Development of a new measure of encounters with health care barriers: The Commonly Experienced Health Care Barriers Index.

Common barriers to health care, such as lack of insurance or transportation, hold a key theoretical role in many models attempting to explain problems with health care utilization (not seeking needed health care). However, the assessment of barriers is often post hoc, with no existing scales appropriate for a general population. This study developed and tested a new measure of commonly experienced health care barriers across three studies (Study 1, N = 194; Study 2, N = 206; Study 3, N = 741). Items were developed in line with recommendations for causal indicator models, emphasizing content validity. The measure showed preliminary test-retest reliability, sensitivity to health care inequities between Black and White individuals (beyond socioeconomic status and including association with health care discrimination), expected associations with health care utilization problems and other health experiences and life stressors, and unique associations with health care utilization problems accounting for health experiences and life stressors. The new measure has the potential to identify modifiable factors related to health care inequities and common problems with health care utilization. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Hypnosis Intervention for Sleep Disturbances in Individuals with Mild Cognitive Impairment: A Randomized Pilot Study.

Poor sleep quality is highly prevalent among individuals with mild cognitive impairment (MCI). Further, poor sleep quality is associated with reduced quality of life, increased stress response, memory impairments, and progression to dementia among individuals with MCI. Pharmacological treatments for sleep have mixed efficacy and can lead to dependency. Therefore, alternatives to pharmacological treatments for improving sleep among individuals with MCI are needed. The present study reports on the feasibility of a non-pharmacological self-administered hypnosis intervention focused on sleep quality in adults with MCI. It was hypothesized that the hypnosis intervention program would be feasible and have acceptable levels of adherence to daily hypnosis practice. A two-armed randomized controlled pilot trial was conducted using a sample of 21 adults with MCI. Eligible participants were randomly assigned to listen to either hypnosis audio recordings or sham hypnosis recordings for five weeks. Program feasibility, program adherence, pain intensity, stress, and sleep quality were measured using a daily home practice log, questionnaires, and wrist actigraphy. The results found mid or higher levels of treatment satisfaction, ease of use, and perceived effectiveness at one-week follow-up, with participants in the hypnosis arm reporting greater perceived benefit. Adherence to assigned audio recordings and meetings were likewise within acceptable margins in both groups. No intervention-related adverse events were reported in either treatment condition. Significant improvements in sleep quality, sleep duration, and daytime sleepiness were found for the hypnosis intervention. The results of this study can be used to inform future research on the effects of hypnosis on sleep quality in adults with MCI.

The Healthcare Discrimination Experience Scale: Assessing a Variable Crucial for Explaining Racial/Ethnic Inequities in Patient Activation and Health.

Healthcare discrimination experience is expected to be a consequential variable that explains racial/ethnic inequities in patient activation and health; however, existing scales assessing healthcare discrimination experience are limited by insufficient psychometric development and overly narrow construct definitions. A new Healthcare Discrimination Experience Scale was developed, validated, compared to an existing scale, and used to estimate effects in explaining racial/ethnic health inequities. Across two studies, 975 patients with hypertension or diabetes (43% Black, 10% other Persons of Color, 47% White, 53% having household incomes < 40 thousand dollars) were recruited through marketing research panels to complete online questionnaires. Compared to an existing measure, the new scale better detected differences between People of Color and White people. It produced good results in confirmatory factor analysis and item response theory analysis, and it mediated the effects of racial/ethnic identity on eight variables regarding patient-practitioner relationships, treatment adherence, general health, blood pressure, and life stress. The new scale is valid for assessing a broadly defined healthcare discrimination experience construct in diverse patients with chronic medical conditions, and it is more sensitive to group differences than the best existing alternative scale. Compared to research using unvalidated scales, the results of this study demonstrate that healthcare discrimination experience plays a larger role in explaining racial/ethnic inequities in patient activation and health.

Social relationships, stress, and treatment adherence perceptions in type 2 diabetes and hypertension: between-person, within-person, and compositional associations.

OBJECTIVE: Type 2 diabetes and hypertension are "intertwined" conditions with lifestyle treatment plans, but patients often struggle to consistently engage in and follow treatment plans. To identify potential mechanisms for improving patient adherence to lifestyle treatment plans for type 2 diabetes and hypertension, this longitudinal study investigated the extent to which situational changes in patient-practitioner relationships, close relationships, and stress, explain between-person, immediate within-person, and compositional change in patient behavior and attitudes.Methods and measures: Over one year, 167 participants with type 2 diabetes and/or hypertension completed seven questionnaires assessing adherence perceptions (adherence, benefit, and burden), patient-practitioner experiences (alliance and confusion), close interpersonal interactions (positive and negative), and stress. RESULTS: Multilevel structural equation modeling analyses revealed that nearly all hypothesized between-person associations were significant. Moreover, all hypothesized predictors explained within-person change in at least one adherence outcome. Predictors also produced compositional effects where outcomes were predicted by scores sustained over time. Most social and stress variables had unique associations with adherence perceptions after controlling for other predictors. CONCLUSION: Results highlight the complexity of change processes and importance of social relationships and stress for adherence. Greater understanding of these processes may improve outcomes for individuals with type 2 diabetes and/or hypertension.

Positive exchanges buffer negative exchanges: Associations with marital satisfaction among U.S. mixed-sex couples.

Perceived positive and negative exchanges in relationships contribute to marital satisfaction in qualitatively distinct manners. However, the nature of these associations is unclear with some studies demonstrating curvilinear relationships and some literature suggesting interaction effects of positive and negative exchanges on marital satisfaction. Extant work has not compared curvilinear and interactive models to address this discrepancy. The present study clarifies these associations by comparing multiple models. Based on cross-sectional data from 886 mixed-sex married couples from across the U.S., we found that marital satisfaction was associated with greater positive exchanges and lower negative exchanges. In addition, the data support interaction effects of positive and negative exchanges on marital satisfaction, but not curvilinear effects. Specifically, high positive exchanges may buffer the impact of negative exchanges on relational satisfaction. Gender differences in effects were not supported. These findings confirm that positive and negative exchanges are distinct constructs and demonstrate how relationship satisfaction scores suffer from issues of equifinality by failing to distinguish between very different qualitative relational experiences. We suggest that curvilinear, plateauing effects may be an artifact of data loss when analyzing individuals in relationships rather than whole dyads, and suggest that scholars study positive and negative exchanges with both members of a dyad moving forward. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Attitudinal and social predictors of adherence to oral endocrine therapy: A psychometrically-informed model.

There is a need for a psychometrically-informed model identifying attitudinal and social factors explaining adherence to oral endocrine therapy (OET) for women with hormone receptor positive breast cancer. This study tested a model with variables selected by stringent psychometric criteria, including attitudes about benefit and burden, patient-practitioner alliance and confusion, and positive and negative interpersonal interactions. Self-report scales were completed by 150 current or past OET users. Fourteen correlations and six mediated pathways implied by the model were tested. All hypothesized associations were significant. This preliminary study suggests the model is a valuable framework for OET adherence research and intervention.

Assessing Attitudes Toward COVID-19 Prevention: Defining Two Attitudes Crucial for Understanding Systemic and Social Variables Associated with Disparities.

This study tested a conceptual model identifying two distinct types of attitudes people may have toward following recommendations to prevent COVID-19. These attitudes were expected to be important for understanding types of systemic and social variables associated with health disparities such as racial discrimination, residential environment, lack of healthcare access, and negative healthcare experiences. The conceptual model was drawn from previous work examining adherence to medical recommendations that identified two distinct and consequential attitudes that influence behavior: perceived benefit (believing recommendations are effective and necessary) and perceived burden (experiencing recommendations as unpleasant or difficult). Approximately equal proportions of Black and White individuals living in the USA (N = 194) were recruited to complete an online survey. A psychometric analysis indicated that perceived benefit and burden attitudes were two distinct and meaningful dimensions that could be assessed with high validity, and scales demonstrated measurement invariance across Black and White groups. In correlation analyses, benefit and burden attitudes were robustly associated with neighborhood violence, healthcare access, and healthcare experiences (but not with experiences of discrimination), and all these associations remained significant after accounting for subjective stress and political affiliation. These findings have implications for increasing compliance to public health recommendations and addressing health disparities.

The Medical Mistrust Multiformat Scale: Links with vaccine hesitancy, treatment adherence, and patient-physician relationships.

The assessment of medical mistrust is essential to progress in understanding behavioral health outcomes such as vaccine hesitancy, treatment adherence, and patient-practitioner relationships. To address limitations of existing medical mistrust scales and to address a need for clear psychometric information, a new Medical Mistrust Multiformat Scale (MMMS) was developed and tested. Study 1 included 741 Black and White participants with hypertension, with one subsample used for item selection and a second for cross-validation. Study 2 included 234 lower-income participants with diabetes or hypertension representing diverse racial/ethnic identities. All participants were recruited via marketing panels to complete online questionnaires. In both studies, the MMMS fit a unidimensional factor structure; items demonstrated high discrimination; and the scale was correlated with vaccine compliance. In Study 1, measurement invariance was demonstrated across Black and White groups. In Study 2, the MMMS correlated with additional tested outcomes regarding treatment adherence and patient-practitioner relationships, all effects remained significant after controlling for other related variables (conspiracy beliefs, race/ethnicity, political affiliation, stress), and the MMMS produced significantly larger convergent validity effects than a widely used existing mistrust scale. Results highlight the importance of medical mistrust and support use of the MMMS to assess mistrust in populations that include people with diverse racial/ethnic identities, people with chronic medical conditions, and people with lower incomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A special kind of stress: Assessing feelings of decisional distress for breast cancer treatment decisions.

OBJECTIVE: Women with breast cancer need to make difficult treatment decisions and may experience decisional distress (worry, anxiety, and thought intrusion) associated with these decisions. This study investigated ways that decisional distress was both associated with and distinct from other variables regarding decisional process and life functioning, and it investigated the validity of a decisional distress scale. METHODS: A total of 263 women previously or currently diagnosed with breast cancer reported on initial treatment decisions regarding surgery, chemotherapy, or radiation, or decisions involving oral endocrine therapy (either currently or retrospectively). Participants completed online measures of decisional distress, alliance and confusion in patient-practitioner relationships, positive and negative interactions in close relationships, financial and general distress, and decision satisfaction. RESULTS: Decisional distress demonstrated a unidimensional factor structure invariant across treatment context groups, a wide range of meaningful variation, significant correlations with all hypothesized variables (especially patient confusion), but also key distinctions from other variables. CONCLUSION: Decisional distress is a meaningful construct that can be assessed with precision, and important for understanding medical decision-making processes and patient quality of life. PRACTICE IMPLICATIONS: Assessing decisional distress is crucial for evaluating treatment decision outcomes. One key to reducing decisional distress may involve reducing patient confusion.

Treatment Adherence Perception Questionnaire: Assessing patient perceptions regarding their adherence to medical treatment plans.

The Treatment Adherence Perception Questionnaire (TAPQ) is a new, brief self-report instrument for assessing patient perceptions and attitudes regarding their own adherence to medical treatment plans. It includes 3 distinct scales: Perceived Behavior, Perceived Benefit, and Perceived Burden. In contrast with existing measures, the TAPQ was expected to have a clear factor structure; have good discrimination; and assess distinct types of perception, each of which has different patterns of association with interpersonal, personality, motivational, and emotional variables. Foundational work on the TAPQ (with 891 patients) included 5 quantitative scale development studies and 1 qualitative study. The present report focuses on results from a final validation study using 450 patients recruited via market research panels to complete online questionnaires. This study included a general medical sample and a sample of people with either diabetes or hypertension. A confirmatory factor analysis specifying strict measurement invariance across these groups produced a good fit. Analysis with item-response theory suggested that the scales on the TAPQ provide good discrimination across a wide range of experience levels. The 3 scales on the TAPQ each had distinct patterns of association with criterion variables regarding conscientiousness, health behavior, motivation, affect, type of diagnosis, and interpersonal communication with health-care professionals. These effects could not be explained by another existing measure of adherence or by a measure of response bias. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Both trusting and understanding medical advice: Assessing patient alliance and confusion after medical consultations.

OBJECTIVE: The current objective is to validate the Medical Consultation Experience Questionnaire (MCEQ) and to examine distinctions between constructs of patient perceived alliance and experienced confusion in relation to key health outcomes. METHODS: A total of 857 participants were recruited online across two samples (adults with various medical conditions and with diabetes and/or hypertension specifically). RESULTS: A confirmatory factor analysis demonstrated good fit and high item loadings for the theoretical bifactor model. Item response theory analyses showed very high individual item discrimination and good test information across a wide range of values. Confusion was uniquely and significantly more strongly related to psychological distress than was alliance; the same was true for alliance with positive affect. Both alliance and confusion significantly contributed to treatment motivation. Only confusion explained unique variance in control of HbA1C levels and blood pressure after controlling for alliance and other variables. CONCLUSIONS: The MCEQ is a valid instrument for assessing distinct constructs of alliance and confusion. Future research should focus on the unique role of confusion for patient outcomes. PRACTICE IMPLICATIONS: By using the MCEQ to assess patient alliance and confusion, it may be possible to detect and prioritize individual patient needs and improve patient outcomes.

Medical Consultation Experience Questionnaire: Assessing perceived alliance and experienced confusion during medical consultations.

The Medical Consultation Experience Questionnaire (MCEQ) is a new, brief self-report instrument that can be used with both adult patients and parents of child patients to assess two dimensions of people's experiences interacting with medical practitioners: Alliance and Confusion. In contrast with existing measures, the MCEQ was expected to provide good discrimination across a full range of experience levels and to assess two distinct dimensions of experience with good factor validity. It was developed in a series of 7 preliminary studies (with 758 participants) and tested in 3 subsequent validation studies, which are the focus of the present report. Study 1 was an Internet sample of 199 parents of child patients, Study 2 was a hospital sample of 173 parents of child surgery patients, and Study 3 was an Internet sample of 204 adult patients. A confirmatory factor analysis specifying strict measurement invariance across the 3 groups produced a good fit. An item response theory analysis suggested that scales on the MCEQ provide good discrimination across a wide range of experience levels. The new scales measuring Alliance and Confusion each had a distinct pattern of convergent validity associations with criterion variables regarding alternate measures of consultation experience, treatment context, and patient-reported perception, behavior, and affect. Results support the validity of the MCEQ and suggest that Alliance and Confusion are two distinct and informative dimensions of medical consultation experience. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Negative relationship behavior is more important than positive: Correlates of outcomes during stressful life events.

When people who are married or cohabiting face stressful life situations, their ability to cope may be associated with two separate dimensions of interpersonal behavior: positive and negative. These behaviors can be assessed with the Couple Resilience Inventory (CRI). It was expected that scales on this instrument would correlate with outcome variables regarding life well-being, stress, and relationship satisfaction. It was also expected that effects for negative behavior would be larger than effects for positive and that the effects might be curvilinear. Study 1 included 325 married or cohabiting people currently experiencing nonmedical major life stressors and Study 2 included 154 married or cohabiting people with current, serious medical conditions. All participants completed an online questionnaire including the CRI along with an alternate measure of couple behavior (to confirm scale validity), a measure of general coping style (to serve as a covariate), and measures of outcome variables regarding well-being, quality of life, perceived stress, and relationship satisfaction. The effects for negative behavior were larger than effects for positive in predicting most outcomes, and many effects were curvilinear. Notably, results remained significant after controlling for general coping style, and scales measuring positive and negative behavior demonstrated comparable levels of validity. (PsycINFO Database Record

Assessing Context-Specific Attributions During Couples' Conflict Interactions.

Two studies were conducted to develop and validate a six-item scale for measuring context-specific attributions regarding the extent to which people either blame or exonerate partners during couples' conflicts. Context-specific attributions pertain to appraisals made during a single episode of relationship conflict, and the scale was expected to be distinct from existing attribution scales measuring people's schemas regarding the types of attributions they typically make. Study 1 included 2,452 people in marriage or cohabitating relationships; Study 2 included 172 people in dating relationships, and participants in both studies completed Internet questionnaires. Item response theory was used to create an attribution scale using the fewest number of items to discriminate reliably across the full range of attribution levels. The resulting scale produced an expected pattern of convergent and divergent correlations with other context-specific measures, including two types of underlying concerns and three types of emotion. The context-specific attribution scale explained variance in these criterion variables that could not be explained by other existing scales that assess attributions at the schematic level.

The Parting Parent Concern Inventory: Parents' appraisals correlate with divorced family functioning.

When married parents go through a divorce, they may have concerns in 6 areas that are associated with postdivorce family adjustment. These include concerns about malice, power, custody, child rejection, esteem, and finances. The Parting Parent Concern Inventory assesses these concerns. It was developed in a series of preliminary studies, and this report focuses on results from 2 subsequent validation studies including 643 divorced parents with at least 1 child from their former marriage under the age of 18. Participants completed Internet assessments of their concerns and 14 different convergent validity criterion variables regarding aspects of child internalizing behavior, coparenting relationships, settlement outcomes, and personal well-being. Across both studies, the new measure of concerns fit an expected 6-dimensional factor structure. A total of 25 convergent validity correlations were tested, and all were significant. The distinctiveness of each concern scale was supported by the fact that all but 1 convergent association remained significant after controlling for variance explained by other concern scales. These results provide preliminary validation support for the new instrument. (PsycINFO Database Record

Couple Resilience Inventory: Two dimensions of naturally occurring relationship behavior during stressful life events.

A series of 3 studies using samples of married or cohabiting people were conducted to develop a new scale for measuring resilience in couples. Resilience involves the extent to which couples engage in behaviors that help each partner cope during stressful life events. In the first study, 525 people responded to open-ended questions, and a qualitative analysis identified 49 different potential types of resilience behavior that people naturally experience and notice in their relationships. In the second study, 320 people completed a questionnaire assessing the 49 resilience behaviors. Several items were correlated with measures of well-being and quality of life, and results suggested that the domain of resilience items could be reduced to 2 factors: 1 pertaining to positive behavior and the other to negative. In the third study, 18 items were selected to create a new measure of couple resilience, and the measure was tested with a sample of 568 people. The new measure fit an expected 2-dimensional factor structure. Scales measuring positive and negative behavior were nearly orthogonal, but both correlated with measures of quality of life and well-being, and most effects remained significant after controlling for relationship satisfaction. The resilience scales had moderate cross-partner correlations when 2 partners reported on the same stressful event. These results provide preliminary validity evidence for use of the new measure of couple resilience. (PsycINFO Database Record

The validity of retrospectively reported conflict interactions in couples.

This study investigated the extent to which researchers and clinicians can obtain valid retrospective self-reports of couples' conflict interactions outside a laboratory setting. A distinction was made between relationship attribute variance, regarding a shared perspective of both partners, and informant-specific variance, regarding the unique vantage point of each partner. By examining convergent and divergent associations for each type of variance, this study clarified the risk that responses might be influenced by informant-specific biases related to levels of relationship satisfaction. This study also investigated potential moderators of validity. Participants included both members of 269 married and cohabiting couples (538 individuals) who completed online questionnaires. Results were analyzed using a correlated trait-correlated method minus one model. The total true variance included large components of both shared relationship attribute variance and informant-specific variance. Although the shared component was moderately correlated with relationship satisfaction, the informant-specific component was mostly distinct from satisfaction, suggesting minimal bias. Convergent correlations between partners were strong and mostly unrelated to potential moderating variables, albeit slightly smaller than reported in studies conducted in laboratory settings. The results generally support the validity for retrospective self-reports of conflict interactions, especially when reports are obtained from both members of a couple.

Two types of disengagement during couples' conflicts: withdrawal and passive immobility.

A series of 3 studies using nonclinical samples investigated validity associated with the Conflict Disengagement Inventory (CDI), a questionnaire developed to measure passive immobility and withdrawal as context-specific forms of disengagement in couples' conflicts. In the first study, 2,588 married participants completed the CDI, and an expected 2-dimensional factor structure was confirmed. Additionally, results demonstrated measurement invariance across racial/ethnic and gender groups. In the second study, 223 adults in committed romantic relationships completed the CDI along with measures of attachment, emotion, underlying concerns, withdrawal, relationship expectations, relationship satisfaction, and communication behavior. Although the disengagement scales were moderately correlated, the results provided consistent evidence of convergent and divergent validity. In the third study, a sample of 135 undergraduate students in romantic relationships completed the CDI and measures of emotion on up to 5 separate assessment sessions, with sessions spaced at least 2 weeks apart. Analyses of within-person effects using hierarchical linear modeling provide evidence that the CDI captures meaningful variance at the context-specific level. There was substantial variance within persons across different episodes of conflict and within-person changes in disengagement predicted corresponding within-person changes in emotion.

The communication of emotion during conflict in married couples.

This study investigated emotion during interpersonal conflicts between mates. It addressed questions about how clearly couples express emotion (encoding), how accurately they recognize each other's emotion (decoding), and how well they distinguish between types of negative emotion. It was theorized that couples express and perceive both: (a) event-specific emotions, which are unique to particular people on particular occasions, and (b) contextual-couple emotions, which reflect the additive effect of emotions across different events and across both partners. Eighty-three married couples engaged in a series of two conflict conversations. Self-report ratings, observer ratings, and partner ratings were used to assess two types of negative emotion: hard emotion (e.g., angry or annoyed) and soft emotion (e.g., sad or hurt). Couples were reasonably accurate in encoding, decoding, and in distinguishing between types of emotion. Emotion expression was strongly associated with general levels of contextual-couple emotion summed across two conversations, whereas emotion perception was more closely tied to specific events. Hard emotion was readily perceived when it was overtly expressed, and soft emotion could sometimes be recognized even when it was not expressed clearly.

Perceived threat and perceived neglect: Couples' underlying concerns during conflict.

The Couples Underlying Concern Inventory assesses 2 fundamental types of distress that couples experience during interpersonal conflict. Perceived threat involves a perception that one's partner is blaming and controlling the self. Perceived neglect involves a perception that one's partner is failing to make desired contributions or investments. Scales measuring these 2 underlying concerns were developed in Study 1, where a sample of 1,224 married people rated a pool of 57 words describing oneself and perceptions of a partner during a specific episode of conflict. Factor analysis identified 2 dimensions, and 2 brief 8-item scales were created. In Study 2, a sample of 2,315 married people completed the resulting 16-item inventory along with 10 self-report scales measuring types of emotion, cognition, and behavior during conflict. A 2-dimensional factor structure was confirmed, and measurement invariance was demonstrated across 4 racial/ethnic groups. Both perceived threat and perceived neglect correlated with relationship satisfaction and conflict communication. More importantly, each concern was associated with a different, and theoretically expected, set of variables regarding self emotion, emotion perceived in a partner, and cognition during conflict.