Symptom appraisal, help seeking, and lay consultancy for symptoms of head and neck cancer.

OBJECTIVE: Early diagnosis is important in head and neck cancer (HNC) patients to maximize the effectiveness of the treatments and minimize the debilitation associated with both the cancer and the invasive treatments of advanced disease. Many patients present with advanced disease, and there is little understanding as to why. This study investigated patients' symptom appraisal, help seeking, and lay consultancy up to the time they first went to see a health care professional (HCP). METHODS: We interviewed 83 patients diagnosed with HNC. The study design was cross sectional and consisted of structured telephone interviews and a medical chart review. We gathered information on the participant's personal reactions to their symptoms, characteristics of their social network, and the feedback they received. RESULTS: We found that 18% of the participants thought that their symptoms were urgent enough to warrant further investigation. Participants rarely (6%) attributed their symptoms to cancer. Eighty-nine percent reported that they were unaware of the early warning signs and symptoms of HNC. Fifty-seven percent of the participants disclosed their symptoms to at least one lay consultant before seeking help from an HCP. The lay consultants were usually their spouse (77%), and the most common advice they offered was to see a doctor (76%). Lastly, 81% of the participants report that their spouse influenced their decision to see an HCP. CONCLUSIONS: The results of this study suggest that patients frequently believe that their symptoms were nonurgent and that their lay consultants influence their decision to seek help from an HCP.

Coping effectiveness: determinants and relevance to the mental health and affect of family caregivers of persons with dementia.

Family caregivers of persons with dementia (n = 141) rated their effectiveness in coping with a challenging symptom displayed by their relative, and completed measures of their ways of coping, their general (optimism) and specific (caregiving self-efficacy) outcome expectancies, their affect (positive and negative), and the mental health subscale of the SF-36. Hierarchical regression analyses revealed that coping effectiveness is more highly influenced by relatively stable outcome expectancies than by the ways of coping that are employed. In addition, optimism exerted a consistent and relatively strong impact on affect and mental health, overshadowing the influence of coping and judgments of its effectiveness. However, coping effectiveness not only had a significant main effect on the caregivers' mental health and negative affect, but also served a stress buffering function by reducing negative affect.

Coping with family caregiving to persons with dementia: a critical review.

Seventeen empirical studies that relate the ways of coping employed by family caregivers of persons affected by dementia to their health and morale are critically reviewed for the purposes of determining whether there is any consensus regarding ways of coping that serve health-protective functions, and whether the studies' designs and measurement strategies are faithful to the transactional theory of coping upon which they are founded. Due to the use of cross-sectional designs, the adoption of different coping and outcome measures, the lack of specificity and the incomparability of the target stressors, the reliance on retrospective reports, and the use of inappropriate response formats, among other limitations, the interpretability of the cumulative body of empirical findings on caregiver coping is questionable. Ways of strengthening and broadening coping research to make it more fruitful and theoretically coherent are presented.

The source, nature, and direction of work and family conflict: a longitudinal investigation.

The authors examine the source, nature, and direction of work and family conflict. Confirmatory factor analysis of a 22-item scale suggested the appropriateness of distinguishing between strain-based and time-based conflict and between family interfering with work (FIW) and work interfering with family (WIF). Six-month longitudinal survey data (N = 236) suggested that strain-based FIW is a precursor to both stress and turnover intentions. Strain-based WIF emerged as an outcome of stress.

The effect of alternative work arrangements on women's well-being: a demand-control model.

The growth of women's participation in the labor force and evidence of the conflict they experience between job and family demands have spurred many employers to introduce alternative work arrangements such as flextime, job sharing, and telecommuting. Drawing on data gained from a sample of women (N = 998) in two large Canadian organizations, this study evaluates two mediational models of the impact of alternative work arrangements on women's stress and family role competence. Specifically, it tests and finds support for the hypotheses that (a) work arrangements involving scheduling flexibility (telecommuting and flextime) promote these aspects of women's well-being by increasing their perceived control over their time, and (b) arrangements involving reduced hours of employment (part-time employment and job sharing) promote well-being by reducing perceived job overload. Discussion of these findings centers on their implications for employed women, their employers, and future research.

The mismeasure of coping by checklist.

Hundreds of studies have now used standardized checklists to assess respondents' self-reports of coping with naturally occurring stress. This article presents a critical review of the conceptual and methodological issues involved in the use of these checklists. As they are currently employed, conventional checklists render an incomplete and distorted portrait of coping. Specifically, these checklists are grounded in too narrow a conception of coping; the application and interpretation of checklists in the typical study are not faithful to a transactional model of stress and coping; statistical controls cannot eliminate the effects of key person and situation variables on coping; and no consistent interpretation can be assigned to coping scale scores. Researchers are encouraged to consider a broader range of methods for assessing coping, including semistructured interviews, customized checklists tailored to their specific hypotheses and objectives, daily diaries, and traditional trait measures.

Caregivers' appraisals of efficacy in coping with dementia.

This study investigated the types, prevalence, and stability of appraisals of coping efficacy made by 87 family caregivers of persons with dementia. With the use of content analysis, 12 efficacy appraisals were identified that reflected caregivers' perceptions of progress in problem-solving, regulating emotional distress, protecting self-esteem, managing social interactions, and self-development. Most appraisal types showed variability across 2 time points, which suggests that appraisals reflect changing person-environment transactions. Five of the appraisals-namely, nonefficacious coping outcomes, no coping options, no control, an improved ability to cope, and means/ends insights-were prospectively related to distress and well-being. The findings suggest that a broad set of goals guides coping efforts in the context of chronic stress.

Predictors of work-family conflict, stress, and job satisfaction among nurses.

Using multiple regression analysis, this study examined the contribution of demographic, job-related, social-support, and caregiving variables to the prediction of work-family conflict, stress, and job satisfaction among a sample of 101 hospital-based nurses who had responsibility for the care of a child and/or an elderly relative. The results revealed that family support, perceived organizational support for family life, perceived workload size, and involvement in child care were mainly responsible for the outcomes studied. In addition, the study underscores the importance of separately measuring both the source and the direction of work-family conflict.

Research on mutual aid and social support: progress and future directions.

Signs of progress in the study of mutual aid and social support include a greater emphasis on the collection of empirical data to evaluate program effects and to comprehend relations between professional and informal sources of aid, as well as a clearer delineation of concepts and creative integration of practices associated with mutual aid. Several directions for future research on support interventions are addressed, including the nature and timing of outcome measures, analyses of the optimal fit of participants to different intervention formats, and the need for research designs that yield information about the necessary and cost-effective components of support interventions.

Aspects of eldercare that place employees at risk.

Through multiple regression analyses, this study examined the contribution of seven different aspects of eldercare to the prediction of several work and personal outcome among employees of eight organizations. The analyses were restricted to the 1,302 (25.4%) employees over the age of 35 who provided assistance to an elderly relative by helping them with either at least one Activity of Daily Living (ADL) or with at least two Instrumental Activities of Daily Living (IADL). The results revealed that assistance with ADLs, eldercare management activities, and the number of eldercare crises to which the employee responded, each placed respondents at risk of more family interference with work, more stress, and more personal and job costs.

Peer telephone dyads: putting conclusions on hold.

Commentary on Heller et al.'s (1991) peer telephone intervention for elderly women addresses three issues: (a) the sources and kinds of information needed to inform decisions about the choice of intervention; (b) the criteria used to evaluate the process and outcomes of support interventions; (c) the social psychological dynamics stimulated by the intervention protocol and by the particular form of the intervention. The latter two issues complicate interpretation of the study's findings and raise additional questions about whether and why the intervention was unsuccessful.

Using social support to protect and promote health.

This article begins with an explanation of social support's preventive functions as a resource for averting and resisting stress and as a general contributor to health and morale. Next, it presents a variety of emergent interventions involving the mobilization and augmentation of social support, one set classified as health protection (secondary prevention) approaches and the other as health enhancement (primary prevention) approaches. The article concludes with suggestions for future research aimed to improve the conduct and impact of these interventions.

Social networks and social support: an overview of research, practice, and policy implications.

Following a brief overview of the stressful life events-illness model and its implications for intervention, this article highlights the role of social support as a resource for resisting stress-induced illness and disability. It identifies three different connotative meanings that have been assigned to the social support construct, and describes their empirical operationalizations in several recent studies. Specifically, the social integration/participation formulation, the social network approach, and the social intimacy measurement strategy are described and contrasted. Within the latter approach, one study that illuminated types of informal helping behaviors is discussed in greater detail. A review of possible mechanisms whereby social support accomplishes its health-protective impact is also offered, and two types of planned interventions involving the mobilization or optimization of social support are spotlighted. The article concludes with ideas about ways that professionals can safeguard the natural helping skills of citizens and achieve an appropriate balance between formal and informal systems of service delivery in the health and human services fields.

Mutual-help groups: members' views of their benefits and of roles for professionals.

Members of 18 self-help groups in Canada were surveyed as to the benefits of participation in mutual help groups and the roles for professionals in such groups. Three distinctions are made among mutual help groups: (1) those dealing with loss-transition (L-T), (2) those with members one step removed (OSR) from the problem, and (3) groups for stress, coping and support (SC&S). Members in OSR groups feel they benefit significantly more from participation than SC&S group members, while many L-T members feel they could get along well without the group if they had to. Members of SC&S groups tend to favor indirect involvement of professionals and see professional help and mutual help as complementary, more than do members of L-T and OSR groups. The traditional health care system is found to ignore the needs of L-T and OSR group members; mutual help thus provides a critical source of support and education for these people.

The primary group as supportive milieu: applications to community psychology.

The paper reviews evidence documenting the health-protective effects of the informal social support extended by kith, kin, and community gatekeepers. Noteworthy features of a classification scheme describing the substance of informal helping behaviors are reviewed. Implications for future research and action address: (a) the need for professionals to reexamine occasions for the provision of consultation and crisis-intervention services; (b) the potential for using social network analysis to identify vulnerable groups in the community; (c) the merits of advocating on behalf of informal support systems as favorable settings for the accomplishment of primary prevention.