Measuring Team Hierarchy During High-Stakes Clinical Decision Making: Development and Validation of a New Behavioral Observation Method.

PURPOSE: Hierarchy is often cited as a cause of health care team failure; however, there are no validated measures of team hierarchy. Research on group processes in sociology provides a theoretical framework-status characteristics and expectation states (SCES)-that explains the mechanisms that produce the observable power and prestige order (status hierarchy) of the team. The authors use this formal theoretical framework to gather evidence of validity by adapting the method to measure the status hierarchy of medical teams. METHOD: In this retrospective, secondary analysis, the authors analyzed archived videorecorded training exercises conducted between 2007 and 2010 of mixed-gender health care teams of first-year residents and nurses engaged in simulated, complex decision-making scenarios. Analyses were conducted in 2013 with data reanalyzed in July 2022. By adapting the SCES framework for the unique features of academic health care, they developed and refined a coding method from videos and transcripts. To examine validity, they consider the content, response process, internal structure, relation to other variables, and consequences of the framework. RESULTS: Having established an acceptable level of coding reliability for key variables for videos and transcripts, the authors demonstrate relation to other variables, specifically detailing how the coding scheme delineates 2 status characteristics-occupation and gender. The mean numbers of statement types by gender and occupation were largely as predicted. Directives, question directives, patient work, and knowledge claims were more likely to be coded during video than transcript coding, whereas questions, statements of fact, and compliance were more likely to be coded during transcript than video coding. However, the relative rates of each statement type by status remained largely consistent among the coding methods. CONCLUSIONS: This study provides important insight into the mechanisms by which hierarchy impacts team decision making and develops the necessary framework and measurement tool to perform larger studies.

The past, present, and future of experimental methods in the social sciences.

In the midst of the current causal revolution, experimental methods are increasingly embraced across the social sciences. We first document the growth in the use of the experimental method and then overview the current state of the field along with suggestions for future research. Our review covers the core features of experiments that facilitate causal inference, and we offer numerous examples of different experimental designs and the types of research questions they are well-suited to test. We then harmonize popular but differing perspectives on validity in regard to experiments focused on theoretical considerations. Next, we detail a new framework of purposive sampling for social science experiments, suggesting researchers could benefit from moving beyond only two stock choices of representativeness or convenience. We then discuss issues of analysis unique to experimental data before ending with a critical discussion of null findings, open-science practices, social desirability, and other open debates in the experimental methods literature.

The status and stigma consequences of mental illness labels, deviant behavior, and fear.

Despite the breadth of research on mental illness, there remains some ambivalence about the distinct and combined effects of mental illness labels and deviant behavior for stigma and status. To examine the effects of mental illness labels and deviant behavior on stigma and status, we use experimental methods. Because fear is tightly linked with understandings of mental illness, we also consider the role of fear in these processes. We find that absent behavioral descriptions, mental illness labels do not affect status; however, deviant behavior that is and is not labeled as a mental illness decreases status. Neither deviant behavior nor mental illness labels independently affect stigma; however, compared to unlabeled deviant behavior, deviant behavior that is labeled as a mental illness either increases or decreases stigma for fear-inducing and fear-neutral behavior, respectively. In summary, the effects of mental illness labels appear to depend on behavioral connotations, including fear.

The global use of diverse medical systems.

In 1969, anthropologist Irwin Press introduced the concept of dual use in an attempt to lay to rest the idea that individuals in the real world must choose between allopathic and alternative systems. While providers of medical traditions have a vested interest in seeing the public use one system exclusively, individuals do not. Yet, utilization research generally follows a bifurcated research agenda. thwarting our understanding of how the population uses health care resources. Here, we frame a global analysis of individuals' yearly use of different medical systems. Using the Network Episode Model (NEM), we shift the focus to patterns of care and lay out seven hypotheses, testing whether socio-demographic, cultural, access and health factors are associated with use of one, another, or both system. Data from the 2011 International Social Survey Program's Health Module, reveals that the use of alternative systems alone has virtually disappeared as a pattern of care while dual use remains relevant. Using multilevel models to take into account country differences, we find that being older or younger (i.e., curvilinear effect), female, out-group member, employed, unsatisfied with last allopathic visit; or, reporting barriers to allopathic options, chronic illness, poor health, or positive assessment of alternative options are associated with dual use. Education, income, rural residence, or reporting sufficient insurance coverage are insignificant. Thus, nearly all hypotheses reveal the complexity of contemporary utilization behavior.

Evolving Public Views On The Likelihood Of Violence From People With Mental Illness: Stigma And Its Consequences.

Highly publicized acts of violence routinely spark reactions that place blame on the perpetrator's presumed mental illness. Despite solid evidence that people with mental illness are unlikely to be dangerous, such prejudice can lead to support for inappropriately using legal means to force people into treatment. We examined trends in public perceptions of violence and support for coerced treatment across a twenty-two-year period using data from three National Stigma Studies. The studies gave respondents one of three vignettes describing people who met clinical criteria for mental disorders or one describing a person with nonclinical "daily troubles." Perceptions regarding potential violence and support for coercion generally rose over time-significantly so for schizophrenia. By 2018 over 60 percent of respondents saw people who met criteria for schizophrenia as dangerous to others, and 44-59 percent supported coercive treatment. Sixty-eight percent saw people with alcohol dependence as dangerous to others, and 26-38 percent supported coercion. Lower but substantial percentages were reported for people with depression and, remarkably, for those with nonclinical "daily troubles," who were viewed as dangerous. These findings reflect political discourse, not scientific data, and could lead to policies that would be ineffective and misdirect the search for the underlying roots of violence while unnecessarily increasing stigma toward people with mental illness.

Icelandic inclusion, German hesitation and American fear: A cross-cultural comparison of mental-health stigma and the media.

AIMS: Quantitative survey research findings reveal that Western countries have lower rates of public stigma surrounding mental illness than other nations. However, qualitative media research across selected Western countries reports differences in stigmatising messages. Here, we take an in-depth look at country-level data exploring both similarities and differences in this stigma across three countries. Specifically, we use previous findings on global differences in public stigma and media to examine whether there is a correspondence between themes in newspaper reporting and variations in attitudes across seven stigma dimensions. METHODS: The Stigma in Global Context - Mental Health Study provides nationally representative data from Iceland ( N=1033; response rate=71%), Germany ( N=1255; response rate=63.16%) and the USA ( N=1425; response rate=67.31%). We limit analyses to respondents who received a vignette describing an individual meeting clinical criterion for schizophrenia or depression. Exploratory data analyses are used to examine overall patterns and cross-national differences. RESULTS: Graphical analyses show patterned similarities, especially for more individuals endorsing social distance as contact becomes more intimate. However, results also corroborate cross-national differences documented in media research. More Americans endorse evaluations of dangerousness, to both self and others. Fewer Icelanders report exclusionary tendencies, whilst Germans report the most consistently moderate levels of stigma. CONCLUSIONS: While Western nations tend to report similar, lower levels of stigma globally, they each have unique areas of concern. Anti-stigma programs must take note of both similarities and differences to tailor their efforts to the local context.

Distribution and disavowal: Managing the parental stigma of Children's weight and weight loss.

Parents who seek weight loss treatment for their children find themselves pulled between double moral burdens. Blamed and shamed for the weight itself while culpable for the psychological effects of encouraging weight loss, parental stigma comes from multiple directions. Through interviews with parents who send their children to weight loss camps (N = 47), we ask: how do parents maintain a moral sense of self? We show that parents distribute moral blame for their children's weight and disavow moral blame for encouraging weight loss. We further interrogate how parents' own weight status informs moral management strategies. We find parents' bodies and biographies affect the ways distribution and disavowal take form. Parents with self-identified weight problems internalize significant self-blame for children's weight gain, while parents without personal weight problems more freely allocate blame to outside actors and factors. However, when disavowing the effects of encouraging weight loss, parents with current or past weight issues rely on a shared experience that is unavailable to their slender counterparts. Our findings elucidate the moral tensions of parents who embark on weight loss intervention for their children while highlighting the interplay between primary and associative moral stigma in a family context.

Discourse in Action: Parents' use of medical and social models to resist disability stigma.

For parents of children with disabilities, stigmatization is part of everyday life. To resist the negative social and emotional consequences of stigma, parents both challenge and deflect social devaluations. Challenges work to upend the stigmatizing structure, while deflections maintain the interaction order. We examine how parents of children with disabilities deploy deflections and challenges, and how their stigma resistance strategies combine with available models of disability discourse. Disability discourse falls into two broad categories: medical and social. The medical model emphasizes diagnostic labels and treats impairment as an individual deficit, while the social model centralizes unaccommodating social structures. The social model's activist underpinnings make it a logical frame for parents to use as they challenge disability stigma. In turn, the medical model's focus on individual "improvement" seems to most closely align with stigma deflections. However, the relationship between stigma resistance strategies and models of disability is an empirical question not yet addressed in the literature. In this study, we examine 117 instances of stigmatization from 40 interviews with 43 parents, and document how parents respond. We find that challenges and deflections do not map cleanly onto the social or medical models. Rather, parents invoke medical and social meanings in ways that serve diverse ends, sometimes centralizing a medical label to challenge stigma, and sometimes recognizing disabling social structures, but deflecting stigma nonetheless.