Avoidance Attitudes Research Articles

Attitudes of US physician assistants toward persons with HIV/AIDS

Early in the HIV/AIDS epidemic, a large number of health care workers had negative attitudes toward persons infected with HIV, but a more positive shift has occurred in these attitudes over the past decade. However, recent information about attitudes of physician assistants (PAs) is missing. A nationwide randomized sample of 1,500 PAs was surveyed through the US mail. The AIDS Attitudes Scale (AAS) developed by Froman, Owen, and Daisy in 1992 was used for this purpose. The results were analyzed using descriptive, t test, and analysis of variance (ANOVA) statistics. A majority of respondents had high empathy, low avoidance, and positive general attitude scores. Respondents living in the South had the highest avoidance and lowest general attitude scores compared with those living in other regions (ANOVA, P < .05). The results were consistent with similar current studies of health care workers, which demonstrated supportive attitudes towards persons with HIV/AIDS.

HIV-related avoidance and universal precaution in medical settings: opportunities to intervene.

To determine the association between adherence to universal precaution (UP) and avoidance attitudes toward patients living with HIV/AIDS (PLH) among service providers. A total of 1,760 health service providers were randomly selected from 40 county hospitals in two provinces of China. A self-administered questionnaire was used to collect demographic characteristics, UP knowledge and training, UP adherence, availability of UP supplies at work, and avoidance attitudes toward PLH in a cross-sectional survey. A series of regression models were used to examine associations among the UP-related factors and their relationship to avoidance attitudes toward PLH. UP training was associated with better knowledge of and adherence to UP and perceived availability of UP supplies in hospitals. UP training, knowledge, and adherence were significantly associated with avoidance attitudes toward PLH in medical practice. Being a nurse was also related to HIV-related avoidance. UP promotion campaigns, including in-service training and reinforcement of UP adherence, could play an important role in the battle against HIV-related avoidance in medical settings. Intervention programs should focus on not only individual providers' attitudes and behaviors but also on structural support for norms shifts in the medical community.

Schmerzchronifizierung und -dysfunktion: Evidenz zu Diagnostik und Therapie

Rehabilitation for chronic pain has to concern the degree of dysfunctional pain. Up to now there is a lack of a consistent definition for chronic pain. A graded chronic pain status could facilitate to focus on the right treatment strategies. There exists a body of evidence that functional rehabilitation programs within a multidisciplinary treatment team are of utmost importance for chronic pain patients. Assessments should include baseline and outcome measures in accordance with the ICF-model. Psychosocial risk factors have to be observed and handled. Behaviorial pain coping strategies intend to reinforce self-reliance and to adapt fear avoidance attitudes. The restoration of function and activity has to be strengthened and should be the focus of attention for the whole rehabilitation team.

Exploring Sun Avoidant Attitudes and Behaviors in the United Arab Emirates

The aim in this study was to develop a Sun Avoidance Inventory (SAI) and then test its factor structure and reliability. The SAI is a culturally grounded self-report measure of the attitudes and behaviors indicative of minimizing direct exposure to the sun. In our study 193 Emirati females completed the SAI. The results of analysis of their responses support the validity of the instrument with 6 domains of avoidance being identified: recreational, occupational, head covering, body covering, and skin tone preference (light or tanned). The most strongly endorsed attitude was that even brief exposure to sun is bad for health and the most strongly endorsed behavior was wearing a niqab (veil) outdoors. In previous studies carried out in the United Arab Emirates elevated levels of vitamin D (VTD) deficiency have been found, especially among females. High scores on the SAI may predict VTD deficiency and in the future researchers could explore the validity of the SAI as a predictor of VTD deficiency and also investigate the potential use of the SAI in multiphase screening procedures for VTD deficiency.

Adult Attachment; Lesbian, Gay, and Bisexual Identity; and Sexual Attitudes of Nonheterosexual Individuals

Lesbian, gay, and bisexual (LGB) college students from 12 university campuses (N = 177) participated in this study that examined the relationships between adult attachment, LGB identity, and sexual attitudes. Findings indicated that adult attachment was significantly related to LGB identity and sexual attitudes and that an LGB identity variable moderated the relationship between attachment avoidance and sexual permissiveness attitudes. Findings, counseling implications, and future research directions are discussed in terms of attachment and LGB identity theory.

Bedingungen für den Erfolg übergewichtiger und adipöser Kinder in einem ambulanten Programm zur Gewichtsreduktion durch Veränderungen des Lebensstils

To analyze whether caregiver and family characteristics predict success in a family-based lifestyle intervention programme for overweight or obese children and adolescents. Participants were 136 overweight or obese children and adolescents (7-15 years) who attended a family-based weight-reduction programme. BMI and BMI standard deviation scores (BMI-SDS) of the index child, BMI of family members, family adversity characteristics, and depression and attachment attitudes of the primary caregiver were assessed. 116 participants finished the 12-month programme: 100 (85.3%) showed a decrease of the BMI-SDS, 79 (68.1%) a more than 5% reduction of the BMI-SDS. These "successful" children were compared to 56 "unsuccessful" ones (dropouts and children with a BMI-SDS reduction of 5% or less). Failure to reduce weight considerably (≤ 5% reduction of BMI-SDS, or dropout) occurred more frequently in older children and in cases with obese sibling(s), maternal depression, and maternal avoidant attachment attitude. In a logistic regression analysis, maternal depression as well as attachment attitude, and the age of the index child explained common variance, while the presence of obese sibling(s) explained unique variance in non-responding. Our data suggest that special support should be provided to adolescents with obese sibling(s) and to adolescents with mothers suffering from depression and exhibiting an avoidant attachment style, so as to meet the specific needs of all participating families and to prevent the discouraging experience of failure in weight-control interventions. The efficacy of these modules must be tested in further studies.

Stigmatized Attitudes Toward People Living With HIV in Bangladesh: Health Care Workers’ Perspectives

This study was conducted among 526 health care workers (HCWs) in Bangladesh to identify the levels and correlates of stigmatized attitudes toward people living with HIV (PLHIV). HIV-related stigmatized attitudes were measured by a set of items that reflected avoidance attitude of HCWs in hypothetical situations. A multiple linear regression model identified the following correlates of stigma: higher age, high level of irrational fear about HIV and AIDS, being HCW other than a doctor, working in teaching hospital, and rating religion as very important in their life (R (2) = .502). The findings are important for both public health policy planners and human rights activists as high prevalence of stigmatized attitudes among HCWs influence the decision-making process of PLHIV and stop them from accessing voluntary counseling and testing, care, support, and treatment services.

Treating childhood obesity: Family background variables and the child's success in a weight‐control intervention

To analyze whether caregiver and family characteristics predict success in a family-based lifestyle intervention program for children and adolescents. Participants were 111 overweight and obese children (7-15 years) who attended a family-based weight-reduction program. Body mass index (BMI) and BMI standard deviation scores (BMI-SDS) of index child, and BMI of family members, family adversity characteristics, depression, and attachment attitudes of the primary caregiver were assessed. Risk of nonresponse (<or=5% reduction of BMI-SDS or dropout) was elevated in older children, cases with obese sibling(s), maternal depression, and avoidant attachment attitude. In a logistic regression analysis, maternal depression, attachment attitude, and age of index child explained common variance whereas the presence of obese siblings explained unique variance in nonresponding. To meet the specific needs of all participating families and to prevent the discouraging experience of failure in weight-control interventions, our data suggest that special support should be provided to adolescents with obese siblings, and cases of maternal depression, and avoidant attachment attitude.

Association of Conventional Goals and Perceptions of Pregnancy with Female Teenagers’ Pregnancy Avoidance Behavior and Attitudes

Fostering conventional goals is a key component of pregnancy prevention interventions for teenagers. However, research has not shown whether having goals independently influences sexual behavior, or whether the perception that pregnancy represents an impediment to achieving goals mediates any association. In 1999-2001, a racially mixed group of 351 sexually experienced female teenagers who were inadequate contraceptive users completed surveys about goals, the anticipated impact of childbearing on these goals, and protective behaviors and attitudes. Chi-square, regression and two-by-two table analyses assessed associations between goals and perceptions of early childbearing and pregnancy avoidance measures. Three-fourths of respondents had educational or vocational goals. Eight in 10 of these teenagers perceived their goals to be achievable, but fewer than half thought pregnancy would be an impediment to achieving these goals. Teenagers who had goals were more likely than others to have used a contraceptive at last intercourse (odds ratio, 1.9), but controlling for the perception of pregnancy as an impediment eliminated this association. In contrast, considering pregnancy an impediment was associated with an increased likelihood of supporting each pregnancy avoidance measure (2.1-9.6), and of intending to avoid pregnancy and to have an abortion if pregnant, regardless of whether teenagers had goals (8.3-13.8). Conventional goals appear to motivate teenagers to avoid getting pregnant only if they believe pregnancy will be an impediment. Thus, it may be less important to encourage young women to formulate goals than to ensure that they consider adolescent childbearing a threat to their plans.

Changing College Students’ Financial Knowledge, Attitudes, and Behavior through Seminar Participation

This pilot study examined the influence of Credit Wise Cats, a financial education seminar presented by Students in Free Enterprise, on the attitudes, knowledge, and intentions toward financial responsibility of college students (N = 93). Findings suggest that the seminar effectively increased students’ financial knowledge, increased responsible attitudes toward credit and decreased avoidant attitudes towards credit from pre-test to post-test. At post-test, students reported intending to engage in significantly more effective financial behaviors and fewer risky financial behaviors. Finally, demographic factors (e.g., gender and employment status) predicted students’ financial knowledge, attitudes, and behaviors. These results suggest that a seminar format may be useful in reaching a wider audience of college students and, thus, warrants future longitudinal evaluation.

Existential Underpinnings of Approach and Avoidance of the Physical Body

In addition to enjoying pleasurable bodily activities, people appear threatened by the physical aspects of the body; they experience anxiety and inhibitions surrounding sex, eating, bodily appearance and functions. Based on terror management theory, we posit that people are dually motivated to approach the life-affirming properties of the physical body, and to avoid the physical or animalistic aspects of the body because of their association with death. This paper summarizes a substantial body of research, consisting of over twenty empirical studies, that identify personality and situational variables that interact with mortality concerns, moderating approach and avoidance attitudes and behaviors with respect to the physical body. We suggest that this dynamic motivation can go far in explaining the often observed ambivalence toward the body.

“I wouldn’t do it; it looks dangerous”: Changing students’ attitudes and emotions in physical education

The purpose of the study was to verify whether physical education (PE) acrobatic activities would be effective in modifying the individual’s tendency to undertake out-of-school leisure and adventurous sports typified by physical and psychological challenges. The Motor Activity Anxiety Test and pictures of adventurous sports were presented to Italian male high school students ( N = 72) to assess their approach–avoidance attitude towards the activities portrayed. An emotion-profiling assessment grounded on the IZOF framework was also employed to identify idiosyncratic optimal-dysfunctional and pleasant–unpleasant emotional descriptors. Two experimental groups were engaged in highly emotion-arousing PE tasks for 12 lessons, while two control groups were involved in team sports. Findings demonstrated the effectiveness of the intervention in modifying the participants’ attitudes.

Prevalence and factors associated with social avoidance of recovered SARS patients in the Hong Kong general population

The study investigated the general population's perceived infectivity of asymptomatic and recovered severe acute respiratory syndrome (SARS) patients and factors associated with avoidance and discriminatory attitudes, including demographic background, SARS-related perceptions and emotional response to the SARS epidemic. A population-based survey was conducted in Hong Kong during 3 December 2003 through 4 January 2004; 475 Hong Kong Chinese adults participated in the survey. Perceptions of the infectivity and health conditions of recovered SARS patients and avoidance and discrimination towards them were measured. Of the respondents, 75.7% and 16.2%, respectively, believed that SARS could be transmitted via asymptomatic SARS patients and those patients who have recovered from SARS for 18 months; 72.7% of the respondents believed that the health of SARS patients would severely and permanently be damaged; 16.6% showed some tendency of avoiding recovered SARS patients and 35.7% expressed some sort of job-related discriminatory attitudes. Perceived infectivity of asymptomatic and recovered SARS patients, health sequelae and emotional distress from SARS were independently associated with avoidance and discriminatory attitudes. The study showed that misconceptions about the infectivity of asymptomatic and recovered SARS patients were common. Recovered SARS patients may also be facing avoidance and discrimination.

The Positive and Negative Effects of Disaster Work: A Preliminary Investigation

Research into the psychological effects of occupational exposure to disasters has tended to focus on the negative consequences for disaster workers, but recent trends in traumatic stress research have indicated the potential for positive changes and posttraumatic growth. This study examined occupational death exposure, death attitudes, subjective appraisals, intrusions, avoidance, and social support and their associations with positive and negative psychological changes in disaster workers, both cross sectionally and at a 6-month follow-up. Correlation analyses cross sectionally revealed that posttraumatic growth was significantly associated with subjective appraisal and intrusions. Negative changes were significantly associated with subjective appraisal, avoidance, fear of death, and death avoidance attitudes. Posttraumatic growth, positive changes, and negative changes evidenced substantial stability over the 6-month follow-up. Discussion focuses on how these findings extend the literature dealing with occupational death exposure, together with a consideration of limitations of the study that inform directions for future research.

Attitudes of clinicians in emergency room towards suicide

Objective. The present study brings to focus common attitudes of clinicians working in the emergency room. Methods. A questionnaire was used to assess the attitudes of clinicians working in the emergency room. The data were subjected to factor analysis. Results. These clinicians show attitudes of avoidance, rejection, hostility, anxiety and fear, and inadequacy. They also considered the act of suicide as manipulative and unlawful. Conclusion. Due to various internal as well as external factors these medical professionals have negative attitudes towards suicide attempters, with a resultant low quality of care. Dealing with one's own anxieties over suicide and death, along with having good evaluation skills and a multidisciplinary approach to handle such cases, could save many more lives.

The woman patient after WHI

An epidemic of fear and distrust has infected women (and physicians) after publication of the Women's Health Initiative (WHI). The overinflated negative data emerging from the oestroprogestinic arm of WHI have frightened women and gave rise to the most difficult emotions to cope with. Keywords such as cancer, death and hormones combined together, have potentiated an avoidant attitude towards hormonal therapy (HT) driven more emotionally than rationally. This negative aura has not been dissipated by the positive data from the oestrogen-only arm of WHI. This paper will discuss: women's different emotional reactions to and coping strategies for HT-related fear after WHI; the communication skills physicians should use in focusing on positive messages emerging from WHI; predictors of current HT use; the meaning of the higher use of HT in postmenopausal highly-educated women and women gynaecologists; the importance of increasing healthy life-styles as a taking of responsibility towards aging by every woman; shifting from passivity to active sharing of the decision making process with the caring physician; and the use of an individually tailored HT, when appropriate, as part of an active strategy in the pursuit of a longer health expectancy.

Validation of the French version of the fear avoidance belief questionnaire.

Observational prospective study. To assess the reliability, validity, and responsiveness of the French version of the Fear Avoidance Belief Questionnaire. Fear, avoidance attitudes, and belief play pivotal roles in disability perceived by patients with chronic low back pain. The Fear Avoidance Belief Questionnaire is a two-part questionnaire assessing fear, avoidance, and beliefs about professional activity and physical activity. The Fear Avoidance Belief Questionnaire was translated by use of the forward and backward translation procedure. Test-retest reliability was assessed in 31 patients (Group 1) with the intraclass correlation coefficient and the Bland and Altman method. Construct validity was assessed in two groups of patients (Group 2, n = 147; Group 3, n = 70) with the Spearman rank correlation coefficient and factor analysis. Responsiveness was assessed in Group 3, after they underwent a functional restoration program, by the effect size and the standardized response mean. Test-retest reliability was good, with an intra-class correlation coefficient value of 0.88 and 0.72 for fear, avoidance, and beliefs about professional activity and physical activity, respectively. Use of the Bland and Altman method produced a homogeneous distribution of the differences, with no systematic trend observed. The expected divergent validity was observed in Groups 2 and 3. Factor analysis extracted four factors in Group 2 and the two original factors of the English Fear Avoidance Belief Questionnaire in Group 3. The lowest effect size and standardized response mean values (0.30 and 0.31, respectively) were observed with the fear, avoidance, and beliefs about professional activity. The psychometric properties (test-retest reliability, construct validity, and responsiveness) of the French version of the Fear Avoidance Belief Questionnaire are acceptable, and fear, avoidance, and belief can now be assessed in French-speaking patients with low back pain.

Fear information and the development of fears during childhood: effects on implicit fear responses and behavioural avoidance

Field, Argyris and Knowles ( Behav Res Ther 39 (2001) 1259), and Field, Hamilton, Knowles and Plews ( Behav Res Thera 41 (2003) 113) have developed a prospective paradigm for testing Rachman’s ( Behav Res Ther 15 (1977) 375) proposition that fear information is important in the development of fears and phobias in children. Despite this paradigm being an advance on retrospective reports, the research so far has been restricted to self-reported fear beliefs measured after the information is given. This gives rise to two possible shortcomings: (1) the effects could simply reflect demand characteristics resulting from children conforming to the experimental demands, and (2) although fear information changes beliefs, this might not translate into the behavioural change that would be expected if this information has a powerful effect relevant to the development of pathological fear. This paper describes an experiment that attempts to address these concerns by improving Field et al.’s (2001, 2003) basic paradigm but with the addition of two measures: (1) a behavioural measure of avoidance, and (2) an implicit attitude task that should not be susceptible to deliberate attempts to conform to experimental demands. The result showed that negative and positive information have dramatic, and opposite, effects on self-reported fear beliefs, behavioural avoidance and implicit attitudes. There were no effects of gender on any of these results. This study fully supports Rachman’s model and suggests that past work does not merely reflect demand characteristics and that fear information increases behavioural avoidance as well as fear beliefs.

Nursing staff and nursing students' attitudes towards HIV-infected and homosexual HIV-infected patients in Sweden and the wish to refrain from nursing.

Two decades after the emergence of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), the infection remains enigmatic and shameful. In Sweden, many HIV-infected persons still encounter attitudes of avoidance. The aims were to investigate differences between attitudes of nurses, assistant nurses, nursing students and assistant nursing students towards HIV-infected and homosexual HIV-infected patients; to measure their fear of contracting HIV; and to investigate whether nurses, assistant nurses, nursing students and assistant nursing students wanted to refrain from caring for HIV-infected patients. The participants were informed of the study orally and in writing. Completing and returning the anonymous questionnaires indicated the participants' tacit consent. The study had a descriptive, comparative quantitative design. The AIDS Attitude Scale was used, along with a questionnaire specially designed for the study. The participants were nurses and assistant nurses from one infectious disease clinic in central Sweden [response rate was 67% (n = 57)]. Students enrolled in a university nursing programme and students of upper secondary assistant nurses' training [response rate was 62% (n = 165)] were also included. In general, both the nursing staff and the nursing students expressed empathic attitudes towards HIV-infected and homosexual HIV-infected patients, as well as a low degree of fear of HIV contagion. The findings also showed, in the professional groups, that 36% would refrain from caring for HIV-infected patients if that possibility existed. The corresponding figure for the student groups was 26%. The chosen sample was small and not randomly selected therefore precludes a generalization in a wider context. Furthermore, the questionnaire was untested for reliability and validity, and may have influenced the findings with respect to the wish to refrain from nursing HIV-infected patients. Suggested guidelines for nursing, mentor-ship by AIDS-dedicated nurses, and educational interventions, are given in 'Implications for nursing and nursing education'.

Declining the offer of flexible sigmoidoscopy screening for bowel cancer:: a qualitative investigation of the decision-making process

Qualitative methods were used to investigate decision-making among a group of older adults who declined the offer of flexible sigmoidoscopy screening for bowel cancer. Interviews were conducted with 60 people (30 men and 30 women) who either had not responded to the screening letter or who responded saying that they were not interested in participating. The findings suggest that low perceived susceptibility to bowel cancer, in terms of current health status, family history or absence of bowel symptoms, was an important factor in the decision to decline screening. Procedural barriers such as embarrassment, pain/discomfort and perceived unpleasantness of the test were reported as relatively minor, although the test was considered more physically intrusive than other screening tests. Avoidant attitudes emerged as an important theme and were reported by a third of respondents. Distinct patterns of decision-making were also observed and three groups emerged from accounts: (i) forgetting or avoiding making a decision about the test (ii) a confident rejection of the test based on a few salient factors, and (iii) a more careful consideration of the test focusing on issues of susceptibility. The findings are discussed in the context of models of health behaviour and bowel cancer screening participation research.