Psychological reactance impacts ratings of pediatrician vaccine-related communication quality, perceived vaccine safety, and vaccination priority among U.S. parents.

Physician communication surrounding vaccination is important in driving patient compliance with schedules and recommendations, but patient psychological factors suggest that communication strategies may have differential effects on patients. This paper investigates how psychological reactance, defined as an individuals' propensity to restore their autonomy when they perceive that others are trying to impose their will on them, impacts perceptions about physician communication and perceptions and prioritizations of vaccination. We propose and describe the results of a study that was conducted to assess the relationship between individual differences in reactance, perceived quality of pediatrician communication, perceptions of vaccination safety, and vaccination prioritization using a sample of parents. We recruited 300 parent participants via the online platform Prolific Academic in which they completed a computer-mediated survey. Results show that compared to those who are low in psychological reactance, those high in psychological reactance place less of a priority on vaccination, and that this relationship is driven by evaluations of physician communication quality and perceived vaccine safety. Our findings suggest that physicians should not adopt a one-size-fits-all approach when interacting with patients and should tailor messaging to patients based on psychological factors including reactance.

When variety is not the spice of life: The influence of perceived relational self-threat on variety seeking in snack choices.

People often seek variety in food choices because they believe variety offers them many benefits such as giving them a chance to explore new foods while decreasing the likelihood of boredom from eating the same food repeatedly. While much research has explored situational factors that increase variety seeking behavior, we explore a situational factor that decreases variety seeking. Specifically, this research investigates how perceived relational threat affects variety seeking in snack choices. Across three studies, we experimentally manipulate relational self-threat and find that those who experience high (vs. low) threat seek less variety (Study 1), even when the same choice set is construed as having more (vs. less) variety (Study 2). This effect is attenuated when people have the chance to engage in self-affirmation (Study 3).

Negative associations of frozen compared with fresh vegetables.

Despite convenience and nutrition advantages of frozen vegetables, consumption of them is low compared with fresh vegetables and continues to decrease. In two studies, we observe a negative bias for frozen vegetables compared with fresh vegetables. In study 1, we used an Implicit Association Test (IAT) to demonstrate that generalized negative associations with frozen vegetables are automatic, robust, and ingrained in long-term memory. In study 2, we conceptually replicate this finding with an explicit measure and extend it by examining the role of transforming the food product in formation of the observed negative bias. We find no improvement in evaluation for frozen spinach when participants contemplate the final cooked product. Instead, we see less favorable evaluations of fresh spinach when participants contemplate the final cooked product. These findings are consistent with previous research that demonstrates that transformation of a food from its "natural" state leads to less favorable evaluations of it.

When open access might not work: Understanding patient attitudes in appointment scheduling.

BACKGROUND: Open-access (OA) systems aim to reduce delays to care. However, recent evidence suggests that OA systems might reduce patient satisfaction and result in poorer patient experiences due to patients' inability to obtain appointments with their usual care provider. We conducted a series of experiments to explore the role of risk attitudes, an individual difference variable that measures preferences for risky options, in patients' perception of OA systems. PURPOSE: The aim of the study was to investigate the relationship between patient's risk attitudes and attitudes toward OA systems and demonstrate whether patients' attitudes toward OA systems will vary as a function of their risk attitudes. METHODOLOGY: Three separate experiments were conducted to assess the relationship between patient risk attitudes and their attitudes about OA systems. Study 1 (patient population) explored the aforementioned relationship. We explored two potential moderators for this effect: how salient the tradeoff is between delays to care and quality of care (Study 2; online population) and the severity of the patient's health condition (Study 3; patient population). RESULTS: Compared to risk-averse patients, risk-seeking patients have more favorable attitudes toward OA systems (a 1-point increase in risk attitudes on a 7-point scale resulted in a 0.44-point boost in attitudes toward OA systems on a 7-point scale). This relationship holds even when the tradeoff between access to care and quality of care is made salient (e.g., a practice informs patients they can have a same-day appointment but are unlikely to see their regular provider) and when people consider having a minor health condition. This relationship is attenuated when patients imagine having a serious medical condition because speedy access to care becomes a top priority. CONCLUSION: Risk-seeking patients have more favorable attitudes toward OA systems. PRACTICE IMPLICATIONS: Risk-seeking patients are primarily driven by speed to access at the potential expense of continuity of care. Organizations that better understand patient motives in scheduling medical appointments can introduce more effective interventions and positively impact patient experiences of care.

Helping lower income parents reduce the risk of food waste resulting from children's aversion to healthier food options: Comment on Daniel (2016).

We reflect on Daniel's (2016) finding that a challenge to improving the diets of lower income children is parental worry over food waste that results from children's rejection of healthier food options such as vegetables. This finding has important implications because previous research has indicated novel foods that have a bitter or sour flavor profile (as is the case with many vegetables) must be introduced to children several times before these foods are accepted. We suggest research-based techniques that parents could utilize to reduce the risk of costly food waste, and discuss obstacles that could impede well-intended parents from reaching their goals of improving their children's diets.

Dissociation from beloved unhealthy brands decreases preference for and consumption of vegetables.

Many people form strong bonds with brands, including those for unhealthy foods. Thus, prompting people to dissociate from beloved but unhealthy food brands is an intuitively appealing means to shift consumption away from unhealthy options and toward healthy options. Contrary to this position, we demonstrate that dissociating from unhealthy but beloved brands diminishes people's interest in consuming vegetables because the dissociation depletes self-regulatory resources. Across three experimental studies, we manipulate dissociation from two beloved brands both implicitly (studies 1-2) and explicitly (study 3) and observe effects on both preference for vegetables (studies 2-3) and actual vegetable consumption (study 1). In study 1, participants consumed fewer vegetables following dissociation from (vs. association with) a beloved candy brand. Study 2 demonstrates that the effect of depletion on preference for vegetables is more pronounced for those who strongly identify with the brand, as these individuals are most depleted by the dissociation attempt. Finally, study 3 illustrates that the difficulty experienced when trying to dissociate from beloved brands drives the observed effects on vegetable preference and consumption for those who strongly (vs. weakly) identify with the brand.

A new model for nurse practitioner utilization in primary care: increased efficiency and implications.

BACKGROUND: Nurse practitioners (NPs) play an important role in providing quality primary care. However, little is known about organizational processes that best utilize NPs in care delivery and what kind of resources and support NPs need to deliver quality care within their organizations. In primary care settings, NPs often receive little support from ancillary personnel compared with physicians. PURPOSE: The aim of this article was to compare the productivity and cost efficiency of NP utilization models implemented in primary care sites with and without medical assistant (MA) support. METHODOLOGY/APPROACH: We develop queueing models for these NP utilization models, of which the parameters are extracted from literature or government reports. Appropriate analyses are conducted to generate formulas and values for the productivity and cost efficiency. Sensitivity analyses are conducted to investigate different scenarios and to verify the robustness of findings. FINDINGS: The productivity and cost efficiency of these models improve significantly if NPs have access to MA support in serving patients. On the basis of the model parameters we use, the average cost of serving a patient can be reduced by 9%-12% if MAs are hired to support NPs. Such improvements are robust across practice environments with different variability in provider service times. Improving provider service rate is a much more effective strategy to increase productivity compared with reducing the variability in provider service times. PRACTICE IMPLICATIONS: To contain costs and improve the utilization of NPs in primary care settings, MA assistance for NPs is necessary.

Development and psychometric testing of the Nurse Practitioner Primary Care Organizational Climate Questionnaire.

BACKGROUND: Policy makers and healthcare organizations are calling for expansion of the nurse practitioner (NP) workforce in primary care settings to assure timely access and high-quality care for the American public. However, many barriers, including those at the organizational level, exist that may undermine NP workforce expansion and their optimal utilization in primary care. OBJECTIVES: This study developed a new NP-specific survey instrument, Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ), to measure organizational climate in primary care settings and conducted its psychometric testing. METHODS: Using instrument development design, the organizational climate domain pertinent for primary care NPs was identified. Items were generated from the evidence and qualitative data. Face and content validity were established through two expert meetings. Content validity index was computed. The 86-item pool was reduced to 55 items, which was pilot tested with 81 NPs using mailed surveys and then field-tested with 278 NPs in New York State. SPSS 18 and Mplus software were used for item analysis, reliability testing, and maximum likelihood exploratory factor analysis. RESULTS: Nurse Practitioner Primary Care Organizational Climate Questionnaire had face and content validity. The content validity index was .90. Twenty-nine items loaded on four subscale factors: professional visibility, NP-administration relations, NP-physician relations, and independent practice and support. The subscales had high internal consistency reliability. Cronbach's alphas ranged from.87 to .95. DISCUSSION: Having a strong instrument is important to promote future research. Also, administrators can use it to assess organizational climate in their clinics and propose interventions to improve it, thus promoting NP practice and the expansion of NP workforce.

Appointment reminder systems and patient preferences: Patient technology usage and familiarity with other service providers as predictive variables.

This study had two aims: to measure patient preferences for medical appointment reminder systems and to assess the predictive value of patient usage and familiarity with other service providers contacting them on responsiveness to appointment reminder systems. We used a cross-sectional design wherein patients' at an urban, primary-care clinic ranked various reminder systems and indicated their usage of technology and familiarity with other service providers contacting them over text messages and e-mails. We assessed the impact of patient usage of text messages and e-mails and patient familiarity with other service providers contacting them over text messages and e-mails on effectiveness of and responsiveness to appointment reminder systems. We found that patient usage of text messages or e-mails and familiarity with other service providers contacting them are the best predictors of perceived effectiveness and responsiveness to text message and e-mail reminders. When these variables are accounted for, age and other demographic variables do not predict responsiveness to reminder systems.

Recommendations implicit in policy defaults.

Should people be considered organ donors after their death unless they request not to be, or should they not be considered donors unless they request to be? Because people tend to stay with the default in a variety of domains, policymakers' choice of default has large and often important effects. In the United States, where the organ-donation policy default is "not a donor," about 5,000 people die every year because there are too few donors. Four experiments examined two domains-being an organ donor and saving for retirement-where default effects occur and have important implications. The results indicate that default effects occur in part because policymakers' attitudes can be revealed through their choice of default, and people perceive the default as indicating the recommended course of action. Policymakers need to be aware of the implicit messages conveyed by their choice of default.