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People face increasingly detailed information related to a range of risky decisions. To aid individuals in thinking through such risks, various forms of policy and health messaging often enumerate their causes. Whereas some prior literature suggests that adding information about causes of an outcome increases its perceived likelihood, we identify a novel mechanism through which the opposite regularly occurs. Across seven primary and six supplementary experiments, we find that the estimated likelihood of an outcome decreases when people learn about the (by- definition lower) probabilities of the pathways that lead to that outcome. This "unlikelihood" bias exists despite explicit communication of the outcome's total objective probability and occurs for both positive and negative outcomes. Indeed, awareness of a low-probability pathway decreases subjective perceptions of the outcome's likelihood even when its addition objectively increases the outcome's actual probability. These findings advance the current understanding of how people integrate information under uncertainty and derive subjective perceptions of risk. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Procedural fairness is an accepted requirement for health decision-making. Fair procedures promote the acceptability and quality of health decisions while simultaneously advancing broader goals of participatory democracy. We conducted a case study of the Sugary Beverage Tax in South Africa known as the Health Promotion Levy (HPL), which was legislated in 2018. The case study examines the process around the adoption of the HPL from the perspective of procedural fairness with the view of identifying local gaps and lessons transferable to other local decision-making processes and other jurisdictions. We conducted a desk review of publically available data relating to the passage and implementation of the HPL, including a review of the policy documents, public submissions during the public participation process, response documents from policymakers, review of national legislative committee minutes, legal instruments and academic literature capturing public awareness, stakeholder views and media content. The data collection is novel in terms of the large scope of data considered, as well as the variety of sources. An analytical framework consisting of key criteria for procedural fairness, informed by a scoping review of the literature, guided the analysis of the decision-making process in South Africa. The process of the adoption and passage of the HPL met the majority of the procedural fairness criteria. However, a shortcoming, which impacted several criteria, was the failure to actively source the participation of community representatives and the larger public. Non-governmental organizations did not adequately fulfil this representative role. Industry interests were also disproportionately considered. The case study highlights the overall importance of viewing general members of the public as interested parties in health policies and the dangers of over-involving policy opponents under a mistaken understanding that this constitutes meaningful public engagement in decision-making procedures. [ABSTRACT FROM AUTHOR]

Abstract Introduction International organisations have called to increase young people’s involvement in healthcare and health policy development. We currently lack effective methods for facilitating meaningful engagement by young people in health-related decision-making. The purpose of this scoping review is to identify deliberative priority setting methods and explore the effectiveness of these in engaging young people in healthcare and health policy decision-making. Methods Seven databases were searched systematically, using MeSH and free text terms, for articles published in English before July 2021 that described the use of deliberative priority setting methods for health decision-making with young people. All titles, abstracts and full-text papers were screened by a team of six independent reviewers between them. Data extraction followed the Centre for Reviews and Dissemination guidelines. The results are presented as a narrative synthesis, structured around four components for evaluating deliberative processes: 1) representation and inclusion of diverse participants, 2) the way the process is run including levels and timing of participant engagement, 3) the quality of the information provided to participants and 4) resulting outcomes and decisions. Findings The search yielded 9 reviews and 21 studies. The more engaging deliberative priority setting tools involved young people-led committees, mixed methods for identifying and prioritising issues and digital data collection and communication tools. Long-term and frequent contact with young people to build trust underpinned the success of some of the tools, as did offering incentives for taking part and skills development using creative methods. The review also suggests that successful priority setting processes with young people involve consideration of power dynamics, since young people’s decisions are likely to be made together with family members, health professionals and academics. Discussion Young people’s engagement in decision-making about their health is best achieved through investing time in building strong relationships and ensuring young people are appropriately rewarded for their time and contribution. If young people are to be instrumental in improving their health and architects of their own futures, decision-making processes need to respect young people’s autonomy and agency. Our review suggests that methods of power-sharing with young people do exist but that they have yet to be adopted by organisations and global institutions setting global health policy.

The language used to present an argument has long been argued to influence people's reaction to that argument. This study examined how language and grammatical structure influenced response to health-related dilemmas. We investigated whether medical students' willingness to receive a medical treatment or to take an action (regarding advancing one's own health or other people's health) was influenced by the language (first versus foreign) and the grammatical structures (modifiers and quantifiers) used. Saudi medical students (N = 368) read health-related dilemmas using different adverbial modifiers and quantifiers in Arabic or in English. The participants were randomly assigned to one of four conditions: Arabic with high certainty (i.e., very-modifier and all-quantifier), Arabic with low certainty (no very-modifier and some-quantifier), English with high certainty, and English with low certainty. The results showed that the participants were susceptible to a foreign language effect, but not to a grammatical structure effect. We discuss the implications of these results in relation to how different health-scenarios may affect decision making for health professionals. [ABSTRACT FROM AUTHOR]

Major strides have been made in understanding the impact of intersectionality in everyday life. However, there is a significant gap in the research literature on how individuals with multiple minority statuses must uniquely interact and navigate health services. We carried out an exploratory qualitative study with twenty sexual minority gender expansive women of Latinx and African American descent to explore participants' access to health services and the impact of cultural factors on their health decisions and behaviors. Participants described long-term challenges with accessing health services that were primarily tied to income and discriminatory treatment on the part of health providers. Participants also shared regular discouragement from family members to engage with U.S./Western medicine and health traditions. Together, participants' early life experiences and the continued messages from family members, influenced their health behaviors (e.g., delaying care). Implications for future research and health services are discussed. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic provided an opportunity to investigate factors related to public response to public health measures, which could help better prepare implementation of similar measures for inevitable future pandemics. To understand individual and environmental factors that influence likelihood in engaging in personal and public health measures, three crowdsourced convenience samples from Amazon Mechanical Turk (MTurk) completed likelihood‐discounting tasks of engaging in health behaviors given a variety of hypothetical viral outbreak scenarios. Experiment 1 assessed likelihood of mask wearing for a novel virus. Experiment 2 assessed vaccination likelihood based on efficacy and cost. Experiment 3 assessed likelihood of seeking health care based on number of symptoms and cost of treatment. Volume‐based measures and three‐dimensional modeling were used to analyze hypothetical decision making. Hypothetical public and personal health participation increased as viral fatality increased and generally followed a hyperbolic function. Public health participation was moderated by political orientation and trust in science, whereas treatment‐seeking was only moderated by income. Analytic methods used in this cross‐sectional study predicted population‐level outcomes that occurred later in the pandemic and can be extended to various health behaviors. [ABSTRACT FROM AUTHOR]

Following preventive measures is crucial for slowing the rate of COVID-19 spread. To date, most research has focused on the role of individual differences and personality in compliance with preventive measures to COVID-19. Building on findings that interpersonal touch instills a feeling of security, we propose that interpersonal touching behavior, an underexplored factor tied to social interaction, leads to more breaches of coronavirus restrictions by inducing security feelings. In a lab experiment (Experiment 1) and a field study (Experiment 2), we demonstrated that a female experimenter's fleeting and comforting pat on the shoulder made people less willing to abide by preventive measures in their self-report and actual behavior. Further, we excluded a potential alternative explanation that touch intervention by the experimenter presents the defiance of COVID-19 rules because the effect cannot be observed when the touch consists of a handshake rather than a comforting pat on the shoulder (Experiment 3). Finally, consistent with our theoretical perspective, the results revealed that sense of security mediated the effect of interpersonal touch on violation of instructions to follow coronavirus precautions. Taken together, interpersonal touch not only enhances trust and security, but also can push people away from health guidelines. [ABSTRACT FROM AUTHOR]

Introduction: International organisations have called to increase young people's involvement in healthcare and health policy development. We currently lack effective methods for facilitating meaningful engagement by young people in health-related decision-making. The purpose of this scoping review is to identify deliberative priority setting methods and explore the effectiveness of these in engaging young people in healthcare and health policy decision-making. Methods: Seven databases were searched systematically, using MeSH and free text terms, for articles published in English before July 2021 that described the use of deliberative priority setting methods for health decision-making with young people. All titles, abstracts and full-text papers were screened by a team of six independent reviewers between them. Data extraction followed the Centre for Reviews and Dissemination guidelines. The results are presented as a narrative synthesis, structured around four components for evaluating deliberative processes: 1) representation and inclusion of diverse participants, 2) the way the process is run including levels and timing of participant engagement, 3) the quality of the information provided to participants and 4) resulting outcomes and decisions. Findings: The search yielded 9 reviews and 21 studies. The more engaging deliberative priority setting tools involved young people-led committees, mixed methods for identifying and prioritising issues and digital data collection and communication tools. Long-term and frequent contact with young people to build trust underpinned the success of some of the tools, as did offering incentives for taking part and skills development using creative methods. The review also suggests that successful priority setting processes with young people involve consideration of power dynamics, since young people's decisions are likely to be made together with family members, health professionals and academics. Discussion: Young people's engagement in decision-making about their health is best achieved through investing time in building strong relationships and ensuring young people are appropriately rewarded for their time and contribution. If young people are to be instrumental in improving their health and architects of their own futures, decision-making processes need to respect young people's autonomy and agency. Our review suggests that methods of power-sharing with young people do exist but that they have yet to be adopted by organisations and global institutions setting global health policy. [ABSTRACT FROM AUTHOR]

Abstract Background A number of factors may determine family planning decisions; however, some may be dependent on the social and cultural context. To understand these factors, we conducted a qualitative study with family planning providers and community stakeholders in a diverse, low-income neighborhood of Istanbul, Turkey. Methods We used purposeful sampling to recruit 16 respondents (eight family planning service providers and eight community stakeholders) based on their potential role and influence on matters related to sexual and reproductive health issues. Interviews were audio-recorded with participants' permission and subsequently transcribed in Turkish and translated into English for analysis. We applied a multi-stage analytical strategy, following the principles of the constant comparative method to develop a codebook and identify key themes. Results Results indicate that family planning decision-making—that is, decision on whether or not to avoid a pregnancy—is largely considered a women’s issue although men do not actively object to family planning or play a passive role in actual use of methods. Many respondents indicated that women generally prefer to use family planning methods that do not have side-effects and are convenient to use. Although women trust healthcare providers and the information that they receive from them, they prefer to obtain contraceptive advice from friends and family members. Additionally, attitude of men toward childbearing, fertility desires, characteristics of providers, and religious beliefs of the couple exert considerable influence on family planning decisions. Conclusions Numerous factors influence family planning decision-making in Turkey. Women have a strong preference for traditional methods compared to modern contraceptives. Additionally, religious factors play a leading role in the choice of the particular method, such as withdrawal. Besides, there is a lack of men’s involvement in family planning decision-making. Public health interventions should focus on incorporating men into their efforts and understanding how providers can better provide information to women about contraception.

Racial and ethnic minority communities have been disproportionately affected by COVID-19, but the uptake of COVID-19 mitigation strategies like vaccination and testing have been slower in these populations. With the continued spread of COVID-19 while in-person learning is a priority, school-aged youth and their caregivers must make health-related decisions daily to ensure health at school. It is critical to understand factors associated with COVID-related health decisions such as vaccination, testing, and other health behaviors (e.g., wearing masks, hand washing). Community-engaged campaigns are necessary to overcome barriers to these health behaviors and promote health equity. The aim of this study was to examine COVID-19-related concerns and influences on health decisions in middle and high schools serving primarily racial and ethnic minority, low-income families. Seven focus groups were conducted with school staff, parents, and students (aged 16 years and older). Qualitative data were analyzed using a general inductive approach. Factors related to COVID-19 concerns and health decisions centered on (1) vaccine hesitancy, (2) testing hesitancy, (3) developmental stage (i.e., ability to engage in health behaviors based on developmental factors like age), (4) cultural and family traditions and beliefs, (5) compatibility of policies and places with recommended health behaviors, (6) reliability of information, and (7) perceived risk. We explore sub-themes in further detail. It is important to understand the community's level of concern and identify factors that influence COVID-19 medical decision making to better address disparities in COVID-19 testing and vaccination uptake.

A commonplace observation across many cultures is that humans show a strong preference for natural items on drug choice in the medical domain. Despite an emerging line of psychological research on individual differences in the naturalness-is-better bias, few studies have focused on the role of religious beliefs. According to the core idea of Taoism, people should free themselves from selfishness and desire and behave in concert with the alternating cycles of Nature. Based on the findings regarding the positive relationship between connectedness to nature and naturalness preference, we predict that Taoists, who emphasize harmony between humanity and nature, should show a stronger naturalness-is-better bias than atheists on drug choice due to their higher level of natural connectedness. The results showed that both Chinese atheists and Taoists selected a natural over synthetic drug even though the safety and efficacy of the medicines were described as identical. More importantly, the naturalness-is-better bias is more pronounced in Taoists than atheists. These data suggest that religious beliefs related to individuals' connectedness to nature may moderate the naturalness-is-better bias in health decisions. [ABSTRACT FROM AUTHOR]

Every day important healthcare decisions are made with incomplete or outdated information about the effects of the healthcare interventions available, what delivers the best value for the health system and where more research is needed. It is necessary to invest in strategies that allow access to reliable and updated evidence on which to base health decisions. The objective is to develop and evaluate a strategy for building the capacity among different actors of a country’s health system to implement the model known as “Living Evidence” [LE] in the evidence synthesis and dissemination of knowledge transfer [KT] products to inform health decisions. The study will involve professional members of health system organizations in charge of developing KT products to inform health decisions. The project will be developed in three complementary phases: 1) LE-implementation framework development through review of the literature, brainstorming meetings, user testing, and expert consultation; 2) training in LE tools and strategies; 3) developing LE synthesis for KT products by applying the framework to real-life diverse situations. To achieve the capacity-building strategy assessment goal, several surveys and interviews will take place during the process to assess: 1) the LE-implementation framework for the incorporation of LE synthesis in the development of KT products; 2) the training workshops; 3) the whole capacity-building strategy used for health system organizations be able of implementing the LE as part of the KT products they regularly produce. The expected results are an effective capacity-building strategy for health system organizations to implement the living evidence model in different KT products; a LE-implementation framework to be applicable to any country or region to incorporate LE in the KT products; LE synthesis for KT products directly applicable to the real-setting situations; integration of Epistemonikos-L.OVE platform for keeping the LE process in the development and updating of KT products.

The phenomenon of ambiguity aversion suggests that people prefer options that offer precisely rather than imprecisely known chances of success. However, past work on people's responses to ambiguity in health treatment contexts found ambiguity seeking rather than aversion. The present work addressed whether such findings reflected a broad tendency for ambiguity seeking in health treatment contexts or whether specific attributions for ambiguity play a substantial role. In three studies, people choose between two treatment options that involved similar underlying probabilities, except that the probabilities for one option involved ambiguity. The attributions offered for the ambiguity played an important role in the results. For example, when the range of probabilities associated with an ambiguous treatment was attributed to the fact that different studies yield different results, participants tended to show ambiguity aversion or indifference. However, when the range was attributed to something that participants could control (e.g., regular application of a cream) or something about which they were overoptimistic (e.g., their immune system function), participants tended to show ambiguity seeking. Health professionals should be mindful of how people will interpret and use information about ambiguity when choosing among treatments. [ABSTRACT FROM AUTHOR]

Background: Health disparities disproportionally affect Black and Hispanic older US adults. Health research is needed to understand and eliminate these disparities; however, older adults, and particularly Black and Hispanic/Latino older adults are underrepresented in health research. Adult children have influenced health behavior and health outcomes of their older parents in several demographics in the US. Analysis of these studies can lead to a model for the development of interventions aimed at improving health and healthcare participation of older Black and Hispanic US adults.Objectives: To review the role of intergenerational communication and social support in health behavior, health research, and health outcomes for older adults and to apply these findings toward a model for health interventions for Black and Hispanic US older adults.Methods: An analytical narrative review and application toward an intervention model.Results: Key topic areas were reviewed and analyzed by examining studies that applied forms of intergenerational communication and/or intergenerational social support with the goal of either improving health, disease management and/or participation in health research in populations world-wide. Next, a model for providing health interventions in older Black and Hispanic US adults was developed using strategies gleaned from the findings.Conclusion: A model for health intervention for Black and Hispanic/Latino US older adults was presented based on an analytical review and intergenerational communication and/or social support. Qualitative data are necessary to understand the enablers and barriers of intergenerational communication and social support to improve health outcomes in these populations.

Body shame predicts decisions to engage in appearance-improving behaviors that compromise health, suggesting that body shame may promote the devaluing of health in service of appearance. Furthermore, body shame may drive such decisions by diminishing body responsiveness, or the valuing of health-related bodily functions. Two studies tested these ideas in undergraduate students. In Study 1 (cross-sectional), trait body shame predicted decisions to improve appearance at the expense of health, and low body responsiveness mediated this relationship, controlling for BMI and gender. In Study 2 (experimental), body shame was induced and state body shame, state body responsiveness, and the same poor health decisions were measured. State body shame and diminished state body responsiveness mediated the relationship between experimental condition and poor health decisions, controlling for trait body shame, BMI, and gender. These studies demonstrate that body shame may promote the devaluing of health via the mechanism of diminished body responsiveness. [ABSTRACT FROM AUTHOR]

Background: A number of factors may determine family planning decisions; however, some may be dependent on the social and cultural context. To understand these factors, we conducted a qualitative study with family planning providers and community stakeholders in a diverse, low-income neighborhood of Istanbul, Turkey.Methods: We used purposeful sampling to recruit 16 respondents (eight family planning service providers and eight community stakeholders) based on their potential role and influence on matters related to sexual and reproductive health issues. Interviews were audio-recorded with participants' permission and subsequently transcribed in Turkish and translated into English for analysis. We applied a multi-stage analytical strategy, following the principles of the constant comparative method to develop a codebook and identify key themes.Results: Results indicate that family planning decision-making-that is, decision on whether or not to avoid a pregnancy-is largely considered a women's issue although men do not actively object to family planning or play a passive role in actual use of methods. Many respondents indicated that women generally prefer to use family planning methods that do not have side-effects and are convenient to use. Although women trust healthcare providers and the information that they receive from them, they prefer to obtain contraceptive advice from friends and family members. Additionally, attitude of men toward childbearing, fertility desires, characteristics of providers, and religious beliefs of the couple exert considerable influence on family planning decisions.Conclusions: Numerous factors influence family planning decision-making in Turkey. Women have a strong preference for traditional methods compared to modern contraceptives. Additionally, religious factors play a leading role in the choice of the particular method, such as withdrawal. Besides, there is a lack of men's involvement in family planning decision-making. Public health interventions should focus on incorporating men into their efforts and understanding how providers can better provide information to women about contraception. [ABSTRACT FROM AUTHOR]

The aim of this study was twofold: one was to test the impact of the involvement on the parental outcome bias, and the second was to refine the measurement of outcome bias, normally reported as the difference between evaluations of a single decision, with different outcomes assigned to it. We introduced the evaluation of a decision without an outcome, to induce theoretically normative evaluation, unbiased by outcome, from which the evaluation shift could be calculated in either direction. To test this refinement in the parental decision-making context, we produced childcare dilemmas with varying levels of complexity, since the rise of complexity induces stronger bias. Complexity was determined by the particular combination of two factors: parental involvement in a decision - the amount of motivation, interest and drive evoked by it – and whether the decision was health-related or not. We presented parents with the decisions for evaluation, followed by a positive and a negative outcome, and without an outcome. The results confirm the interaction between involvement and domain on decision evaluation. Highly involving decisions yielded weaker outcome bias than low-involvement decisions in both health and non-health domain. Results also confirm the validity of the proposed way of measuring OB, revealing that in some situations positive outcomes skew evaluations more than negative outcomes. Also, a highly-involving dilemma followed by negative outcome did not produce significantly different evaluation compared to evaluation of a decision without outcome. Thus, adding a neutral position rendered OB measurement more precise and our involvement-related insights more nuanced.

Current theories of risk perception point to the powerful role of emotion and the neglect of probabilistic information in the face of risk, but these tendencies differ across individuals. We propose a method for measuring individuals' emotional sensitivity to probability to assess how feelings about probabilities, rather than the probabilities themselves, influence decisions. Participants gave affective ratings (worry or excitement) to 14 risky events, each with a specified probability ranging from 1 in 10 to 1 in 10,000,000. For each participant, we regressed these emotional responses against item probabilities, estimating a slope (the degree to which emotional responses change with probability) and an intercept (the emotional reaction to an event with a fixed probability). These two parameters were treated as individual difference scores and included in models predicting reactions to several health risk scenarios. Both emotional sensitivity to probability (slope) and emotional reactivity to possibility (intercept) significantly predicted responses to these scenarios, above and beyond the predictive power of other well‐established individual difference measures. [ABSTRACT FROM AUTHOR]

A growing number of parents delay vaccinations or are deciding not to vaccinate their children altogether. This increases the risk of contracting vaccine-preventable diseases and disrupting herd immunity, and also impairs the trust in the capacities of health care systems to protect people. Vaccine hesitancy is related to a range of both psychological and demographic determinants, such as attitudes toward vaccinations, social norms, and trust in science. Our aim is to understand those determinants in parents, because they are a special group in this issue—they act as proxy decision makers for their children, who are unable to decide for themselves. The fact that deciding to vaccinate is a socially forced choice that concerns a child's health makes vaccine-related decisions highly important and involving for parents. This high involvement might lead to parents overemphasizing the potential side effects that they know to be vaccine-related, and by amplifying those, parents are more focused on the potential outcomes of vaccine-related decisions, which can yield specific pattern of the outcome bias. We propose two related studies to investigate factors which promote vaccine hesitancy, protective factors that determine parental vaccination decisions, and outcome bias in parental vaccination intentions. We will explore demographic and psychological factors, and test parental involvement related to vaccine hesitancy using an online battery in a correlation panel design study. The second study is an experimental study, in which we will investigate the moderating role of parents' high involvement in the specific domain of vaccination decision making. We expect that higher involvement among parents, compared to non-parents, will shape the pattern of the proneness to outcome bias. The studies will be conducted across eight countries in Europe and Asia (Finland, Germany, Hong Kong, the Netherlands, Serbia, Slovenia, Spain, and the United Kingdom), rendering findings that will aid with understanding the underlying mechanisms of vaccine hesitancy and paving the way for developing interventions custom-made for parents.

The aim of this study was twofold: one was to test the impact of the involvement on the parental outcome bias, and the second was to refine the measurement of outcome bias, normally reported as the difference between evaluations of a single decision, with different outcomes assigned to it. We introduced the evaluation of a decision without an outcome, to induce theoretically normative evaluation, unbiased by outcome, from which the evaluation shift could be calculated in either direction. To test this refinement in the parental decision-making context, we produced childcare dilemmas with varying levels of complexity, since the rise of complexity induces stronger bias. Complexity was determined by the particular combination of two factors: parental involvement in a decision - the amount of motivation, interest and drive evoked by it - and whether the decision was health-related or not. We presented parents with the decisions for evaluation, followed by a positive and a negative outcome, and without an outcome. The results confirm the interaction between involvement and domain on decision evaluation. Highly involving decisions yielded weaker outcome bias than low-involvement decisions in both health and non-health domain. Results also confirm the validity of the proposed way of measuring OB, revealing that in some situations positive outcomes skew evaluations more than negative outcomes. Also, a highly-involving dilemma followed by negative outcome did not produce significantly different evaluation compared to evaluation of a decision without outcome. Thus, adding a neutral position rendered OB measurement more precise and our involvement-related insights more nuanced. [ABSTRACT FROM AUTHOR]

Abstract: Background: A partnership of large health‐care purchasers created a workgroup to reduce the overuse of harmful and wasteful medical care in California. Objective: Employ a civic engagement process to identify the social values important to the public in considering different strategies to reduce overuse. Intervention: Use of deliberation techniques for 3 case examples that explore possible strategies: physician oversight, physician compensation, increased patient cost‐sharing or taking no definitive action. Results: Five themes were identified, including strong support for physicians’ leadership role to reduce overuse; nuanced enthusiasm for increasing patient cost‐sharing to discourage excessive demand; and marked disapproval of physician compensation as a motivator. Conclusion: Most but not all of the perspectives voiced by participants are congruent with efforts to reduce overuse that is being initiated or discussed at the state, provider and health plan level. As health‐care policymakers and leaders consider more targeted approaches to reducing overuse, these findings will inform decision‐making. [ABSTRACT FROM AUTHOR]

Perceived discrimination is associated with increased engagement in unhealthy behaviors. We propose an identity-based pathway to explain this link. Drawing on an identity-based motivation model of health behaviors (Oyserman, Fryberg, & Yoder, 2007), we propose that perceptions of discrimination lead individuals to engage in ingroup-prototypical behaviors in the service of validating their identity and creating a sense of ingroup belonging. To the extent that people perceive unhealthy behaviors as ingroup-prototypical, perceived discrimination may thus increase motivation to engage in unhealthy behaviors. We describe our theoretical model and two studies that demonstrate initial support for some paths in this model. In Study 1, African American participants who reflected on racial discrimination were more likely to endorse unhealthy ingroup-prototypical behavior as self-characteristic than those who reflected on a neutral event. In Study 2, among African American participants who perceived unhealthy behaviors to be ingroup-prototypical, discrimination predicted greater endorsement of unhealthy behaviors as self-characteristic as compared to a control condition. These effects held both with and without controlling for body mass index (BMI) and income. Broader implications of this model for how discrimination adversely affects health-related decisions are discussed. [ABSTRACT FROM AUTHOR]

Ethno-cultural disparities in blood and tissue donation patterns have been described as an emergent challenge in the context of the transfusion medicine literature (Boulware et al. in Med Care 40(2):85-95, ; Molzahn et al. in Nephrol Nurs J 30(1):17-26, , Can J Nurs Res 36(4):110-128, ). In the North American context, much has been written about blood and tissue donation patterns among different religious and cultural groups within the United States. However, there are few available statistics or descriptive research that discusses blood donation decisions among Aboriginal Canadians. In 2001, Aboriginal Canadians represented approximately 4.1 % of the total Canadian population, or 1.1 million persons (Birn et al., in Textbook of international health: global health in a dynamic world. Oxford University Press, New York, NY, ). Comparatively, Canada Blood Services reports that Aboriginal Canadians represent only 0.9% of registered donors (Canadian Blood Services ). These low donation patterns suggest that blood donation choice among Aboriginal Canadians requires better understanding. This paper discusses several factors that may influence Aboriginal health choices, specifically those associated with blood donation decision-making. Several influential factors will be discussed, including: the meaning of the body and its parts in relationship to the interconnectedness of all things (religio-cultural), the reflexivity of choice and control (political), and relationships with others (social). [ABSTRACT FROM AUTHOR]

Abstract: People with serious mental illness have higher rates of mortality and morbidity due to physical illness. In part, this occurs because primary care and other health providers sometimes make decisions contrary to typical care standards. This might occur because providers endorse mental illness stigma, which seems inversely related to prior personal experience with mental illness and mental health care. In this study, 166 health care providers (42.2% primary care, 57.8% mental health practice) from the Veteran׳s Affairs (VA) medical system completed measures of stigma characteristics, expected adherence, and subsequent health decisions (referral to a specialist and refill pain prescription) about a male patient with schizophrenia who was seeking help for low back pain due to arthritis. Research participants reported comfort with previous mental health interventions. Path analyses showed participants who endorsed stigmatizing characteristics of the patient were more likely to believe he would not adhere to treatment and hence, less likely to refer to a specialist or refill his prescription. Endorsement of stigmatizing characteristics was inversely related to comfort with one׳s previous mental health care. Implications of these findings will inform a program meant to enhance VA provider attitudes about people with mental illness, as well as their health decisions. [Copyright &y& Elsevier]

Purpose: Limited knowledge exists pertaining to advance care planning (ACP) among Colombian, Mexican, and Puerto Rican women with a cancer diagnosis living in Central Florida, in the USA. The purpose of the study is to identify factors that facilitated the completion of ACP and decisions making patterns among the three groups of Latinas. Methods: The research method used was an exploratory qualitative in-depth open-ended semi-structured interview with a grounded theoretical approach and thematic analysis. The interviews were conducted in Spanish with a purposeful sample of 45 Latinas (15 in each group) diagnosed with cancer. Results: A total of ten women (22 %) in the study documented at least one form of ACP. Thirty-five women identified obstacles to accessing information regarding ACP, relating this to insurance and financial factors. Among the Colombian women, one completed a living will, health care surrogate, and power of attorney (all forms of ACP), and three just a living will. Two Puerto Rican women completed all, two a living will, and one both a living will and an enduring power of attorney. Only one Mexican woman completed a living will. Conclusions: This study identifies a knowledge gap regarding ACP among Latina women with cancer diagnosis living in Central Florida, in the USA. Differences between the three groups exist as a result of migration/immigration history, family support, education, English language proficiency, income, knowledge gaps, and information ascertained by medical and health professionals. These differences contribute to their readiness, receptiveness, and willingness to engage in documenting a living will, a health care surrogate, and an enduring power of attorney for health decisions. [ABSTRACT FROM AUTHOR]

Objectives: There is very often a lengthy delay between first noticing symptoms of dementia and making first contact with Health Care Professionals (HCPs). This article identifies influences on the decision to contact HCPs for the first time. Method: Qualitative thematic analysis of 20 case studies of carer experience. Participants were carers of people who attended Memory Clinic services. Results: Key themes emerging were: triggers, supports and constraints. The analysis draws out the social nature of the decision to engage with the health care system, considering the negotiations that occur and the areas that are contested. Conclusions: Constraints generate delays at several points during the journey from first noticing something may be amiss to making first contact with an HCP. Supports and Triggers legitimise carer's actions to contact HCPs for the first time. [ABSTRACT FROM AUTHOR]

Abstract: We used an experimental game to determine whether people imitate restaurant choice, reciprocate food gifts, and thus spread health choices. We randomly paired 138 subjects and recorded their decision to give or keep restaurant vouchers and their choice of restaurant. The majority (83.3%) chose an unhealthy restaurant if their randomly assigned partner chose an unhealthy restaurant. Similarly, 77.8% chose a healthy restaurant if their partner did (p =0.005). The altruistic were more likely to choose a healthy restaurant (p =0.017). In sum, restaurant choice is influenced by reciprocity. A cycle of projection, gifting and reciprocation may explain the social dynamics of food choice. We propose policies that capitalize on people’s tendency towards altruism and imitation. [Copyright &y& Elsevier]

ABSTRACT There is an important gap in philosophical, clinical and bioethical conceptions of decision-making capacity. These fields recognize that when traumatic life circumstances occur, people not only feel afraid and demoralized, but may develop catastrophic thinking and other beliefs that can lead to poor judgment. Yet there has been no articulation of the ways in which such beliefs may actually derail decision-making capacity. In particular, certain emotionally grounded beliefs are systematically unresponsive to evidence, and this can block the ability to deliberate about alternatives. People who meet medico-legal criteria for decision-making capacity can react to health and personal crises with such capacity-derailing reactions. One aspect of this is that a person who is otherwise cognitively intact may be unable to appreciate her own future quality of life while in this complex state of mind. This raises troubling ethical challenges. We cannot rely on the current standard assessment of cognition to determine decisional rights in medical and other settings. We need to understand better how emotionally grounded beliefs interfere with decision-making capacity, in order to identify when caregivers have an obligation to intervene. [ABSTRACT FROM AUTHOR]

Researchers have long held that fatalism (the belief in a lack of personal power or control over destiny or fate) constitutes a major barrier to participation in positive health behaviors and, subsequently, adversely affects health outcomes. In this article, we present two in-depth, ethnographic studies of rural women's health decisions surrounding cancer treatments to illustrate the complexity and contestability of the long-established fatalism construct. Narrative analyses suggest that for these women, numerous and complex factors-including inadequate access to health services, a legacy of self-reliance, insufficient privacy, combined with a culturally acceptable idiom of fatalism-foster the use of, but not necessarily a rigid conviction in, the notion of fatalism. [ABSTRACT FROM AUTHOR]

Abstract: Background: State and national policymakers are actively debating the merits of legally mandating the human papillomavirus (HPV) vaccine. Methods: This was a cross-sectional pilot study designed to identify factors associated with HPV vaccination in 170 high school girls and the decision making by girls about vaccination. Results: Overall, 48.4% participated in the vaccination decision making and 37.8% were vaccinated, but there were significant vaccine-related knowledge gaps. Girls often lacked basic knowledge necessary to make vaccine decisions. Vaccination was significantly associated with older age, vaccine information sources, and higher vaccine-related knowledge, but not with estimates of risk of HPV-related diseases, religion, or frequency of health care visits. Conclusions: This paper describes the first study to have identified factors associated with HPV vaccination among California high school girls and to have documented that a high percentage are participating in the vaccination decision making. These findings have implications for adolescent health education and nursing practice and provide new information relevant to the current public policy debates about mandatory vaccination. [Copyright &y& Elsevier]

In 4 studies, the role of extrinsic esteem contingencies in adjusting to shifting health-relevant standards when managing existential fears was examined. Study I demonstrated that after reminders of death, higher dispositional focus on extrinsic self-esteem contingencies predicted greater interest in tanning. Using a more domain-specific approach, Study 2 showed that, after being reminded of death, the more individuals smoke for social esteem reasons, the more compelling they find an antismoking commercial that exposes adverse social consequences of smoking. Study 3 explored how situational factors (i.e., priming a contingent relational schema) that implicate extrinsic contingencies facilitated the impact of shifting standard primes on tanning intentions after mortality salience. Finally, Study 4 found that mortality salience led to increased endorsement of exercise as a basis of self-worth when participants who derive self-esteem from extrinsic sources visualized someone who exercises. Together, these studies demonstrate that reminders of death interact with prevalent social standards to influence everyday health decisions. [ABSTRACT FROM AUTHOR]