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.     

Substance Use,Distress, and Adolescent School Networks

This study examined the associations of substance use, psychological distress, and mental health services receipt with the structure and content of adolescent school‐based networks. Using data from the National Longitudinal Study of Adolescent Health, we found that substance use was associated with receiving more, but making fewer, peer nominations. It also was associated with less favorable network characteristics, such as low GPA. Services receipt was associated with receiving and making fewer nominations, less favorable network characteristics, and a lower likelihood of reciprocated best friendships. Psychological distress had fewer significant associations. All associations were modest in magnitude. Our results suggest the importance of considering multiple indicators of socioemotional problems and multiple dimensions of social networks in research on adolescent peer relations.     

Excluding Children: Autonomy, Friendship and the Experience of the Care System

The concept of social exclusion is increasingly important in policy and research but has rarely been addressed from a child-centred perspective. Childhood is a social experience in itself, one that has its own norms and customs, and where the demands of participation and inclusion may be considerable, likewise the costs of exclusion. This paper explores the meaning and experience of social exclusion for children by focusing on a particular group of children and young people, those 'looked after' in the public care system. The sample involved children who had minimal contact with their parents, and who although not currently materially poor were vulnerable to a high future risk of experiencing poverty. They thus provided a valuable opportunity to explore some of the relational aspects of social exclusion. Using in-depth interviews to explore the meaning of friendship in their lives, the study revealed the importance of social relationships for these children, andin particular the impact of the care system on their capacity to make and sustain social networks. The findings suggest that the relational aspects of poverty are not just consequences of material poverty but can have a dynamic of their own, one that may have a particular resonance for children. This has implications not just for children in the care system, but also for children in families, where family poverty and the restricted social and economic integration of parents may also have an impact on children's capacity for developing social relationships and wider social networks.     

Political Interests and the Implementation of China's Urban Health Insurance Reform

During the 1980s and 1990s China has been experimenting with reform of its health insurance system. Based on a study of experimental schemes in several cities in eastern China in the late 1990s, this paper shows that the schemes' main problems are due to the vested interests of enterprises, hospitals, officials, and other beneficiaries of the pre-reform system. Reform policy has been implemented slowly, and local health insurance schemes have (1) suffered from poor participation rates, and (2) had difficulties balancing contributions into local government-run pooled funds with expenditures needed for medical treatment. These problems threaten the viability of the national programme announced in late 1998. The solution lies in improving local government capacity through effective legislation and training, but this will be difficult to achieve.     

Achievement in a Relational Context: Preferences and Influences in Female Adolescents

Friends' influence on achievement‐related choices in female adolescents was investigated using the Thematic Apperception Test (H. Murray, 1943), in the context of self‐in‐relation theory (J. V. Jordon, A. G. Kaplan, J. B. Miller, I. P. Stiver, & J. L. Surrey, 1991). Two hypotheses were tested: (1) Achievement‐related stimuli will elicit stories with more unfavorable and conflicted outcomes than will affiliation stimuli; (2) Thematic representation of achievement will be more homogeneous in more highly cohesive peer groups. A multivariate analysis of variance with repeated measures yielded significant results for Hypothesis 1. Thematic analysis of stories supported Hypothesis 2, showing peer group influence on achievement strivings in female adolescents.     

Proposing a model for promoting Children's Health in Early Childhood Education and Care Settings

This pilot study was conducted in one early childhood pre-school nursery setting in an area of high deprivation in England to explore the under-researched area of how practitioners promote the health of children. The research used an original tool, Child Health Promotion: A Toolkit for Early Childhood Education and Care Practitioners, containing a 5 Step Programme as a model to guide practitioners in identifying and implementing a health promotion activity. The findings will help to set the onward agenda for a larger scale study which will foreground the voices of practitioners and highlight the role that ECEC practitioners can play in promoting the health of children.