Control Vignette Research Articles

Assessing if motives-based vignettes influence plans for drinking and alcohol cues: protocol for a randomised controlled trial

IntroductionIn Sweden and the UK, there is a high prevalence of risky drinking, a pattern of drinking associated with adverse consequences. Drinking motives are a proximal predictor of risky drinking...

Psychiatry and Family Medicine Residents' Likelihood of Prescribing HIV Pre-exposure Prophylaxis to Patients With Mental Illness and HIV Vulnerability.

People living with mental illness (PLMI) experience disproportionately high incidence of and vulnerability to HIV. Pre-exposure prophylaxis (PrEP) is an effective and safe HIV prevention method, but data regarding prescription to PLMI are lacking. Psychiatrists may serve as important points of access for PrEP prescription for PLMI. We conducted a vignette-based study of residents in psychiatry and family medicine (FM) to assess likelihood of prescribing PrEP and assumptions about the fictional patient. Participants were randomized to one of five vignettes in which the patients' psychiatric diagnosis was varied (schizophrenia on long-acting injectable or oral antipsychotic, bipolar disorder, major depression) or a control vignette without a psychiatric diagnosis. A total of 439 residents participated. We found that high percentages of psychiatry (96.8%) and FM (97.4%) residents were aware of PrEP. High percentages of psychiatry (92.0%-98.1%) and FM (80.8%-100%) residents reported that PrEP was indicated for all patient conditions. Family medicine residents were more likely to prescribe PrEP to all experimental conditions than psychiatry residents. There was no difference in likelihood of prescribing to the control condition without a psychiatric diagnosis. The belief that PrEP prescription was out of scope of practice was greater among psychiatry residents. A majority of psychiatry residents responded that PrEP was indicated for an array of patients with psychiatric diagnoses. However, psychiatry residents were broadly less likely to prescribe PrEP to patients with these diagnoses. The high percentage of psychiatry residents who reported that PrEP was indicated for all patients suggests that additional training is needed to facilitate PrEP prescription by psychiatrists.

No evidence of theory of mind reasoning in the human language network.

Language comprehension and the ability to infer others' thoughts (theory of mind [ToM]) are interrelated during development and language use. However, neural evidence that bears on the relationship between language and ToM mechanisms is mixed. Although robust dissociations have been reported in brain disorders, brain activations for contrasts that target language and ToM bear similarities, and some have reported overlap. We take another look at the language-ToM relationship by evaluating the response of the language network, as measured with fMRI, to verbal and nonverbal ToM across 151 participants. Individual-participant analyses reveal that all core language regions respond more strongly when participants read vignettes about false beliefs compared to the control vignettes. However, we show that these differences are largely due to linguistic confounds, and no such effects appear in a nonverbal ToM task. These results argue against cognitive and neural overlap between language processing and ToM. In exploratory analyses, we find responses to social processing in the "periphery" of the language network-right-hemisphere homotopes of core language areas and areas in bilateral angular gyri-but these responses are not selectively ToM-related and may reflect general visual semantic processing.

Student and clinician perceptions of medical student mistreatment: a cross-sectional vignette survey

ObjectivesThe mistreatment of medical students remains pervasive in medical education. Understanding the extent to which clinicians and students recognise mistreatment can assist in creating targeted interventions that reduce mistreatment. The...

Separating binge‐eating disorder stigma and weight stigma: A vignette study

Vignette research on binge-eating disorder (BED) stigma is limited and lacking methodological rigor. Existing studies lack control vignettes and typically present characters with overweight or obesity, introducing the confound of weight stigma. This study examined BED stigma while addressing these limitations. Participants (N = 421) were assigned to read one of six vignettes describing a woman with either BED or no BED as well as either no mention of weight, a recommended weight, or an obese weight. Four questionnaires examined personality stereotypes, emotional reactions to the character, desire for social distance from the character, and blame attributions. The character with BED was ascribed more negative personality characteristics and faced less positive emotional reactions than the character without BED, regardless of weight status. However, BED stigma did not emerge for social distance or blame attributions. Regarding weight stigma, evidence was limited and moderated by the presence of BED, suggesting no additive effect between BED stigma and weight stigma. In fact, blame attributions toward the character with obesity were reduced by the presence of BED. The results reveal that BED is a highly stigmatized eating disorder and suggest that weight stigma may be driven by assumptions about a person's eating behavior rather than their body size per se. Future studies must consider the relationship between BED stigma and weight stigma when assessing either form of stigma. The results also indicate new information to be integrated into anti-weight stigma campaigns as well as policy and public health initiatives.

In smiles we trust? Smiling in the context of antisocial and borderline personality pathology.

Research suggests that people behave more cooperatively towards those who smile and less cooperatively towards those with personality pathology. Here, we integrated these two lines of research to model the combined effects of smiles and personality pathology on trust. In two experiments, participants read vignettes portraying a person with either borderline personality disorder, antisocial personality disorder, or no personality pathology. These portrayals were paired with a brief video clip that showed a person with either a neutral expression or a smile. Participants then played a Trust game with the "person" presented using each vignette and video clip combination. In Experiment 1, rates of trust were lower in response to the borderline and antisocial personality disorder vignettes compared with the control vignette. Interestingly, the effect of smiles was dependent upon personality. Although participants were more trusting of smiling confederates portrayed as having borderline personality disorder or no pathology, they were less trusting of confederates portrayed as having antisocial personality disorder if they smiled. In Experiment 2, run with a second set of personality vignettes, rates of trust were lower in response to both personality disorder vignettes and higher in response to smiles with no significant interaction. Together, these results suggest that information regarding both the current emotional state as well as the personality traits of a partner are important for creating trust.

Peer Recognition of Disordered Eating Behaviors: Implications for Improving Awareness through Health Education

ABSTRACTBackground: Eating disorders (ED) are a concern on college campuses, yet comprehensive education and awareness is low. Few studies have investigated knowledge of disordered eating not fitting prototypical depictions or recognition of disordered eating in males. Purpose: To assess college students’ ability to identify behavioral symptoms of ED in men and women. Methods: We explored problem identification ability after reading vignettes depicting either males or females displaying ED behaviors aligned with anorexia, bulimia, and binge eating disorder, and a healthy control vignette. Ordinal logistic was used to examine the effect of vignette target gender, participant gender, and disorder depicted on identification. Results: Approximately half of the sampled students correctly categorized vignettes as EDs. Participants were most likely to correctly identify the bulimia scenario as an ED, followed by anorexia, and binge-eating, and were more likely to identify ED if the vignette target was a woman. Discussion: The findings suggest awareness of behavioral presentations of ED, particularly in males, is low. This may stem from prototypical depictions of ED in the media and existing education material. Translation to Health Education Practice: Health education can focus on observable, behavioral symptoms of ED to improve identification in college students.A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI)http://portal.shapeamerica.org/trn-Webinars

Nurses' perceptions of medical procedures and nursing practices for older patients with non-cancer long-term illness and do-not-attempt-resuscitation orders: A vignette study.

AimTo elucidate influence of a do‐not‐attempt‐resuscitation (DNAR) order on nurses’ perceptions of the medical procedures and nursing practices for non‐cancer older patients.DesignA vignette‐based questionnaire study.MethodsA questionnaire survey asking nurses their perceptions of clinical practices for the following three vignettes was performed in a community hospital in Japan (N = 120): the control vignettes with an older patient with repeated heart failure who was living alone and the other two with either an absence of relatives or a diagnosis of dementia. We also prepared additions to each vignette describing a DNAR order.ResultsNurses’ perception on cardiopulmonary resuscitation, defibrillation, blood tests and intravenous nutrition showed statistically significant and minimally important declines after the DNAR order compared with before for all three vignettes (p < .001). DNAR orders can influence nurses’ perceptions of clinical practices for non‐cancer older patients with chronic heart failure.

Absence of Relatives Impairs the Approach of Nurses to Cardiopulmonary Resuscitation in Non-Cancer Elderly Patients without a Do-Not-Attempt-Resuscitation Order: A Vignette-Based Questionnaire Study.

A Do-Not-Attempt-Resuscitation (DNAR) order solely precludes performing cardiopulmonary resuscitation (CPR) following cardiopulmonary arrest. A patient's personal status is known to influence a range of clinical practices, not only CPR, when a DNAR order is given. We assessed whether the absence of supporting relatives or a diagnosis of dementia can influence nurses' perceptions of clinical practices for elderly patients with non-malignant and chronic diseases. A vignette-based questionnaire was used to evaluate nurses' beliefs both before and after issuance of a DNAR order. Three vignettes were developed: the control vignette described an 85-year-old woman with repeated heart failure, the second and third incorporated a lack of relatives and a dementia diagnosis, respectively. The survey assessed the approach of nurses to 10 routine medical procedures, including CPR, clinical laboratory testing and nursing care, using a 5-base Likert-scale, for six vignette scenarios. A questionnaire was completed by 186 nurses (64% response). The pre-DNAR non-relative vignette showed significantly lower scores for CPR, indicating a deterioration in willingness to perform CPR, compared to the pre-DNAR control (median [interquartile]; 3 [2-4] and 4 [3-4] in the non-relative and control vignettes, respectively, p < 0.001). No significant differences were observed between the dementia and control vignettes. Absence of contactable relatives and resultant lack of communication can diminish the perception of nurses regarding the provision of CPR, even when a DNAR does not exist. This result suggests a necessity for comprehensive training all medical staff about issuance of DNAR orders and what care should be provided thereafter.

Portrayals of mental illness, treatment, and relapse and their effects on the stigma of mental illness: Population-based, randomized survey experiment in rural Uganda.

BackgroundMental illness stigma is a fundamental barrier to improving mental health worldwide, but little is known about how to durably reduce it. Understanding of mental illness as a treatable medical condition may influence stigmatizing beliefs, but available evidence to inform this hypothesis has been derived solely from high-income countries. We embedded a randomized survey experiment within a whole-population cohort study in rural southwestern Uganda to assess the extent to which portrayals of mental illness treatment effectiveness influence personal beliefs and perceived norms about mental illness and about persons with mental illness.Methods and findingsStudy participants were randomly assigned to receive a vignette describing a typical woman (control condition) or one of nine variants describing a different symptom presentation (suggestive of schizophrenia, bipolar, or major depression) and treatment course (no treatment, treatment with remission, or treatment with remission followed by subsequent relapse). Participants then answered questions about personal beliefs and perceived norms in three domains of stigma: willingness to have the woman marry into their family, belief that she is receiving divine punishment, and belief that she brings shame on her family. We used multivariable Poisson and ordered logit regression models to estimate the causal effect of vignette treatment assignment on each stigma-related outcome. Of the participants randomized, 1,355 were successfully interviewed (76%) from November 2016 to June 2018. Roughly half of respondents were women (56%), half had completed primary school (57%), and two-thirds were married or cohabiting (64%). The mean age was 42 years. Across all types of mental illness and treatment scenarios, relative to the control vignette (22%–30%), substantially more study participants believed the woman in the vignette was receiving divine punishment (31%–54%) or believed she brought shame on her family (51%–73%), and most were unwilling to have her marry into their families (80%–88%). In multivariable Poisson regression models, vignette portrayals of untreated mental illness, relative to the control condition, increased the risk that study participants endorsed stigmatizing personal beliefs about mental illness and about persons with mental illness, irrespective of mental illness type (adjusted risk ratios [ARRs] varied from 1.7–3.1, all p < 0.001). Portrayals of effectively treated mental illness or treatment followed by subsequent relapse also increased the risk of responses indicating stigmatizing personal beliefs relative to control (ARRs varied from 1.5–3.0, all p < 0.001). The magnitudes of the estimates suggested that portrayals of initially effective treatment (whether followed by relapse or not) had little moderating influence on stigmatizing responses relative to vignettes portraying untreated mental illness. Responses to questions about perceived norms followed similar patterns. The primary limitations of this study are that the vignettes may have omitted context that could have influenced stigma and that generalizability beyond rural Uganda may be limited.ConclusionsIn a population-based, randomized survey experiment conducted in rural southwestern Uganda, portrayals of effectively treated mental illness did not appear to reduce endorsement of stigmatizing beliefs about mental illness or about persons with mental illness. These findings run counter to evidence from the United States. Further research is necessary to understand the relationship between mental illness treatment and stigmatizing attitudes in Uganda and other countries worldwide.Trial registrationThe experimental procedures for this study were registered with ClinicalTrials.gov as "Measuring Beliefs and Norms About Persons With Mental Illness" (NCT03656770).

Bargaining with characters: How personality pathology affects behavior in the ultimatum and dictator games

Although disorders of personality are associated with a range of interpersonal difficulties, little is known about how knowledge of a partner's personality pathology affects behavior in bargaining situations. We asked study participants to play two economic games with virtual confederates. Participants were told that the confederates had been interviewed and were now portrayed using brief vignettes. The vignettes described one of eight DSM-5 personality disorders and a control (no personality pathology) vignette. In Experiment 1, participants played either the role of proposer (specifying offers) or responder (specifying minimum acceptable offers) in an Ultimatum game. In the role of proposer, participants made lower offers to the avoidant, histrionic, antisocial, narcissistic, schizotypal, dependent, and borderline vignettes in comparison to the control vignette. In the role of responder, participants showed no differences among vignettes with respect to responder minimum acceptable offers. To isolate the effects of fairness or altruism, we conducted a second experiment in which participants played the role of allocator in a Dictator game. Participants made lower allocations to vignettes depicting schizoid, histrionic, antisocial, narcissistic, dependent, and borderline personality disorders compared to the control vignette. Taken together, these findings suggest that knowledge of personality pathology plays a role in bargaining situations.

Cooperation with characters: How a partner's personality disorder decreases cooperation in two economic games

How does your personality affect how others treat you? Previous research suggests the characteristic patterns of social behavior in personality disorders can be captured using economic games. Here we test the opposite: whether personality disorders elicit characteristic patterns of social behavior from others. Participants read vignettes portraying individuals with one of eight DSM-5 personality disorders (plus a control vignette) then played either a Prisoner's Dilemma (Experiment 1) or Chicken (Experiment 2) game with a confederate said to have been interviewed and portrayed by each vignette. Experiment 1 found higher cooperation rates in response to the control vignette in comparison to all personality disorder vignettes. Experiment 2, found similar results, apart from the vignette depicting schizoid personality disorder. Findings suggest that people use information about personality to guide how they interact with others. They also illuminate the role others play in the difficult social situations those with personality disorders frequently experience.

Portraying mental illness and drug addiction as treatable health conditions: Effects of a randomized experiment on stigma and discrimination

Despite significant advances in treatment, stigma and discrimination toward persons with mental illness and drug addiction have remained constant in past decades. Prior work suggests that portraying other stigmatized health conditions (i.e., HIV/AIDS) as treatable can improve public attitudes toward those affected. Our study compared the effects of vignettes portraying persons with untreated and symptomatic versus successfully treated and asymptomatic mental illness and drug addiction on several dimensions of public attitudes about these conditions. We conducted a survey-embedded randomized experiment using a national sample (N = 3940) from an online panel. Respondents were randomly assigned to read one of ten vignettes. Vignette one was a control vignette, vignettes 2–5 portrayed individuals with untreated schizophrenia, depression, prescription pain medication addiction and heroin addiction, and vignettes 6–10 portrayed successfully treated individuals with the same conditions. After reading the randomly assigned vignette, respondents answered questions about their attitudes related to mental illness or drug addiction. Portrayals of untreated and symptomatic schizophrenia, depression, and heroin addiction heightened negative public attitudes toward persons with mental illness and drug addiction. In contrast, portrayals of successfully treated schizophrenia, prescription painkiller addiction, and heroin addiction led to less desire for social distance, greater belief in the effectiveness of treatment, and less willingness to discriminate against persons with these conditions. Portrayal of persons with successfully treated mental illness and drug addiction is a promising strategy for reducing stigma and discrimination toward persons with these conditions and improving public perceptions of treatment effectiveness.

Health care students' reactions towards HIV patients: examining prejudice, emotions, attribution of blame and willingness to interact with HIV/AIDS patients

One of the most pervasive stigmatising conditions in society today is HIV/AIDS. In Trinidad and Tobago, stigma and discrimination are still pervasive especially against persons living with HIV/AIDS (PLHIV) and at-risk groups. HIV stigmatisation takes place at all levels including health care institutions, and is a major obstacle to effective HIV/AIDS prevention and care. This study examined health care students' reactions towards HIV patients. A stratified random sample of 339 health care students from Trinidad was used. A 2 × 2 factorial design using vignettes manipulated a male patient's sexual orientation (heterosexual/homosexual) and HIV onset controllability (high/low). Multivariate analysis of variance and discriminant function analysis were used to analyse the data. There was a significant main effect of HIV onset controllability on participants' attribution of blame, emotions, prejudicial evaluation and willingness to interact with PLHIV, Λ (.64) F(6, 330) = 31.44, p <.001, = .37. Attribution of blame and prejudicial evaluation discriminated between reactions to patients in low onset control and high onset control vignettes. Cognitive–affective appraisal processes are instrumental in determining health care providers' reaction towards PLHIV.

The effects of physical activity vignettes on physical activity-related social cognitions among people with spinal cord injury

Purpose: The purpose of this study was to explore the effectiveness of informational portrait vignettes for enhancing physical activity-related psychosocial cognitions in adults with spinal cord injury (n = 90). Methods: Using the Health Action Process Approach (HAPA), participants were classified as being in the motivational or volitional phase of behavior change. Half of the participants were randomly allocated to read an experimental vignette, which described the physical activity behaviours, thoughts, and feelings of a character demographically similar to the reader. The remainder read a control vignette. Social cognitions were measured one-week before, and immediately after reading the vignette. Results: Analyses revealed no significant effects of the vignettes on social cognitions (p > 0.05). Conclusions: Informational portrait vignettes describing a physically active person with SCI and targeting multiple HAPA-based social cognitions are not recommended as a physical activity promotional strategy for people with SCI. The effectiveness of other types of vignettes should be examined.Implications for RehabilitationUntil further research is completed to determine whether social comparison strategies play a meditational role in accounting for the impact of a tailored informational portrait vignette to alter leisure time physical activity among those with spinal cord injury, these types of informational intervention should not be utilized in a rehabilitation, or real-world, setting.Although informational portrait vignettes may not be effective in altering leisure time physical activity social cognitions among those with spinal cord injury, different types of vignettes, such as composite vignettes, should be explored.

Individual Differences in Undergraduate Student Athletes: The Roles of Perfectionism and Trait Anxiety on Perception of Procrastination Behavior

The purpose in this study was to examine how undergraduate student athletes organized different explanations relating to behavioral procrastination into a hierarchy. Participants (N = 201) completed the State-Trait Anxiety Inventory (Spielberger, Gorsuch, Lushene, Vagg, &amp; Jacobs, 1983) and the Multidimensional Perfectionism Scale (Hewitt &amp; Flett, 1991) personality questionnaires. Two groups (low and high trait-anxious and perfectionist) were created from the lower and upper third responses. These participants read 6 vignettes describing different explanations of athletes' behavioral procrastination and 2 control vignettes (nonprocrastinator and reveler drinker), and rated them. The 2 groups both placed the nonprocrastinator vignette in the first position, but rated differently the behavioral self-handicap of reveller drinker and perfectionism with high standards vignettes. Maladaptive aspects of perfectionism associated with procrastination are discussed.

Culture, Children, and Mental Health Treatment: Special Section on the National Stigma Study-Children

Stigma—the prejudice and discrimination linked to individuals with mental illness—has been a mainstay of psychiatric and social science research. Yet a resurgence of academic, policy, and provider interest began in the mid-1990s and culminated in 1999 with the White House Conference on Mental Health and the first-ever Surgeon General’s report on mental illness. Interest has continued, with several programmatic efforts surrounding the recommendations of the President’s New Freedom Commission on Mental Health. As a result, we now have a solid, if not complete, knowledge base about the nature, levels, and correlates of community-based attitudes, beliefs, and behavioral dispositions toward adults with schizophrenia, depression, and addictive disorders. Importantly, no such foundation had existed on the stigma that may accompany the serious emotional disorders that children and adolescents experience or on the attitudinal barriers to and social ramifications of seeking care. Given the high level of media and professional discussion about the rise in children’s use of psychiatric medication, there is a surprising lack of empirical evidence about public perceptions of child and adolescent disorders, the parents and children who experience them, and the need for or reaction to available treatments. In the absence of such data, the tendency is to fall back on what is known about adults’ mental illness and to transfer to our research our own impressions of how cultural subgroups—for example, different racial or ethnic groups or those with more education—think and feel about medical care and the mental health system. Sociologists and other social scientists have long predicted that as modern society became more complex, allowing greater freedom in social interactions, sociodemographic characteristics would be increasingly weak substitutes for cul

Thinking of mental and other representations: The roles of left and right temporo-parietal junction

Adopting new versions of the false belief and “false” photo vignettes used by Saxe & Kanwisher (2003) we were able to show activation in all five areas previously reported. Activations by added false sign and temporal change control vignettes in these areas showed that the right temporo-parietal junction (TPJ-R) is specifically associated with processing mental states like belief. In contrast, TPJ-L was also activated by false signs suggesting an association with processing perspective differences for mental and non-mental objects in line with work on visual perspective tasks. A similar, but less clearly interpretable pattern of activations was also found in the middle temporal gyrus, precuneus and in the MPFC. These results are discussed in relation to findings in normal development where false belief and false sign tasks associate more strongly with each other than does each of them with the “false” photo task.

Bench-Marking Effects in the Blaming of Professionals for Incidents of Aggression and Assault

This study compared all possible orders of responding to three vignettes describing incidents between a male patient and a female nurse in which the nurse is mildly assaulted, severely assaulted, or verbally abused by the patient (the control condition). Subjects were 32 female senior-year nursing students and 28 practicing nurses. It was found that response levels to a given vignette could predict a respondent's response to the other vignettes. Also, a significant "bench-marking" effect was found: if a subject responded to the mild assault vignette first, the subject's overall response pattern best fit the general nonlinear assignment-of-blame pattern observed, but if the subject responded to the severe assault or control vignette first, this vignette set a bench mark for responding from which the subject's subsequent responses did not deviate greatly, which slightly distorted the subject's V-shaped nonlinear response pattern.

The Use of Control Vignettes

A review of the literature revealed control, or placebo, vignettes are not used in numerous studies that employ vignette-based methodology. This is a serious flaw. The nature of this flaw and its methodological and theoretical importance are outlined in this paper as are procedures and a model for developing control vignettes.