Contraceptive behavior among unmarried young women: A theoretical framework for research

Adoption of the most effective methods of contraception requires individual decision-making and negotiation with contraceptive providers. In order to take account of both behavioral elements, a two-dimensional framework for understanding contraceptive adoption and continuation by unmarried young is proposed, incorporating a "social-psychological model" of individual decision-making and an "interpersonal model" of factors affecting provider-client interaction. The social-psychological model is based on an earlier value-expectancy theory of behavior motivation as applied to health-related behaviors. The interpersonal model is derived from conflict-bargaining perspectives on professional-client interaction; it is suggested that expectations for this interaction are based on a limited number of internalized "models": the "professional"; the "bureaucratic"; the "commercial"; and the "parental." Insofar as client and professional "models" disagree, communication may break down and client understanding and/or acceptance of provider advice cannot be assured. The components of the social-psychological and interpersonal models are described in detail, and a combined framework is proposed.     

An analysis of indirect mortality estimation

Abstract In this paper the robustness of Brass's child-survivorship indirect mortality estimation technique is investigated. An analytical method is developed for studying the error or bias caused in indirect mortality estimates by poor data, badly chosen model functions, and specific demographic assumptions that are often violated in practice. The resulting analytical expressions give insight into the rationale of indirect methods, the conditions under which they are robust, and the magnitude of errors that occur when specific assumptions are violated.     

The meaning of patient satisfaction with prepaid primary health care in Israel

This paper reports the development of a self-administered Hebrew-language questionnaire for assessing patient satisfaction with primary care in Israel. Four scale measures of patient satisfaction were empirically constructed. These scales pertained to doctor conduct, doctor-patient communication, teamwork, and ease of access. In addition, a single direct question was used to measure overall satisfaction with the care. Ratings of all aspects of care were negatively skewed, with doctor-conduct and doctor-patient communication usually being the most satisfactory aspects and access the least satisfactory. It was shown that different practices, or the same practice at different points in time, can easily and meaningfully be compared, using mean satisfaction scores, measures of standard deviation, or percentages in each practice with ratings above (or below) the overall mean of all practices. The use of specific measures of patient satisfaction for comparison and intervention is discussed.     

Patient satisfaction with mental health services: a meta-analysis to establish norms

Patients typically express high rates of satisfaction with their mental health care. This finding and the lack of well controlled studies on patient satisfaction in the literature underscore the need for meaningful guidelines for clinicians and program evaluators in interpreting patient satisfaction data. To address this problem a meta-analysis was undertaken to establish norms on patient satisfaction for various types of mental health programs. Programs were categorized according to three dimensions: inpatient vs. outpatient vs. residential care; chronic vs. non-chronic; and conventional vs. innovative. Meta-analysis procedures were modified to accommodate the single-group study designs that dominate the literature. The analysis revealed that chronic patients express less satisfaction with their treatment compared to non-chronic patients. Innovative programs are viewed more positively than conventional ones. No differences were found in rates of patient satisfaction between inpatient and outpatient programs. Acceptably reliable norms and confidence intervals of patient satisfaction were established for conventional inpatient programs serving either chronic or non-chronic patients; conventional outpatient programs for non-chronic patients; and for all programs combined according to chronic vs. non-chronic, inpatient vs. outpatient, and conventional vs. innovative. However, data were insufficient to compute norms for other program types. The norms thus established can be used for comparative purposes by program evaluators. A cumulative, national data base on patient satisfaction is recommended to further refine these norms.     

The effects of psychiatric symptoms on quality of life assessments among the chronic mentally ill

This study of chronically mentally disabled persons in community residences examined the discriminant validity of subjective quality of life indicators and self-report mental health indices to determine the potential confounding effects of psychopathology on the assessment of quality of life (QOL). Factor analyses and difference-score reliabilities identified a general QOL construct and a general mental health construct with 27% common variance. However, psychiatric symptoms did not significantly (p less than .05) alter the bivariate and multivariate relationships among the QOL ratings, except in the health domain in which the correlations of health-related QOL indicators with global QOL were significantly (p less than .05) attenuated after removing the effects of psychopathology. The results suggest that psychopathology does not introduce bias into the overall structure of QOL data, but they also indicate the importance of controlling for mental health effects in the assessment of patients' self-rated health and satisfaction with health care.     

The aims of population statistics and demographic research

A detailed program for the improvement of population statistics and for the development of demographic research is presented, with particular reference to the USSR. Topics covered include global and regional population projections, special surveys on demographic behavior, and the need for improvements in migration data.     

Out-migration and ethnic communities

"Comparative analysis of out-migration [in the United States]...reveals substantial ethnic differentials. Part of the variation results from group compositional differences in social class and other characteristics normally related to migration, particularly age, education and local birth. Equally important, however, are indicators of social and economic bonds." The data concern 3,345 adults who were first interviewed between 1967 and 1969 in Rhode Island and were reinterviewed in 1970, 1971, and 1979. "The results suggest that ethnic groups characterized by a dense network of social and economic ties do not sponsor out-migration, which has been the emphasis of many past studies of chain migration and migrant assimilation. Rather, they deter out-migration by providing alternative opportunities within the ethnic community."