Client Interactions Research Articles

Comparing simulated client experiences with phone survey self-reports for measuring the quality of family planning counseling: The case of depot medroxyprogesterone acetate – subcutaneous (DMPA-SC) in Nigeria

Background: The quality of family planning services can have important implications for uptake and continued method use. The aim of this analysis is to examine aspects of quality for a new injectable contraceptive method, DMPA-SC (depot medroxyprogesterone acetate – subcutaneous, known as Sayana Press®), service provision and contraceptive services more broadly in Nigeria. Methods: We compared self-reports from follow-up phone surveys with users to simulated client interactions that were designed to measure the same concepts. Through mixed-methods, we sought to more deeply understand the biases associated with different data collection methods that ultimately lead to different conclusions regarding quality of contraceptive services, and to further assess to what extent these methods were suitable for detecting differences in quality across sub-groups using the case of married versus unmarried women. Results: We found that simulated clients reported lower levels of quality across all comparable quality indicators than phone survey respondents attending the same facilities. Both methods were able to detect differential treatment by marital status. Conclusions: A mixed-methods approach can provide differential insights into quality of family planning services, especially when aiming to understand both objective and subjective aspects of quality.

Structural basis and mechanism of the unfolding-induced activation of HdeA, a bacterial acid response chaperone

The role of protein structural disorder in biological functions has gained increasing attention in the past decade. The bacterial acid-resistant chaperone HdeA belongs to a group of "conditionally disordered" proteins, because it is inactive in its well-structured state and becomes activated via an order-to-disorder transition under acid stress. However, the mechanism for unfolding-induced activation remains unclear because of a lack of experimental information on the unfolded state conformation and the chaperone-client interactions. Herein, we used advanced solution NMR methods to characterize the activated-state conformation of HdeA under acidic conditions and identify its client-binding sites. We observed that the structure of activated HdeA becomes largely disordered and exposes two hydrophobic patches essential for client interactions. Furthermore, using the pH-dependent chemical exchange saturation transfer (CEST) NMR method, we identified three acid-sensitive regions that act as structural locks in regulating the exposure of the two client-binding sites during the activation process, revealing a multistep activation mechanism of HdeA's chaperone function at the atomic level. Our results highlight the role of intrinsic protein disorder in chaperone function and the self-inhibitory role of ordered structures under nonstress conditions, offering new insights for improving our understanding of protein structure-function paradigms.

The Impact of Therapists’ Responses to Resistance to Change: A Sequential Analysis of Therapist Client Interactions in Motivational Interviewing

The study aims to examine how therapists trained in motivational interviewing (MI) respond to resistance and whether this has an impact on subsequent client speech. Fifty recorded Motivational Enhancement Therapy sessions were examined using a sequential behavioural coding method for speech. Client counter-change talk formed the baseline for coding and categorizing subsequent therapist speech and the following client speech. Transitional analysis identified the probable occurrence of specific therapist and client utterances at each stage. Following client expressed resistance or counter-change talk, MI consistent therapist utterances were most commonly observed. A moderate to strong predictive relationship was found between MI-consistent therapist speech and subsequent client change talk. A moderate predictive relationship was found between therapist MI-consistent behaviours and client ambivalence. A moderate to strong predictive relationship was found between MI-inconsistent therapist speech and subsequent client counter-change talk and a weak negative predictive relationship was found between MI-inconsistent therapist speech and client expressed ambivalence. In the face of initial expressed resistance to change, MI-consistent therapist speech appears to increase subsequent client utterances regarding intentions to change drinking behaviour.

Cleaner personality and client identity have joint consequences on cleaning interaction dynamics.

Mutualistic interactions involve 2 species beneficially cooperating, but it is not clear how these interactions are maintained. In many mutualisms, one species interacts with multiple species, and since partners differ in terms of the commodities they trade, partner identity will directly influence the decisions and behaviors of interacting individuals. Here, we investigated the consequences of within and between-species diversity on a model cleaner–client interaction in a natural environment, by quantifying the behavior of both partners. We found that the predominant Caribbean cleaner fish, the sharknose goby (Elacatinus evelynae), shows personality variation as we documented repeatable individual differences in activity, boldness, and exploratory behaviors. Personality variation was associated with cleaner–client interactions: cleaner boldness and activity were significantly related to posing by clients and cleaning, respectively. Cleaner personality variation was also associated with the functional identity (sociality, mobility, body size, and trophic level) of clients posing and being cleaned. We thus demonstrate that partner identity can have consequences on mutualistic outcomes which will contribute to the context-dependency and highly heterogeneous patterns we observe at a population level. We also suggest that within- and between-species differences have consequences on partner choice, a feature that has been previously thought to be absent from these cleaner–client interactions.

The role of heat shock protein 90 in regulating pain, opioid signaling, and opioid antinociception.

Heat shock protein 90 (Hsp90) is one of the central signal transduction regulators of the cell. Via client interactions with hundreds of proteins, including receptors, receptor regulatory kinases, and downstream signaling regulators, Hsp90 has a crucial and wide-ranging impact on signaling in response to numerous drugs with impacts on resultant physiology and behavior. Despite this importance, however, Hsp90 has barely been studied in the context of pain and the opioid receptor system, leaving open the possibility that Hsp90 could be manipulated to improve pain therapeutic outcomes, a current area of massive medical need. In this review, we will highlight the known roles of Hsp90 in directly regulating the initiation and maintenance of the pain state. We will also explore how Hsp90 regulates signaling and antinociceptive responses to opioid analgesic drugs, with a special emphasis on ERK MAPK signaling. Understanding this new and growing area will improve our understanding of how Hsp90 regulates signaling and physiology, and also may provide new ways to treat pain, and perhaps reduce the severe impact of the ongoing opioid addiction and overdose crisis.

Development of a Healthy Eating and Lifestyle Program (HELP) Online Website for Filipinos: A Case Report

Background and Purpose: Non-communicable diseases (NCDs) are a major public health problem in the Philippines and around the world. Preventive measures to reduce its continuous rise require improvement in the health system. Utilization of information and communication technology-(ICT)-based tools will allow dissemination of evidenced-based information in the population. This case report contains the description of the development process of a Web-based nutrition Website. Case Description: ICT-based tools were explored as means of communicating nutrition information to the public because of the increasing access and usage of the Internet among Filipinos. An iterative process with five major phases were followed in the development. Outcome: The Website HELP Online can be accessed through (http://i.fnri.dost.gov.ph/helponline). There is integration of two modules: one for the general public and the other for registered nutritionist dietitians (RND) of the Food and Nutrition Research Institute (FNRI). The first module contained the nutrition counseling platform that connects and records all interactions of online and walk-in clients with their RNDs. The second module contained nutrition calculators, a health tracker, and nutrition education materials. Discussion: The developed HELP Online Website was used for online users to easily access nutrition information and services offered by Department of Science and Technology (DOST)-FNRI. The user-centered design focus in combination with a responsive Web platform resulted in improved user satisfaction. In terms of content, use of the current and accepted scientific information translated to simpler and easier messages were found to be more effective among the target group. Although many issues exist with the continuous use of ICT-based tools, the main purpose is to improve the delivery of evidence-based information to the public.

Street-level bureaucracy and categorization processes in social workers’ encounters with parents who have financial and cognitive difficulties

ABSTRACT In the Swedish welfare state, assessment of applications regarding benefits for rent costs varies greatly between municipalities which could partly be explained by the inherent discretion in social work practice. This study focuses on practices of categorisation in processes of eviction risk among families, where there are indications of parental cognitive difficulties. The present article aims at exploring social workers’ discretionary approaches in these client interactions, and specifically how indications of cognitive difficulties are handled in relation to financial problems. This paper highlights how they, as street-level-bureaucrats, define and assess these particular clients’ needs of support but also how they view their professional role and the scope for interventions regarding parental impairments in relation to need for income support.This qualitative analysis is based on interviews with 10 social workers in different units of the social welfare agency, who in their work encounter families in eviction risk due to financial problems. The findings show that although the interviewees note that cognitive difficulties may partly explain the need for income support on a general level, the strategies to address indications of such difficulties and adjust the process and/or offer alternative interventions to suit the clients needs vary.

A Sequential Analysis of Clinician Skills and Client Change Statements in a Brief Motivational Intervention for Young Adult Heavy Drinking

This study examined sequential relationships between clinician skills and client statements about behavior change in a randomized clinical trial comparing a brief motivational intervention (BMI) to a relaxation training control condition (REL) in a sample of heavy drinking young adults. Clinician and client interactions (N = 167) were assessed according to two established observational rating systems. Sequential analyses examined the transitional associations between clinicians’ use of MI-eliciting skills (i.e., questions and reflections), MI-supportive skills (e.g., affirmations, emphasize client autonomy, statements of support), MI-inconsistent skills (e.g., confrontations, unsolicited advice), and subsequent client statements about behavior change (i.e., change talk or sustain talk). In both conditions, clinicians’ use of MI-elicitation skills operated in a manner that was largely consistent (100% in BMI; 84% in REL) with the directional relationships proposed by MI theory (i.e., The Technical Hypothesis). More detailed analyses of the BMI condition showed clinician skills were related to statements about behavior change somewhat differently in drinking compared to coping discussions. While elicitations of change talk were associated with increased odds of their intended response (i.e., distal drinking and proximal coping change talk), elicitations of proximal coping sustain talk were associated with higher odds of proximal change talk. MI-supportive skills were also associated with increased odds of proximal change talk, and instances of proximal sustain talk were rare in the sample. This fine-grained analysis presents sequential transitions to client change and sustain talk with greater classification specificity than has been previously reported. Such efforts have the potential to advance our understanding of the function of MI skills in promoting client discussions about drinking (i.e., evoking) and coping (i.e., planning) behavior change.

Evaluating the Level of Burnout among Healthcare Professionals

Abstract The professional staff in human service institutions are often required to spend considerable time in intense involvement with other people. Frequently, the staff–client interaction is centered around the client’s current problems (psychological, social, and/or physical) and is therefore charged with feelings of anger, embarrassment, fear, or despair. Solutions for these problems are not always obvious and easily obtained, thus adding ambiguity and frustration to the situation. For the helping professional who works continuously with people under such circumstances, the chronic stress can be emotionally draining and poses the risk of burnout. Extensive literature highlighted that healthcare professionals’ work is relentlessly overloaded, emotionally overwhelming, escalating their private life, and thus favoring burnout development. In the present research, there was found a significant difference (p < 0.001) between the burnout level (Maslach HSS) of staff working in state hospitals and staff working in private hospitals. None of the other differences were significant: age (p = 0.155), gender (p = 0.083), work experience (p = 0.480), and job (p = 0.015).

Evaluation of the accuracy, reliability, efficiency, and acceptability of fast forwarding to score problem behavior

Technological advances have allowed professionals to obtain extended recordings of caregiver-client interactions in natural settings, but scoring recorded video at normal speed to identify instances of low-rate problem behavior is impractical in terms of scoring time. Fast forwarding is a continuous measurement system in which all seconds of an observation are viewed at a speed faster than normal. In Study 1, we evaluated whether three groups of five observers could discriminate problem behavior at three fast-forwarding speeds across 10-min observations. We analyzed the efficiency of using fast forwarding compared to continuous scoring, and interobserver agreement across the fast-forwarding speeds. In Study 2, we compared the accuracy, efficiency, and social acceptability of fast forwarding (3.5x) and momentary time sampling (3.5 s) across 90-min observations. Results support the use of 3.5x fast forwarding as a viable measurement system of improving the practicality of scoring problem behavior from video.

Tax Preparer Certification and Organization Form among Uncertified Preparers Influence Client Satisfaction and Experience

ABSTRACTHow does state certification (e.g., CPA, enrolled agent [EA], or attorney) and organizational form among uncertified preparers (big box “franchise” firms versus not) influence client satisfaction and interactions? Results from a sample (n = 3,984) of Yelp ratings of U.S. tax preparers indicates that certified preparers receive higher ratings than do uncertified small-firm preparers, who earn higher ratings than do franchise preparers. Linguistic analysis suggests that clients of certified preparers experience tax preparation service as a “relational” interaction, with reviews evidencing more positive affect and inclusive pronouns (e.g., we). In contrast, the clients of franchise firms experience tax preparation as “transactional,” with reviews evidencing more swear words and impersonal pronouns. Linguistic results for uncertified small preparers fall between those of certified and franchise preparers. The paper is among the first to adapt emerging corpus linguistic methods to examine client perceptions of professional accounting services.

Experiential Counselor Supervision for Rehabilitation Counselors-in-Training

Background:Preprofessional training for rehabilitation counselors necessarily includes experiential components designed to develop the clinical skills of trainees. Though there are a broad range of supervision models and modes of delivery available, thorough descriptions of supervisory practices are rare, particularly for existential and experiential approaches.Objective:The purpose of this article is to describe an approach to experiential rehabilitation counselor supervision (ERCS) which orients counselors-in-training toward heightened awareness of the clinical environment and being fully present within their counselor–client interactions. Within this existential approach, the depth of focus on the interpersonal counseling experience is offered as a counterbalance to an overemphasis on technical proficiency and procedural fidelity.Framework:The ERCS process exposes students to counseling and supervision in intensified experiential forms within: (a) the counseling session, (b) individual supervision, and (c) group supervision. The supervision format and mode of trainee observation of the counseling session may vary, though in each case, the focus is on awareness and presence above techniques. During individual supervision, the emphasis on awareness is maintained, though precedence is given to supervisee anxiety, supervisee countertransference, and parallel process. In group supervision, trainee and group process dynamics may initially escalate anxieties, but this format opens opportunities for insight through sharing of experiences, facilitated feedback, and activation of therapeutic factors.Conclusion:The ERCS approach is intended to emphasize the primacy of relational components of counseling and to promote interpersonal learning that will be useful for trainees in their direct client work in internship and future employment.

Determinants of Fertility Desires and Intentions among HIV Infected and Uninfected Women and Contraceptive use among HIV-infected women in the study atSix hospitals in two regions of Kenya

HIV epidemic in Kenya is geographically diverse ranging from a prevalence of 26 percent and 0.4 percent. Evidence indicates that a higher proportion of HIV infected women are more likely to be associated with unintended pregnancies.Despite this evidence, little is known about determinants of fertility desires and intentions of HIVinfectedand HIV-uninfected women in Kenya. 437 HIV-infected and 365 HIV-uninfected women were enrolled in the study. Using a cross-sectional mixed method, the study sought to investigate determinants of fertility desires and intentions among HIV-infected and uninfected women, and further determined factors associated with desire and intention to use contraceptives among HIV-infected women. Focus group discussions and key informant interviews were conducted with HIV-infected and uninfected women and Health providers respectively. Sampling was proportionate to the size based on client volumes at each study hospital. Similar factors including; age, region ofresidence, place of residence, level of education, employment and marital status were found to significantly influence desire and intention to have children among HIV-infected and uninfected women. Older women were more likely to desire or intend to have more children P<0.001), marital status was the only factor that influenced desire and intention to utilize contraceptives among HIV-infected women. Myths and misconception and poor provider -client interactions on family planning methods were some of the demand and supply system gaps that hinder utilization of family planning methods Innovative approaches are required to promote use of contraceptives among HIV infected women to reduce maternal morbidity, mortality and vertical transmission of HIV.

An Experiential Investigation of Tax Professionals' Contentious Interactions with Clients

ABSTRACTThis paper is a descriptive exploration of the under-researched area of contentious interactions between tax professionals in public accounting and their clients. We collect data in two waves. First, we employ an experiential questionnaire (EQ) to obtain rich, detailed data about actual contentious client interactions experienced by tax professionals. Second, we conduct a follow-up survey based on the results of the EQ to provide additional insight. We find that tax professionals often employ arguments relating to possible taxing authority (e.g., Internal Revenue Service) actions and the technical merits of the tax position to persuade their clients. We also provide additional details about the types of contentious issues tax professionals experience and how these issues are resolved. Importantly, our results point to a need for more training on how to deal with contentious issues, as most professionals strongly believe training is needed, even though few have actually received training.Data Availability: Contact authors.

The importance of the advisor’s relational and professional competence and formal power in meetings with farmers

ABSTRACTPurpose: The aim of the paper is to explore how advisors’ relational and professional competence influences inter-subjectivity and farmers’ perceptions of farm visits in a setting where advisors have formal power.Methodology: Advisors from the dairy company Tine, which is owned by farmers in collaboration, visit farmers at least once a year. The aim of the visit is to assist farmers in managing the farm and to control the production conditions in the cowshed. In a case study, we attended 10 such mandatory advisor visits and interviewed both farmers and advisors.Findings: Together with advisor style, our findings show that the power relation leaves room for advisors to define their roles widely, ranging from inspector to coach. Advisors have different perceptions of what their jobs are and when they have done a good job. These differences determine the degree of inter-subjectivity and how satisfied farmers are with visits. Furthermore, advisors’ relational and professional competencies are crucial for achieving high inter-subjectivity and satisfied farmers.Theoretical implications: This paper contributes to the theory by identifying factors that influence farmers’ perceptions of advisor visits, as well as by showing the importance of the advisor’s relational and professional competence in a setting where they have formal power.Practical implications: Partly as an outcome of this study, Tine has started a process to separate the control function from farm visits. Tine has also decided to let farmers choose advisors themselves. Originality/value: The power relation in our study differs from most consultant–client interactions in the literature.

Effects of Inhibitors on Hsp90's Conformational Dynamics, Cochaperone and Client Interactions.

The molecular chaperone and heat-shock protein Hsp90 has become a central target in anti-cancer therapy. Nevertheless, the effect of Hsp90 inhibition is still not understood at the molecular level, preventing a truly rational drug design. Here we report on the effect of the most prominent drug candidates, namely, radicicol, geldanamycin, derivatives of purine, and novobiocin, on Hsp90's characteristic conformational dynamics and the binding of three interaction partners. Unexpectedly, the global opening and closing transitions are hardly affected by Hsp90 inhibitors. Moreover, we find no significant changes in the binding of the cochaperones Aha1 and p23 nor of the model substrate Δ131Δ. This holds true for competitive and allosteric inhibitors. Therefore, direct inhibition mechanisms affecting only one molecular interaction are unlikely. We suggest that the inhibitory action observed in vivo is caused by a combination of subtle effects, which can be used in the search for novel Hsp90 inhibition mechanisms.

Detached concern in client interaction and burnout.

Emotion regulation in client interactions is a crucial predictor of employee well-being in human service work. This article provides a dual concept of detached concern (DC) drawing on Lief and Fox’s (1963) description, newly embedded in approaches of emotion regulation, comprising elements of emotio

Efficacy of Communication Training of Community Health Workers on Service Delivery to People Who Inject Drugs in Vietnam: A Clustered Randomized Trial.

To evaluate the efficacy of an intervention targeted to commune health workers (CHWs) who deliver services to people who inject drugs (PWID) in Vietnam. From 2014 to 2016, we conducted a cluster randomized controlled trial of 300 CHWs and 900 PWID in 60 communes in 2 provinces of Vietnam. Intervention CHWs participated in training sessions to enhance their communication skills. Trained CHWs were asked to deliver individual sessions to PWID. We assessed the outcomes at baseline and at 3-, 6-, 9-, and 12-month follow-ups. Intervention CHWs showed greater improvement in provider-client interactions than did control CHWs at all follow-ups (range of difference = 3.33-5.18; P < .001). Intervention CHWs showed greater reduction in negative attitudes toward PWID at the 12-month follow-up (mean ±SD = 1.75 ±0.50; P < .001). PWID in the intervention group exhibited greater improvement in drug avoidance than did those in the control group from the 6-month follow-up on (range of difference = 1.21-1.65; P < .001). We observed no intervention effect on heroin use as measured by urinalysis. This intervention targeting CHWs could lead to desired outcomes for both CHWs and PWID. ClinicalTrials.gov: NCT0213092.1.

Common Patterns in Chaperone Interactions with a Native Client Protein.

Many molecular chaperones are promiscuous and interact with a wide range of unfolded, quasi-native, and native client proteins. The mechanisms by which chaperones interact with the highly diverse structures of native clients thus remain puzzling. In this work, we investigate at the atomic level how three ATP-independent chaperones interact with a β-sheet-rich protein, the Fyn SH3 domain. The results reveal that the chaperone Spy recognizes the locally frustrated surface of the client Fyn SH3 and that the interaction is transient and highly dynamic, leaving the chaperone-interacting surface on Fyn SH3 solvent accessible. The two alternative molecular chaperones SurA and Skp recognize the same locally frustrated surface of the Fyn SH3 domain. These results indicate dynamic recognition of frustrated segments as a common mechanism underlying the chaperone-native client interaction, which also provides a basis for chaperone promiscuousness.

A switch point in the molecular chaperone Hsp90 responding to client interaction

Heat shock protein 90 (Hsp90) is a dimeric molecular chaperone that undergoes large conformational changes during its functional cycle. It has been established that conformational switch points exist in the N-terminal (Hsp90-N) and C-terminal (Hsp90-C) domains of Hsp90, however information for switch points in the large middle-domain (Hsp90-M) is scarce. Here we report on a tryptophan residue in Hsp90-M as a new type of switch point. Our study shows that this conserved tryptophan senses the interaction of Hsp90 with a stringent client protein and transfers this information via a cation–π interaction with a neighboring lysine. Mutations at this position hamper the communication between domains and the ability of a client protein to affect the Hsp90 cycle. The residue thus allows Hsp90 to transmit information on the binding of a client from Hsp90-M to Hsp90-N which is important for progression of the conformational cycle and the efficient processing of client proteins.