Evaluating Artificial Intelligence in Clinical Settings-Let Us Not Reinvent the Wheel

Given the requirement to minimize the risks and maximize the benefits of technology applications in health care provision, there is an urgent need to incorporate theory-informed health IT (HIT) evaluation frameworks into existing and emerging guidelines for the evaluation of artificial intelligence (AI). Such frameworks can help developers, implementers, and strategic decision makers to build on experience and the existing empirical evidence base. We provide a pragmatic conceptual overview of selected concrete examples of how existing theory-informed HIT evaluation frameworks may be used to inform the safe development and implementation of AI in health care settings. The list is not exhaustive and is intended to illustrate applications in line with various stakeholder requirements. Existing HIT evaluation frameworks can help to inform AI-based development and implementation by supporting developers and strategic decision makers in considering relevant technology, user, and organizational dimensions. This can facilitate the design of technologies, their implementation in user and organizational settings, and the sustainability and scalability of technologies.

Future Directions in Lay Health Worker Involvement in Children's Mental Health Services in the U.S

Nearly half of children meeting criteria for a mental health disorder in the United States (U.S.) do not receive the treatment they need. Unfortunately, lack of access to and engagement in mental health services can be seen at even higher rates for historically marginalized groups, including low-income, racial, and ethnic minority youth. Lay Health Workers (LHWs) represent a valuable workforce that has been identified as a promising solution to address mental health disparities. LHWs are individuals without formal mental health training who oftentimes share lived experiences with the communities that they serve. A growing body of research has supported the mobilization of LHWs to address service disparities around the globe; however, challenges persist in how to scale-up and sustain LHW models of care, with specific barriers in the U.S. In this paper, we describe LHWs' different roles and involvement in the mental health field as well as the current state of the literature around LHW implementation. We integrate the RE-AIM Framework with a conceptual model of how LHWs address disparities to outline future directions in research and practice to enhance equity in the reach, effectiveness, adoption, implementation, and maintenance of LHW models of care and evidence-based practices for historically marginalized communities within the U.S.

The medicalization of cancer as socially constructed and culturally negotiated

Sociological considerations of medicalization frequently employ a limited use of the term that focuses on the transformation of social phenomena into issues subject to medical control. Informed by a salutogenic perspective, this essay argues that it is possible to understand cancer as having been medicalized. I show that far from exclusively a biophysical issue, the medicalization of cancer is a socially constructed and culturally negotiated process, with a fairly recent historical origin. While changing social relations of healing have led our medico-centric culture to a near single-minded understanding of cancer as a cellular pathology rooted in biology, Antonovsky's salutogenic perspective instructs that it is possible to understand and control cancer in non-medicalized ways. Indoor radon gas remediation is presented as an illustration of what form salutary cancer control and disease prevention may take.

Emotions, relationships, health and illness into old age

There is strong evidence linking relationships and emotions to physical health outcomes. What is critically missing is a more comprehensive understanding of how these important psychosocial factors influence disease over the lifespan. In this narrative review, existing lifespan models of social support and emotion regulation are reviewed and integrated into a general conceptual framework in the health domain. This integrated model takes into account bidirectional links between relationships and emotions, as well as health behaviors, biological pathways, and health. Evidence is consistent with the utility of an integrative model attempting to understand its links to health-relevant pathways and outcomes in older adults. Future work that examines multiple pathways using prospective designs will be necessary for this work to reach its full potential, including intervention and policy opportunities.

Self-Rated Health and Age-Related Differences in Ambulatory Blood Pressure: The Mediating Role of Behavioral and Affective Factors

OBJECTIVE

Despite the well-established association between self-rated health (SRH) and health, little is known about the potential psychobiological mechanisms responsible for such links and if these associations differ by age. The main goals of this study were to investigate the links between SRH and ambulatory blood pressure (ABP), if age moderated the risk, and the health behavior/affective mechanisms responsible for such links.

METHODS

A total of 188 men and women (94 married couples; ages, 18-63 years) completed a standard measure of SRH and a 1-day ABP assessment. Multilevel models were run to examine whether SRH was associated with daily ABP and whether these links were moderated by age. The Monte Carlo method was used to construct confidence intervals for mediation analyses.

RESULTS

Results indicated that poor SRH was associated with higher ambulatory systolic blood pressure (SBP; b = 3.14, SE = 0.68, p < .001) and diastolic blood pressure (DBP; b = 1.34, SE = 0.43, p = .002) levels. Age also moderated the links between SRH and ambulatory SBP (b = 0.19, SE = 0.08, p = .011) and DBP (b = 0.14, SE = 0.05, p = .004), with links being stronger in relatively older individuals. However, only daily life negative affect significantly mediated the age by SRH interaction for both ambulatory SBP and DBP.

CONCLUSIONS

These results highlight the potential psychobiological mechanisms linking SRH to longer-term health outcomes. Such work can inform basic theory in the area as well as intervention approaches that target such pathways.

Effects of the Values and Options in Cancer Care Communication Intervention on Personal Caregiver Experiences of Cancer Care and Bereavement Outcomes

Background: Care teams are increasingly expected to attend to the needs of patient's personal caregivers (e.g., family members). Improving communication among oncologists, patients with advanced cancer, and their personal caregivers might enhance caregivers' experiences of end-of-life (EoL) cancer care and bereavement outcomes. Objective: To explore the effects of the Values and Options in Cancer Care intervention on caregivers' experiences of EoL care and bereavement outcomes. Design: We developed a brief behavioral intervention to improve communication among oncologists, patients with advanced cancer, and their personal caregivers. The intervention was designed to help patients/caregivers ask questions, express concerns, and help oncologists respond effectively. We randomly assigned oncologists (and their patients/caregivers) to the intervention or usual care. Setting/Subjects: Medical oncologists in NY and CA; patients/personal caregivers with advanced cancer. Measurements: Two months after the patient's death, caregivers completed three instruments assessing their experiences of EoL care. Seven months after the patient's death, caregivers completed the Prolonged Grief Disorder-13 (PG-13; primary prespecified outcome), the Purpose-in-Life scale, and scales assessing mental health function, depression, and anxiety. Results: The intervention did not significantly improve caregivers' scores on the PG-13 (p = 0.21), mental health function, depression, or anxiety, but it did improve purpose-in-life scores (p = 0.018). Cohen's d (95% confidence interval) for all three experiences of EoL care outcomes were promising, ranging from 0.22 (-0.19 to 0.63) to 0.39 (-0.07 to 0.86) although none was statistically significant. Conclusion: Preliminary findings show promise that scalable interventions in cancer care settings may improve caregiver experiences with cancer care and some bereavement outcomes.

Assessment of Surgery Resident Competency Provided by Patients

The objective of this study was to assess the competency of surgery residents from the patient perspective in the current healthcare environment in China. The authors performed an assessment of 508 surgery residents in Liaoning province. Seven patients were as a group to complete the self-administered questionnaires on the survey for each individual corresponding resident. A 5-point rating scale with an unable-to-evaluate category was used to assess surgery resident competency by patients. Reliability and validity were assessed by Cronbach alpha (α) and exploratory factor analysis, respectively. Statistical analysis was performed using SPSS 13.0. The surveys on 421 residents were valid, and the valid response rate was 82.8%. A total of 2947 questionnaires from patients were analyzed in this study. The Cronbach α coefficient was 0.92. The 4 factors emerging in the exploratory factor analysis reached a cumulative contribution rate of 66.98%. The items of "promotes health maintenance (talks about preventive care)" (206/7.0%), "tells me about any side effects of the medicine" (177/6.0%), "spends enough time with me" (189/6.4%), and "answers my questions thoroughly" (168/5.7%) were scored <4 by higher percentage of patients. The instrument provided an acceptable means for patients to evaluate the competency of Chinese surgery residents. Surgery residents should improve their competencies on preventive care, patient safety, and communication skills.

Towards a Critical Health Psychology Practice

The field of critical psychology is exerting an influence in the way various sub-disciplines within psychology operate. In this article we use a critical psychology framework to review the field of health psychology. Through the use of values, assumptions and practices we review progress in health psychology and offer recommendations for aligning contemporary practices with current thinking in critical psychology. We discuss typical expectations, critical formulations and critical practice for interventions with individuals, groups and communities along these dimensions.

Primary Prevention in Counseling Psychology

This study examined primary prevention articles published in four counseling journals from 1985 to 1999. The authors’ results indicated a relative paucity of prevention-focused literature in counseling journals. Specifically, 52 (1.29%) of the 4,028 articles published over this 15-year period focused on primary prevention. The 52 articles were reviewed for type of article, article topic, setting, and general populations sampled. The lack of prevention articles in counseling journals is problematic as journals reflect issues relevant and important to the field. Implications of the results and recommendations for how counseling psychologists can become more involved in prevention are discussed.

Best Practice Guidelines on Prevention Practice, Research, Training, and Social Advocacy for Psychologists

Preventive interventions have been shown to successfully aid the development of children, youths, and adults and avert maladjustment in individuals at risk for negative outcomes. Continued scientific advancement of preventive interventions is crucial to further the health of U.S. children, youths, and families. This article presents 15 best practice guidelines on prevention practice, research, training, and social advocacy for psychology. These guidelines articulate clear standards and a framework for moving the profession toward improving the well-being of a greater number of individuals and communities. The guidelines are intended to assist psychologists in evaluating their preparation for engaging in prevention work and in furthering their understanding through increased knowledge, skills, and experience in prevention.

School-Linked Prevention

Principles drawn from contemporary developmental-contextualism are presented as a framework for guiding the design, implementation, and evaluation of school-linked prevention programs that are consistent with an emerging body of research specifying best practices in prevention. Two school-linked preventive interventions, the Gardner Extended Services School (GESS) and Supporting Teachers Supporting Students, are described and discussed according to developmental principles. Roles of counseling psychologists in each intervention are also discussed. Implications of the theory and science of school-linked prevention and the two program examples for training of counseling psychologists are described.

Feminist Interventions: Accountability Beyond Symptom Reduction

Feminist interventions to facilitate women's psychological well-being are forging new pathways to achieving the goals of the Decade of Behavior. In emphasizing the complex interplay between internal and external factors in women's lives, feminist interventions are designed to promote women's safety health, positive life styles, personal strength, competence, and resilience. In contrast, prevailing medical models locate the problem within the woman by concentrating on diagnosis and treatment of pathology and internal disorders. I offer a model here for implementing and assessing intervention strategies that targets both the effects of unsupportive or negative environments and the imperative to strengthen and empower girls and women, their families, and their communities. The obligation to be accountable for the outcomes of feminist interventions encompasses a major focus of this article. Evolving developments in research on accountability are reviewed in relation to conceptualization, goal setting, and assessment of feminist interventions. I encourage continuing collaboration between the feminist-informed research and practitioner communities to promote women's health, safety, and well-being in the Decade of Behavior and beyond.

A Multilevel Logit Estimation on the Determinants of Utilization of Preventive Health Care and Healthy Lifestyle Practice in China

The purpose of this study is to provide policy implications by estimating the individual and community level determinants of preventive health-care utilization in China based upon data from the China Health and Nutrition Survey. Two different frameworks, a human capital model and a psychological-behavioral model, are tested using a multilevel logit estimation. The results demonstrate different patterns for medical and nonmedical preventive activities. There is a strong correlation between having medical insurance and utilizing preventive health services. For the usage of medical-related preventive health care (MP), age, gender, education, urban residence, and medical insurance are strong predictors. High income did not provide much of an increase in the usage level of MP, but the lack of income was a huge obstacle for low-income people to overcome. Community variation in number of facilities accounted for about one third of the total variation in the utilization of MP. The utilization of MP in China remains dependent upon the individual's social-economic conditions.

Understanding the Links Between Social Support and Physical Health: A Life-Span Perspective With Emphasis on the Separability of Perceived and Received Support

Social support has been reliably related to physical health outcomes. However, the conceptual basis of such links needs greater development. In this article, I argue for a life-span perspective on social support and health that takes into account distinct antecedent processes and mechanisms that are related to measures of support over time. Such a view highlights the need to distinguish measures of perceived and received support and its links to more specific diseases (e.g., chronic, acute) and stages of disease development (e.g., incidence). I discuss both the novel implications of these theoretical arguments for research on social support and physical health, as well as the potential intervention approaches that are apparent from this perspective.

Behavior change and reducing health disparities

The mission of the National Institutes of Health,"... is science in pursuit of fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability". A wide range of factors contribute to longer life and to less illness. Although estimates vary, most analyses suggest that only about 10% of the variation in health outcome is attributable to medical care. Further, medical care is most effective in addressing and preventing infectious disease and acute illnesses. Recent large randomized clinical trials often fail to demonstrate that medical care lengthens life expectancy. International comparisons suggest that life expectancy in the United States is increasing, but the rate of increase is falling behind that of other wealthy countries. Strategies for improving health outcomes include better dissemination and implementation of proven evidence-based interventions. Further, reduction of services that use resources but do not offer health benefits must be considered. The final section of this paper reviews evidence relevant to factors outside the health care system that may enhance life expectancy and reduce illness and the disability. The relationship between educational attainment and life expectancy is used as a case example. The potential of behavioral and social interventions for increasing life expectancy may be orders of magnitude greater than traditional medial interventions. However, considerably more research is necessary in order to provide persuasive evidence for the benefits of these programs.

Early-Life Stress and Adult Inflammation

The origins of modern psychology are deeply rooted in the notion that stressful early-life experiences negatively impact people’s mental health. Emerging work in the field of health psychology suggests that early-life stress also impacts physical well-being. Indeed, those who experienced severe early-life stress as children are more at risk for cardiovascular disease, type 2 diabetes, and cancer compared with those who did not have those early-life experiences. Recent work in the field of psychoneuroimmunology suggests that inflammation may be one mechanism underlying these associations. In this article, we provide a brief overview of the literature on early-life stress and inflammation and how psychological, autonomic, neuroendocrine, and epigenetic responses to the early environment lead to potentiated inflammation in adulthood. We conclude by highlighting the need for health-promotion and disease-prevention programs that are designed to reduce the frequency and severity of early-life stress.

Thinking about health-related outcomes: what do we need evidence about?

BACKGROUND

There is an urgent need for efficient, equitable interventions across the disease spectrum from prevention to palliative care. To identify and prioritize such interventions, evidence of effectiveness important to potential constituents is needed on outcomes relevant to them.

METHODS

To inform practice and policy, evidence is needed on actionable, harmonized outcomes which are feasible to collect in most settings and relevant to citizens, practitioners, and decision makers. We propose that increased priority should be given to certain outcomes that are infrequently collected across multiple domains.

RESULTS

A modification of a logic model of health outcomes by Proctor et al. is used to propose key domains and measures of implementation, service delivery, biomarkers, and health and functioning outcomes. Recommendations are made to give increased priority to implementation (especially reach, resource requirements/costs; and fidelity/adaptation); Institute of Medicine service delivery categories of equity and safety; and patient reported health and functioning outcomes.

CONCLUSIONS

Implications of this outcomes framework include that biomarkers are not always the most important or relevant outcomes; that harmonized, pragmatic, and actionable measures are needed for each of these types of outcomes, and that significant changes in training and review of grants and publications are needed.

A systematic review of social factors and suicidal behavior in older adulthood

Suicide in later life is a global public health problem. The aim of this review was to conduct a systematic analysis of studies with comparison groups that examined the associations between social factors and suicidal behavior (including ideation, non-fatal suicidal behavior, or deaths) among individuals aged 65 and older. Our search identified only 16 articles (across 14 independent samples) that met inclusion criteria. The limited number of studies points to the need for further research. Included studies were conducted in Canada (n = 2), Germany (n = 1), Hong Kong (n = 1), Japan (n = 1), Singapore (n = 1), Sweden (n = 2), Taiwan (n = 1), the U.K. (n = 2), and the U.S. (n = 3). The majority of the social factors examined in this review can be conceptualized as indices of positive social connectedness-the degree of positive involvement with family, friends, and social groups. Findings indicated that at least in industrialized countries, limited social connectedness is associated with suicidal ideation, non-fatal suicidal behavior, and suicide in later life. Primary prevention programs designed to enhance social connections as well as a sense of community could potentially decrease suicide risk, especially among men.

Quality of Life: Concept and Definition

This paper will consider 4 topics: (1) the definition of health-related quality of life, (2) the measurement of health-related quality of life, (3) the relationship between exercise and health-related quality of life in the general population, and (4) the relationship between exercise and health-related quality of life in patients with COPD. The paper presents data from the National Health Interview Survey, the San Diego COPD Rehabilitation Trials, and the National Emphysema Treatment Trial (NETT).

Topics and sources of memorable breast cancer messages and their impact on prevention and detection behaviors

Often, people are able to recall a message on a particular topic for a long period of time. These memorable messages have the ability to influence behavior when they are recalled from memory long after initial exposure. Knowing the topics and sources of the messages that are remembered about breast cancer can improve the efficacy of future breast cancer outreach. To this end, 359 women completed an online survey about memorable breast cancer messages. Most women (60%) recalled a memorable message, described it, identified its source, and noted whether it had resulted in prevention or detection behaviors. Four categories of message topics emerged: early detection (37.3%), awareness (30.9%), treatment (25.8%), and prevention (6%). Furthermore, five categories of sources of these memorable messages were found: media (35.5%), friends (22.2%), family (21.6%), medical professionals (15.2%), and others (5.5%). The media were a major source of all four topics of messages, although family members, friends, and the medical community were major sources for particular message topics as well. Memorable messages originating from medical professionals were substantially more likely to motivate detection behaviors than prevention behaviors. This research demonstrates that message topic and source both play roles in determining message recall as well as in determining how memorable messages impacted behavior.

What a Lifespan Approach Might Tell Us about Why Distinct Measures of Social Support have Differential Links to Physical Health

Social support has been reliably related to physical health outcomes. However, an examination of mediators of such links has been slowed by the lack of understanding regarding two complex and related questions: what is social support and what phase of the disease process does it impact? In this paper, I argue for the importance of a lifespan perspective that takes into account distinct antecedent processes and mechanisms that are related to measures of support over time. This view makes clear the need to distinguish measures of perceived and received support and its links to more specific aspects of disease (e.g., acute, chronic, disease incidence). The implications of these theoretical arguments for research on social support and physical health are discussed.

Thrust to Wholeness: The Nature of Self-Protection

Although the literature enlists “self-protection” to explain widely varied behavior (e.g., startle, defense mechanism, hoarding), the concept is not defined, nor are its varied modes classified. Few textbooks even index the term. To help remedy this odd neglect, the author postulated the protective motive as a biologically given “thrust to wholeness,” modified by experience and dependent on social support. Utilizing mechanisms of homeostasis, defense, prevention, healing, and “outreach” (i.e., wholeness expressed), the motive disposes the individual to maintain and express the functional integrity of body and self (including “all that is mine”). Seemingly unrelated phenomena (e.g., immune response, quest for immortality, forgiveness, sharing, urge to procreate) are thus afforded common explanation. Prospectively, the thrust to wholeness affords conceptual unity, parsimony, and pedagogical utility. Also, it may furnish a conceptual anchor for well-being and its paradoxes, self-defeat and suicide.

Conceptualizing changes in behavior in intervention research: the range of possible changes model

An international movement has focused on identifying evidence-based interventions that were developed to change psychological constructs and that are supported by controlled studies. However, inconsistent findings within individual intervention studies and among multiple studies raise critical problems in interpreting the evidence, and deciding when and whether an intervention is evidence-based. A theoretical and methodological framework (Range of Possible Changes [RPC] Model) is proposed to guide the study of change in intervention research. The authors recommend that future quantitative reviews of the research literature use the RPC Model to conceptualize, examine, and classify the available evidence for interventions. Future research should adopt the RPC Model to both develop theory-driven hypotheses and conduct examinations of the instances in which interventions may or may not change psychological constructs.

Unhealthy parenting and potential mediators as contributing factors to future intimate violence: a review of the literature

Efforts to understand and prevent intimate violence have often focused on the intergenerational transmission of intimate violence. Although witnessing and/or experiencing abuse in the family of origin is well supported in the literature as a key component of the intergenerational transmission of intimate violence, there has been less attention to other family-of-origin factors that contribute to or mediate and/or moderate future intimate violence. Particularly, a focus on the effect of parenting on future intimate violence is needed beyond the effect of modeling abusive behavior. In this article, corporal punishment and poor parenting are reviewed as family-of-origin factors related to future intimate violence. In addition, attachment theory, interpersonal skills, and emotional and behavioral regulation and/or conduct disorder are reviewed as variables that may result and mediate the relationship between family-of-origin factors and future intimate violence. Implications for preventing intimate violence by intervening in the family of origin are also identified.

Quality of life as an outcome measure in pulmonary diseases

Chronic obstructive pulmonary disease is a serious debilitating condition that is a major cause of death and disability in the modern world. There is no medical or surgical cure for chronic obstructive pulmonary disease and rehabilitation has become an accepted component of disease management and recommended in practice guidelines. Pulmonary rehabilitation programs are designed to restore patients to their highest level of functioning. Traditional physiological measures of lung function are of limited value in the evaluation of outcomes from rehabilitation and rarely capture the benefits of intervention. This review considers quality-of-life outcome measures. There are 2 major approaches to quality-of-life assessment: psychometric and decision theory. The psychometric approach is used to offer a profile summarizing different dimensions of quality of life. The decision theory approach attempts to weight the different dimensions of health in order to provide a single expression of health status. Measures can be classified as either generic or disease targeted. Generic measures can be used with any population, whereas disease-targeted measures are used for patients with a particular diagnosis. Finally, measures can be categorized by their probable uses. Most measures can be used to characterize populations and to study clinical change. However, only generic, decision theory-based measures can be used to evaluate cost-effectiveness. In this article, we review measures for chronic lung diseases in these different categories and identify those more suitable for particular purposes. We devote particular attention to methods designed for use in cost-effectiveness analysis.

Twenty-first century graduate education in clinical psychology: a four level matrix model

Clinical psychology is positioned to play key roles in mental and physical health issues of 21st century America. In this regard, however, the present Boulder model of educating clinical psychologists is not preparing our graduates to meet the diverse demands of either today's or tomorrow's marketplaces. Accordingly, we introduce a new, four level "matrix model" for the education of future clinical psychologists. The core focus of the proposed matrix model is on the weaknesses and strengths of people in their personalities and their environments. Moreover, this matrix model operates at the individual, interpersonal, institutional, and societal-community levels of analyses. The details and implications of this proposed educational curriculum are described.

Screening for cancer: are resources being used wisely?

Cancer screening is commonly offered in order to detect tumors at an early, treatable stage. These efforts are highly advocated and widely accepted by the general public. However, there is conflicting evidence about the benefits of screening for breast cancer in pre-menopausal women, prostate cancer in older men, and colorectal cancer for both sexes. This paper examines cancer screening in relation to a disease reservoir hypothesis. There is a reservoir of undetected disease that can be found with more aggressive screening. However, much of the disease that is detected may be classified as pseudodisease because it will have no effect of life expectancy or health-related quality of life. Pseudodisease is defined as detectable disease that will never be clinically significant. A second concern about screening is that randomized clinical trials often show benefits of cancer screening for disease-specific endpoints but no benefit for total mortality. Further, screening for some cancers may significantly increase healthcare costs without enhancing population health status. Improvements in biomarkers and in screening methodologies will significantly increase the number of cancers detected. Future research is necessary in order to determine which population-based screening programs are the best use of public health resources.

Diagnostic and treatment decisions in US healthcare

The practice of medicine links diagnosis to treatment. However, for many diagnosed conditions diagnosis and treatment may not affect health outcome. Examples include low-grade cancers that do not influence life expectancy or quality of life. Further, there is considerable uncertainty about the point along a biologic continuum where treatment should begin. Changes in diagnostic thresholds often increase healthcare costs even though the benefit of the treatment is uncertain. Although this uncertainty is understood by the healthcare providers, it often is not shared with patients. We advocate a new paradigm called shared medical decision making that makes uncertainty about diagnosis and treatment transparent to patients and engages them in the treatment decision process.

Evidence-based behavioral medicine: what is it and how do we achieve it?

The goal of evidence-based medicine is ultimately to improve patient outcomes and quality of care. Systematic reviews of the available published evidence are required to identify interventions that lead to improvements in behavior, health, and well-being. Authoritative literature reviews depend on the quality of published research and research reports. The Consolidated Standards for Reporting Trials (CONSORT) Statement (www.consort-statement.org) was developed to improve the design and reporting of interventions involving randomized clinical trials (RCTs) in medical journals. We describe the 22 CONSORT guidelines and explain their application to behavioral medicine research and to evidence-based practice. Additional behavioral medicine-specific guidelines (e.g., treatment adherence) are also presented. Use of these guidelines by clinicians, educators, policymakers, and researchers who design, report, and evaluate or review RCTs will strengthen the research itself and accelerate efforts to apply behavioral medicine research to improve the processes and outcomes of behavioral medicine practice.

Adaptation of a wellness intervention for women with chronic disabling conditions

Women with chronic disabling conditions live with multiple symptoms that decrease their ability to function in society, and they may be at elevated risk for further morbidity with age. Despite research indicating that health-promoting behaviors decrease the risk for further morbidity, few interventions have been designed to help women with chronic disabling conditions promote their health. The purpose of this article is to present the results of a pilot study of a wellness intervention adapted for use with women with fibromyalgia syndrome (FMS). First, the development of the original wellness intervention for women with multiple sclerosis (MS) will be described. Next, the steps taken to adapt the intervention to the needs of women with FMS will be described. Finally, it wil be argued that commonalities in symptoms and social experiences and the universal need for health-promoting skills make this intervention adaptable to multiple groups of women with chronic disabling conditions.

Assessing the costs, benefits, cost-effectiveness, and cost-benefit of psychological assessment: we should, we can, and here's how

To the extent that assessment improves the effectiveness of treatment, prevention, or other services, it can be said to be effective. If an assessment is as effective as alternatives for improving treatment and less costly, it can be said to be cost-effective. If that improvement in the effectiveness of the service is monetary or monetizable, the assessment can be judged beneficial. And, if the sum of monetary and monetizable benefits of assessment exceeds the sum of the costs of treatment, the assessment can be said to be cost-beneficial. An overview of cost-related issues is followed by practical strategies that researchers and administrators can use to measure incremental costs, incremental effectiveness, and incremental benefits of adding psychological assessments to other psychological interventions.

General practice, primary care, and health service psychology: Concepts, competencies, and the Combined-Integrated model

The profession of psychology is being impacted profoundly by broader changes within the national system of health care, as mental and behavioral health services are being recognized as essential components of a comprehensive, preventive, and cost-efficient primary care system. To fully define and embrace this role, the discipline of professional psychology must develop a shared disciplinary identity of health service psychology and a generalized competency-based model for doctoral education and training. This very framework has been adopted by Combined-Integrated (C-I) doctoral programs in professional psychology, which train across the practice areas (clinical, counseling, and school psychology) to provide a general and integrative foundation for their students. Because C-I programs produce general practitioners who are competent to function within a variety of health service settings, this innovative training approach has great potential to educate and train psychologists for a changing health care marketplace.

Prevention Pathways: Application of the Critical Path Methodology in Occupational Health Services

Occupational health services face important changes as a result of changes in work environment, changing health and safety concepts, and legislation. To ensure good quality at a good price, it is important to control the processes in occupational health services. The concept of "prevention pathways" is presented for the management of occupational health services. The model is based on the critical pathway concept. The approach is illustrated by means of a case study performed in a Belgian occupational health service. A prevention pathway for the evaluation of chemical risks at the workplace was constructed. The prevention pathway methodology revealed inefficiencies and quality problems in the current practice of chemical risk assessment and biomonitoring. The case shows how prevention pathways can be used to pilot the members of a multidisciplinary team by focusing on a specific occupational risk.

Eliminating disparities: empowering health promotion within preventive medicine

The estimated 800,000 U.S. deaths in 1990 related to behavioral decisions challenge physicians to better assist behavioral change through expanded health promotion activities. Based on the format guidelines of this special issue, this brief paper first examines the current and optimal roles of health promotion within Preventive Medicine, including five physician roles for improving modifiable public health-risk behavior burdens: (1) preventive services clinician, (2) health promotion researcher, (3) educator-communicator, (4) systems manager, and (5) health promotion advocate. After presenting a new vision statement, this paper proceeds to discuss the opportunities and barriers, including system, clinician-office, and patient factors, to attaining this new vision of empowering health promotion within Preventive Medicine. Finally, all physicians are invited to engage in a threefold strategic plan for change through at least one of five action items: (1) health promotion advocacy, (2) health promotion research, (3) public communication, (4) protocol dissemination and implementation, and (5) Preventive Medicine training.

Dating violence prevention with at-risk youth: a controlled outcome evaluation

This study evaluated a community-based intervention to help at-risk teens develop healthy, nonabusive relationships with dating partners. Participants were 158 14-16-year-olds with histories of child maltreatment who were randomly assigned to a preventive intervention group or a no-treatment control group. They completed measures of abuse and victimization with dating partners, emotional distress, and healthy relationship skills at bimonthly intervals when dating someone. Intervention consisted of education about healthy and abusive relationships, conflict resolution and communication skills, and social action activities. Growth curve analyses showed that intervention was effective in reducing incidents of physical and emotional abuse and symptoms of emotional distress over-time. Findings support involvement of youths in reducing the cycle of violence as they initiate dating in midadolescence.

Social cognitive determinants of physical activity in young adults: a prospective structural equation analysis

This study used a prospective design to test a model of the relation between social cognitive variables and physical activity in a sample of 277 university students. Social support, self-efficacy, outcome expectations, and self-regulation were measured at baseline and used to predict physical activity 8 weeks later. Results of structural equation modeling indicated a good fit of the social cognitive model to the data. Within the model, self-efficacy had the greatest total effect on physical activity, mediated largely by self-regulation, which directly predicted physical activity. Social support indirectly predicted physical activity through its effect on self-efficacy. Outcome expectations had a small total effect on physical activity, which did not reach significance. The social cognitive model explained 55% of the variance observed in physical activity.

The meaning of health and illness: some considerations for health psychology

The importance of understanding individuals’ ideas of health and illness is well acknowledged by research for its theoretical and practical implications for both health psychology and education. Insofar as researchers agree that individuals’ ideas of health and illness have an impact on their health attitudes and behaviour, people’s thoughts of health and health and illness - related issues are increasingly being investigated. In consonance, the objective of this study is to critically review major ideas that underlies individuals’ concepts of health and illness. Findings are discussed in terms of their potential contributions for health psychology.

Complete health: prevalence and predictors among U.S. adults in 1995

PURPOSE

To operationalize, estimate the prevalence, and ascertain the epidemiology of complete health.

DESIGN

Cross-sectional analyses of self-reported survey data collected via a telephone interview and a self-administered questionnaire.

SETTING

Households in the 48 contiguous states in the United States in 1995.

SUBJECTS

Random-digit dialing sample of 3032 adults between the ages of 25 and 74, with a response rate of 61%.

MEASURES

Physical illness and health were measured with a total of 37 items--a checklist of 29 chronic health conditions, a six-item scale of limitations of daily living, and a single item for perceived current health and for perceived 5-year change in energy. Mental illness and health were measured with the Composite International Diagnostic Interview Short Form diagnostic scale of major depression, panic, and generalized anxiety disorders and three established multi-item scales of subjective well-being (emotional, psychological, and social well-being). Completely healthy adults have high levels of physical and mental health and low levels of physical and mental illnesses; completely unhealthy adults have high levels of physical and mental illnesses and low levels of physical and mental health. Incompletely healthy adults consisted of two groups: one group is physically healthy (high physical health and low physical illness) and mentally unhealthy, and the second group is mentally healthy (high mental health and low mental illness) and physically unhealthy.

RESULTS

Nineteen percent of adults were completely healthy, 18.8% were completely unhealthy, and 62.2% had a version of incomplete health. Compared with completely unhealthy adults, completely healthy adults are likely to be young (25-34 years of age) or old (55-64 and 65-74 years), are married, are male, are college educated, and have higher household incomes.

CONCLUSIONS

Operationalizing complete health highlights objectives for increasing the prevalence of complete health, and reducing the prevalence of complete ill-health and incomplete health.