Discordant Beliefs Research Articles

Discordant Beliefs and Conflict Avoidance among Islamic Sects in North-Western Nigeria

This article examined the discordant beliefs among Islamic sects in Northwest Nigeria on the second coming of Prophet ‘Iisa (Jesus), within the context of Hadeeth as a primary source of Islamic law; respecting the companions of Prophet Muhammad (SAW); abiding by the governance of secular political rulers and using Shaykhs (past pious spiritual leaders) as intermediaries to attain spirituality from Allah. It then investigated how each sect reacts when confronted with rivalry or aggression fromanother sect(s). Focus Group Discussions (FGDs) was used to collect data from male and female members of four purposively selected sects in Katsina, Kaduna and Kano States. Findings were analysed using thematic, narrative and textual explication approaches. Findings indicate that discordant beliefs within the context of believing in the second coming of Prophet ‘Iisa (Jesus), using Hadeeth as an Islamic source of legislation, respecting the Prophet’s companions, and abiding by secular leaders’ rules exist among the sects. While some of the discordant beliefs among them led to verbal insults and confrontations, some were managed and handled with calmness, wisdom and avoidance of potential conflicts, thereby averting any potential combative/physical intra-religious and inter-sectarian violent conflicts that may arise from discordant beliefs among the sects. The study concludes that although there were discordant beliefs among the four Islamic sects, they were able to manage their discordance through strategic conflict avoidance techniques. Therefore, we recommend that members of different Islamic sects in Northwest Nigeria find time to enroll themselves in formal education where they can seek knowledge for self-development and intellectual growth instead of relying only on the interpretations of their leaders on religious matters.

Girls Are Better Students but Boys Will Be More Successful at Work: Discordance Between Academic and Career Gender Stereotypes in Middle Childhood.

Despite findings of female advantages at school, men still are higher achieving in the workplace. Only a small amount of research has simultaneously investigated stereotypes of these different domains. We investigated whether stereotypes about academic female superiority and paradoxical stereotypes about workplace male superiority coexist. Participants were 1144 Grades 1-6 students (Mage = 9.66) from Hong Kong. They completed measures of academic gender stereotypes and meta-stereotypes, career gender stereotypes, career-related motivation for school excellence, and school engagement. Teachers provided school exam scores. We examined (1) gender and age differences, (2) the relationship between the stereotypes, and (3) the moderating role of these stereotypes in gender differences in school engagement, exam scores, and career-related motivation. Both boys and girls perceived girls as better students but a belief in female superiority did not translate to the career domain. Although both boys and girls beginning primary school believed their gender was superior in both domains, those at the end of primary school believed that girls do better at school while men are more successful at work. Also, at the end of primary school, these two stereotypes were more discordant on the individual level, i.e., the tendency for children who believed that girls perform better at school to also believe that women perform better at work was weaker in older children. Academic gender stereotypes moderated gender differences in school engagement and exam scores. Understanding why children hold discordant beliefs about success in different arenas and combating both academic and career stereotypes early may help improve gender equality for both genders.

Identifying and Overcoming Racial Disparities in Multiple Myeloma Care: Results from a Large-Scale Equity-Focused Quality Improvement Initiative

Background A prior quality improvement (QI) initiative (Mikhael ASH 2020) was conducted to address root causes of racial disparities in care delivery among patients with relapsed/refractory (R/R) multiple myeloma (MM) in 2 large oncology systems. Preliminary survey data suggested discordant beliefs regarding patients’ primary treatment concerns. Thus, this study was scaled up to 4 community-based oncology practices to greater evaluate disparities with electronic medical record (EMR) audits and team-based audit-feedback (AF) sessions to identify factors which could enhance more equitable care. Methods This QI initiative included patient and provider surveys, baseline and follow-up EMR audits, and small-group, team-based AF sessions at each participating clinic. Surveys were completed by 59 hematology/oncology healthcare providers (HCPs) and 100 R/R MM patients (Table 1; N=47 Black, N=50 White/Non-Hispanic) to examine alignments and discordances in attitudes, beliefs, perceptions, and practices regarding MM care. A baseline EMR audit of 200 R/R MM patients (Table 1; N=32 Black, N=122 White/Non-Hispanic) was conducted to identify patient/disease characteristics, treatment history, clinical practice metrics, and patient-centered measures (e.g., shared decision-making). During 1-hour AF sessions, HCP cohorts (Table 1) (a) assessed clinic-specific practice gaps identified by the patient-provider surveys and baseline EMR audit, (b) prioritized areas for improvement, and (c) developed action plans to address root causes. Surveys completed before (N=59) and after (N=41) the AF sessions measured changes in participants’ beliefs and confidence in care delivery. A follow-up EMR audit after completion of the AF sessions was performed to assess behavioral and practice change. Results Patient and HCP tethered survey data revealed discordant beliefs about patients’ primary treatment concerns. HCPs overestimated patients concern regarding treatment cost (32% vs 9%) and treatmentrisks (55% vs 29%), but underestimated patient's largest reported challenge in feeling confident that their treatment plan is the best for their cancer (18% vs 32%). Providers reported the most challenging aspect of MM management was individualizing treatment plans. There was large divergence between HCPs and all patients’ top goals (Figure 1) and stark racial disparities were observed in improving quality of life, preventing progression or recurrence, and surviving as long as possible (Figure 1). Disparities also persisted among patients who reported being on track or somewhat on track to achieve their treatment goals (76% White vs 54% Black/Hispanic, p = 0.021). Regarding shared decision-making (SDM) with their HCP, only 14% of Black/Hispanic patients felt completely involved in treatment decision making compared to 54% of White patients (p = < 0.001). EMR audits revealed fewer Black patients using maintenance therapy (63% vs 71% non-Black) and greater numbers of stem cell transplants (53% Black vs 44% non-Black). Following AF sessions 55% of HCPs set action plans to incorporate strategies to eliminate disparities in care for diverse MM patient populations and 48% to develop personalized treatment plans incorporating patient-specific factors and preferences. To achieve these goals, providers committed to engage patients in shared decision-making (17% pre-AF vs 38% post-AF), and provide adequate patient education about treatments (17% pre-AF vs 28% post-AF). Participants’ views of the impact of race and socioeconomic factors on equitable MM care changed as a result of the program increasing from 37% to 54% reporting a considerable or a great deal of impact. Conclusions Barriers to equitable, patient-centered care in patients with R/R MM included inadequate education and personalizing of treatment plans by HCPs as well as ineffective SDM. Discordances were observed between providers and all patients in describing the goals of treatment, and between White and Black/Hispanic patients in the challenges faced in their MM care. Action plans developed during this QI initiative intend to address identified gaps and improve equitable care for patients with R/R MM. Study Sponsor Statement The study reported in this abstract was funded by independent educational grants from AbbVie, Inc. Bristol-Myers Squibb, and Janssen Biotech Inc., who had no role in the study design, execution, analysis, or reporting. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Discordant Beliefs and Practices of Physicians Referring Cancer Patients to Palliative Care

Objectives We aimed to examine the concordance between beliefs and practices of physicians regarding the timing of referring cancer patients to a PC team. Methods We reviewed records of cancer deaths in a palliative care unit (PCU) over three years. Physicians who initiated the referral to PC completed a questionnaire. The referral time was categorized into early (> 90 days), intermediate (31–90 days) or late (≤ 30 days). Results For 208 cancer deaths (63% females), the median age was 55 years. The median referral time was 33 days. Only 9.6% of patients were referred early, while the majority were either referred late (47.1%) or fell in the intermediate category (43.3%). All of the referring physicians believed that a PC service is essential in an oncology center and 73.7% stated that cancer patients should be referred to PC at diagnosis or when cancer becomes incurable. No patient- or physician-related factors were significantly associated with the referral time. Conclusions Despite the unanimous belief among this group of physicians that cancer patients should be referred to PC at or before diagnosing its incurability, initiation of early referrals to PC was remarkably rare. Such a striking discordance between beliefs and practices merits further investigation.

Discordant Beliefs, Perceptions, and Experiences between Patients with Sickle Cell Disease and Their Care Teams: Insights from a Pilot Program to Support Shared Decision-Making

Background For patients with sickle cell disease (SCD), shared learning, understanding, and decision-making with their healthcare providers (HCPs) is critical for achieving treatment goals. Using a validated collaborative learning model (Sapir 2017), we evaluated patient and HCP perceptions of shared decision-making (SDM) related to SCD treatment. Methods In June 2020, 113 patients/caregivers of patients with SCD and 30 HCPs participated in 3 live, virtual collaborative learning sessions developed with the Sickle Cell Disease Association of America (Table 1). Before and after the sessions, patients and their HCPs completed tethered surveys to assess alignments and discordances in preferences, experiences, and concerns around SCD treatment and SDM. Results Patients and HCPs held discordant beliefs about the degree of patients' progress toward treatment goals. While HCPs estimated that only 29% of their patients are on track to meet their goals, 85% of patients reported that they felt somewhat (39%) or fully (46%) on track. The magnitude of this discrepancy suggests that patients may not be aware of treatment milestones they are not reaching. Participants differed in their perceptions of how often HCPs engage patients in SDM (Figure 1). Relative to patients' estimates, HCPs were more likely to report that they usually or always: ask about the patient's goals for treatment (41% vs 61%), work with the patient to create a treatment plan (47% vs 55%), explain their own goals for the patient's treatment (47% vs 55%), and explain the pros/cons of each treatment choice (47% vs 55%). The biggest missed opportunity for SDM involved how often HCPs ask patients about stigma related to opioids for pain management (28% vs 35%). The reported lack of communication around stigma may contribute to providers' underestimation of how often their patients encounter stigma. HCPs estimated that 47% of their patients have faced barriers to adequate pain management in the ER due to opioid stigma and/or poor knowledge of pain crises among ER staff. By comparison, 74% of patients reported ever feeling that ER doctors, nurses, or staff questioned their need for pain medication during a pain crisis (20% once; 54% more than once). When asked why patients are not more involved in SDM (Figure 2), HCPs were more likely to select patient factors: feeling too overwhelmed to make treatment decisions (52% HCPs, 14% patients), low health literacy (49% HCPs, 12% patients), and lack of confidence in validity of opinions/concerns (44% HCPs, 10% patients). In contrast, patients were more likely to report that they are completely involved in treatment decisions (40% patients, 4% HCPs) and that they trust their care team to make decisions on their behalf (37% patients, 30% HCPs). Regarding adjusting SCD therapy, HCPs overestimated how many patients were concerned about learning a new routine/schedule (23% HCPs, 7% patients), but underestimated concerns about being able to pay for it (4% HCPs, 9% patients). HCPs correctly estimated concerns about knowing whether treatment will work (33% HCPs, 34% patients), fear of side effects (29% HCPs, 25% patients), and knowing how to manage a pain episode (9% HCPs, 9% patients). Overall, HCPs underestimated how many patients would not worry about switching treatment (1% HCPs, 9% patients). Following the collaborative learning sessions, patients made commitments to talk to their care team about their treatment goals (52%), consider treatment options more closely (50%), take a more active role in decision-making (46%), and notify their care team with concerns (41%). HCPs set goals to increase the types of educational materials they provide (57%), attempt to ease the transition to the adult care setting (50%), engage their patients more frequently in SDM (47%), and train colleagues on how to conduct additional learning sessions (34%). The full data set with 2 additional learning sessions (Aug 2020) will be presented. Conclusions Patients with SCD and their care teams differed in their experiences and beliefs related to SDM. Collaborative education can reveal opportunities for greater understanding and facilitate improved patient-provider communication, leading to greater engagement in SDM around SCD treatment. Study Sponsor Statement The study reported in this abstract was funded by an independent educational grant from bluebird bio. The grantor had no role in the study design, execution, analysis, or reporting. Disclosures Smith-Whitley: Prime: Other: Education material; Novartis: Membership on an entity's Board of Directors or advisory committees; Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees.

Understanding Root Causes Contributing to Real-World Racial Disparities in Multiple Myeloma Care: Insights from a Mixed-Methods Study Utilizing Tethered Patient-Provider Surveys and Chart Reviews

Background Multiple myeloma (MM) is the most common hematologic malignancy among Black patients, who experience a 2-fold increase in MM risk and earlier age of onset compared with non-Black patients. Relative to other groups, Black patients are less likely to undergo autologous stem cell transplant (ASCT), receive timely access to novel therapies (e.g., immunomodulatory drugs, proteasome inhibitors), and enroll in clinical trials (Ailawadhi Blood Adv 2019). However, when Black patients with MM do undergo ASCT or receive novel therapies, their clinical outcomes match those observed in other patient groups, with some data suggesting a possible survival advantage (Fillmore Blood 2019). Therefore, in the absence of a clear biologic rationale for different treatment patterns, it is necessary to examine structural and other barriers to optimal care. In this ongoing quality improvement (QI) initiative, we are assessing and attempting to address the root causes of disparities in care delivery among patients with relapsed/refractory (R/R) MM in 2 large oncology systems. Methods Building on the design of our prior QI programs (Hussein ASCO 2020), this multicomponent initiative includes patient and provider surveys (n = 70), baseline and follow-up audits of electronic medical records (EMRs) (n = 400), and small-group, team-based audit-feedback (AF) sessions. Patient-Provider Surveys: 30 hematology/oncology healthcare providers (HCPs) and 40 patients with relapsed/refractory MM (20 African American [AA] and 20 non-AA patients, including Hispanic and non-Hispanic White patients) will complete 30-item and 35-item surveys, respectively. In addition to assessing MM treatment experiences, survey questions will evaluate health literacy, medication adherence, cancer beliefs, patient-HCP communication, and awareness of health disparities. With multiple shared questions, the surveys are designed to reveal alignments and discordances in attitudes, beliefs, perceptions, and practices regarding MM care (a) between patients and HCPs and (b) between AA and non-AA patient subgroups. In addition, HCPs' self-reported practice behaviors will be compared against documented practice patterns in the EMR audit. EMR Audits: Variables for the baseline EMR audit include patient/disease characteristics, treatment history, clinical practice metrics, and patient-centered measures (e.g., shared decision-making) documented for 100 AA and 100 non-AA adults with R/R MM and ≥2 clinic visits within the past year. Six months after the AF sessions, the follow-up EMR audit of 100 AA and 100 non-AA patients will assess changes in EMR documentation and practice behavior. Team-Based AF Sessions: HCP cohorts within each oncology system will participate in 1-hour live small-group AF sessions scheduled as part of each system's grand rounds series. Hematology/oncology teams will (a) assess system-specific practice gaps identified via the patient-provider surveys and baseline EMR audit, (b) prioritize areas for improvement, and (c) develop action plans for addressing root causes. Additional surveys completed before and after the AF sessions will measure changes in participants' beliefs and confidence in care delivery. Results Two large oncology systems in Chicago and Washington, DC, are enrolled. Preliminary HCP (n = 6) and patient (n = 9) survey data suggest discordant beliefs about patients' primary MM treatment concerns. HCPs overestimated how many patients are concerned about notfeeling confident that their treatment plan is the best for their cancer (83% vs 11%) and underestimated how many are concerned about lack of reliable transportation (0% vs 33%), difficulty communicating with their care team (0% vs 33%), meeting responsibilities at work and home (0% vs 11%), and treatment cost (0% vs 11%). Full findings from the baseline EMR audit (n = 200) and patient and HCP surveys (n = 70), as well as outcomes from the 2 small-group AF sessions (scheduled for September 2020), will be presented. Conclusions Factors contributing to racial disparities in MM care are complex. QI programs are critical tools for understanding and addressing system-specific barriers to optimal care for all patients with MM. Study Sponsor Statement The study reported in this abstract was funded by independent educational grants from AbbVie, Inc. and Celgene Corporation, who had no role in the study design, execution, analysis, or reporting. Disclosures Mikhael: Amgen, Celgene, GSK, Janssen, Karyopharm, Sanofi, Takeda: Honoraria.

Addressing Discordant Perceptions and Beliefs between Patients with Hemophilia and Their Care Teams: Results from a Pilot Program to Build Skills in Shared Decision-Making

Background Evidence-based guidelines for hemophilia management support shared decision-making (SDM) as a method for personalizing treatment decisions and achieving hemophilia control. Using a validated collaborative learning model (Sapir 2017), we evaluated patient and healthcare provider (HCP) perceptions regarding SDM and hemophilia treatment. Methods From April to June 2020, 161 patients and caregivers of patients with hemophilia and 66 HCPs participated in 1 of 6 live, virtual collaborative learning sessions developed with the National Hemophilia Foundation (Table 1). Before and after the sessions, patients and their providers completed tethered surveys to assess alignments and discordances in preferences, experiences, and concerns around hemophilia treatment and SDM. Results Patients and HCPs differed in their estimates of how often providers engage their patients in components of SDM (Figure 1; all comparisons P &amp;lt; 0.01). Relative to patients' responses, HCPs were more likely to report that they usually or always: askhow hemophilia is affecting the patient's quality of life (50% vs 71%), ask about the patient's goals for treatment (48% vs 67%), explain their goals for hemophilia treatment (48% vs 67%), describe different treatment options (46% vs 67%), explain the pros/cons of each treatment option (45% vs 71%), and work with the patient to create a treatment plan that fits the patient's needs and goals (52% vs 74%). When asked why patients are not more involved in treatment decisions, HCPs were more likely than patients to select the following reasons: patients trust the care team to make decisions on their behalf (42% HCPs, 26% patients), patients lack knowledge about hemophilia and available therapies (30% HCPs, 15% patients), and patients feel too overwhelmed to make decisions (27% HCPs, 5% patients). Conversely, HCPs were less likely to report that patients are already fully involved in treatment decisions (15% HCPs, 46% patients). In addition, 10% of patients reported that they are not more involved in treatment decisions because their care team never asks about their treatment goals and priorities. Patients and HCPs held discordant beliefs about the degree of patients' progress toward treatment goals. While HCPs estimated that 79% of their patients are on track to meet their goals, only 49% of patients described themselves similarly; instead, 51% reported that they are only somewhat on track, not on track, or unsure about their degree of progress. Notably, during the past year, 49% of patients treated 2 or more bleeds at home and 22% had 2 or more bleeds treated at an ER. Regarding switching hemophilia treatments, HCPs overestimated patients' concerns about whether a new plan will work for the patient's type of hemophilia (39% HCPs, 25% patients) and fear of side effects (30% HCPs, 22% patients). By comparison, providers correctly estimated patients' low degree of concern about adapting to a new treatment schedule (9% HCPs, 11% patients) and knowing how to treat a bleed (9% HCPs, 7% patients), but underestimated patients' concern about affording different treatment (3% HCPs, 8% patients). In total, providers underestimated how many patients would not worry about switching treatment (8% HCPs, 19% patients). Following the collaborative learning sessions, patients set goals to talk to their care team about their treatment goals (45%), consider their treatment options more closely (40%), take a more active role in treatment decision-making (38%), and notify their care team with concerns about their treatment (31%). HCPs made commitments to engage their patients more frequently in SDM (52%), increase the variety of educational materials they provide to patients (52%), educate their patients about wellness strategies and self-care (33%), and conduct additional small-group education sessions with their patients (30%). Conclusions Patients with hemophilia and their HCPs differed in their experiences, perceptions, and beliefs related to SDM and other key aspects of patient-centered care. Collaborative education can support improved knowledge, communication, and understanding between patients and providers, leading to greater engagement in SDM around personalized hemophilia care. Study Sponsor Statement The study reported in this abstract was funded by an independent educational grant from Genentech. The grantor had no role in the study design, execution, analysis, or reporting. Disclosures No relevant conflicts of interest to declare.

Conflicted epistemic beliefs about teaching for creativity

Educational policymakers and workforce studies emphasize creativity for teachers and students, yet there is an overreliance on performance measures and ratings of creativity that excludes the perspective of how teachers construct epistemic beliefs about what creativity means to them. This paper presents results from a qualitative study using semi-structured interviews to unearth epistemic beliefs about teaching for creativity as described by sixteen pre-service and in-service teachers enrolled in teacher education, Masters and PhD programs in an American university. Using qualitative content analysis, five themes emerged: teaching for creativity as a component of teaching success, discordant beliefs about creative teaching abilities, diverse beliefs about student creative potential, the importance of creativity for student learning and freedom to express new ideas. We discuss further how beliefs conflicted, namely the confusion about student potential as innate, malleable or a fusion of both, and the conflation of creativity with the arts. For implications, we propose future research exploring the calibration of teacher epistemic beliefs with teaching behavior in the classroom.

Associations of Caregiver-Oncologist Discordance in Prognostic Understanding With Caregiver-Reported Therapeutic Alliance and Anxiety

ContextDiscordance in prognostic understanding between caregivers of adults with advanced cancer and the oncologist may shape caregivers' views of the oncologist and bereavement outcomes. ObjectivesWe examined prospective associations of caregiver-oncologist discordance with caregiver-oncologist therapeutic alliance and caregiver anxiety after patient death. MethodsWe conducted a secondary analysis of data collected in a cluster randomized controlled trial from August 2012 to June 2014 in Western New York and California. At enrollment, caregivers and oncologists used a seven-point scale to rate their beliefs about the patient's curability and living two years or more: 100%, about 90%, about 75%, about 50 of 50, about 25%, about 10%, and 0%. Discordance was defined as a difference of two points or more. Outcomes at seven months after patient death included caregiver-oncologist therapeutic alliance (The Human Connection scale, modified into five items) and caregiver anxiety (Generalized Anxiety Disorder-7). We conducted multivariable linear regression models to assess the independent associations of discordance with alliance and anxiety. ResultsWe included 97 caregivers (mean age 63) and 38 oncologists; 41% of caregiver-oncologist dyads had discordant beliefs about the patient's curability, and 63% of caregiver-oncologist dyads had discordant beliefs about living two years or more. On multivariate analysis, discordance in beliefs about curability was associated with lower anxiety (β = −2.20; SE 0.77; P = 0.005). Discordance in beliefs about length of life was associated with a weaker alliance (β = −5.87; SE = 2.56; P = 0.02). ConclusionA better understanding of how caregivers understand and come to terms with poor prognoses will guide interventions to improve cancer care delivery and outcomes of cancer treatment.

Associations of caregiver-oncologist discordance in prognostic understanding with caregiver-reported therapeutic alliance and anxiety.

15 Background: Discordance in prognostic understanding between caregivers of adults with cancer and the patient’s oncologist is common. However, the relationship between caregiver-oncologist discordance and caregiver bereavement outcomes is unknown. We evaluated the associations of caregiver-oncologist discordance in beliefs about the patient’s curability and life expectancy with caregiver-reported therapeutic alliance and anxiety. Methods: This is a secondary analysis of a multicenter study that assessed the effect of a communication intervention among patients with advanced cancer and their caregivers. Prior to intervention exposure, caregivers and oncologists were asked about their belief in the patient’s chances for cure and living ≥2 years: 100%, about 90%, about 75%, about 50/50, about 25%, about 10%, and 0%. Discordance was defined as a difference by 2 response levels on each prognostic understanding item. Outcomes at 7 months after patient death included caregiver-reported therapeutic alliance [modified 5-item Human Connection (THC) scale] and anxiety (Generalized Anxiety Disorder-7). We used multivariable linear regression models to assess the independent associations of discordance with therapeutic alliance and anxiety. Results: We included 97 caregivers (mean age 63, range 22-83). Approximately 40% of caregiver-oncologist dyads had discordant beliefs about curability (caregivers were more optimistic in 100% of dyads) and 63% had discordant beliefs about life expectancy (caregivers were more optimistic in 94% of dyads). On multivariate analysis, discordance in beliefs about prognostic estimates was associated with lower THC score (b = -6.94, SE 3.17, p = 0.03). Discordance in beliefs about curability was associated with lower anxiety levels (b = -1.79, SE 0.90, p = 0.05). Conclusions: Caregiver-oncologist discordance may decrease caregiver-reported therapeutic alliance and anxiety, both of which may shape how caregivers interact with the healthcare system. A better understanding the role of caregivers’ prognostic understanding will guide interventions to improve caregiver-oncologist therapeutic alliance and caregiver anxiety. Clinical trial information: NCT01485627.

The Use of Theory-Based Formative Research to Design Suicide Prevention Messaging for U.S. Veterans in Midlife.

Communication campaigns offer a viable mechanism to promote suicide prevention and reinforce mental health for U.S. veterans in midlife, a group with a high suicide burden. However, little empirical investigation of this type of messaging has been conducted, with formative campaign research conspicuously missing from the limited literature. Using the theory of planned behavior as a guide, formative research was conducted to inform the design of suicide prevention messaging by (a) describing and measuring several theoretical constructs among our audience and (b) modeling associations between constructs and intentions to seek help for suicidal behaviors and mental health more broadly. Telephone-based cross-sectional surveys were collected between 2014 and 2016 from a nationally representative sample of veterans with analyses restricted to those aged between 44 and 65 years ( n = 809). Multiple logistic regression was used to identify significant factors associated with intentions to seek help for either suicidal behaviors or mental health. Perceived behavioral control was one of the largest predictors of intentions to seek help for both suicidal behaviors and mental health concerns. Descriptive norms were also significantly associated with suicide-related intentions. Data further suggest several types of attitudes (i.e., discordant beliefs, stereotypes) to consider when designing messages for this group. This study represents one of the first efforts to document and describe theoretical constructs and their influence on intentions among veterans in midlife to contribute to the development of evidence-based messaging for veterans informed by a conceptual framework. Findings have important implications as the use of communication strategies for suicide prevention grows increasingly popular.

Do Prescription Drug Ads Tell Consumers Enough About Benefits and Side Effects? Results From the Health Information National Trends Survey, Fourth Administration

Direct-to-consumer prescription drug advertising (DTCA) is a major source of consumer information about prescription drugs. The present study updates 2002 U.S. Food and Drug Administration phone survey questions that found that 44% and 61% of consumers thought that DTCA did not include enough information about benefits and risks, respectively. The present study was administered by mail using a nationally representative sample, and provides a more in-depth understanding of how these beliefs relate to demographic and health characteristics. Data collected from 3,959 respondents to the National Cancer Institute's 2011 Health Information National Trends Survey find results similar to the 2002 survey: 46% and 52% of respondents thought that DCTA did not include enough information about benefits and risks, respectively. Respondents fell into four groups: 23% agreed that DTCA tells enough about drug benefits and risks, 41% disagreed, 18% expressed no opinion, and 18% had discordant beliefs. DTCA attitudes were negatively associated with education, income, and whether respondents purchase prescription drugs; attitudes were positively associated with whether respondents understand prescription drug information. This study confirms that a plurality of Americans believe that DTCA does not include enough information about benefits and risks, suggesting that the educational effect of DTCA could be improved.

Parental and Home Environmental Facilitators of Sugar-Sweetened Beverage Consumption Among Overweight and Obese Latino Youth

ObjectiveTo explore parental and home environmental facilitators of sugar-sweetened beverage (SSB) and water consumption among obese/overweight Latino youth. MethodsSemistructured interviews were conducted with 55 overweight/obese Latino youth aged 10 to 18 and 55 parents, recruited from school-based clinics and a school in one West Coast district. All youth consumed SSBs regularly and lived in a home where SSBs were available. We used qualitative methods to examine key themes around beliefs about SSBs and water, facilitators of SSB and water consumption, and barriers to reducing SSB consumption. ResultsA few parents and youth believed that sports drinks are healthy. Although nearly all thought that water is healthy, most parents and about half of youth thought that tap water is unsafe. About half of parent–child dyads had discordant beliefs regarding their perceptions of tap water. About half of parents believed that homemade culturally relevant drinks (eg, aguas frescas), which typically contain sugar, fruit, and water, were healthy because of their “natural” ingredients. Participants cited home availability as a key factor in SSB consumption. About half of parents set no rules about SSB consumption at home. Among those with rules, most parent–child pairs differed on their beliefs about the content of the rules, and youth reported few consequences for breaking rules. ConclusionsObesity programs for Latino youth should address misconceptions around water and should discuss culturally relevant drinks and sports drinks as potential sources of weight gain. Health care providers can help parents set appropriate rules by educating about the risks of keeping SSBs at home.

Transvaginal Mesh for Prolapse Repair: What is All the Controversy About?

The use of synthetic mesh for the management of pelvic organ prolapse has been embroiled in a contentious debate over the past decade, with only more partisanship among physicians strictly against its use versus those pelvic surgeons who believe it to be a useful tool in their armamentarium. At the heart of the controversy lies the concern, by its detractors, for complications related to mesh use outweighing the as yet not rigorously tested benefit of augmenting repairs with mesh. This article discusses, in detail, the current literature supporting the use of mesh in the management of pelvic organ prolapse repair. The rising concern for complications, both simple and complex, will be addressed. This review aims to narrow the divide between physicians and to address their discordant beliefs by objectively reporting the most up-to-date data on biologic and synthetic mesh use in pelvic organ prolapse repair.

Somali immigrant women and the American health care system: Discordant beliefs, divergent expectations, and silent worries

The civil war in Somalia resulted in massive resettlement of Somali refugees. The largest diaspora of Somali refugees in the United States currently reside in Minnesota. Partnering with three community organizations in 2007-8, we implemented the Community Connections and Collaboration Project to address health disparities that Somali refugees experienced. Specifically, we examined factors that influenced Somali women's health experiences. Utilizing a socio-ecological perspective and a social action research design, we conducted six community-based focus groups with 57 Somali women and interviewed 11 key informants including Somali healthcare professionals. Inductively coding, sorting and reducing data into categories, we analyzed each category for specific patterns. The categorical findings on healthcare experiences are reported here. We found that Somali women's health beliefs related closely to situational factors and contrasted sharply with the biological model that drives Western medicine. These discordant health beliefs resulted in divergent expectations regarding treatment and healthcare interactions. Experiencing unmet expectations, Somali women and their healthcare providers reported multiple frustrations which often diminished perceived quality of health care. Moreover, silent worries about mental health and reproductive decision making surfaced. To provide high quality, transcultural health care, providers must encourage patients to voice their own health explanations, expectations, and worries.

“Theatre in the ‘Engaged University’: A Context for Habermas’s Communicative Action”

Throughout its history, the American university has learned to accommodate divergent functions—theological, humanistic, vocational, and scholarly, for example—that have been organized into curricula, and legitimized on the basis of changing ideas about the uses of knowledge. The growth of theatre studies has been complex and multifaceted but, in the end, its generalizable characteristics can be understood to fall into two prevailing curricular orientations. The first, an aesthetically-oriented curriculum, teaches the values of the liberal humanist approach. The second, a market-oriented curriculum, is characterized by professionalism and vocationalism. These formulations mark the triumph of “Enlightened” objectivity that has afflicted our practices with discordant beliefs about whether to teach humanistic content or the crafts of theatrical production. In the 1930s, this debate came to be identified as a dichotomy between “craft” or “culture.” 1 The field has never resolved this clash and is still mired in disagreements about whether to emphasize intellectual growth or technical skills, or whether and how to do both. Currently, liberal arts education embraces a market-oriented, utilitarian aim as students’ intentions for the bachelor of arts (B.A.) degree have changed from developing a philosophy of life to that of preparing for economic security. 2 This trend is especially troubling for theatre studies because it raises questions about the ethics of professional training for a labor market with so few careers. All too often now an entrenched dichotomy frustrates efforts to teach a theoretically coherent curriculum. Both foundations of the theatre curriculum—the liberal arts and the pre-professional—have been exhausted. Programs are notoriously disjointed and dysfunctional, quagmires of turf battles, ideological discrepancies, and fiscal scarcity. So in its 200 year struggle for recognition worthy of its potential in liberal arts education, theatre’s disciplinary potency and integration with larger university concerns remain illusive. The field often suffers, in sum, from a crisis of legitimacy. But educational dispensations are neither monolithic nor neutral, not intransigent but malleable.