Provision of online eye movement and desensitisation therapy (EMDR) for people with post-traumatic stress disorder (PTSD): a multi-method service evaluation

Background: The evidence for the effectiveness of online EMDR for PTSD is scarce.Objective: This service evaluation aimed to assess how online EMDR compared to in-person EMDR, in terms of its potential effectiveness and acceptability to therapists and patients.Method: The evaluation was carried out in the Cardiff and Vale University Health Board Traumatic Stress Service. We compared the outcome of therapy (PTSD scores at end of treatment), number of sessions, drop-out rate, and adverse events using linear/logistic regression in those receiving online EMDR over a 12-month period with those who had received in-person therapy in the year previous to that. Interviews with therapists and clients who had provided or undertaken online EMDR explored their views and experiences of treatment. Interviews were analysed thematically.Results: 33 people received in-person EMDR (15.3 sessions, SD = 1.4), and 45 received online EMDR (12.4 sessions, SD = 0.9). 24 individuals completed therapy in-person, and 32 online. There was no evidence of a difference in therapy completion, drop-out rates or adverse events between the two delivery modes. There was weak evidence that those who completed EMDR online and had available data (N = 29), had slightly lower PTSD scores at the end of therapy compared to those who received in-person EMDR (N = 24) (17.1 (SD = 3.2) versus 24.5 (SD = 3.0), mean difference = 7.8, 95% CI -0.3, 15.9, p = .06). However, groups were not randomised and only those who completed treatment were analysed, so estimates may be biased. 11 patients and five therapists were interviewed. Overall, both therapists and clients viewed online EMDR as safe and effective. Benefits mentioned by clients included feeling more in control and not having to travel. Clients' concerns related to lack of privacy and 'transition time/space' between therapy and their daily lives.Conclusion: Results suggest that online EMDR is an acceptable, safe and effective alternative to in-person EMDR for PTSD in this service.

Finding a path in a methodological jungle: a qualitative research of resilience

Qualitative research provides an in-depth understanding of lived experiences. However, these experiences can be hard to apprehend by using just one method of data analysis. A good example is the experience of resilience. In this paper, the authors describe the chain of the decision-making process in the research of the construct of "resilience". s The authors justify the implications of a multi-method, pluralistic approach, and show how the triangulation of two or more qualitative methods and integration of several qualitative data analysis methods can improve a deeper understanding of the resilience among people with chronic pain. By combining the thematic analysis, narrative analysis, and critical incident technique, lived experiences can be seen from different perspectives.Therefore, the thematic analysis describes the content and answers to "what" regarding resilience, the narrative analysis describes the dynamics of resilience, and answers to "how", while the critical incident technique clarifies the most significant experience and the answers to "why" changes happen. This integrative approach could be used in the analysis of other psychological constructs and can serve as an example of how the rigour of qualitative research could be provided.

Comparing Measures of Criterion A to Better Understand Incremental Validity in the Alternative Model of Personality Disorders

The Alternative Model of Personality Disorders distinguishes between the severity of personality dysfunction (Criterion A) and individual differences in personality disorder expression (Criterion B). Several Criterion A measures exist, but few studies have compared these measures with each other. Moreover, debates about whether the constructs of Criteria A and B are redundant (i.e., weak incremental validity) should be framed around how different Criterion A measures perform relative to others. This study of 204 undergraduate students evaluated multiple measures of Criterion A. These measures were strongly correlated with Criterion B, but evidenced incremental validity (39% of outcomes, 5% average additional variance explained) with outcomes of psychopathology and interpersonal impairments, and less consistent incremental validity with suicidality, aggression, and mental health utilization. We discuss how these results inform the construct of Criterion A relative to Criterion B and evaluate strengths/weaknesses of Criterion A measures.

A multi-method study identifying and describing areas of concern for patients during the first month after colorectal cancer surgery

AIM

Identify and describe areas of concern focusing on day-to-day variations during the first month after surgery for patients recovering from colorectal cancer surgery.

DESIGN

A multi-method design was applied using diaries and interviews.

METHOD

Data was collected using semi-structured diaries kept 1 month after surgery by seven patients recovering from colorectal cancer surgery. Also, face-to-face interviews were conducted 1 month after surgery. Data from the diaries constituted a framework for the following directed content analysis of interviews.

FINDINGS

Low levels of pain were experienced but caused reduced mobility and tiredness. Practical matters in daily living were restricted, while social life could be hampered by a frequent need to defecate. Appetite and consequently the ability to eat and drink was the most prominent concern, due to changes in taste and ability to tolerate food. Worries were mainly related to changes in bowel movements. No Patient or Public Contribution.

A Multi-Method Approach to Addressing the Toddler Data Desert in Attention Research

Visual attention skills undergo robust development change during infancy and continue to co-develop with other cognitive processes in early childhood. Despite this, this is a general disconnect between measures of the earliest foundations of attention during infancy and later development of attention in relation to executive functioning during the toddler years. To examine associations between these different measures of attention, the current study administered an oculomotor task (infant orienting with attention, IOWA) and a manual response (Flanker) task with a group of toddlers. We collected simultaneous neural recordings (using functional near-infrared spectroscopy), eye-tracking, and behavioral responses in 2.5- and 3.5-year-olds to examine the neural and behavioral associations between these skills. Results revealed that oculomotor facilitation in the IOWA task was negatively associated with accuracy on neutral trials in the Flanker task. Second, conflict scores between the two tasks were positively associated. At the neural level, however, the tasks showed distinct patterns of activation. Left frontal cortex was engaged during the Flanker task whereas right frontal and parietal cortex was engaged during the IOWA task. Activation during the IOWA task differed based on how well children could control oculomotor behavior during the task. Children with high levels of stimulus reactivity activated parietal cortex more strongly, but children with more controlled oculomotor behavior activated frontal cortex more strongly.

Effective practices for improving service professionals' ethical behaviors: A multiple method study

Introduction

Enhancing frontline professional service employees' ethics has been an increasingly important issue for organizations in sustaining their reputation and long-term profitability. While many organizations have implemented general ethics programes such as ethics codes and ethical training, unethical scandals regularly still appear in many service organizations. This research offers new insights into the practices that can effectively enhance marketing practitioners' ethical behaviors and the pertinent contextual factors that have a bearing on the effectiveness of ethics programes.

Methods

It uses a multi-method methodology to conduct two studies in the Chinese banking setting. Based on the rank of revenue and profitability published by Fortune magazine of year 2021, in Study 1, we choose five main Chinese banking organizations to conduct case studies to explore the framework of effective ethics programes of banks. In Study 2 we use the valid instruments from the literature to measure the involved constructs and employs data from randomly selected 146 frontline banking teams in five main Chinese banking organizations to examine the effectiveness of three specific ethics practices and ascertain the moderating role of role stress in such effectiveness.

Results and discussion

Our findings indicate the effective behavior control practices within organizations' ethics programes and the implications of having a stressful workplace when adopting such practices. In addition, we integrate organizational concepts regarding behavior control and employee ethics, and use two empirical methods to systematically explore the effectiveness of ethics programes. This paper advances the management and marketing literature and has significant managerial implications for improving frontline service professionals' ethical behaviors.

Qualitative evaluation of the symptoms and quality of life impacts of long-chain fatty acid oxidation disorders

BACKGROUND

Long-chain fatty acid oxidation disorders (LC-FAOD) are a group of rare autosomal-recessive genetic disorders characterized by metabolic deficiencies in which the body is unable to convert long-chain fatty acids into energy. To date, however, there is limited understanding of the patient experience of LC-FAOD.

METHODS

The symptoms, observable signs, and quality of life (QoL) impacts associated with LC-FAOD were explored via a focus group (n = 8) and semi-structured interviews (n = 6) with patients and caregivers of patients with LC-FAOD, and interviews (n = 4) with expert clinicians. Data were analyzed via thematic analysis and summarized in a conceptual model.

RESULTS

Participants reported a wide range of signs and symptoms associated with LC-FAOD, broadly categorized as musculoskeletal, endocrine/nutritional/metabolic, neurological, gastrointestinal/digestive, sensory, cardiovascular, respiratory, urological, and constitutional. LC-FAOD were reported to have a significant impact on various aspects of patients' lives including physical functioning, participation in daily activities, emotional/psychological wellbeing, and social functioning. Lifestyle modifications (such as diet and exercise restrictions) were necessary because of the condition. Symptoms were typically episodic in presentation often arising or exacerbated during catabolic conditions such as prolonged exercise, fasting, physiological stress, and illness/infection. Symptoms were also commonly reported to lead to emergency room visits, hospitalization, and clinical complications.

CONCLUSION

LC-FAOD have a considerable impact on patients' lives. There is a high degree of concordance in the signs, symptoms, and impacts of LC-FAOD reported by patients, caregivers, and clinicians; however, there were many symptoms and impacts that were only reported by patients and caregivers, thus demonstrating that insights from patient/caregiver experience data are integral for informing medical product development and facilitating patient-centered care.

Wellbeing and Work Design in Brazilian Teleworkers

Studies suggest that work characteristics may be related to workers' wellbeing. However, little is known about how these work characteristics may influence telework wellbeing in the face of the long period of social isolation and restrictions imposed by COVID-19. This study aimed to relate work characteristics in remote work to wellbeing using a two-stage multi-method approach. The general hypothesis is that different work characteristics will be organized into different groups and related to wellbeing. In Step 1, 108 teleworkers who participated in compulsory telework conditions answered the Work Design Questionnaire (WDQ) and Wellbeing at Work scale. A cluster analysis was conducted in which two clusters emerged based solely on their valence. The variables that contributed most to the cluster were: feedback from the job, social support, problem-solving, and decision and execution autonomy. Cluster 1 aggregated higher scores on work characteristics, and Cluster 2, lower scores. Cluster 1 presented significantly higher scores on wellbeing. In Step 2, 27 of these workers were blindly interviewed. Five classes of words emerged from the interviews: Class 1 - wellbeing, Class 2 - work dissatisfaction lexicon, Class 3 - role clarity, Class 4 - job demands, and Class 5 - job resources, including receiving feedback, conversations, praise, and support. Chi-square analysis suggests significant differences in classes 2, 3, 4, and 5. Cluster 1 appears more frequently in the role clarity class and less frequently in the work dissatisfaction and job demands classes. Cluster 2 is more frequent in the job dissatisfaction and job demands classes, however, less frequent in the job resources class. Class 1 shows no significant difference. These results partially support the general hypothesis that different work characteristics will be organized into different clusters and related to the teleworker's wellbeing, but in the sense that it prevents suffering but does not necessarily promote wellbeing. The results contribute to the understanding of the relationship between work characteristics and wellbeing during the pandemic by using a different methodological approach, describing that work feedback, social support, skill variety, and problem-solving are the most significant in differentiating the perception of the groups. Social support and feedback from the job differentiate cluster 1 from cluster 2, but social support is not able to increase wellbeing, unless buffering unwellness.

A Multi-Theoretical and Multi-Method Family Study Approach to Preschool Inhibitory Control: Links to Working Memory, Receptive Vocabulary, Behavioral Maladjustment, and Parent Mental Health in the Context of Temperament and Executive Functioning Perspectives

Inhibitory control (IC) is defined as the executive functioning (EF) and self-regulatory temperamental inhibition of impulsive or pre-potent behavior and has been consistently linked to multiple forms of childhood cognitive and socio-emotional maladjustment including academic and learning challenges, externalizing behaviors, and attention deficit hyperactivity disorder. However, the results of relevant investigations are somewhat dependent on the method of IC assessment and the theoretical approach of the researcher. The two primary theoretical perspectives on IC are the temperament and the EF approaches, and although there is considerable overlap between these perspectives, there are some distinctions with regard to assessment and emphases on cognition vs. emotion. Therefore, investigations including both temperament and EF approaches to IC are of considerable interest and will best inform future education, prevention, and intervention efforts. This investigation examined associations between child IC, working memory (WM), receptive vocabulary, externalizing behavioral problems, and primary caregiver depression and anxiety symptoms using a family study design. The sample was composed of 99 families with two typically developing preschool children (n = 198; 2.5-5.5 years old; M = 3.88, SD = 1.04) and one primary caregiver/parent. Child IC was assessed using a multi-method approach consisting of one parent-rated questionnaire, three independent observer rating subscales, two videotaped in-person laboratory temperament episodes, and an EF Stroop task. Child WM and receptive vocabulary were measured in the laboratory using standard assessment techniques, and the remaining measures were parent-reported. Male child participants had significantly higher levels of observer-rated hyperactivity and impulsivity, and females had higher levels of observer-rated attention and Stroop-assessed IC. Correlational results showed that excepting IC-Stroop and a snack delay task, all IC measures were significantly correlated. All IC measures except snack delay were positively correlated with WM, and with receptive vocabulary (except Lab-TAB snack delay and observer-rated hyperactivity), and WM and receptive vocabulary were also positively correlated. All IC variables, WM, and receptive vocabulary were significantly related to externalizing behavior problems. Generally, children with higher IC, WM, and receptive vocabulary had lower levels of behavioral maladjustment. Lower parent-rated IC and higher levels of externalizing behavior problems were positively associated with maternal depression and anxiety (lower receptive vocabulary level was related to depression only). Employing structural equation modeling (SEM) analyses, we further examined the interrelationships among IC temperament variables, IC-Stroop, WM, and receptive vocabulary, controlling for age, gender, externalizing behaviors, maternal depression and anxiety, and the parent-rater variance (the multi-method effect). The results of our hypothesized model showed that the IC Temperament factor, composed of the six temperament IC measures, showed a positive effect on receptive vocabulary, while the IC-Stroop positively predicted WM. The IC Temperament factor and IC-Stroop were positively correlated with each other, and the IC Temperament factor, IC-Stroop, WM, and receptive vocabulary were positively related to age. The IC Temperament factor was also associated with fewer externalizing behavior problems, maternal depression had a negative effect on receptive vocabulary, and females showed lower levels of WM and receptive vocabulary than males. Overall, the IC Temperament factor and other covariates together accounted for 22.5% of the variance in vocabulary, whereas IC-Stroop and other controlled variables could explain 49.8% of the variance in WM. These findings indicate that theoretical perspectives (in this case temperament and EF IC contexts) and the different types of assessments used are crucial considerations when interpreting the results of studies of early childhood IC. Although most assessments of IC were associated with the outcomes under study, we found specific associations between temperament measures of IC and receptive vocabulary as well as externalizing, and IC-Stroop and WM. In addition, maternal depression had an effect on receptive vocabulary, emphasizing the developmental importance of family environment in preschool. These findings are relevant to the field of child development because they address several important questions about child EF and self-regulation. 1. Do temperament and EF conceptions of IC differentially predict outcomes? 2. How does the way we measure IC from the EF and self-regulation/temperament perspectives impact our conceptualizations of these important constructs? 3. How can we reconcile the various ways different disciplines define IC and their independence/overlap? 4. How can multi-method and multi-disciplinary perspectives and data collection approaches be combined to better understand both the temperament and EF conceptions of IC? Future studies with this sample will employ this multi-theoretical and multi-method approach on assessment in preschool to predict temperament, EF, and behavioral and academic adjustment in elementary school longitudinally.

The perceptions of translation apps for everyday health care in healthcare workers and older people: A multi-method study

AIMS AND OBJECTIVES

To understand the attitudes and perceptions of older people with limited English proficiency (LEP) and healthcare workers to using mobile translation technology for overcoming language barriers in the healthcare setting.

BACKGROUND

Australia's cohort of people aged 65 and over has a sizeable population with LEP. In healthcare settings, difficulties with communication may potentially result in inadequate care. Mobile language translation applications have been identified as a potential way to improve communication between patients and healthcare staff when used as an adjunct to professional interpreters in low-risk scenarios; however, the perceptions of the use of mobile translation applications for such communication is unknown.

METHODS

A multi-method design was used. Focus group discussions were conducted with older people from culturally and linguistically diverse (CALD) backgrounds and nursing and allied health professionals to understand their perceptions of translation technology. Qualitative data were analysed using inductive content analysis. Qualitative findings were reported using the Standards for Reporting of Qualitative Research (SRQR) checklist. Participants also appraised three existing translation apps via survey and results were analysed using descriptive statistics.

RESULTS

Overall, older people from CALD backgrounds (n = 12) and healthcare staff (n = 17) agreed that translation technology could play a role in reducing communication barriers. There was enthusiasm amongst older people to learn and use the technology, while healthcare staff saw the potential to address communication barriers in their own work. Barriers identified by older people and healthcare staff included: accuracy of translation and phrases, possible technological learning curves, risk of mistranslation in high-risk conversation and inability to check accuracy of translation. Fixed-phrase translation apps were seen as more favourable than real-time voice-to-voice mobile translation applications.

CONCLUSIONS

Older people from CALD backgrounds and healthcare staff were open to the use of mobile translation applications for everyday healthcare communications.

RELEVANCE TO CLINICAL PRACTICE

Translation applications may have a role in reducing language barriers in everyday healthcare communication but context, accuracy and ease of use need to be considered.

Understanding usual care in randomised controlled trials of complex interventions: A multi-method approach

BACKGROUND

Evaluations of complex interventions compared to usual care provided in palliative care are increasing. Not describing usual care may affect the interpretation of an intervention's effectiveness, yet how it can be described remains unclear.

AIM

To demonstrate the feasibility of using multi-methods to describe usual care provided in randomised controlled trials (RCTs) of complex interventions, shown within a feasibility cluster RCT.

DESIGN

Multi-method approach comprising usual care questionnaires, baseline case note review and focus groups with ward staff completed at study end. Thematic analysis of qualitative data, descriptive statistics of quantitative data, followed by methodological triangulation to appraise approach in relation to study aim.

SETTING/PARTICIPANTS

Four general medical wards chosen from UK hospitals. Purposive sampling of healthcare professionals for usual care questionnaires, and focus groups. Review of 20 patients' notes from each ward who died during admission or within 100 days of discharge.

RESULTS

Twenty-three usual care questionnaires at baseline, two focus groups comprising 20 healthcare professionals and 80 case note reviews. Triangulation of findings resulted in understanding the usual care provided to the targeted population in terms of context, structures, processes and outcomes for patients, families and healthcare professionals. Usual care was described, highlighting (1) similarities and embedded practices, (2) heterogeneity and (3) subtle changes in care during the trial within and across sites.

CONCLUSIONS

We provide a feasible approach to defining usual care that can be practically adopted in different settings. Understanding usual care enhances the reliability of tested complex interventions, and informs research and policy priorities.

A multi-method and multi-informant approach to assessing post-traumatic stress disorder (PTSD) in children

Trauma exposure is highly prevalent among children globally, and is associated with elevated rates of PTSD. The goal of this study was to systematically evaluate the effects of multiple informants and multiple screening measures on the identification of specific PTSD symptoms and rates of PTSD diagnoses. Participants in this study included 350 maltreated children from two cohorts, one recruited from Connecticut (n = 130), and the other from Vermont (n = 220). Both cohorts completed the Screen for Child Anxiety-Related Emotional Disorders (SCARED) before a PTSD self-report measure. The KSADS psychiatric interview was also completed with the Connecticut cohort, with best-estimate ratings generated using parent and child interview, child self-report, and teacher questionnaire data. In addition to the SCARED and PTSD self-report scale, parents of the Vermont cohort completed the Child Behavioural Checklist. Significant differences emerged between parent and child report of sleep, nightmares, concentration, and irritability problems, suggesting the need for multiple informants in PTSD screening. Children also under-reported nightmares when asked in the context of a trauma-specific screening tool. As child trauma is associated with a broad range of psychiatric sequelae, comprehensive assessment using both general symptomatology and trauma-specific measures is recommended, since children often shut down when completing trauma measures.

State-Level Impulsivity, Affect, and Alcohol: A Psychometric Evaluation of the Momentary Impulsivity Scale Across Two Intensive Longitudinal Samples

We reexamined the psychometric properties of the Momentary Impulsivity Scale (MIS) in two young adult samples using daily diary (N=77) and ecological momentary assessment (N=147). A one-factor between- and within-person structure was supported, though "I felt impatient" loaded poorly within-person. MIS scores consistently related to emotion-driven trait impulsivity; however, MSSDs of MIS scores were unrelated to outcomes after accounting for aggregate MIS scores. We observed positive, within-person correlations with negative, but not positive, affect. Between-person MIS scores correlated with alcohol problems, though within-person MIS-alcohol relations were inconsistent. MIS scores were unrelated to laboratory-based impulsivity tasks. Findings inform the assessment of state-level impulsivity in young adults. Future research should prioritize expanding the MIS to capture the potential multidimensionality of state-level impulsivity.

Incorporating neurophysiological measures into clinical assessments: Fundamental challenges and a strategy for addressing them

Recent scientific initiatives have called for increased use of neurobiological variables in clinical and other applied assessments. However, the task of incorporating neural measures into psychological assessments entails significant methodological challenges that have not been effectively addressed to date. As a result, neurophysiological measures remain underutilized in clinical and applied assessments, and formal procedures for integrating such measures with report-based measures are lacking. In this article, we discuss major methodological issues that have impeded progress in this direction, and propose a systematic research strategy for integrating neurophysiological measures into psychological assessment protocols. The strategy we propose is an iterative psychoneurometric approach that provides a means to establish multimethod (MM) measurement models for core biobehavioral traits that influence functioning across diverse areas of life. We provide a detailed illustration of a MM model for one such trait, inhibitory control (inhibition-disinhibition), and highlight work being done to develop counterpart models for other biobehavioral traits (i.e., threat sensitivity, reward sensitivity, affiliative capacity). We discuss how these measurement models can be refined and extended through use of already existing data sets, and outline steps that can be taken to establish norms for MM assessments and optimize the feasibility of their use in everyday practice. We believe this model-oriented strategy can provide a viable pathway toward effective use of neurophysiological measures in routine clinical assessments. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Longitudinal Validity and Reliability of Brief Smartphone Self-Monitoring of Diet, Stress, and Physical Activity in a Diverse Sample of Mothers

Background

Multiple strategies can be used when self-monitoring diet, physical activity, and perceived stress, but no gold standards are available. Although self-monitoring is a core element of self-management and behavior change, the success of mHealth behavioral tools depends on their validity and reliability, which lack evidence. African American and Latina mothers in the United States are high-priority populations for apps that can be used for self-monitoring of diet, physical activity, and stress because the body mass index (BMI) of mothers typically increases for several years after childbirth and the risks of obesity and its’ sequelae diseases are elevated among minority populations.

Objective

To examine the intermethod reliability and concurrent validity of smartphone-based self-monitoring via ecological momentary assessments (EMAs) and use of daily diaries for diet, stress, and physical activity compared with brief recall measures, anthropometric biomeasures, and bloodspot biomarkers.

Methods

A purposive sample (n=42) of primarily African American (16/42, 39%) and Latina (18/42, 44%) mothers was assigned Android smartphones for using Ohmage apps to self-monitor diet, perceived stress, and physical activity over 6 months. Participants were assessed at 3- and 6-month follow-ups. Recall measures included brief food frequency screeners, physical activity assessments adapted from the National Health and Nutrition Examination Survey, and the nine-item psychological stress measure. Anthropometric biomeasures included BMI, body fat, waist circumference, and blood pressure. Bloodspot assays for Epstein–Barr virus and C-reactive protein were used as systemic load and stress biomarkers. EMAs and daily diary questions assessed perceived quality and quantity of meals, perceived stress levels, and moderate, vigorous, and light physical activity. Units of analysis were follow-up assessments (n=29 to n=45 depending on the domain) of the participants (n=29 with sufficient data for analyses). Correlations, R² statistics, and multivariate linear regressions were used to assess the strength of associations between variables.

Results

Almost all participants (39/42, 93%) completed the study. Intermethod reliability between smartphone-based EMAs and diary reports and their corresponding recall reports was highest for stress and diet; correlations ranged from .27 to .52 (P<.05). However, it was unexpectedly low for physical activity; no significant associations were observed. Concurrent validity was demonstrated for diet EMAs and diary reports on systolic blood pressure (r=−.32), C-reactive protein level (r=−.34), and moderate and vigorous physical activity recalls (r=.35 to.48), suggesting a covariation between healthy diet and physical activity behaviors. EMAs and diary reports on stress were not associated with Epstein–Barr virus and C-reactive protein level. Diary reports on moderate and vigorous physical activity were negatively associated with BMI and body fat (r=−.35 to −.44, P<.05).

Conclusions

Brief smartphone-based EMA use may be valid and reliable for long-term self-monitoring of diet, stress, and physical activity. Lack of intermethod reliability for physical activity measures is consistent with prior research, warranting more research on the efficacy of smartphone-based self-monitoring of self-management and behavior change support.

The Effects of Leadership and Job Autonomy on Vitality: Survey and Experimental Evidence

Vitality refers to the experience of having energy available to one's self. Vital employees are full of positive energy when they work, and feel mentally and physically strong. Such employees often show higher job performance and lower stress than their less vital colleagues. Despite the importance of vitality, few public administration studies have studied vitality. More generally, by focusing on vitality, we aim to bring a "positive psychology" perspective into the domain of public administration. We analyze whether two important job characteristics (leader's task communication and job autonomy) affect vitality. We use a multi-method design. A large-scale survey (N = 1,502) shows that leader's task communication and job autonomy are positively related to vitality. A lab experiment (N = 102) replicated these findings, showing cause-and-effect relationships. In conclusion, public organizations can potentially increase employee vitality (a) by increased task communication from leaders and (b) by providing employees with greater job autonomy.

An exploration of men's knowledge, attitudes, and perceptions of HIV, HIV risk, and willingness to test for HIV in Yendi District, Northern Ghana

We explored men's HIV knowledge, perceptions of HIV risk, and willingness to test for HIV in preparation for the initiation of formalized voluntary counseling and testing (VCT) services at Yendi Hospital in Yendi District, Ghana. A multi-method approach was used, including surveys of 129 male hospital patrons, three men-only focus group discussions, and eight interviews with clinical staff at the hospital. History of condom use, perception of risk, paying for an HIV test, and age were all significantly associated (p < .05) with willingness to test. An aversion to the hospital was the most prominent theme among participants. Aversion was due to perceived lack of confidentiality, preference for traditional healers, perceived costs, and fear of testing. Our participants (a) expressed the need for VCT services, (b) recommended that VCT target men for HIV prevention and VCT patronage, and (c) thought locations outside of hospitals should provide testing services.