabetes Scale [PAID]). Assessments were conducted at baseline, post-intervention, and 6-month follow-up. Acceptability and feasibility were evaluated using patient surveys, focused exit interviews, and session attendance data. RESULTS: Clinically significant improvements were realized post-intervention and at 6-month follow-up for outcomes related to diabetes and depression. Effect sizes using Cohen's d were determined post-intervention and at 6-month follow-up, respectively, for HbA1c (d=0.36; d=0.28), PHQ-9 (d=1.48; d=1.67, and PAID (d=1.50; d=1.06) scores. Among study participants, HbA1c improved from baseline by a mean (M) of 1.13 (SD=1.70) post-intervention and M=0.84 (SD=1.62) at 6 months. Depression scores, measured by the PHQ-9, improved from baseline by M=5.14 (SD=2.27) post-intervention and M=7.03 (SD=4.43) at 6-month follow-up. PAID scores also improved by M=17.68 (SD=10.7) post-intervention and M=20.42 (SD=20.66) from baseline to 6-month follow-up. Case examples are provided for additional context and to more fully articulate salient intervention concepts. CONCLUSION: Although preliminary, data from this small open trial suggest that HOPE holds the potential to improve both physical (diabetes) and emotional (diabetes distress, depression) health outcomes and that changes can be maintained over a 6-month time period. As envisioned by the authors, HOPE may function as an extension of traditional primary care for rural-dwelling older adults with multiple comorbidities. A future randomized clinical trial will test HOPE's broader effectiveness with rural-dwelling older adults. TRIAL REGISTRATION: NCT01274715.

Selection BIAS: Stereotypes and discrimination related to having a history of cancer.

Although great strides have been made in increasing equality and inclusion in organizations, a number of stigmatized groups are overlooked by diversity initiatives, including people with a history of cancer. To examine the workplace experiences of these individuals in selection contexts, we conducted 3 complementary studies that assess the extent to which cancer is disclosed, the stereotypes associated with cancer in the workplace, and discrimination resulting from these stereotypes. In a pilot study, we surveyed 196 individuals with a history of cancer (across 2 samples) about their workplace disclosure habits. In Study 1, we explored stereotypes related to employees with a history of cancer using the framework outlined by the stereotype content model. In Study 2, we used a field study to assess the experiences of job applicants who indicated they were "cancer survivors" (vs. not) with both formal and interpersonal forms of discrimination. This research shows that cancer is disclosed at relatively high rates (pilot study), those with a history of cancer are stereotyped as being higher in warmth than competence (Study 1), and the stereotypes associated with those who have had cancer result in actual discrimination toward them (Study 2). We discuss the theory behind these findings and aim to inform both science and practice with respect to this growing workplace population.

Comparative evaluation of three situational judgment test response formats in terms of construct-related validity, subgroup differences, and susceptibility to response distortion.

As a testing method, the efficacy of situational judgment tests (SJTs) is a function of a number of design features. One such design feature is the response format. However, despite the considerable interest in SJT design features, there is little guidance in the extant literature as to which response format is superior or the conditions under which one might be preferable to others. Using an integrity-based SJT measure administered to 31,194 job applicants, we present a comparative evaluation of 3 response formats (rate, rank, and most/least) in terms of construct-related validity, subgroup differences, and score reliability. The results indicate that the rate-SJT displayed stronger correlations with the hypothesized personality traits; weaker correlations with general mental ability and, consequently, lower levels of subgroup differences; and higher levels of internal consistency reliability. A follow-up study with 492 college students (Study 2; details of which are presented in the online supplemental materials) also indicates that the rate response format displayed higher levels of internal consistency and retest reliability as well as favorable reactions from test takers. However, it displayed the strongest relationships with a measure of response distortion, suggesting that it is more susceptible to this threat. Although there were a few exceptions, the rank and most/least response formats were generally quite similar in terms of several of the study outcomes. The results suggest that in the context of SJTs designed to measure noncognitive constructs, the rate response format appears to be the superior, preferred response format, with its main drawback being that it is susceptible to response distortion, although not any more so than the rank response format.