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.     

Integrating Dream Analysis with Intersubjectivity in Group Psychotherapy

The author discusses her application of Daniel Stern's theories of intersubjectivity to group psychotherapy. The group members were women presenting with issues regarding childhood molestation and/or abuse. From her case notes, she examines the dreams the women discussed in the group treatment setting and illustrates how the group members mutually constructed life narratives, which ultimately created new meanings regarding their lives. Through mutual construction of these narratives, her clients ultimately organized new senses of self, affecting them both interpersonally and intrapsychically.     

Time,Stress and Intellectual Engagement in Academic Work: Exploring Gender Difference

This article is based on a pilot study that examines the effects of recent organizational and public policy changes on Canadian academics' work practices and academic culture. It explores the differences between the use of online technologies by women and male academics in managing these effects. It interprets the complex and often contradictory findings of the study through the lens of time theorization, and speculates about the broader cultural implications of academics' changing work practices, including the possibility of a gestalt shift in the identity of the university, less as a site of research and reflection on society and increasingly as a productive and efficient part of the economy.     

Screening Networks: shared agendas in feminist and disability movement challenges to antenatal screening and abortion

This paper identifies common ground in feminist and disability movement concerns with the social and ethical implications of antenatal screening and abortion. By examining the frameworks used by particular authors within each area, I argue that they both can and do have a shared agenda, which is focused on the social values that are embedded in antenatal screening and promote abortion as the obvious choice to the diagnosis of a congenital condition. It is important to develop some kind of shared agenda in order to construct theoretical and methodological approaches, which pay equal attention to pregnant women (disabled and non-disabled) and disabled people. To aid the development of such an agenda I draw on Actor Network Theory (ANT), which focuses on analysing the role of sociotechnical networks in securing particular social values and moral worlds. The issue for both disability studies and feminism is what kind of screening networks produce moral worlds that promote abortion, shape women's choices and express discrimination against disabled people?     

Career Counseling in a Volatile Job Market: Tiedeman's Perspective Revisited

This article explores implications of Tiedeman's original theory for career counselors. Some components of the theory seem to be compatible with existing volatile job market conditions. Notions of career path recycling, development in reverse, nonlinear progress, and parallel streams in career development are explored. Suggestions are made for counseling interventions and future research using this perspective.     

Protecting children in Scotland: examining the impact of the Children (Scotland) Act 1995

This paper discusses findings from a small‐scale study of the impact on child protection practice following implementation of the Children (Scotland) Act 1995. The Act introduced three new measures to allow the state to intervene in families to protect a child where there is a risk of significant harm. These include the child protection order, the child assessment order and the exclusion order. The child protection order provides for the removal of a child to (or his or her retention in) a place of safety. In the first two years of the operation of the 1995 Act fewer applications were made for this order compared with similar provisions under the previous legislation. This reduction in applications appears to be related to unfamiliarity with new legislation; greater scrutiny resulting from the more formal application to the sheriff court; and the introduction of a new legal criterion for intervention, the presence or likelihood of ‘significant harm’. The introduction of the ‘no order’ principle into Scottish child care law is also likely to be a factor.     

Stress Hormone Changes and Marital Conflict: Spouses’ Relative Power Makes a Difference

We investigated the impact of relative marital power on 72 newlywed couples’ endocrinological responses to marital conflict. Marital power was determined by comparing spouses’ reports of dependent love for one another. Less powerful spouses displayed elevated adrenocorticotropic hormone (ACTH) responses to a conflict discussion. Shared power appeared to have a beneficial effect on wives’ but not husbands’ ACTH responses. Spouses’ cortisol levels declined over time, except for wives who were less powerful and for husbands who shared power with their wives. Conflict behaviors did not differ as a function of this marital power index. These data suggest that relative levels of general emotional power in relationships may play an important role in spouses’ physiological responses to marital conflict.     

A Preliminary Investigation of Factors Associated With Job Loss Grief

This study investigated relationships among factors hypothesized as related to job loss grief. A summary grief score correlated positively with time since job loss and number of dependents, and negatively with length of notice. Perceived reemployment prospects and income loss related positively to some grief index subscales, as did the condition of living on one's own. Job duration correlated negatively with some grief responses. Implications for counseling and avenues for future research are discussed.