Do the Words We Choose Matter When Prescribing Medications?

BACKGROUND: Caregivers are often apprehensive about treating childhood atopic dermatitis (AD) with topical corticosteroids but may find comfort if treatments are presented in a patient-centered manner. OBJECTIVE: We assessed caregivers' willingness to treat AD with either a "topical steroid," "topical medication," or "treatment, similar to the all-natural signals produced by the adrenal glands in the body." METHODS: A survey randomized 874 caregivers of children with AD to receive a "topical steroid," "topical medication," or "treatment, similar to the all-natural signals produced by the adrenal glands in the body." A scenario-only dataset received these descriptions, while a descriptive heading dataset and expanded scale dataset also received headings of "Topical Steroid Use," "Topical Medication Use," and "All-Natural Treatment Use," respectively. Responses were recorded on a 6-point Likert scale or 0-100 slider scale. Whole and dichotomized responses were evaluated using 2-tailed, independent sample t-tests. RESULTS: For the descriptive heading and expanded scale datasets, those presented with a "topical medication" reported greater willingness to treat than those presented with a "topical steroid" and "all-natural treatment" in the descriptive heading dataset (P<0.05). For the dichotomized scenario-only dataset, those presented with a "treatment, similar to the all-natural signals produced by the adrenal glands in the body," reported greater willingness than those presented with a "topical medication" (P<0.05). CONCLUSION: Initially presenting caregivers with a "topical medication" rather than a "topical steroid" may improve willingness to treat AD for some caregivers. However, tailoring the discussion to best fit caregivers’ understanding of treatment may be the most beneficial approach. J Drugs Dermatol. 2023;22(12):1216-1219. doi:10.36849/JDD.5746.

The presence of accountability in digital interventions targeting non-adherence: A review.

OBJECTIVES: Provider-centered accountability, defined as the anticipation of a social interaction between a patient and their provider, increases patients' adherence to prescribed treatment. Digital adherence interventions based on accountability may be especially effective at promoting adherence. The current study aimed to assess whether publications on digital adherence interventions discuss accountability, include intervention components related to accountability, and measure feelings of patient accountability as an outcome. METHODS: PubMed was queried between January 2010 and March 2021 to identify randomized controlled trials incorporating digital adherence interventions. Full-text articles were assessed for participant demographics, interventions utilized, outcomes, and intervention effectiveness. RESULTS: A total of 131 publications met inclusion criteria. Only four publications discussed accountability as a potential factor influencing patient adherence. Although 11% of publications included an intervention with direct accountability, only one did so by design. None of the included studies assessed feelings of accountability as an outcome. CONCLUSIONS: While provider-centered accountability has the potential to boost the efficacy of digital adherence interventions, accountability is rarely incorporated in studies of such interventions. PRACTICE IMPLICATIONS: Additional investigation into the influence of accountability on adherence interventions will allow for the development of these interventions as effective tools applicable to the full range of patients.

Tolerability of and Adherence to Topical Treatments in Atopic Dermatitis: A Narrative Review.

Atopic dermatitis (AD) is a common, chronic inflammatory skin disease that oftentimes requires complex therapy. Poor adherence is a major barrier to AD treatment success. An interspecialty, virtual roundtable panel was held, through which clinical dermatologists, allergists, and behavioral and social psychologists discussed AD management and adherence. Relevant literature was reviewed, and the content of this article was organized based on the roundtable discussion. Current guidelines for AD treatment include maintenance and acute therapy for mild-to-severe AD. Therapy is often complex and requires significant patient involvement, which may contribute to poor treatment adherence. Behavioral and social psychology strategies that may help improve adherence include scheduling timely follow-up appointments, using a clearly written eczema action plan (EAP), reducing perceived treatment burden, utilizing anchoring techniques, sharing anecdotes, and rewarding children using positive reinforcement and stickers. There are multiple practical ways by which providers can improve both the management and treatment adherence of patients with AD.

Advertising techniques increase biologic treatment willingness in patients with psoriasis.

BACKGROUND: Although biologics have revolutionized psoriasis care, some patients may be reluctant to consider implementing biologic therapy. OBJECTIVE: To determine whether willingness to take a biologic is increased by commonly used advertising techniques. METHODS: An online survey was used to assess subjects with a self-reported diagnosis of psoriasis and their willingness to initiate biologic treatment (N=400). Subjects were randomized to receive one of the following surveys: clinical data with positive framing (N=80), bandwagon-based statement (N=80), testimonial-based statement (N=80), comparative advertising (N=80), and negative framing (N=80). Willingness to take treatment was recorded on a 10-point Likert scale and evaluated using one-way ANOVA, two-group t-tests, and chi-squared tests. RESULTS: Compared to subjects presented with positive framing (M=5.5, SD=3.2), subjects presented with a bandwagon-based statement (M=6.5, SD=2.7; P=0.04) and testimonial-based statement (M=7.0, SD=2.7; P=0.01) reported a greater willingness to take treatment, whereas negative framing (M=4.5, SD=3.0; P=0.03) decreased willingness and comparative advertising (M=5.5, SD=2.7; P=0.96) yielded the same willingness as positive framing. CONCLUSION: Providers might be able to enhance biologic acceptance by utilizing commonly used advertising techniques, such as the bandwagon effect, testimonial effect, and positive framing.

Evaluation of Accountability Measurement Tool in Patients with Psoriasis: A Validation Study.

INTRODUCTION: The role of accountability in promoting patient adherence to medication is not well characterized. An accountability measurement tool (AMT) has been developed to quantify accountability but has not been investigated for use with patients with skin disease. We aim to test the reliability and validity of the AMT for patients with psoriasis. METHODS: A 12-item AMT was used for patients with psoriasis. English-speaking adults with psoriasis who were expected to continue their medication were asked to complete the questionnaire. Reliability was measured using Cronbach's alpha. Validity was measured using Pearson's correlation coefficient and t-tests between the AMT and other validated scales measuring fear of negative evaluation and self-regulation. RESULTS: A total of 30 patients were recruited for this study. The AMT demonstrated excellent internal consistency (Cronbach's [Formula: see text] = 0.86). Total accountability positively correlated with fear of negative evaluation (r = 0.59), autonomous motivation (r = 0.46), introjected regulation (r = 0.60), and external regulation (r = 0.57), demonstrating good convergent validity. Divergent validity was supported by nonsignificant associations between psoriasis accountability and age, gender, race, education level, years with physician, and amotivation. CONCLUSIONS: The AMT has been further validated for measuring accountability in patients with psoriasis.

Thinking Through Secrets: Rethinking the Role of Thought Suppression in Secrecy.

Having secrets on the mind is associated with lower well-being, and a common view of secrets is that people work to suppress and avoid them-but might people actually want to think about their secrets? Four studies examining more than 11,000 real-world secrets found that the answer depends on the importance of the secret: People generally seek to engage with thoughts of significant secrets and seek to suppress thoughts of trivial secrets. Inconsistent with an ironic process account, adopting the strategy to suppress thoughts of a secret was not related to a tendency to think about the secret. Instead, adopting the strategy to engage with thoughts of a secret was related the tendency to think about the secret. Moreover, the temporal focus of one's thoughts moderated the relationship between mind-wandering to the secret and well-being, with a focus on the past exacerbating a harmful link. These results suggest that people do not universally seek to suppress their secrets; they also seek to engage with them, although not always effectively.

Comparing psoriasis advertisement methods with patient willingness to initiate treatment.

Background: Many patients with psoriasis struggle with taking biologic agents. The way in which providers present medications could enhance treatment adherence.Objectives: To determine how fear appeals, personal appeals, and social appeals influence psoriasis patients' willingness to use a biologic.Methods: A randomized online survey study was used to assess subjects with a self-reported diagnosis of psoriasis and their willingness to initiate treatment. Subjects were randomized in a 1:1:1 ratio to receive an online survey with the following emotional appeals: social, fear, or personal (n = 315). Subject-reported willingness to take treatment was recorded on a 10-point Likert scale and analyzed via single-factor ANOVA, two-group t-tests, chi-squared analysis, and multiple linear regression analysis.Results: A total of 315 subjects with a reported diagnosis of psoriasis completed the survey. Patient demographic information includes the following: mean age of 35 years ± 11.2; 67% female. Compared to subjects presented with a social appeal (M = 6.2, SD = 2.9), subjects presented with a fear appeal (M = 7.1, SD = 2.5, p = .01) and personal appeal (M = 7.0, SD = 2.7, p = .03) reported a greater average willingness to take treatment.Conclusions: Presenting biologic agents using fear or personal appeals may be a simple and effective technique to improve patients' willingness to take treatment.

Accountability in patient adherence.

BACKGROUND: The accountability inherent in the social interaction between a patient and healthcare provider affects patients' motivation to adhere to treatment. To characterize the role of accountability as a tool to improve self-efficacy and self-management and thereby promote patients' adherence to treatment, a measure of accountability is needed. AIMS: To develop and test the validity, reliability, and sensitivity of a new outcome measure designed to assess accountability. METHODS: The accountability measurement tool was developed from the literature, expert consultation, and focus groups. A focus group and three pilot studies were performed both in clinic and through an online crowdsourcing platform. Principal Component Analysis evaluated constructs, and Cronbach's alpha measured internal consistency. Validity was established using convergent and divergent correlations to other validated scales. RESULTS: A total of 292 participants took part in this study. The 12-item accountability scale demonstrated very good internal consistency (Cronbach's α=0.92). Components of the accountability measurement tool correlated with predicted validated measures, including the Treatment Self-Regulation Questionnaire. Divergent validity was established with no significant difference noted between age, sex, race, and education level. CONCLUSION: Future use of this questionnaire will allow for the assessment of the interaction between accountability and adherence to treatment and lead to the development of new interventions to promote better adherence.

Protecting the Innocence of Youth: Moral Sanctity Values Underlie Censorship From Young Children.

Three studies examined the relationship between people's moral values (drawing on moral foundations theory) and their willingness to censor immoral acts from children. Results revealed that diverse moral values did not predict censorship judgments. It was not the case that participants who valued loyalty and authority, respectively, sought to censor depictions of disloyal and disobedient acts. Rather, censorship intentions were predicted by a single moral value-sanctity. The more people valued sanctity, the more willing they were to censor from children, regardless of the types of violations depicted (impurity, disloyalty, disobedience, etc.). Furthermore, people who valued sanctity objected to indecent exposure only to apparently innocent and pure children-those who were relatively young and who had not been previously exposed to immoral acts. These data suggest that sanctity, purity, and the preservation of innocence underlie intentions to censor from young children.

Accountability: a missing construct in models of adherence behavior and in clinical practice.

Piano lessons, weekly laboratory meetings, and visits to health care providers have in common an accountability that encourages people to follow a specified course of action. The accountability inherent in the social interaction between a patient and a health care provider affects patients' motivation to adhere to treatment. Nevertheless, accountability is a concept not found in adherence models, and is rarely employed in typical medical practice, where patients may be prescribed a treatment and not seen again until a return appointment 8-12 weeks later. The purpose of this paper is to describe the concept of accountability and to incorporate accountability into an existing adherence model framework. Based on the Self-Determination Theory, accountability can be considered in a spectrum from a paternalistic use of duress to comply with instructions (controlled accountability) to patients' autonomous internal desire to please a respected health care provider (autonomous accountability), the latter expected to best enhance long-term adherence behavior. Existing adherence models were reviewed with a panel of experts, and an accountability construct was incorporated into a modified version of Bandura's Social Cognitive Theory. Defining accountability and incorporating it into an adherence model will facilitate the development of measures of accountability as well as the testing and refinement of adherence interventions that make use of this critical determinant of human behavior.

The hidden effects of recalling secrets: Assimilation, contrast, and the burdens of secrecy.

Three high-power studies (N = 3,000 total) demonstrated that asking participants to recall an experience as a manipulation can have unintended consequences. Participants who recalled preoccupying secrets made more extreme judgments of an external environment, supporting the notion that secrecy is burdensome. This influence was found, however, only among a subset of participants (i.e., participants who successfully recalled secrets that corresponded to their condition). We introduce the concept of manipulation correspondence to understand these patterns of results. Without taking into account whether participants' recalled secrets corresponded to their manipulation, there was no main effect of the recall manipulation on hill slant judgments. Among participants whose secrets did not correspond with the manipulation, a contrast effect emerged (i.e., influences on perceptual judgments opposite to the intention of the recall prompts). Moreover, the very process of recalling a secret in response to a prompt can lead to contrast from that prompt. Exposing participants to extreme exemplar secrets can experimentally produce, or counteract, this contrast effect. Preoccupying secrets are burdensome but tests of this phenomenon must take into account whether participants are actually preoccupied with their secrets (i.e., whether their recalled secrets correspond with the experimental manipulation), or experimentally ensure that participants judge their secrets as in line with the manipulation. More broadly, the current research speaks to a fundamental principle of recall manipulations; when recalling a particular experience, correspondence with the manipulation will determine its effects, and the process of recalling an experience (and comparing it to a prompt) might change how one perceives that experience. (PsycINFO Database Record

Reducing Stereotype Threat With Embodied Triggers: A Case of Sensorimotor-Mental Congruence.

In four experiments, we tested whether embodied triggers may reduce stereotype threat. We predicted that left-side sensorimotor inductions would increase cognitive performance under stereotype threat, because such inductions are linked to avoidance motivation among right-handers. This sensorimotor-mental congruence hypothesis rests on regulatory fit research showing that stereotype threat may be reduced by avoidance-oriented interventions, and motor congruence research showing positive effects when two parameters of a motor action activate the same motivational system (avoidance or approach). Results indicated that under stereotype threat, cognitive performance was higher when participants contracted their left hand (Study 1) or when the stimuli were presented on the left side of the visual field (Studies 2-4), as compared with right-hand contraction or right-side visual stimulation. These results were observed on math (Studies 1, 2, and 4) and Stroop (Study 3) performance. An indirect effect of congruence on math performance through subjective fluency was also observed.

The science of consciousness must include its more advanced forms.

Morsella et al. argue that science should not focus on high forms of consciousness. We disagree. An understanding of high forms of consciousness is invaluable to the scientific study of consciousness. Moreover, it poses challenges to the passive frame theory. Specifically, it challenges the notions that conscious thoughts are not connected and that consciousness serves skeletomotor conflict only.

Exploring the secrecy burden: secrets, preoccupation, and perceptual judgments.

Recent work suggests that secrecy is perceived as burdensome. A secrecy-burden relationship would have a number of consequences for cognitive, perceptual, social, and health psychology, but the reliability of these influences, and potential mechanisms that support such influences are unknown. Across 4 studies, the current work examines both the reliability of, and mechanisms that support, the influence of secrecy processes upon a judgment that varies with diminished resources (i.e., judgments of hill slant). The current work finds that a manipulation of secret "size" fails to reliably predict judged hill slant, whereas measurement and manipulation of preoccupation with a secret does reliably predict judged hill slant. Moreover, these effects are found to be mediated by judged effort to keep the secret, consistent with a resource-based mechanism of the burdens of secrecy.

Cognition from on high and down low: Verticality and construal level.

Across 7 studies, the authors examined the relationship between experiences of verticality and abstract versus concrete processing. Experiencing high, relative to low, verticality led to higher level identifications for actions (Study 1), greater willingness to delay short-term monetary gains for larger long-term monetary gains (Studies 2 and 5), and more frequent perceptions of meaningful relationships between objects and categories (Studies 3, 4, and 6), demonstrating that high verticality leads to more high-level construals. Mechanisms of these effects were explored, and the studies present evidence suggesting that mood (Studies 3 and 4), felt power (Study 4), arousal (Study 4), perceptual scope (Study 4), superficial semantic associations (Study 5), and movement (Study 5) do not mediate these effects. Instead, we found that even minimal experiences of verticality influence construal level (Study 6) and that verticality can influence construal level independent of the many plausible mediators. Furthermore, the relationship is reciprocal with abstract and concrete processing influencing the verticality of one's visual perspective (Study 7), suggesting an intimate link between construal level (abstract vs. concrete processing) and experiences of verticality.