Comparative influence of political, cost/benefit, and statistical information on administrative decision making.

The influence of three types of evaluation information was studied in simulated decisionmaking situations within a community mental health center setting. Twelve administrators reviewed one of two decision problems (direct services or indirect services funding) and were then presented political, cost/benefit and statistical information. After each presentation, the administrators rated the importance of each type of information for decision making. Only the cost/benefit data were rated as significantly influencing their decisions. The influence of each type was not dependent upon the decision problem, nor to length of time in administrative positions. The results were interpreted in terms of “who says what, how, and to whom. ” If evaluators desire a greater impact on the decision making behavior of community health administrators, they should consider employing a pay off-based evaluation strategy and providing cost/benefit information.     

The effects of conflict,quality, and time on small group information use and behavior in evaluative decision making situations

Graduate students simulated school board members making decisions about educational programs. Situation contexts within the program evaluation reports were varied by conflict (high, low), quality (high, low), and time (long, short). Analyses of Variance (ANOVA) of the qualitative measures m the 2 × 2 × 2 factorial design indicated significant results at the .01 level. The quality of decisions affect support for program continuation. Interactions of conflict and quality affected need for more information and more time in decision making. A conflict and time interaction affected preference to talk to other board members. Changes in situational contexts affected information need and use in small, decision making groups.     

Physical health decision making and decision aid preferences of individuals with severe mental illness

Individuals with severe mental illness (SMI) often suffer from comorbid physical health conditions that reduce quality of life and longevity. The integrated care movement has improved access to primary care services, but system change does not necessarily impact health behaviors. In an effort to better understand health behaviors of persons with SMI in integrated care, we explored physical health decision making and decision aid preferences. We conducted three focus groups, including two consumer groups and one mental health staff group. Data were analyzed using a grounded theory approach, employing independent coding, thematic analysis, and meaning-making processes. Data suggest that overall, the consumer groups preferred a shared decision making process, with the doctor making the final treatment decision. Staff indicated that decision making depended on a consumer’s functioning level. Consumers liked the idea of using a decision aid, and reported preferring the computerized aid. Staff felt that decision aids were dependent on consumer level of functioning. Consumers generally view primary care doctors as experts, but like the idea of using decision aids to assist in making medical decisions. Staff feel that consumers may need help in both decision making and decision aid use in primary care.     

Lessons from the evolution of 401(k) retirement plans for increased consumerism in health care: an application of behavioral research

Employment-based health and retirement benefit programs have followed a similar path of evolution. The relative decision-making roles of the employer and the worker have shifted from the employer to the worker, and workers are more responsible than perhaps they ever have been for their well being--both in terms of their health in general and their financial security during retirement. This shift has been supported, in part, by legislation--namely ERISA, the HMO Act of 1973, the Revenue Act of 1978, and most recently, the Pension Protection Act. This Issue Brief does not pass judgment on this development or address who should bear the responsibilities of preparing workers for retirement or of rationing health care services. The current trend in health care design is toward increased "consumerism." Consumer-driven health is based on the assumption that the combination of greater cost sharing (by workers) and better information about the cost and quality of health care will engage workers to become better health care decision makers. It is hoped that workers will seek important, necessary, high-quality, cost-effective care and services, and become less likely to engage providers and services that are unnecessary and ineffective from either a quality or cost perspective. As employers look ahead toward continually improved plan design, there may be benefits in considering the lessons learned from studying worker behaviors. Specifically, there is evidence about the effects of choice, financial incentives, and information on worker decision making. As a result of research in this area, many retirement plan sponsors have moved toward plan designs and programs that recognize the benefits of well-designed defaults, simplified choices, required active decision making, framing, and commitment to future improvements. With respect to choice, it is now known that more is not always better and may even be worse in some cases. Just as fewer shoppers actually bought a jar of jelly when it was one of 24 as opposed to one of six, evidence has shown that people tend to be less likely to join a company-sponsored retirement plan when more investment options are offered. More choice can also lead to lower satisfaction. It is also known that workers may not be able to appropriately sort through many complex alternatives and that education is not always as effective as employers would hope. Decision complexity often forces people to find a way to simplify, and one of the easiest rules of thumb is to pick the option with the lowest short-term cost, even when that alternative is more costly in the longer run. It is also known that, for good or for bad, choices are constructed on the fly; preferences are dynamic, and logic does not always apply. Financial incentives are helpful in motivating behavior, but they do not affect everyone's decisions. Despite significant financial incentives to participate in 401(k) plans, many workers choose not to. Similarly, despite many of the financial incentives embedded in health care plan design, it can be expected that these incentives will not effectively motivate and engage all workers. One seemingly rational approach to improve workers' decision making is to provide education and guidance to help them sort through complex alternatives and to demonstrate the value of financial incentives. Certainly, providing education and guidance in the form of decision support tools may be an employer's responsibility. However, some studies have shown that, even when "educated" workers have the intent to make improved decisions, they often lack follow-through and fail to take action. In short, education and guidance may not be enough to foster improved health care consumerism. Some employers have begun to design benefit programs with a view toward overcoming behavioral tendencies that negatively affect workers' well-being. Newer retirement plan designs involve careful consideration of default choices. These defaults apply unless workers actively choose a different alternative. Typically, the default attempts to "nudge" workers toward optimal behavior. In the case of 401(k) retirement plan design, more employers are moving toward a default of automatic enrollment in the plan, with automatic investment in a diversified portfolio. Still, additional empirical research and experimentation may be needed to further understand the effects of new retirement plan design features. Future work may also precisely illuminate how the lessons discussed in this Issue Brief may apply to health care plan design that results in improved health-related behaviors. Given the impressive preliminary results in improving retirement planning behaviors, such research and experimentation are likely to be worthwhile.     

The value of being precise

This study investigates how individuals assess imprecise information. We focus on two essential dimensions of decision under uncertainty, outcomes and probabilities, and their respective precision. We believe the precision of information is highly relevant in the investment setting, as reflected in the well-known “home (familiarity) bias”, and the outcome and probability dimensions, separately or jointly, may affect investors’ knowledge of uncertainty and perceived risk of the investment options, and subsequently affect investors’ choices. To test this conjecture, we conducted three experiments. Our results show that 1) participants demonstrate a pattern of preference for precision and aversion of extreme vagueness and associate vagueness with higher perceived risk and lower investment (experiments one and two); 2) participants prefer vague outcome information to vague probability information (experiment two); 3) familiarity indeed positively affects the precision of estimated values, but this association is stronger for the outcome dimension than for probabilities (experiment three). Our results confirm that precision in information, especially in the outcome dimension has an impact on investors’ resource allocation choices.     

Initiating Sexual Experiences: How Do Young Adolescents Make Decisions Regarding Early Sexual Activity?

Understanding how young adolescents make decisions to engage in early sexual activities is vital for intervention efforts aimed at fostering positive youth development and reducing the negative outcomes of adolescent sexual behavior. In‐depth interviews with 42 suburban, mostly White, ninth‐grade adolescents (52% females, mean age=14.1, SD=.45) elicited accounts of their early sexual decisions. We adapted grounded theory methodology to build a model of sexual decision making from the adolescents' narratives. Six dominant categories emerged: contextual factors (relationship and personal characteristics), consideration of risks and benefits, boundary setting, boundary communication, the sexual experience, and evaluation. Our model of early sexual decision‐making processes, developed from the perspectives of young adolescents, highlights active consideration of health and social risks and benefits, as well as the generation of options regarding sexual activity. The model also shows that young adolescents set clear boundaries of sexual limits and evaluate sexual experiences, suggesting a dynamic process of decision making.     

An analysis of morbidity and mortality using Google Trends

Improvement in information technology has led to an increase in the ability of individuals to access health information; however, there still exists a large gap between patient and physician knowledge about diseases and/or illnesses. Often patients find themselves in doubt or overwhelmed by the care they are given. High medical costs also persist which makes the experience of patients less than ideal. For these reasons, among others, the internet has become a very popular tool in the hands of individuals who may wish to better understand the status of their health, make more informed decisions about their treatment options, and/or find cheaper ways to maintain good health status or cure a disease. Internet search engines, especially Google, play a crucial role in providing a means for patients to get the health information they need. The analysis presented in this article seeks to investigate the possibility of using Google Trends data to analyze the relationship between internet searches on the major causes of death and actual mortality in the United States. Specifically, this research seeks to investigate how well Google search query data serve as proxy for data on the actual causes of death.     

Construction and Initial Validation of the Career Maximizing Scale

Applying the concept of maximizing—careful evaluation of options in pursuit of optimal goals—to career decisions, the authors developed the Career Maximizing Scale (CMS). The measure was administered to samples of working adults and university students across 3 studies. Factor analysis indicated that the measure is unidimensional and has favorable psychometric properties. Career maximizing was related to but distinct from general maximizing. Career maximizing was positively related to indicators of decision confidence (e.g., career decision‐making self‐efficacy) and positively related to desirable career outcomes (e.g., career satisfaction). Career maximizing was also modestly related to certain desirable academic outcomes (e.g., commitment to university major). Use of the CMS may facilitate effective career counseling.     

Discourse,affect and affliction

While much recent theorizing into affect has challenged the primacy of discourse in understanding social life, this paper is premised on the intertwining of affective experience with discursive meaning. Furthermore, appreciating the entwining of affect and discourse facilitates broader understanding into the illness experience, medical decision‐making and experiences of healing. Today, the biomedical discourse carries particular affective weight that can saturate experiences of affliction. Cultural understandings of disease similarly shape affect that may emerge in affliction. Social meaning, more specifically stereotypes pertaining to identities, interweave with emotion also in the context of medical practice. The doctor‐patient relationship is an affect‐laden encounter where the entwining of affect with social assumptions carries important, yet poorly understood, repercussions for treatment decisions and for the furthering of health inequalities. Both the elusiveness and the power of affect that unfolds in relation to discursive meaning rest on the way in which affect dwells in and resounds through the body.     

The contribution of a cultural perspective in understanding and evaluating client satisfaction

Increasing attention is being given to including measures of client satisfaction as a component in the evaluation of health care services. An understanding of cultural factors that may influence attitudes and behaviors in the health care situation can contribute to the theory and measurement of client satisfaction. Through an examination of some of the cross-cultural literature, this paper delineates dimensions of the health care situation in which clients have been shown to have distinctive preferences, behavioral patterns, attitudes, and treatment expectations. A knowledge of the beliefs and attitudes concerning health and illness that are espoused by a particular cultural group can be a valuable asset in understanding how members of that group will evaluate the delivery of health care services. The examination of how cultural and ethnic differences may affect client satisfaction outcomes points to the necessity of avoiding a global measure of client satisfaction without first examining those particular aspects of health care delivery and of the measurement context that may have a predictable influence on client satisfaction ratings.     

Give your child and adolescent mental health service a health economics makeover

Specialist child and adolescent mental health services (CAMHS) must make decisions about what treatments to provide to whom, when, where and how, within limited budgets. This raises questions about how services make such decisions, to best meet the mental health needs of their catchment. The methods and practices of Health Economics, a field with considerable expertise in measuring performance in health systems, can help CAMHS make better informed decisions regarding service provision. This paper identifies a process through a set of focused questions to help CAMHS examine and improve their performance. The aspects covered are service profile, costs, conceptualisation of outcomes and identification of value for money. The recommended approach should help CAMHS redirect resources to maximise benefits for their catchment population.     

Psychiatric Information Systems: An Analysis of Inpatient and Outpatient Unit Capabilities

This paper describes how a sample of inpatient and out-patient psychiatric treatment units use technology to aid in patient care through scheduling, tracking, billing, and documenting clinical services. We conducted semi-structured interviews (n = 68) at four inpatient and four outpatient psychiatric facilities in Oregon. Results indicate psychiatric facilities are assembling systems for managing information that include a combination of electronic linked clinical records, paper records, and unit-specific, unlinked databases. Barriers remain in (1) improving the sophistication of psychiatric information systems, (2) improving linkages of behavioral health with other medical information systems, and (3) increasing information technology support.     

Red light,green light: Color priming in financial decisions

Colors are widely present in the financial decision making arena: at firms’ and data providers’ websites; television reports; newspaper publications; advertizements; security market displays, with colors such as red and green prominently employed. Our experimental analysis involves a between subject design exposing subjects to financial substance on colored backgrounds and exploring the effect on their investment decisions. We focus on financial decisions under uncertainty about probability, examining subjects’ investment valuations and the probabilities they assign to the possible outcomes.This study explores the role of color exposure as a priming factor in financial decision making. Priming is a process of activating particular connections or associations in memory prior to carrying out an action or task. The associations occur when a certain stimulus or event increases the availability of specific information categories and, as a result, affect decision making.The results indicate that red color priming emphasizes value losses of the underlying asset. To wit, subjects who were exposed to red (R) assigned higher valuations and probabilities to events involving the loss domain, than to events involving the gain domain, relatively to the valuations assigned by subjects who were exposed to green (G). The aggregated evaluation given by the R subjects when the investment payback was subject to negative (positive) underlying asset returns was higher (lower) than that of the G subjects by roughly 15% (19%) of the invested amount.     

College Students and the Diagnosis of Attention Deficit Hyperactivity Disorder

Abstract

Background: When H1N1 emerged in 2009, institutions of higher education were immediately faced with questions about how best to protect their community from the virus, yet limited information existed to help predict student preventive behaviors. Methods: The authors surveyed students at a large urban university in November 2009 to better understand how students perceived their susceptibility to and the severity of H1N1, which preventive behaviors they engaged in, and if policies impacted their preventive health decisions. Results: Preventive health behavior messaging had a mixed impact on students. Students made simple behavior changes to protect themselves from H1N1, especially if they perceived a high personal risk of contracting H1N1. Although policies were instituted to enable students to avoid classes when ill, almost no student self-isolated for the entire duration of their illness. Conclusions: These findings can help inform future decision making in a university setting to best influence preventive health behaviors.     

The benefits of information communication technology use by the homeless: a narrative synthesis review

Recent studies have suggested that technologies are becoming an increasingly ubiquitous element in the lives of individuals experiencing homelessness. With both Canadian and US researchers reporting staggering levels of homelessness on both sides of the border, an understanding and synthesis of the current literature exploring how technologies are being utilized by homeless individuals and how it may impact their well-being is of relevance to policy makers and social service organizations. The study explored and synthesized literature to examine the ways in which individuals experiencing homelessness utilize information and communication technologies (ICTs), and how the use of ICTs influences the health and social outcomes of individuals experiencing homelessness. The study examined 16 peer reviewed articles using a narrative synthesis systematic review, following three elements of the narrative synthesis approach: preliminary synthesis of findings; exploration of relationships between studies; and assessment of the robustness of the synthesis. In relation to what ICTs are used for by homeless individuals, three major themes emerged: social connectedness, identity management, and instrumental purposes. Furthermore, there was some tentative evidence about a positive relationship between ICT use among individuals experiencing homelessness and health outcomes. The paper discussed limitations, future areas of research, as well as some policy directions.     

How and why are Theory of Change and Realist Evaluation used in food security contexts? A scoping review

The complex ways in which food security actions lead to nutrition and other health outcomes make it important to clarify what programs work and how, with theory-driven evaluation emerging as a promising approach to evaluate complex programs. However, it is unclear how and why theory-driven evaluation is applied in food security contexts. Our objective is to examine the development and use of Theory of Change and Realist Evaluation to support food security programs globally. Using a systematic search and screening process, we included studies that described a food security program, used a Theory of Change or Realist Evaluation, and presented original research or evaluations. We found a total of 59 relevant Theory of Change studies and eight Realist Evaluation studies. Based on our analysis, Theories of Change arose in response to three main problems: 1) the need to evaluate under complexity; 2) challenges with evaluation; and, 3) information gaps surrounding a program. In contrast, Realist Evaluation was reported to be developed primarily to understand a program’s outcomes. Reflecting on the problem to be addressed in the evaluation would help improve understandings of the evaluation context, which would then inform the choice and design of an evaluation approach.     

Evaluating a private foundation's health program

Public policy decisions in health are increasingly difficult and expensive. Although there will never be enough information available, private foundations can help to bridge the most important gaps in knowledge. Larger foundations may also wish to respond to those who doubt the value of foundation activities. This article reviews the experiences over the past eight years of The Robert Wood Johnson Foundation in employing evaluation and related social research procedures in the planning and implementation of a major philanthropic effort to improve the health and medical care of Americans. Discussed are the still evolving Foundation evaluation framework, the unanticipated problems in undertaking specific evaluations, and the substantive findings of some of the studies.     

International female students’ experiences of navigating the Canadian health care system in a small town setting

Abstract

This pilot study explored the international female (IF) students’ (n = 17) lived experiences of health care accessibility while studying in a small town in Canada. Analysis guided by a phenomenological method resulted in three major themes – (1) after arriving to attend university, IF students experienced challenges in staying healthy, such as learning how Canadian medical insurance works and how to access medical help, (2) IF students developed a support system over time, consisting of their university’s student advisors, host families and friends and (3) as IF students became familiar with living in Canada, they developed self-directed care strategies such as taking care of each other if they became sick. They also became comfortable reaching out through social media to ask questions and connect with others who were also new to Canada. Recommendations included providing (1) alternative times for IF students to access medical care on campus, (2) a fund where IF students could borrow the upfront costs to see a doctor and (3) health care knowledge dissemination through various media throughout the school year. The outcomes of this study are generally encouraging and may assist IF students to make effective health care decisions while in Canada resulting in a less stressful academic experience.