Client-centered Research Articles

Clusters of borderline personality disorder traits and functional life outcomes: A novel person-centered approach

Individuals with borderline personality disorder (BPD) experience significant distress in daily life. However, the symptoms and functional impairment presented varies across affected individuals. The present study sought to parse out the heterogeneity within BPD by clarifying clusters of BPD traits and examining how they predict functional outcomes. Undergraduates (N = 504) completed the Personality Assessment Inventory-Borderline Features Scale (PAI-BOR) and several self-report questionnaires to assess functioning across life domains (i.e., global life functioning, social functioning, romantic functioning [trust and attachment], and emotional functioning [emotional intelligence and emotion regulation]). Confirmatory factor analysis revealed a five-factor structure within the PAI-BOR, consisting of Impulsivity, Mood Instability, Chronic Emptiness, Separation Concerns, and Negative Relationships. Using these BPD factors, a person-centered approach identified three distinct clusters in the data and how they relate to functional life outcomes: (1) High Functioning (i.e., low scores on factors and best outcomes), (2) Moderate Functioning (i.e., average scores on factors and outcomes), and (3) Low Functioning (i.e., high scores on factors and poorest outcomes). The findings have important implications for assessment, prognosis, and treatment planning, such as anticipating the extent of life dysfunction and emphasizing the need to comprehensively intervene with all five traits.

Exploring engineering majors’ engineering identities utilizing a traditional identity framework: validity evidence for the new EngID Scale

ABSTRACT Engineering identity is a developing construct within the field of engineering that has been found to be a strong predictor of engineering persistence, retention, and success. While the theoretical definitions and operationalizations of the construct have matured, instruments used to measure engineering identity lack in one vital component – they are not embedded in traditional identity theory reflecting identity formation as the two successive processes of Exploration and Commitment. Consequently, current measures are hindered in providing insight into how engineering identity forms within students and, simultaneously, lack the theoretical underpinnings well-suited for person-centered investigations. The purpose of this work is to relay to the research community a tool capable of producing valid and reliable data for answering the call to introduce person-centered analytical approaches into engineering education investigations while simultaneously advancing forward the bodies of literature regarding role identity formation and the relationship between engineering identity and persistence.

SES and academic achievement are (not always) related: Profiles of student SES, academic achievement and their links to socio-emotional, cognitive, and metacognitive characteristics

BackgroundSES is a well-established predictor of academic achievement. However, not all students perform according to their SES-background and the predominantly variable-oriented body of research has neglected the investigation of constellations of SES and academic achievement differing from the commonly reported correlational links. AimsThis study adopted a person-centered approach to identify different SES-achievement patterns and to compare them in terms of individual psychological characteristics. SampleData were collected from an SES-diverse sample of 171 French ninth-graders (Mage = 14.40 years). MethodWe applied latent profile analysis (LPA) to (a) identify the various profiles when considering SES and academic achievement in a national standardized exam, and (b) investigate differences between the profiles regarding individual student characteristics (i.e., school well-being, academic self-concept, text anxiety, executive functions, and metacognition). ResultsLPA revealed 4 profiles: Group 1 (‘resilient achievers’, 19.9% of the sample) was characterized by below-average SES but above-average achievement, Group 2 (‘expected high achievers’, 42.1%) by above-average SES and achievement, Group 3 (‘expected low achievers’, 12.9%) by below-average SES and achievement, and Group 4 (‘underachievers’, 25.1%) by above-average SES and below-average achievement. ‘Resilient achievers’ displayed higher school happiness, better working memory and metacognitive knowledge than ‘underachievers’, and higher academic self-concept than ‘underachievers’ and ‘expected low achievers’. ConclusionsOverall, these results suggest that academic resilience of low-SES students is related to socio-emotional, cognitive, and metacognitive resources that should be fostered in all students to promote academic achievement.

Skills for communicating effectively with people who have mental health issues.

Nurses have an important role in providing high-quality care to meet the needs of diverse populations, including people with mental health issues. Developing rapport is essential for engaging with service users and promoting a person-centred approach in the context of mental health care. However, in practice this may not always come naturally to all nurses. In this article, the author discusses several evidence-based methods for effective communication with people who have mental health issues, such as making a good introduction, active listening, using open questions, using silence and being aware of body language. The author also explains how nurses can communicate compassionately, demonstrate cultural sensitivity and develop trust within a therapeutic relationship, thereby enabling them to effectively explore service users' thoughts, feelings and needs.

Evolution of Linguistic Markers of Agency, Centrality and Content During Metacognitive Therapy for Psychosis: A Pilot Exploratory Study.

Metacognitive Reflection and Insight Therapy (MERIT) is a form of person-centred psychotherapy that promotes recovery-oriented outcomes by targeting metacognitive capacity. Previous research has shown the feasibility and clinical benefits of MERIT. However, it is not clear whether and how the specific processes targeted by MERIT (e.g., improved sense of agency, self-reflectivity, awareness of others, etc.) are manifested in the patient-therapist communications. In this study, we used natural language processing (NLP) to explore objective linguistic markers of change during MERIT for early psychosis. Five patients underwent 24 sessions each of MERIT, which were recorded and transcribed verbatim. The transcripts underwent NLP to determine the patterns of pronoun use and the frequency of semantic categories related to temporality and mental processing. Mixed linear regressions were used to examine how NLP features evolve over the course of psychotherapeutic sessions. Analyses detected shifts in specific language signals over time including (1) changes in patterns of pronoun usage with more active and central first-person plural pronoun (We); (2) transition in temporal focus of speech from past-focus towards present- and future-focus and (3) increased words representing perceptual and cognitive processes. Our findings suggest NLP can objectively quantify meaningful signals consistent with expected subjective changes in MERIT and potentially other psychotherapeutic interventions.

Patterns of self-regulation and emotional well-being among Syrian refugee children in Lebanon: An exploratory person-centered approach.

This study explores patterns of self-regulation and emotional well-being among Syrian refugee children in Lebanon, employing a person-centered approach, responding to theoretical challenges articulated by Dante Cicchetti and other psychologists. Using latent profile analysis with data from 2,132 children, we identified seven distinct profiles across cognitive regulation, emotional-behavioral regulation, interpersonal regulation, and emotional well-being. These profiles showed significant heterogeneity in patterns of self-regulation across domains and emotional well-being among Syrian children. Some profiles consistently exhibited either positive ("Well-regulated and Adjusted") or negative ("Moody and Frustrated") functioning across all domains, while others revealed domain-specific challenges, e.g., particularly sensitive to interpersonal conflict. This heterogeneity in the organization of self-regulatory skill and emotional well-being challenges the traditional homogeneous view of child development in conflict settings. The study also underscores the profiles' differential associations with demographic characteristics and experiences, with school-related experiences being particularly salient. We discuss the implications of these findings for future research in developmental psychopathology on self-regulation and emotional well-being in conflict-affected contexts. In addition, we advocate for tailored interventions to meet the diverse needs of children affected by conflict.

Attitudes of health and social care professionals towards the use of blended diets for enteral tube feeding for children and young people.

Using a blended diet as an alternative to commercial formula is becoming more popular amongst parents and carers of children and young people (CYP) requiring long-term enteral tube feeding (ETF). Emerging evidence has demonstrated physiological and social benefits; however, families report feeling unsupported to use a blended diet in settings outside the home. This study aimed to explore the attitudes of health and social care staff towards the use of blended diets for CYP. Health and social care professionals with experience of blended diets were invited to partake in an online semi-structured qualitative interview. Thematic analysis was used to identify themes. Five participants from health, education and social care settings were interviewed. Online interviews worked effectively for data collection to allow flexibility to accommodate participants' care roles and avoid face-to-face contact necessary with Coronavirus disease 2019 restrictions. Three themes were identified in the data:• Change from medicalised enteral tube feeding practice.• Individual, person-centred approach.• Open support networks and responsibility.Findings showed that blended diets can be accommodated; however, barriers to implementation remain. Medicalisation of ETF continues to impair acceptance of blended diets whilst effective multi-disciplinary team communication and support facilitates its use in settings outside the home.

Environmental audit scoring evaluation: evolution of an evidence-based environmental assessment tool to support person-centered care.

Long-term care settings are at the center of strongly debated approaches to policies that shape the delivery of care and operational practices. There is advocacy for transformational change within these settings to support a person-centered approach to care delivery, but it is difficult and multifaceted involving everything from changing the level of staffing and care models to developing appropriate metrics to assess an individual's quality of life. The physical environment is a key component for accomplishing the organizational and operational goals related to person-centered care, but providers and their design teams need the appropriate tools to guide evidence-based decision-making. The Environmental Audit Scoring Evaluation (EASE) is a tool that helps lend structure to the process of developing the environment for our senior population-especially those living with dementia. This perspective article will discuss how EASE aims to align the design process to more fully support the myriad environmental elements that have a demonstrable impact on the individual, and the associated quality of life they experience. The article will also explore how EASE differs from previous planning strategies that did not prioritize residents' psychological wellbeing in conforming to current person-centered philosophies.

Distress of surgical nursing personnel in dealing with patients with dementia : An integrative review.

Challenging behavior of patients with dementia (PawD) leads to distress among nursing staff in acute hospital settings. Different levels of distress can be assumed between medical and surgical staff. Less is known about distress in surgical departments. The aim is to summarize and synthesize current empirical studies on distress experienced by surgical nursing staff in dealing with PawD and the associated occurrence of challenging behavior. As part of an integrative review, aliterature search was conducted in September 2024 in the databases CINAHL, MEDLINE (via PubMed) and PubPsych. German and English language studies from January 2011 onwards were included to reflect the most recent empirical results. The analysis was carried out according to the 4phases of Whittemore and Knafl. A total of 7studies were included in which surgical nursing staff described distress in connection with the topics of challenging behavior, in the form of behavioral and psychological symptoms of dementia (BPSD), communication, hospital setting, implementation of person-centered approaches and training as well as pain assessment and identification. Surgical nursing personnel need more opportunities and knowledge to be able to deal more confidently with the distress and challenges of dealing with PawD. Further studies are necessary to be able to make more reliable statements.

Shared Decision-Making and Body Mass Index in Australian Antenatal Care: An Exploratory OPTION12 Evaluation.

Shared decision-making is recommended as a person-centred approach to decision-making in antenatal care. Little is known about the implementation of shared decision-making in antenatal care. An exploratory study to understand how shared decision-making is implemented in antenatal clinics and whether body mass index influences maternity clinicians' use of shared decision-making when providing antenatal care for women. Twenty-six antenatal clinic consultations were audio-recorded with maternity clinicians and women with body mass index ≥ 35 kg/m2, and a comparison group of women with body mass index 18.5-24.9 kg/m2. Data were analysed quantitatively using the OPTION12 scale. Narrative case studies are presented to compare shared decision-making behaviour related to induction of labour. Twelve clinicians and 26 pregnant women were recruited to the study. The total scores ranged from 0 to 24, with a mean score of 9 and a median of 9.5 indicating low implementation of shared decision-making by clinicians and limited involvement of women in decision-making. No difference was observed in OPTION12 scores in decision-making for women by body mass index. This study suggests that shared decision-making is limited in the antenatal clinic setting for all women, regardless of body mass index. Further research is required to confirm the findings of this exploratory study. The perspectives of women with body mass index ≥ 35 kg/m2 informed many aspects of this study including the language/terminology adopted by researchers. A consumer group reviewed the language used in the study materials, to ensure readability and avoidance of stigmatising terminology.

Co-Existence Patterns of Social Norms and Positive Defending Intention Among Adolescents as School Bullying Bystanders.

School bullying occurs frequently in primary and secondary schools, which is a global problem and it often brings serious physical and mental harm to the victims. When school bullying occurs, there may be a large number of bystanders in addition to the bullies and victims. What actions bystanders take affects the progress of school bullying. Relevant studies indicate that social norms including how peers around them react (descriptive norms) and how important adults such as teachers and parents demand (injunctive norms) play important roles in bystanders' action-taking, but limited studies have considered individual differences. Therefore, this study used a person-centered approach to explore the co-existence patterns of social norms and bystanders' defending intention to further understand their relations. We surveyed 1,384 junior high school students in China by self-report questionnaires, and they were asked to assess their defending intention when witnessing school bullying events under different contexts of social norms. Through latent profiles analysis, five co-existing patterns were identified: no norms-no defending group (4.8%), parent norms-no defending group (3.6%), weak norms-low defending group (24.3%), teacher-peer norms-medium defending group (40.6%), teacher-peer norms-high defending group (26.7%). In four out of the five patterns, students' levels of defending intention were highly consistent with the levels of peer and teacher norms, but largely contradicted parent norms. This suggests that descriptive norms from peers and injunctive norms from teachers, other than those from parents are crucial for promoting bystanders' defending intention, which provides important enlightenment for school bullying prevention. These findings provide important enlightenment for the prevention and control of school bullying in the future.

Everyone is searching for it and those who acquired it enjoy better mental health: a latent profile analysis of Chinese adolescents' meaning in life.

One factor associated with rising rates of depression and anxiety among youth is a lack of meaning in life (MIL). The importance of living a meaningful and purposeful life cannot be overstressed, especially for adolescents who are in a critical life stage and have recently experienced a 3-year-long global health crisis, namely the COVID-19 pandemic. Although previous studies have examined adolescents' MIL, the majority of them adopted a variable-centered approach. The present study adopts a person-centered approach to investigate the updated MIL among Chinese adolescents in the aftermath of the COVID-19 pandemic, the demographic factors related to profile classification, and the differences in mental health among adolescents in different MIL classes. A questionnaire assessing MIL, depression, anxiety, stress, and demographic information was administered to 1,196 Chinese adolescents (mean age = 13.07 ± 0.58; 44.73% were female individuals). A three-step latent profile analysis was conducted. This study revealed that (1) adolescents can be categorized into three classes: high MIL, medium MIL, and low and searching MIL. (2) Adolescents from intact families with higher educated mothers were more likely to be classified as high MIL class rather than low MIL class. Furthermore, (3) adolescents with high MIL experienced the best mental health outcomes, those with medium MIL experienced moderate mental health, and those with low MIL, who were still searching for MIL, exhibited the poorest mental health. External support may be necessary in the search process for Chinese adolescents. Future research could explore the process of searching for MIL and identify the challenges adolescents encounter when developing their sense of MIL.

Contribution of Temperament and Family Functioning on Psychological Well-Being in Spanish Emergent Adults: A Person-Centered Approach

There is a gap in the literature on relationships between temperament, family functioning, and psychological well-being from a eudamonic perspective in emerging adulthood. To shed light on this issue, the aim of our study was to analyze the effect of temperament and family functioning profiles on psychological well-being in a sample of Spanish university students (N = 332). Results showed a positive association between the resilient temperament profile and psychological well-being, while the inverse relationship was observed for the non-desirable temperament profile. The reserved profile was not significantly associated with psychological well-being. On the other hand, the healthy family functioning profile (with moderate and high scores in cohesion and moderate scores in flexibility) was linked to higher levels of well-being, unlike the unhealthy functioning profile (with low scores in cohesion and extreme scores in flexibility). Finally, the joint effect of temperament and family functioning points to a buffering or protective effect of family functioning profiles in relation to potentially “dangerous” or “beneficial” temperamental profiles in university students. Practical and clinical implications are discussed.

A person-centered approach to understanding psychosocial stressor subgroups and cardiovascular disease: new perspectives from the Multi-Ethnic Study of Atherosclerosis (MESA) study.

This study examined the longitudinal associations of baseline psychosocial stress subgroups with cardiovascular disease (CVD) events and whether social support, neighborhood cohesion, and physical activity modified these associations in the Multi-Ethnic Study of Atherosclerosis (MESA). Data from 6,349 adults (aged: 62.2±10.2 years; 52.9% women) from the MESA study with no prior CVD in 2000-2002 were used in this analysis. Latent class analysis (LCA) was used to specify distinct psychosocial stress subgroups based on self-reported stressors stemming from respondents' neighborhood and social environment. Adjudicated CVD events (fatal and nonfatal events) were ascertained annually through the year 2019. Cox proportional hazards models were used to examine the associations between subgroup membership and CVD events. Five distinct psychosocial stress subgroups were identified via LCA and were labeled 'moderate neighborhood noise' (12.1%), 'excessive neighborhood noise' (6.4%), 'multiple high stressors' (6.3%), 'high discrimination' (21.4%), and 'optimal' (53.8%). By the year 2019, 1,121 participants had experienced a CVD event. Membership in the 'high discrimination' (HR: 1.29; 95%CI: 1.10, 1.51) subgroup was associated with higher risk of a CVD event when adjusted for sociodemographic characteristics and cardiovascular health metrics. Neither social support, neighborhood cohesion, nor physical activity modified this association (ps>0.05). Distinct subgroups of individuals with high self-reported psychological distress-particularly related to discrimination and chronic stress are associated with high incident cardiovascular events.

Diabetes prevention after gestational diabetes: challenges and opportunities.

Gestational diabetes (GDM) poses significant health concerns for women and their offspring, with implications that extend beyond pregnancy. While GDM often resolves postpartum, a diagnosis of GDM confers a greater risk of future type 2 diabetes (T2D) and other chronic illnesses. Furthermore, the intergenerational impact of GDM predisposes offspring to increased chronic disease risk. Despite the awareness of the short- and long-term consequences of GDM, translating this knowledge into prevention strategies remains challenging. Challenges arise from a lack of clarity among health professionals regarding roles and responsibilities in chronic disease prevention and women's lack of awareness of the magnitude of associated health risks. These challenges are compounded by changes in the circumstances of new mothers as they adjust to balance the demands of infant and family care with their own needs. Insights into behaviour change strategies, coupled with advances in technology and digital healthcare delivery options, have presented new opportunities for diabetes prevention among women with a history of GDM. Additionally, there is growing recognition of the benefits of adopting an implementation science approach to intervention delivery, which seeks to enhance the effectiveness and scalability of interventions. Effective prevention of T2D following GDM requires a comprehensive person-centred approach that leverages technology, targeted interventions, and implementation science methodologies to address the complex needs of this population. Through a multifaceted approach, it is possible to improve the long-term health outcomes of women with prior GDM.

Healthcare Experiences and Needs of Older Adults Living With HIV: A Qualitative Study.

To explore the healthcare experiences and needs of older adults living with HIV in Sweden. A phenomenological study using qualitative thematic analysis. Data were gathered through semistructured qualitative interviews and analysed using thematic analysis. A purposive sample of individuals ageing and living with HIV was recruited for this study. A total of 22 participants aged 65 years and older, with a mean age of 75 years, participated in the study. Living with HIV meant a need to rely on consistent healthcare and treatment over the course of one's lifetime. The experiences of older adults were described under four themes: relying on access to health care, desiring involvement and shared decision-making, the importance of trust and confidentiality and experiences of stigma in healthcare visits. Living and ageing with HIV involved recurring exposure and vulnerability in healthcare encounters, and experiences of being exposed to HIV-related stigma, especially outside HIV clinics. Continuity and being seen as a person in healthcare encounters were important. Enhancing HIV knowledge alongside fostering supportive attitudes and approaches of healthcare professionals is critical for ensuring high-quality and nondiscriminating health care. Meeting the needs of older adults living with HIV requires a person-centred approach, including active involvement and shared decision-making between patients and healthcare providers. This study describes the healthcare experiences and needs of older adults, aged 65 years and older, living with HIV, a population that is not typically investigated in qualitative research. Living and ageing with HIV means a vulnerability where the attitudes of professionals and the active involvement of the patient become significant for quality care. The findings can help with the implementation of policies and practices for the care of older adults living with HIV. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) was used. Patient representatives were involved in discussions on data collection and the development of the interview guide.

Evaluating a Kid’s Dementia Awareness Game with Pre-Licensure Children and Young People’s Nursing (CYP) Students in Northern Ireland – A Pre/Posttest Study

ABSTRACT Dementia not only affects the person living with the condition but also their family and wider social circle. For that reason, it is important to educate family members, the wider public and health professionals. How a child and young people’s (CYP) nurse supports and responds to a CYP whose family member has dementia or acts as a carer is of interest to pre-licensure (pre-registration) CYP nursing programs. With serious games becoming more common as a method to educate a diverse population regardless of age and gender, this study aims to learn if playing a kid’s dementia awareness game improves CYP nursing student’s attitude to dementia using a validated pre-/posttest questionnaire. This study adopted a pretest, posttest design to assess the attitudes of pre-licensure CYP nursing students toward dementia. The Approaches to Dementia Questionnaire (ADQ) was administered before and after playing a serious CYP kid’s dementia game developed by children and people living with dementia for 10- to 11-year-old children. The ADQ measured the total score, Hope subscale, and person-centered approaches. Matched paired t-test was used for analysis conducted with SPSS statistics 29. Seventy-two participants, from one university in Northern Ireland, completed pretest measures, of these, 55 also completed the posttest questionnaire. The participating CYP pre-licensure undergraduate and postgraduate nursing students demonstrated a significant increase in overall dementia attitudes post-gameplay, with an increase from 78.31 to 83.27. Subscales for Hope (27.75 to 30.44) and person-centered approaches also exhibited significant improvement (50.56 to 52.84). Demographic data revealed all participants as female, with 50% knowing a person living with dementia, and limited training experiences. In conclusion, this study has shown a positive response to playing a dementia game relevant to the child population. This adds to the literature building on the use of serious games for health education. Attitudes and hope scales increased with the use of the game.

Assessing palliative care needs in patients with dementia: A cross-sectional analysis of an predominantly oldest-old population from a geriatric memory clinic.

In this cross-sectional study, we assessed palliative care (PC) needs in older adults with dementia. Using the NECPAL CCOMS-ICO© 3.1 tool and comprehensive geriatric assessment, 16.25% of the 554 evaluated patients required PC, which had clinical frailty and a moderate stage of dementia. Advanced frailty was associated with the poorest prognosis, according to the PC-based stratification. Our findings support the use of PC assessment in dementia care, which focuses on a person-centered approach while minimizing unnecessary or ineffective treatments and meeting the real-world patient's needs. PC care may fulfill the multidimensional nature of dementia, shifting towards personalized palliative approaches.

The roles of task-specific self-efficacy and enjoyment in EFL learners’ development of speaking CALF: A longitudinal study

This longitudinal study adopts a person-centred approach to examine EFL learners' development of speaking CALF; the fluctuating correlations of affective ID variables (self-efficacy and enjoyment), as well as their impacts on oral task performance over time. Thirty-one Chinese EFL learners completed eight oral tasks bi-weekly over six months, followed by post-task scales to measure task-specific self-efficacy and enjoyment. Data were subjected to group-based multi-trajectory modelling (GBMM) to discern the development of speaking CALF, moving correlation analysis to explore the interactions between task-specific self-efficacy and enjoyment, and panel data regression to examine the longitudinal impact of task-specific self-efficacy and enjoyment on oral task performance. GBMM results revealed variability at both the group and individual levels, despite similar educational backgrounds and learning contexts, as evidenced by differing speaking CALF patterns. Moving correlation analyses revealed dynamic, non-linear trends between self-efficacy and enjoyment. Panel data regression analyses suggested that higher levels of affective ID variables would generate better oral performance, as evidenced by speaking CALF patterns. This study successfully integrated ID variables into TBLT research within a CDST framework for enhancing our understanding of the complex nature of EFL learners’ speaking competence and underscoring the interconnectivity between task-specific self-efficacy and enjoyment.

Examining the Empathy Profiles and Work Outcomes of Trauma Workers

Trauma work involves intervening with others enduring acute pain and suffering, often with heavy psychological and physical health impacts. An important question is whether dispositional empathy helps or hurts trauma workers in their occupational functioning. The current study addresses this gap in the research literature by using a person-centered approach to examine the empathy profiles and professional outcomes of a broad sample of trauma workers ( n = 315). We measured their trait empathy and organizational outcomes (occupational burnout, person-job fit, turnover intentions, job performance), and found three distinct empathy profiles which differed significantly in their occupational functioning. A ‘self-focused’ empathy profile (dominated by high personal distress responding) reported the worst functioning; an ‘other-oriented’ profile (high on perspective taking and empathic concern) had more positive functioning, and an unexpected ‘low reactivity’ profile (a full SD below the general population on empathy facets) showed the lowest exhaustion. Exploratory analyses revealed that first responders (e.g., police, firefighters, EMTs, paramedics) were overrepresented in the ‘low reactivity’ profile, while psychology-related professions (e.g., psychologists, counsellors, social workers) were underrepresented in that profile. The significance of these results, as well as their implications for empathy research and vocational counselling in the field of trauma work, are discussed.