Formative research methods to understand patient and provider responses to heart attack symptoms

Formative research is often required for program planning, and for reducing uncertainty about generalizability of program effects. This article describes and justifies methods of formative research conducted for the REACT study (Rapid Early Action for Coronary Treatment), a multi-center collaborative randomized community trial aimed at reducing patient delay in seeking care for acute myocardial infarction (AMI). Formative research cast light on patient and community members’ decision-making process in seeking help for AMI, as well as barriers and facilitators of this process. Investigators at all five REACT Field Centers participated in the formative research. The process consisted of: (1) developing a common theoretical framework for the study intervention; (2) conducting a literature review and qualitative research to identify and address gaps in knowledge; and (3) developing a common protocol for the REACT study that accommodated the diversity of the target communities in terms of services, resources, history, and ethnicity. Analysis employed triangulation, defined as an explicit search for heterogeneous data sources to reduce uncertainty about forces at work and opportunities for intervention across settings and populations. Because the collection and interpretation of data went in stages, staff of several REACT Field Centers had independent input to the overall synthesis, then shared and revised the results. Advantages and limitations of this approach are discussed.     

Local Government and the Politics of Decency*

Objective. Local government officials exhibit a variety of responses to morality issues involving “decency” (i.e., pornography, prostitution, sexually explicit businesses). The purpose of this research is to account for these differences. Methods. This research analyzes a subset of data from a larger study of morality policy making at the local level, that is, all cases of decision making on decency issues (e.g., pornography, prostitution, regulation of sexually explicit businesses, etc.) that occurred in the period 1994–2000 in 10 of the 52 largest cities in the United States. Results. In mayoral settings, decision making on decency cases is likely to evoke pro‐decency action from officials when a high level of issue salience is combined with high levels of church adherence, low levels of women's political empowerment, low levels of fundamentalist religious attachment, and higher levels of per capita income. Officials in city manager settings act more favorably toward decency activists if (1) higher levels of salience combine with a lower prevalence of fundamentalist religious adherents and higher levels of per capita income or (2) there is an interaction of salience and low levels of female political empowerment and high unemployment. Conclusions. Although exploratory in nature, the results confirm conventional expectations concerning the importance of salience and the prevalence of church affiliation; the results are counterintuitive with respect to the prevalence of fundamentalist forces and the extent of female political empowerment.     

Fathers-The Secondary Partners: Professional Perceptions and Fathers' Reflections

SUMMARY. The following is an account of a research project exploring the recollections of seven fathers at the time of the birth of their children with Down's Syndrome. It discusses the disclosure of diagnosis and subsequent contacts the fathers made both professionally and socially during the period following both in the hospital and at home. This is combined with the personal recollections of one father, not part of the original study, whose child was born with special needs. The implications for both professional practice and fathers are highlighted. Whilst there is an acknowledgement that the project was small scale, the conclusions will raise challenging issues for further discussion both among professionals and individual members of families.     

Commercial and sexual exploitation of children and young people in the UK—a review

This paper reviews recent information and data relevant to the commercial sexual exploitation of children and young people in the UK. Three main aspects of exploitation are addressed: abuse through prostitution; abuse through pornography; and the trafficking of children and young people to and through the UK for the purposes of commercial sexual exploitation. Most published research in this area relates to young people exploited through prostitution. The review explores the range of vulnerability factors, the processes used to engage young people in prostitution and the types of support strategies for those being exploited. Rather less information is currently available on the scale of child pornography, or the links between the use of pornography and other forms of sexual abuse. The internet as a modern technology for proliferating child pornography is discussed, alongside its role in providing opportunities for paedophiles to access and ‘groom’ children for sexual purposes. Finally, the review provides a summary of research on trafficking of children to and through the UK for the purposes of commercial sexual exploitation and demonstrates the limited knowledge about this topic. Copyright © 2005 John Wiley & Sons, Ltd.     

Parenting fostered adolescents: skills and strategies

This paper discusses findings from a recently completed study of adolescent foster care, which included a detailed assessment of the parenting approaches and strategies used by the foster carers of adolescents in long‐term placements. Sixty‐eight foster carers were interviewed at two points in time. The first interview was conducted two months after the start of a new adolescent placement and the second after the placement had been continuing for a year, or at the point of disruption if this occurred earlier. The interview schedules were designed specifically for this study and were based upon well‐established techniques developed in other studies of parenting. They enabled the researchers to make summary ratings for each carer on established dimensions of parenting such as control and discipline, responsiveness and the level of engagement with the child. The researchers assessed how these strategies changed and developed in relation to the young person's behaviour and whether these approaches influenced either the likelihood of placement disruption or the quality of the placement for the child. This paper describes the parenting strategies used by the foster carers, highlighting the areas of parenting that significantly affected the placement outcomes and the corresponding implications for policy and practice.     

'Dealing With It': Experiences of Young Fathers in and Leaving Care

The interface between two major UK Government priorities—reducingunwanted teenage pregnancies and supporting teenage parents,and improving the health and well-being of young people in andleaving local authority care—has been the focus of recentresearch. The overall aims of this study were to explore factorscontributing to early pregnancy and parenthood among young peoplein and leaving local authority care; to determine the kindsof support available to these young people; and to identifywhat enables or prevents the delivery of the support they need.Via in-depth interviews, and in four contrasting geographicalareas, data were collected from young people and service providersacross England. This paper analyses data of relevance to theexperience of young fathers who have been looked after—toconsider how the needs of these young men might be better addressedthrough policy and practice. In-depth interviews conducted withyoung fathers and service providers highlighted three key aspectsof their experience that must be addressed if future needs areto be better provided for. These are: social exclusion, trustand more flexible forms of service provision. The implicationsof these issues for future policy and programme developmentare discussed.     

REFOCUSING FROM CHILD TO MARITAL PROBLEMS USING THE MARRIAGE CONTRACT GAME

Couples experiencing marital distress often request treatment for child behavior problems. These families have been found to respond poorly to behavioral parent-training programs and to reject offers of marital therapy. The Marriage Contract Game (MCG) structures and teaches problem-solving and communication skills; the game can be used to improve the skills of distressed couples and to refocus their attention away from their children and toward their own marriages. A multiple-baseline design was applied to four distressed couples who requested treatment for a target child. Results showed that game play improved couple's problem-solving and positive feeling statements in home discussions of problems, parents' ratings of target children's problems, and, in three cases, couples' perceptions of the difficulty of resolving their problems. Therapists untrained in behavioral methods were able to use the game with success and comfort. While four sessions of the MCG were not sufficient treatment for this population, intervention improved couples' skills and shifted their focus away from child problems and toward their own.     

‘Someone of Your Own to Love’: Experiences of Being Looked After as Influences on Teenage Pregnancy

Previous research has shown that children and young people who are looked after are vulnerable to poor life outcomes, including early pregnancy. This paper examines how experiences of being looked after may contribute to teenage pregnancy. Using in‐depth interviews, data were collected from 63 young people recently looked after who are aged 15–24 and 78 professionals, across four research sites. The young people reported feelings of loneliness, rejection, stigma and not being able to trust others, emotions which seriously influenced their decisions about becoming parents. The findings suggest that such young people may benefit from a greater degree of emotional and practical support throughout their lives in care. Copyright © 2006 Institute of Education, University of London.     

The impact of gender on gambling attitudes and behavior

Researchers have often attributed the consistent relation of gender and gambling behavior to gender role socialization. If they are correct, gender should affect different sets of gambling attitudes in a manner consistent with at least three aspects of gender role socialization: a double standard of morality, a guardian of the hearth role for women, and a dualism of orientations. A survey measuring gambling attitudes and behavior was sent to a sample of residents in North Dakota after legalization of several games of chance (e.g., blackjack). Gender affects behavior but only some of the specified attitudes. These mixed results may reflect changes in gender role socialization and the increasing legalization of gambling.