Vignette methodologies for studying clinicians' decision-making: Validity, utility, and application in ICD-11 field studies

Vignette-based methodologies are frequently used to examine judgments and decision-making processes, including clinical judgments made by health professionals. Concerns are sometimes raised that vignettes do not accurately reflect "real world" phenomena, and that this affects the validity of results and conclusions of these studies. This article provides an overview of the defining features, design variations, strengths, and weaknesses of vignette studies as a way of examining how health professionals form clinical judgments (e.g., assigning diagnoses, selecting treatments). As a "hybrid" of traditional survey and experimental methods, vignette studies can offer aspects of both the high internal validity of experiments and the high external validity of survey research in order to disentangle multiple predictors of clinician behavior. When vignette studies are well designed to test specific questions about judgments and decision-making, they can be highly generalizable to "real life" behavior, while overcoming the ethical, practical, and scientific limitations associated with alternative methods (e.g., observation, self-report, standardized patients, archival analysis). We conclude with methodological recommendations and a description of how vignette methodologies are being used to investigate clinicians' diagnostic decisions in case-controlled field studies for the ICD-11 classification of mental and behavioural disorders, and how these studies illustrate the preceding concepts and recommendations.

Minors' attitudes toward peers with asthma: a developmental study

OBJECTIVE

Peers can play a critical role in asthma management, with attitudes toward friends with asthma hindering or supporting self-management. We explored minors' attitudes toward peers with asthma, testing if attitudes varied by grade, sex, asthma knowledge, and asthma status.

METHODS

Three hundred and eighty-one students in grades 5-11 (51% female; 51% White, non-Hispanic; 12% with asthma) read five vignettes about peers with asthma, and rated the characters on 10 adjective pairs (e.g., afraid/brave and sad/happy). Three vignettes portrayed an aspect of uncontrolled asthma (asthma-related school absence, asthma-related limited physical activity, and asthma-related school nurse visit). One vignette depicted controlled asthma; one described taking medication publically. We computed a total attitude score for each vignette and a mean attitude score across the three uncontrolled vignettes. Linear regression analyses tested the effect of each predictor (grade, sex, asthma knowledge, and asthma status) on attitudes, as well as the interaction of asthma status with the remaining three predictors.

RESULTS

Grade was the most robust predictor. Participants in higher grades tended to have more favorable attitudes toward peers with asthma, except for the controlled asthma vignette where participants in lower grades had more favorable attitudes. There were significant interactions between grade and asthma status for the stop-running-and-taking-medication-publically vignettes: among those with asthma, participants in higher grades had more favorable attitudes. Sex interacted with asthma status for the overall uncontrolled, absence, and stop-running vignettes; among those with asthma, girls had more favorable attitudes.

CONCLUSION

With increased grade, minors have better attitudes toward peers with asthma. Living with asthma may normalize asthma. Clinicians can use grade-specific findings to counsel patients.

Practitioner perceptions of peer relationships in adolescents with chronic pain

Nine practitioners who specialize in the treatment of adolescents with chronic pain were interviewed on their perceptions of the adolescents' peer functioning. A qualitative analysis based on Consensual Qualitative Research (CQR) was used. Practitioners generally reported a decline in the adolescents' peer functioning. However, if adolescents had good peer relationships prior to pain onset, they tended to maintain adequate functioning in the social arena while experiencing chronic pain. Practitioners noted that avoidance of peers was a strategy used by adolescents, due more to the pain than social competence issues. They also suggested that adolescents who felt comfortable disclosing pain status, likely to be consistent with good social skills, benefited from peer support. Implications for practice and research are discussed.

Children's attitudes toward people with AIDS in Puerto Rico: exploring stigma through drawings and stories

AIDS stigma refers to prejudice and discrimination directed at people or groups perceived to have HIV/AIDS (Herek, 1999). Although AIDS stigma has been found in adolescent and adult populations, few researchers have explored it among children. Misconceptions about people with AIDS (PWA) might lead to negative attitudes toward PWA and obstruct HIV prevention efforts. The authors assessed 110 Puerto Rican children's attitudes toward PWA using drawings (n=65) and stories (n=45). Although participants held stigmatizing attitudes toward PWA across both methods, the approaches captured different beliefs and attitudes. Drawings depicted PWA as physically deteriorated and performing socially condemned behaviors, whereas stories describing PWA highlighted children's fear of contagion and death. Stigma toward PWA was more pronounced than toward other illnesses (e.g., cancer). The study highlights the importance of assessing children's attitudes through creative data collection procedures.

Peer victimization and psychosocial adjustment in children with type 1 diabetes

This study investigated the frequency and psychosocial correlates of peer victimization in a sample of youths with diabetes. The Social Experience Questionnaire, Children's Depression Inventory, Social Anxiety Scale for Children-Revised, and Asher Loneliness Scale were administered to 32 children diagnosed with type 1 diabetes and 32 control children without a medical diagnosis who were matched for age and gender. Results indicated that children with diabetes reported higher rates of relational victimization and lower levels of prosocial peer support than youths without diabetes. In addition, relational victimization was positively associated with depression, social anxiety, and loneliness for diabetic children. Implications of these findings for clinicians working with this population are discussed.

The role of personal contact with HIV-infected people in explaining urban, African American preadolescents' attitudes toward peers with HIV/AIDS

This article presents the results of a study aimed at describing African American youths' attitudes toward peers with HIV/AIDS and identifying correlates of these attitudes based on the contact theory. Baseline data from a sample of African American, urban mothers and their youth (n = 197) participating in a family-based HIV prevention program were analyzed. In support of contact theory, preadolescents' close relationship to persons infected with HIV/AIDS was highly related to their attitudes. However, no relationship was found between maternal attitudes or communication variables and youth attitudes. The implications of youths' experience with persons with HIV/AIDS as part of prevention programming are discussed.