Health care implications of desire and expectancy for control in elderly adults.

Two cross-sectional studies explored the relationship between age and individuals' desire for control both on a general day-to-day level and as patients in health care situations. The relationship between age and expectancies for control over health also was examined. In Study 1, questionnaire surveys completed by 246 community adults ranging in age from 19 to 77 indicated that for health-specific measures at older ages, belief in internal control and desire for control are lower, and belief in control by powerful others is higher. In contrast, no significant differences in general desires for control were found across age groups. In Study 2, expectancies and desire for control in relation to the health of 350 patients about to undergo barium enemas, chemotherapy, or surgery were measured. Older adults reported a lower desire for control of their health care and a greater belief in the ability of powerful others to control their health than did younger adults. The replication of these age differences across samples differing in several respects, including education and health status, suggests that this is a highly reliable finding.

Age and health care beliefs: self-efficacy as a mediator of low desire for control.

The relation between individuals' age, desire for control, information, and perceived self-efficacy was examined using a cross-sectional comparison of 116 noninstitutionalized adults, ages 20 to 99. We found that individuals over 60 years of age desired less health-related control than did younger adults, and preferred that health professionals make decisions for them. Differences in desire for health-related information were in the same direction but were not significant. Older adults also desired less control in general day-to-day living. Perceived self-efficacy was also lower for individuals over 60 years of age. Results suggested that perceived self-efficacy mediated the age differences in health-related desire for control. Mediation of general desire for control, however, was not strong. Cohort and developmental explanations are provided for these findings. It is suggested that those individuals most at risk for chronic illnesses and hospitalization are also those who are most likely to fail to take an active role in their health care.

Choice and predictability in the preparation for barium enemas: a person-by-situation approach.

The effects of choice and predictability information regarding preparation for a barium enema procedure was investigated for patients differing in desire for control (DFC) and in experience with the barium enema exam. One-third of the patients, randomly assigned to the choice condition, were selected from three equally effective preparations. For these patients, choice and predictability information are confounded. Patients in the instruction only and information conditions were yoked to choice patients to control for type of preparation. Patients in the information condition were given the same sensation information about their specific preparation as those in choice. Instruction only was effective for low DFC patients, but contrary to prediction the choice was problematic for high DFC patients. It was suggested that the limited choice created reactance for these patients. The differential effectiveness of health care interventions in relation to patient predispositions was stressed.

The desire to control terminal health care and attitudes toward living wills.

The desire for control over one's health care is defined as preferring to directly influence the nature of that care. We attempted to measure the following relevant constructs and to examine the relationships among them: (1) desire-for-control (DCON) in a specific health care setting--a hypothetical situation in which a person was facing imminent death; (2) attitude toward an action perceived as enhancing control in that situation--signing a living will; and (3) intention to exercise control by performing that action--actually signing a living will. An analysis of variance (DCON x attitude) of intention to sign a living will yielded statistically significant main effects for DCON and attitude, although DCON was in a direction counter to that predicted. Possible explanations for the DCON finding were explored.

Measuring desire for control of health care processes.

We conducted three known-groups studies to obtain discriminant validity information among potential self-report measures of the construct desire for control over health care processes. In the first study we looked at types of preparation for childbirth; in Studies 2 and 3 we investigated choice of a place in which to die and signing a Living Will. With none of the measures could we adequately distinguish those who had signed a Living Will (or intended to) from those who did not intend to sign one. The best discriminator of a choice of a place to die (hospital vs. home or hospice) and type of preparation for childbirth (Lamaze vs. other types of classes vs. no classes) was the Information subscale of Krantz's Health Opinion Survey (KHOS; Krantz, Baum, & Wideman, 1980). With the Behavioral Involvement subscale of the KHOS and our newly designed situation-specific measure of desire for control, we could only inconsistently discriminate among the groups. The generalized measure, Burger and Cooper's (1979) Desire for Control Scale, did not help us to discriminate among these groups. Correlations of these measures with demographic variables are provided and discussed.

Increasing nurses' person-centeredness.

In a two-phased study, two samples of registered nurses listened to audiotaped disclosure statements from simulated patients and responded to each statement "in as helpful a manner as possible." Their responses were judged for degree of "person-centeredness." Nurses in sample one (N=24) received no intervention between the two phases of the study; nurses in sample two (N=20), after completing phase I, listened to a brief message designed to enhance the helpfulness of their responses. No differences were found for the phase I person-centeredness scores; the nurses who received the intervention showed significant improvement in their degree of person-centeredness as compared to those who did not receive the intervention. Implications of these results are discussed.

Development of the Multidimensional Health Locus of Control (MHLC) Scales.

The development of the Multidimensional Health Locus of Control scales is described. Scales have been developed to tap beliefs that the source of reinforcements for health-related behaviors is primarily internal, a matter of chance, or under the control of powerful others. These scales are based on earlier work with a general Health Locus of Control Scale, which, in turn, was developed from Rotter's social learning theory. Equivalent forms of the scales are presented along with initial internal consistency and validity data. Possible means of utilizing these scales are provided.

Effect of a negative stereotype on nurses' attitudes toward an alcoholic patient.

Nurses' impressions of a hypothetical patient, labeled an alcoholic, were strongly influenced by their negative stereotypic views of alcoholics. Nurses responded more favorably to the same "patient" when he was not labeled an alcoholic even though the behavior of the patient was held constant.

Professionals' preferences for support systems for the bereaved family.

Health-care-related professionals rated the appropriateness and preferred timing of various community intervention strategies for assisting the bereaved individual. Results indicated: (a) agreement about the general need for such assistance programs, but no concensus as to which were most appropriate; (b) endorsement of the "resumption of activity" ethic; (c) belief that the most desirable period in which to intervene is within six months from the death; and (d) the lesser perceived suitability of therapeutic modalities that involve social contact with nonfamily members immediately following the death. Earlier introduction of family therapy and multiple family counseling was advocated by respondents with greater experience treating the bereaved.

A role-playing simulation approach toward studying nurses' decisions to listen to patients.

To test a methodology that used role-playing responses by nurses to simulated patient disclosures, a three-part investigation was carried out at Vanderbilt University, Nashville, Tennessee. Four simulated patients-with diagnoses of diabetes mellitus, alcoholism with bleeding ulcer, ulcerative colitis, and cancer of the large intestine-tape recorded 20- to 30-second segments on 12 topics pertaining to their illness. Six topics dealt with the patients' physical problems; six with psychological aspects of the problems. In the tests for nurses' willingness both to listen and to pass along information to the next nurse, the 48 tape-recorded segments of patient information were played for 16 volunteer nurses in a laboratory set up for the purpose. Although the nurses had an option of listening or preparing a medication, they were expected to listen to at least 16 of the 48 segments. Following this, they were asked to tape record a report on the patient for the nurse who would follow them. The nurses, on average, listened to 29 of the 48 segments. The diabetic patient was listened to least; the cancer and the colitis patients each received a similar amounts of attention. The nurses gave substantial amounts of information as well as interpretive data about the patients so that the methodology seemed to prove that nurses could become sufficiently involved in a simulated patient setting.