Comparison of indirect and direct approaches to measuring patient satisfaction

One indirect (PSQ) and two direct (CSQ-18B and ERS) measures of patient satisfaction were compared across a series of psychometric, acceptability, and concurrent validity criteria. None of the three measures was significantly related to health status or demographic characteristics. Each measure performed as expected from prior research on their psychometric properties. The scales contrasted, however, in regard to acceptability, with the PSQ being much less acceptable to patients than the other two. The PSQ also produced more missing data. The results on the PSQ reflected patient inconsistency on cross-check items and patients tended to be uncertain in their responses to many items. In multivariate analyses the three measures were used as predictors of patient-rated indices of global service satisfaction. The CSQ-18B and the ERS were significant predictors of patient-rated indices of global service satisfaction, whereas the PSQ was unrelated to these indices. It was concluded that the direct and indirect approaches measure different satisfaction domains. The PSQ likely assesses more generalized attitudes about health services while the CSQ-18B and the ERS efficiently reflect opinions about the specific setting in which they are administered.     

How do socio-demographic and psychological factors relate to households’ direct and indirect energy use and savings?

Households constitute an important target group for energy conservation. They not only use energy in a direct way (gas, electricity and fuel) but also in an indirect way (embedded in the production, consumption and disposal of goods). During a period of five months (viz., October 2002–March 2003), direct and indirect energy use and direct and indirect energy savings of 189 Dutch households were monitored. The study examined the relative importance of socio-demographic variables and psychological variables in relation to household energy use and changes in energy use (viz., energy savings). For this purpose, variables from the theory of planned behavior [Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211] and the norm activation model [Schwartz, S. H. (1977). Normative influences on altruism. In L. Berkowitz (Ed.). Advances in experimental social psychology (Vol. 10, pp. 221–279). New York: Academic Press] were used. Results indicate that energy use is determined by socio-demographic variables, whereas changes in energy use, which may require some form of (cognitive) effort, appear to be related to psychological variables. The variables from the norm activation model were able to significantly add to the explanation of energy savings, over and above the variables from the theory of planned behavior. Also, different types of energy use and energy savings appeared to be related to different sets of determinants.     

Nonprofit agency dependence on direct service and indirect support volunteers: An empirical investigation

Thirty agency directors or volunteer coordinators were interviewed regarding the human resource techniques they use to attract and retain two types of volunteers: direct service and indirect support. Agencies that depend on direct (point‐of‐service) volunteers are more likely to bring volunteers on board and use the performance feedback process to guide any needed improvements. Role playing and mentoring are particularly effective training techniques for these volunteers. Despite the critical function of point‐of‐service volunteers, more sophisticated recruitment and screening techniques were not used, contrary to expectations. Agencies that depend on indirect support volunteers use the recruitment process to screen out those who would not be successful volunteers and terminate them quickly for lack of confidentiality and reliability, particularly if they have had on‐the‐job training. Agencies hesitate to terminate direct service volunteers even for lack of ability and violations of policies and procedures. Finally, agencies used nonmonetary rewards with indirect support, but not direct service, volunteers. Implications of these findings and others are discussed.     

Alternative medicine and herbal use among university students

In this study, the authors investigated the predictors of complementary and alternative medicine (CAM) and herbal supplement use among university students. They investigated demographic factors, trait affectivity, symptom reports, and individuals' worries about modernity as potential contributors to use of CAM and herbals. The authors surveyed 506 undergraduates at a large southeastern state universityand administered the following questionnaires to participants in a group setting: a CAM survey, an herbal use survey, a negative affect (NA) and positive affect (PA) scale, Modern Health Worries scale, and the Subjective Health Complaint scale. Overall, 58 % of the participants had used at least one type of CAM, and 79 % of the students had used at least one herbal substance in the past 12 months. A hierarchical regression determined that increased age, female gender, flu-like symptoms, musculoskeletal symptoms, pseudoneurological symptoms, and modern health worries were significantly related to students' CAM use. Herbal use was related to increased age, musculoskeletal, pseudoneurological, and gastrointestinal symptoms.     

Geographically indirect immigration to Canada: description and analysis

"This article is concerned with geographically indirect immigration to Canada over the period 1968-1988. A geographically indirect immigrant is an individual legally admitted to Canada whose country of last permanent residence differs from country of birth. Records maintained by Employment and Immigration Canada on every immigrant legally admitted over the period were used in the study. Relative to geographically direct immigrants, geographically indirect immigrants tend to be older, more educated, and more highly skilled. Moreover, if they were not born in an English or French speaking country, indirect immigrants are more likely to speak English and/or French capably than direct migrants born in such countries. The study also contains bivariate logit estimates of a model of geographically indirect Canadian immigration. This model suggests that indirect migrants tend to be influenced by personal characteristics (age, sex, marital status, occupation, language ability), as well as by various characteristics of the country of birth (distance from Canada, income level, political conditions)."     

An examination of pathways from childhood victimization to violence: the role of early aggression and problematic alcohol use

Using prospective data from a cohort design study involving documented cases of child abuse and neglect and a matched control group, we examine two potential pathways between childhood victimization and violent criminal behavior: early aggressive behavior and problematic drinking. Structural equation models, including controls for race/ethnicity, socioeconomic status, parental alcoholism, and parental criminality, revealed different pathways for men and women. For men, child maltreatment has direct and indirect (through aggressive behavior and problematic alcohol use) paths to violence. For women, problematic alcohol use mediates the relationship between childhood victimization and violence, and, independent of child maltreatment, early aggression leads to alcohol problems, which lead to violence. Interventions for victims of childhood maltreatment need to recognize the role of early aggressive behavior and alcohol problems as risk factors for subsequent violence.     

Precursors and pathways to adolescent prostitution in taiwan

This paper identifies the major precursors and pathways to prostitution for contemporary Taiwanese girls and the socio‐economic and cultural changes that have facilitated the shift in pathways over the past 10 years. Special attention is paid to the case of Taiwanese aborigines, who have particularly suffered systemic disruption due to prostitution. Analysis of case files and interviews provide quantitative and qualitative data that highlight the role of filial piety and the shift from indenture to runaway as the major pathway in Taiwan. Discussion includes relation of these findings to juvenile entry into prostitution in other countries, directions for future research, and policy recommendations for Taiwan's government.     

Precursors and pathways to adolescent prostitution in Taiwan

This paper identifies the major precursors and pathways to prostitution for contemporary Taiwanese girls and the socioeconomic and cultural changes that have facilitated the shift in pathways over the past 10 years. Special attention is paid to the case of Taiwanese aborigines, who have particularly suffered systemic disruption due to prostitution. Analysis of case files and interviews provide quantitative and qualitative data that highlight the role of filial piety and the shift from indenture to runaway as the major pathway in Taiwan. Discussion includes relation of these findings to juvenile entry into prostitution in other countries, directions for future research, and policy recommendations for Taiwan's government.     

Age, ethnicity, and use of complementary and alternative medicine in health self-management

Drawing on models of health self-management, we develop hypotheses that age and ethnicity will modify associations among indicators ofpoor health and use of complementary and alternative medicine. These hypotheses are evaluated using the 2002 National Health Interview Survey with the Alternative Health Supplement. Results produced partial support for hypotheses that the effects of ailments on use of complementary and alternative medicine differ by age. Results suggest that ailments such as bodily pain, chronic conditions, and functional impairment are associated with use of complementary and alternative medicine among midlife and younger adults, but these associations are generally attenuated among older adults. Hypothesized ethnic differences received weak support. These findings suggest that different interpretations of ailments and appropriate responses may explain why complementary and alternative medicine is used by fewer older adults. The results also highlight the significance of social and cultural factors in understanding patterns of complementary and alternative medicine use in the adult population.     

Temporal and spatial patterns of geographically indirect immigration to the United States

"This article examines the little-studied phenomenon of indirect geographic migration to the United States, or the movement of persons whose country of last permanent residence differed from their country of birth. Over 8 million records of legal immigrants to the United States were studied for the period 1972-1987. Geographically indirect migration is shown to be important, amounting to as many as 86,136 persons during a single year. Primarily because of the dislocations of Southeast Asian refugees from their homelands and their subsequent admittance to the United States, indirect immigration increased during the 1980s. Moreover, again somewhat due to refugees, the patterns of geographically indirect movement changed during recent years. Political conditions in countries of birth appear to be important in explaining these patterns, as well as the age and skills of the indirect migrants themselves."     

The communication of anger and disappointment helps to establish cooperation through indirect reciprocity

Indirect reciprocity is cooperation through reputation: third parties cooperate with those known to cooperate and defect against those known to defect. Defection, then, can have the unjust motive of greed or the just motive of retaliation. To establish cooperation, observers should distinguish both motives for defection and respond more cooperatively to the latter. We propose that the expression of emotions may facilitate this inferential process. Indeed, in two laboratory studies participants inferred that defection out of anger or disappointment was a just response to a defector and they responded more cooperatively than when no emotion was communicated. Moreover, participants inferred that defectors who evoked disappointment instead of anger had a relatively positive reputation. We conclude that emotions help establish cooperation through indirect reciprocity.     

One physician's path to addiction medicine

Ajay Manhapra, M.D., began his medical career as a hospitalist. Eventually, he became an addiction treatment specialist. He described his path to addiction medicine in an interview with ADAW last month.