Contextual influences in decoding pain expressions: effects of patient age, informational priming, and observer characteristics

Evaluating gender awareness, gender-related health knowledge and patient pain legitimation among nursing students: A quasi-experimental study

The aim of the study was to measure the associations between and the evolution of gender awareness, gender-related health knowledge and patient pain legitimation among nursing students.

BACKGROUND

Evidence indicates that gender equity skills are still lacking among nurses. Indeed, several studies report gender-biased patient assessment and care, arguing that greater attention should be paid to the gender perspective at university, in order to train nurses who are sensitive to this issue. Recently, certain gender perspective measurement scales have been adapted to the nursing population, offering new opportunities for the educational field.

DESIGN

A quasi-experimental study was used for this study.

METHODS

This study was conducted in the second semester of the first year of the Nursing Degree run by the University of the Basque Country. A sample of 103 students enrolled in the Anthropology, Ethics and Legislation module completed the Nijmegen Gender Awareness in Medicine Scale, the Pain Legitimation Scale and the Gender Perspective Health Knowledge Scale before and after the second semester, during which part of the syllabus focused on developing gender equity skills. Data were collected between January - April 2022.

RESULTS

We found positive correlations between gender-related health knowledge and pain legitimation at post-test, and between said knowledge and gender sensitivity at both pre- and post-test (p < 0.05). The repeated measures indicated that traditional expositive teaching did not increase overall scores for gender awareness, gender-related health knowledge or pain legitimation.

CONCLUSIONS

The results suggest that gender-related health knowledge may be a key modifiable factor that leads to enhanced gender awareness in dealings with patients. However, traditional expositive lectures were not enough to produce a robust increase in gender awareness, pain legitimation or gender-related health knowledge levels. The effectiveness of active teaching methodologies should be tested, in order to help nursing students strengthen their resistance to clinical gender stereotypes and become active assets in the move from inequality to equity.

Perception of typical migraine images on the internet: Comparison between a metropolis and a smaller rural city in Germany

The medial portrayal of migraine is often stereotypical and inaccurate but reflects how society perceives migraine. The discrepancy between others' views and the reality of affected individuals may negatively affect access to treatment and the disease course of patients with migraine. This study aimed to investigate whether images presented in the media as typical migraine attacks are perceived as realistic and representative by migraine patients in Rostock, a smaller town in rural Germany, and compare the results to those from Berlin, a large metropolis. We performed an online survey in Rostock. Migraine patients were shown ten images of migraine attacks, which were among the most downloaded stock pictures on the internet under the search term "migraine". They rated on a scale of 0-100 to what extent the pictures were realistic for migraine attacks (realism score), representative of their own migraine (representation score), or the society's view of migraine (society score). In addition, we compared our results with a recently published study from the metropolitan region of Berlin. A total of 174 migraine patients completed our survey. Mean (SD) realism, representation, and society scores were 59.9 (17.5), 56.7 (18.3), and 58.4 (17.1) respectively. Images of older patients were perceived as significantly more realistic and representative than those of younger patients (P < .001). Patients in Rostock (rural region) rated the images as significantly more realistic and representative than survey participants in Berlin (metropolis). Migraine patients in a rural region found typical migraine images only moderately realistic and representative but to a higher degree than their counterparts from a metropolis.

Criminality labelling influences reactions to others' pain

Disparities in healthcare for underrepresented and stigmatized groups are well documented. Current understanding is that these inequalities arise, at least in part, from psychosocial factors such as stereotypes and in-group/out-group categorization. Pain management, perhaps because of the subjective nature of pain, is one area of research that has spearheaded these efforts. We investigated how observers react to the pain of individuals labelled as criminals. Face models expressing pain of different levels of intensity were portrayed as having committed a crime or not (control group). A sample of n = 327 college students were asked to estimate the intensity of the pain expressed by face models as well as their willingness to help them. Trait empathy was also measured. Data was analyzed using regression, mediation and moderation analyses. We show for the first time that observers were less willing to help individuals with a criminal history. Moreover, a moderation effect was observed whereby empathic participants were more willing to help control face models compared to less empathic participants. However, criminality history did not influence participant's pain estimation. We conclude that negative stereotypes associated with criminality can reduce willingness to help individuals in pain even when pain signals are accurately perceived.

Unique Pain Responses in Different Etiological Subgroups of Intellectual and Developmental Disabilities

We studied whether there exist variations in pain responses between different intellectual and developmental disability (IDD) etiologies. Self-reports and facial expressions (Facial Action Coding System = FACS) were recorded during experimental pressure stimuli and compared among 31 individuals with IDD-13 with cerebral palsy (CP), nine with Down syndrome (DS), nine with unspecified origin (UIDD)-and among 15 typically developing controls (TDCs). The CP and DS groups had higher pain ratings and FACS scores compared to the UIDD and TDC groups, and steeper stimulus-response functions. The DS group exhibited the most diverse facial expressions. There were variations in the foci of facial expressions between groups. It appears that different IDD etiologies display distinct pain responses.

An Eye Tracking Investigation of Pain Decoding Based on Older and Younger Adults' Facial Expressions

Nonverbal pain cues such as facial expressions, are useful in the systematic assessment of pain in people with dementia who have severe limitations in their ability to communicate. Nonetheless, the extent to which observers rely on specific pain-related facial responses (e.g., eye movements, frowning) when judging pain remains unclear. Observers viewed three types of videos of patients expressing pain (younger patients, older patients without dementia, older patients with dementia) while wearing an eye tracker device that recorded their viewing behaviors. They provided pain ratings for each patient in the videos. These observers assigned higher pain ratings to older adults compared to younger adults and the highest pain ratings to patients with dementia. Pain ratings assigned to younger adults showed greater correspondence to objectively coded facial reactions compared to older adults. The correspondence of observer ratings was not affected by the cognitive status of target patients as there were no differences between the ratings assigned to older adults with and without dementia. Observers' percentage of total dwell time (amount of time that an observer glances or fixates within a defined visual area of interest) across specific facial areas did not predict the correspondence of observers' pain ratings to objective coding of facial responses. Our results demonstrate that patient characteristics such as age and cognitive status impact the pain decoding process by observers when viewing facial expressions of pain in others.