Chapter Four Metamemory in Adulthood: Differentiating Knowledge, Belief, and Behavior

Father support breastfeeding self-efficacy positively affects exclusive breastfeeding at 6 weeks postpartum and its influencing factors in Southeast China: a multi-centre, cross-sectional study

BACKGROUND

The exclusive breastfeeding condition in China is not optimism now. Maternal breastfeeding self-efficacy stands as a pivotal factor influencing exclusive breastfeeding. Interestingly, studies have suggested that father support breastfeeding self-efficacy is a pivotal mediator in infant breastfeeding. Thus, the current research aimed to investigate the association between father support breastfeeding self-efficacy and exclusive breastfeeding at six weeks postpartum, and the influencing factors of father support breastfeeding self-efficacy.

METHODS

This research was structured as a multi-centre cross-sectional study, involving 328 fathers, whose partners were six weeks postpartum, and recruited from two public hospitals in Southeast China. Self-designed demographic questionnaires, namely, Father Support Breastfeeding Self-Efficacy Scale-Short Form, Breastfeeding Knowledge Questionnaire, Positive Affect Scale and the 14-item Fatigue Scale, were applied. Descriptive statistics, Chi-square test, logistic regression univariate analysis and multiple linear regression were used to analyse data.

RESULTS

Results indicate a significant difference between the infant feeding methods at six weeks postpartum and fathers with different levels of support breastfeeding self-efficacy (p < 0.05). Particularly, father support breastfeeding self-efficacy positively affected exclusive breastfeeding at six weeks postpartum after adjusting all the demographic characteristics of fathers (OR: 2.407; 95% CI: 1.017-4.121). Moreover, results show that the significant influencing factors of father support breastfeeding self-efficacy include breastfeeding knowledge, fatigue, positive affect, successfully experienced helping mothers to breastfeed, spousal relationships and companionship time.

CONCLUSIONS

High-level father support breastfeeding self-efficacy effectively increased exclusive breastfeeding rate at six weeks postpartum. To enhance the exclusive breastfeeding rate, nurses or midwives can endeavour to design educational programmes or take supportive interventions customised for fathers, such as enhancing their breastfeeding knowledge education, reducing fatigue and mobilising positive emotions, thereby bolstering paternal self-efficacy in breastfeeding.

Factors perpetuating functional cognitive symptoms after mild traumatic brain injury

INTRODUCTION

Self-reported memory difficulties (forgetting familiar names, misplacing objects) often persist long after a mild traumatic brain injury (mTBI), despite normal neuropsychological test performance. This clinical presentation may be a manifestation of a functional cognitive disorder (FCD). Several mechanisms underlying FCD have been proposed, including metacognitive impairment, memory perfectionism, and misdirected attention, as well as depression or anxiety-related explanations. This study aims to explore these candidate perpetuating factors in mTBI, to advance our understanding of why memory symptoms frequently persist following mTBI.

METHODS

A cross-sectional study of 67 adults (n = 39 with mTBI mean = 25 months ago and n = 28 healthy controls). Participants completed standardized questionnaires (including the Functional Memory Disorder Inventory), a metacognitive task (to quantify discrepancies between their trial-by-trial accuracy and confidence), and a brief neuropsychological test battery. We assessed candidate mechanisms in two ways: (1) between-groups, comparing participants with mTBI to healthy controls, and (2) within-group, examining their associations with functional memory symptom severity (FMDI) in the mTBI group.

RESULTS

Participants with mTBI performed similarly to controls on objective measures of memory ability but reported experiencing much more frequent memory lapses in daily life. Contrary to expectations, metacognitive efficiency did not differentiate the mTBI and control groups and was not associated with functional memory symptoms. Memory perfectionism was strongly associated with greater functional memory symptoms among participants with mTBI but did not differ between groups when accounting for age. Depression and checking behaviors produced consistent results across between-groups and within-group analyses: these factors were greater in the mTBI group compared to the control group and were associated with greater functional memory symptoms within the mTBI group.

CONCLUSIONS

This study highlights promising (e.g., depression, checking behaviors) and unlikely (e.g., metacognitive impairment) mechanisms underlying functional memory symptoms after mTBI, to guide future research and treatment.

So you think you can read? Generalized metacomprehension in younger and older adults

This study explored whether age differences in task-specific metacomprehension accuracy are partly explained by age differences in generalized metacomprehension (GM) or the use of GM as a task-specific judgment anchor. GM was measured before and after a summarization and metacomprehension judgment task and then correlated with prediction judgment magnitude to assess anchoring, and correlated with comprehension and task-specific metacomprehension accuracy to assess GM accuracy. Age differences in these relationships were then tested. GM was related to judgment magnitude but despite age differences in GM ratings, age did not moderate anchoring or GM accuracy. Age differences in task-specific metacomprehension accuracy do not seem to be explained by age differences in GM accuracy or its use as a judgment anchor. However, results are the first to show that older adults anchor task-specific metacomprehension judgments on their GM, providing unique evidence for the Anchoring and Adjustment Model of Metacomprehension in advanced age.

The role of metamemory and personality in episodic memory performance in older adults

This study newly investigated the joint contribution of metamemory and personality (traits and facets) in explaining episodic memory (EM) performance in typically aging older adults. Forty-eight participants (age range: 64-75 years) completed a self-paced word list (SPWL) recall task, a metamemory questionnaire assessing perceived control and potential improvement (PCPI) and self-efficacy and satisfaction (SESA) regarding one's mental abilities (e.g., memory), and the Big-Five Questionnaire. Based on the SPWL encoding strategies reported, participants were then classified as effective (N = 20) or ineffective (N = 28) memory strategy users. Hierarchical regression analyses showed that a better SPWL performance was predicted by higher levels of PCPI, Scrupulousness and Dominance personality facets. Effective memory strategy users, then, showed higher SPWL performance and Dominance (Energy facet) than ineffective ones. These findings suggest that both specific metamemory processes and personality facets predict better EM performance in older adults. Moreover, personality dispositions relating to Dominance seem to characterize individuals adopting effective memory strategies to support EM performance. These results represent first evidence of the role of both metamemory and personality-facets-in explaining older adults' EM performance, which should thus be considered when assessing or training EM in old age.

Mental Health Literacy Levels of Medical Staff in China: An Assessment Based on a Meta-Analysis

Background: The awareness rate of mental health knowledge among medical staff is an important evaluation index to assess the service capacity of a country or region, and this indicator in China has not been quantitatively evaluated. Study Design: This study systematically combined pertinent quantitative study data from previous related studies to conclude the awareness rate of mental health knowledge among Chinese medical staff. Methods: Related studies from five electronic databases were searched, and a meta-analysis was conducted to obtain the combined result. The primary outcome of the present study was the awareness rate of medical staff or the sample size and the number of those who can answer the relevant questions correctly. We also performed a hierarchical analysis according to the sample group's region and specialty. The awareness rate of medical staff and corresponding 95% confidence intervals (CIs) were calculated. The heterogeneity was assessed with the I ² test, and Egger's test was used to evaluate publication bias. Results: A total of 15 articles with 11,526 medical staff were included in the present study; the overall awareness rate of mental health knowledge among Chinese medical staff was as low as 81%. The awareness rate of mental health knowledge among medical workers in developed regions is higher than that in developing regions. The awareness rate of mental health among medical staff in the department of psychiatry, non-psychiatry, and community medical staff was 88, 68, and 82%, respectively. Conclusion: The overall awareness rate among medical staff in this country is unsatisfactory, and the awareness rate in developed regions is higher than medical staff in developing regions. Psychiatric hospital staff has a higher awareness rate than community medical staff, and non-psychiatric hospital staff has the lowest awareness rate.

Long-Lasting Effects of a New Memory Self-efficacy Training for Stroke Patients

Background and purpose. This study aims to determine the long-term effects of a new Memory Self-efficacy (MSE) training program for stroke patients on MSE, depression, and quality of life. Methods. In a randomized controlled trial, patients were allocated to a MSE training or a peer support group. Outcome measures were MSE, depression, and quality of life, measured with the Metamemory-In-Adulthood questionnaire, Center for Epidemiological Studies–Depression Scale (CES-D), and the Who-Qol Bref questionnaire, respectively. We used linear mixed models to compare the outcomes of both groups immediately after training, after 6 months, and after 12 months, adjusted for baseline. Results. In total, 153 former inpatients from 2 rehabilitation centers were randomized—77 to the experimental and 76 to the control group. MSE increased significantly more in the experimental group and remained significantly higher than in the control group after 6 and 12 months (B = 0.42; P = .010). Psychological quality of life also increased more in the experimental group but not significantly (B = 0.09; P = .077). However, in the younger subgroup of patients (<65 years old), psychological quality of life significantly improved in the experimental group compared to the control group and remained significantly higher over time (B = 0.14; P = .030). Other outcome measures were not significantly different between both groups. Conclusions. An MSE training program improved MSE and psychological quality of life in stroke patients aged <65 years. These effects persisted during 12 months of follow-up.

Psychometric Properties of the French Version of the Multifactorial Memory Questionnaire for Adults and the Elderly

The aim of this study was to examine the psychometric properties of a French version of the Multifactorial Memory Questionnaire (MMQ) (Troyer & Rich, 2002). The MMQ, which is suited to clinical and research purposes, evaluates subjective memory functioning (i.e., affect related to memory abilities, frequency of problems remembering in different situations, and strategy use in everyday life). The questionnaire was administered to 294 French adult or elderly subjects (46–94 years old). The results allowed us to conclude that the French version of this scale is psychometrically sound. Indeed, the scores proved to be highly reliable (Cronbach's α for the subscales ranged from 0.79 to 0.88) and correlated in the expected directions with measures of other constructs (correlation coefficients ranged from −0.34 to 0.39). Convergent validity evidence for MMQ scores was provided by their statistically significant positive correlations (from 0.56 to 0.73) with several dimensions of the Metamemory in Adulthood scale (MIA) (i.e., the anxiety, change, capacity and strategy dimensions). However, the three-factor model found in the original version was not validated here. An exploratory factor analysis revealed that a four-factor solution offered the most interpretable pattern for the factor scores. Two of the dimensions proposed by Troyer and Rich (2002) were replicated: ability and contentment. The third subscale (strategy) was divided into two factors: internal strategies and external strategies.

Memory prediction accuracy in younger and older adults: a cross-sectional and longitudinal analysis

Across three experiments, the effects of age and normative information on memory prediction accuracy were examined. In Experiment 1, younger and older adults were given an arbitrary midpoint anchor and made global predictions about how they expected to perform on subsequent verbal, visual, and name-face memory tasks. In Experiment 2, the normative information was varied by providing participants with a midpoint anchor, accurate anchor, or no anchor. Across both experiments, older adults successfully adjusted their predictions in accordance with the task demands, regardless of the type of normative information given. In Experiment 3, older adults' prediction accuracy was measured at a 5-year follow-up. Memory performance predictions were found to be just as accurate as they had been at the first assessment. In general, the findings indicate that older adults were as accurate as younger adults in assessing their memory performance abilities. Older adults also did not operate on a negative stereotype of global cognitive decline with age, as they provided varying performance estimates across the different domains and types of memory tasks.

Subjective cognitive complaints, memory performance, and depressive affect in old age: a change-oriented approach

The question of whether and how subjective cognitive complaints are related to actual cognitive performance represents a central issue in applied cognitive aging research. Until recently, however, many studies have failed to find a strong association between subjective cognitive complaints and actual cognitive performance. In our study, we examine two alternative explanations: a) for methodological reasons, strong associations exist only when latent changes rather than differences are examined, and b) strong associations exist only between changes in depression and complaints, not between changes in cognitive performance and complaints. With 427 participants (M = 63 years) and two measurements, we examine both the relation between functioning, complaints, and depressive affect at each measurement point, and the relation between changes in functioning, changes in complaints, and changes in depressive affect between the measurement points with latent difference variables. The results indicate that there are substantial relations between changes in functioning, changes in depression, and changes in complaints.

Memory Self-Efficacy and Memory Performance in Older Males

The study reported here was a secondary analysis of data on 157 males from a larger study of predictors of memory performance in community-dwelling elders. The males' average age was 76 years, with 13 years of education and a Mini-Mental State Exam score of 26. Measures included depression, memory performance, metamemory, and memory self-efficacy. An unusual finding was the multimodal distribution of memory self-efficacy strength scores. Using a median split, the sample was divided into low and high memory self-efficacy groups. The high efficacy group were significantly younger, had larger scores on capacity (+ = high capacity) and change (+ = greater stability). These findings provide new evidence that the memory self-efficacy of aging males influences their perceptions of cognitive performance related to memory.

Memory Beliefs as Social Cognition: A Reconceptualization of What Memory Questionnaires Assess

Few attempts have been made to integrate research on memory beliefs across adulthood with related constructs in social cognition. This article addresses the issue of how respondents formulate answers to memory-beliefs questions from a social–cognitive perspective. We propose that reported memory beliefs represent the outcomes of a process that involves both the retrieval of previously stored information about self and about memory and on-line constructive processes. This article offers a set of assumptions that clarifies existing data on memory beliefs and generates new hypotheses regarding the interactions between beliefs about the aging process, memory, and constructs such as memory self-efficacy and how such variables combine with the on-line constructive processes to produce individual differences in responses.

Metacognition and medication adherence: how do older adults remember?

Fifty-one older adults (M age = 75.9 years, SD = 6.9) reported their use of memory strategies for taking of medication using the Prospective Memory for Medication Questionnaire. Older adults used internal strategies more often when the domain was restricted to medication taking but used external strategies more often when queried across a variety of everyday situations. Surprisingly, the hypothesis that medical factors would be the primary determinants of older adults' reports of memory strategy use and perceived adherence was not supported. Metamemorial variables of non-domain-specific memory self-efficacy and memory anxiety in everyday life were significant predictors of strategy use and perceived adherence over and above variables related to the domain of health.