Health Opinion Survey Research Articles

The role of perceived control and preference for control in adherence to a chronic medical regimen.

Poor patient adherence is a widespread problem among patients undergoing hemodialysis for end-stage renal disease. The goal of this study was to examine the joint role of perceived restriction of control and individual differences in preference for control in predicting adherence to the hemodialysis regimen. Participants were 49 patients recruited from five hemodialysis centers affiliated with the University of Iowa Hospitals and Clinics. Preference for control in the health care context was assessed using the Preference for Information and Preference for Behavioral Involvement subscales of the Krantz Health Opinion Survey, and perceived control was assessed using six items written for this study. Adherence was assessed by examining patients' interdialysis session weight gains (IWG). Hierarchical regression analysis indicated that the interaction between preference for information and perceived control over dialysis context explained a significant proportion of variance in IWG values, change in R2 =.09, F(1, 43) = 5.26, p <.05, standardized beta = -.32. Among patients with lower levels of perceived control in the dialysis setting, a higher preference for information concerning one's own health care was associated with increasingly poorer adherence. IWG levels in these individuals reflected clinically problematic nonadherence with fluid-intake restrictions. Among patients with a higher level of perceived control, preference for information had little effect on adherence. No main or interactive effects were found involving differences in patients' preference for behavioral involvement in their own health care or for the items reflecting perceived control outside the dialysis treatment setting. These data suggest that assessing and examining the interactive effects of patients' preferences for control and perceived control may, in some cases, be useful in identifying those individuals at risk for difficulty in adhering to the complex behavioral restrictions associated with chronic medical regimens.

Parents' decision-making preferences in pediatric oncology: the relationship to health care involvement and complementary therapy use.

This study investigated how parents' preferred level of control in treatment decision-making is related to their personal health care involvement and to their decision to use complementary therapies (CTs) for their child. One hundred-eighteen parents of pediatric oncology patients completed an anonymous CT survey. The Krantz Health Opinion Survey (KHOS) was used to determine parents' preferred involvement in personal health care, and the Control Preferences Scale for Pediatrics (CPS-P) measured preferred role in pediatric treatment decision-making. Unlike previous studies of adult cancer patients, most parents preferred active or collaborative decision-making. The KHOS and CPS-P were significantly correlated, indicating that parents' preferred role in children's treatment decisions was related to their own personal health care involvement. Forty-six percent of parents used CTs for their child, and 33% began using a new CT after diagnosis. The hypothesized relationship between CT use and parents' own health care involvement was partially supported. Preference for control in decision-making was not associated with CT use. These findings provide validation for the newly developed CPS-P and indicate that parents' decisions to use CT for their child are related in part to individual health care preferences.

Appraisal of Desire for Control over Healthcare: Structure, Stability, and Relation to Health Locus of Control and to the ‘Big Five’ Personality Traits

This study addressed the question of whether the traditional tripartite distinction between cognitive, decisional and behavioral control is meaningful as applied to desire for healthcare control. Subscales of the Krantz Health Opinion Survey and the Autonomy Preference Index were administered to 680 undergraduates along with the Multidimensional Health Locus of Control Scales and the NEO-FFI Five-Factor Inventory. These measures were readministered to 523 of these subjects approximately seven weeks later. Confirmatory factor analysis of the data indicated that desire for healthcare control is best conceptualized as having three separate components. Desire for information was clearly unrelated to either desire for behavioral or decisional control; however the latter two forms of control, which are indicative of more active engagement by the individual, overlapped to a moderate degree. The three-factor model was stable over time and the component factors (particularly desire for decisional and behavioral control) were also stable. No strong relationships were found between the component factors and measures of health locus of control or the basic personality trait dimensions measured by the NEO, suggesting that the factors represent largely situation-specific traits. Findings were discussed in terms of how they may have been influenced by variability in the instruments that were used to measure the separate desire for healthcare control components, and in terms of the need for criterion-related validational work especially in the crucial area of decisional control.

Physician expressions of uncertainty during patient encounters

Uncertainty is inherent in clinical medicine and may contribute to variability in physician practice patterns, patient satisfaction, and exchange of information. However, research on physician disclosure of uncertainty to patients is sparse. We measured the frequency of physician expressions of uncertainty to patients using audiotapes of visits to 43 physicians by 216 continuity patients in a university-affiliated general medicine clinic. We also analyzed the audiotapes using Roter Interaction Analysis. Physicians completed Gerrity’s Physicians’ Reaction to Uncertainty scale and patients completed the Kranz Health Opinion Survey and a standardized satisfaction questionnaire. Physicians made verbal expressions of uncertainty in 71% of clinic visits. Physicians with greater self-rated reluctance to disclose uncertainty to patients made fewer expressions. Physicians who made more uncertainty expressions also used more positive talk and partnership building, and gave more information to patients. Physicians also expressed more uncertainty to patients with more education, greater desire for information, and more questions. Physician uncertainty expressions were associated with greater patient satisfaction, but not independently of other physician verbal behaviors that were also associated with satisfaction.

Predicting change in depression following renal transplantation: Effect of patient coping preferences.

Improvement in patient quality of life is a central goal of renal transplantation. This study examined the hypothesis that change in depression following transplantation would vary as a function of patient coping preferences. Sixty patients were assessed with the Krantz Health Opinion Survey and the Beck Depression Inventory while on the waiting list for a cadaveric renal transplant. Patients were reassessed approximately 12 months later. Among the 33 patients receiving a transplant during the follow-up period, those with a high preference for health-related information exhibited a substantial reduction in depression. In contrast, patients low in preference for information showed a slight increase in depression. Among the 27 patients who were not transplanted during the follow-up period, preference for information had no effect on depression. Patient differences in preference for behavioral involvement did not exert a significant effect on depression.

Information needs and preference for information of women with breast cancer over a first course of radiation therapy

The study assessed the information needs of women receiving a course of radiation therapy (RT) for breast cancer and the relationship between information needs and preference for information. Thirty-three women were interviewed during the first (T1), third (T2), and last week of RT (T3), and one month later (T4) using the Toronto Informational Needs Questionnaire–Breast Cancer and the Information Subscale of the Health Opinion Survey. Information need scores were high and did not differ significantly across time. Information need and preference for information were correlated only at T1. Findings indicate that women with breast cancer receiving RT have high information needs and preference for information may not be a meaningful indicator of their desire for information. Health care providers need to assess the women’s information needs frequently and be prepared to offer on-going educational support.

How Daughters of Women With Breast Cancer Cope With the Threat of the Illness

Coping strategies and attitudes toward medical treatment of 45 daughters of women who had had breast cancer were compared with strategies (sense of coherence) and attitudes on a health opinion survey of 51 women with no such family history who were referred to a breast health clinic in northern Israel. The daughters of women with breast cancer ranked lower on sense of coherence than the women with no such history. They also were more actively involved in the medical setting and requested more medical information than women whose mothers did not have breast cancer. The age of the daughter at the time her mother's cancer was diagnosed predicted her level of coherence and attitudes toward treatment.

What Role Do Patients Wish to Play in Treatment Decision Making?

Although current ideology suggests patients should be active participants in decision making about their care, the literature suggests that patients wish to be informed but not involved. To test the hypothesis that most patients want their physicians to take the responsibility for problem solving (PS, identifying the one right answer), but that many want to be involved in decision-making (DM, selecting the most desired bundle of outcomes) tasks. Survey responses from 300 patients undergoing angiogram at a Toronto, Ontario, hospital were analyzed (response rate, 72%). Survey items included scales to measure desire for information and participation, including Autonomy Preference Index, the Krantz Health Opinion Survey, and the Deber-Kraetschmer Problem-Solving Decision-Making Scale measured on a scale from, 1 (doctor only) to 5 (patient only). Patients had a relatively high desire for information. On the Problem-Solving Decision-Making Scale, they overwhelmingly wished the PS tasks to be performed by or shared with the physician (98.4% of the 12 PS scores are between 1 and 3), but wanted to be involved in DM (78% of the 6 DM scores are between 3 and 5). Preference for handing over control to the physician was significantly greater for the vignette involving potential mortality (chest pain) than for the vignettes involving mainly morbidity (urinary problems) or quality of life (fertility). Although patients do not wish to be involved in PS tasks, few wish to hand over DM control to their physician. These findings suggest 2 major roles for clinicians--assisting patients in PS to structure choices and supporting them in making often difficult decisions.

Patient desire for information and decision making in health care decisions

To compare results on the Autonomy Preference Index (API) and the Health Opinion Survey (HOS), two instruments that measure patient desire for information and involvement in decision making. Cross-sectional survey. University-based primary care outpatient longitudinal and acute care clinic. 167 patients with benign prostatic hyperplasia, back pain, or mild hypertension seen from October 1991 to December 1992. On the API and the HOS (both scaled from 0 to 1), the patients had intermediate desire for involvement in decision making (median API: 0.42; HOS: 0.36) and higher desire for information (median API: 0.97; HOS: 0.57). With either instrument, the desire for information exceeded that for involvement in decision making (p < 0.0001). The API information scores were higher than the HOS information scores (p < 0.0001), probably because the HOS focuses on patient behavior rather than desire. Variation in desire for information and involvement in decision making was substantial and largely unexplained. Most patients have a high desire for information, the desire for information and involvement in decision making varies substantially among patients, and the API is preferable to the HOS for researchers interested in focusing solely on patient desire for information.

Screening for Maladjustment in College Students: An Application of Receiver Operating Characteristic Curve to MMPI Scales

The ability of two scales derived from the Minnesota Multiphasic Personality Inventory (MMPI) to identify emotional maladjustment in a college setting was examined. The scales were the College Maladjustment scale (Mt) developed by Kleinmuntz (1961) and the Health Opinion Survey based Emotional Disorder scale (Ed). Emotional maladjustment was defined by criteria established in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) and assessed through a computerized Diagnostic Interview Schedule. Subjects were 94 female and 62 male students, 51 of whom (33%) met criteria for at least one DSM-III-R disorder. Substance use disorders were most frequent (13.5%), followed by anxiety disorders (11.5%) and depressive disorders (7.1%). Both Mt and Ed had no relationship to substance use disorders but were moderately related to nonsubstance use maladjustment (r approximately .47); receiver operating characteristic (ROC) analysis was employed, and Mt and Ed proved to be a fair-to-good indicator of nonsubstance use maladjustment. Types of decision errors are discussed, and tables provide information concerning predictive accuracy across the entire range of scores.

Psychological Predictors of Audiological Outcomes of Multichannel Cochlear Implants: Preliminary Findings

The purpose of this research was to determine whether psychological variables were associated with the variability that characterizes the audiological performance of recipients of multichannel cochlear implants. Twenty-nine consecutive recipients of multichannel implants participated in a preoperative psychological assessment and audiological follow-up assessments after 18 months of implant use. Experimental cognitive measures that assess an ability to rapidly detect and respond to features imbedded in sequentially arrayed information accounted for up to 30% of the variance in implant outcome, suggesting the importance of cognitive abilities in implant outcome. Standardized measures of intellectual ability, however, were not predictive of outcome. The Health Opinion Survey, a measure of participatory engagement, was also a significant predictor of audiological outcome. Overall, the results implicated the importance of several specific psychological factors in the audiological outcome of cochlear implants in postlingually deafened adult recipients.

Afghan Refugee Health: Some Findings and Suggestions

Health problems are often associated with migration, particularly for refugees from such war-torn countries as Afghanistan. This article reports findings of an ethnographic study of Afghan refugees in Northern California. Participant observation and various informal and semistructured interviews of 29 refugees revealed difficulties in social support, cultural conflict, language, economics, and family adjustment. These difficulties, added to traumatic refugee flight sequelae, were expressed in psychosomatic symptoms and high stress scores as indicated by the Health Opinion Survey, which elicits psychosomatic indications of stress. These themes suggest needs for culturally appropriate health and social services.

Measurement of Health Care Attitudes In Cystic Fibrosis Patients and Their Parents

Previous research indicates that attitudes about information acquisition, and attitudes about behavioral involvement, moderate important health behaviors. These attitudes may play an important role in the management of cystic fibrosis (CF) because of the crucial role that patient knowledge and self‐involvement play in maintaining adequate functioning. However, due to the young age of CF onset, and the necessary involvement of parents in CF patients' care, two preliminary questions require attention. First, can health care attitudes be measured reliably in young samples? Second, are parents' attitudes related to their children's attitudes? In this study we examined the measurement of health care attitudes in CF patients and their parents by administering the Health Opinion Survey. Results indicated that health care attitudes could be measured reliably in parents and teens, but that for younger patients (ages 8 to 12 years), reliability was reduced. Results also indicated that parents' attitudes and patients' attitudes were largely unrelated, suggesting that patients do not automatically adopt the health care attitudes of their parents. By implication, educational interventions targeted at parents may have limited effectiveness for their children.

Psychologic distress as a predictor of mortality.

In a 12-year follow-up study of 610 persons (239 black and 371 white) in Evans County, Georgia, psychologic distress as measured by total score on the Health Opinion Survey, a 20-item questionnaire, was a predictor of mortality. The hazard ratio, comparing the 95th percentile score with the median, was 1.93 (97.5% confidence interval (CI) 1.42-2.62), controlling for age, race, and sex; there was no interaction with these variables. A purer measure of distress symptomatology, based on 18 of the questionnaire items, was also predictive of mortality. The hazard ratio was 1.94 (97.5% Cl 1.33-2.82), controlling for age, race, sex, and the item, "Do you have any sickness or illness problems at the present time?"; no interactions with the latter variables were found. This pattern was not affected in any major way by several modifications of the analyses: 1) controlling also for smoking, serum cholesterol, Quetelet index (weight (kg)/height (m)2), diastolic blood pressure, a social network index, and a social class index; 2) excluding persons with a diagnosis (in 1968) of chronic heart disease, angina pectoris, myocardial infarction, stroke, transient cerebral ischemic attach, or diabetes mellitus, or whose deaths were due to neoplastic disease; and 3) restricting the analyses to the last half of the follow-up period to explore the role of incipient or early physical illness in producing the association. With the restricted samples, confidence intervals included 1.00, which may be attributed to both the substantially smaller samples and the slightly reduced strength of the effect. The evidence is consistent with a causal role for psychologic distress, as measured by the Health Opinion Survey, in subsequent mortality rates.

The prevalence and impact of pain after day-care tubal ligation surgery

Empirical data from controlled studies using standardized, reliable measures on the amount and quality of pain after laparoscopic tubal ligation and the consequences of this pain on the activities of daily living are extremely scarce. In a study of 54 women admitted to a day-care unit for this procedure, validated measures were utilized to assess the incidence, intensity and duration of pain after tubal ligation (McGill Pain Questionnaire) and the impact of pain on the activities of daily living (Modified Functional Assessment Inventory). Psychological measures (Brief Symptom Inventory, Kranz Health Opinion Survey, and the State-Trait Anxiety Inventory) were employed to test their use as possible predictors for pain, analgesic usage and the time taken to resume a normal activity level after tubal ligation surgery. The results showed that pain is a significant problem after tubal ligation although pain rating scores over the 7-day study period were lower than those reported after major abdominal surgery. Eighty-five percent of our sample reported that pain and/or fatigue impacted on their recovery and contributed to an average delay of return to normal activity level of 4.4 days, not including the day of surgery. The psychological measures did not prove to be strong predictors of postoperative pain, time of return to normal activity level or analgesic usage. The most powerful predictor of return to normal activity was the total amount of pain experienced, as measured by the McGill Pain Questionnaire, during the 7 day post-operative period.

The Krantz Health Opinion Survey: correlations with preventive health behaviors and intentions.

The Krantz Health Opinion Survey, a measure of treatment preferences, was administered to 124 college women who also completed the Multidimensional Health Locus of Control Scale and rated their own preventive health behaviors and intentions. Analysis confirmed previous findings of relations between the two scales, particularly the moderate negative correlation between the Krantz Behavioral Involvement Scale and Powerful Others Locus of Control. The Krantz scores also were correlated with demographic measures such as education and occupation of the head of the household. With the exception of low correlations with frequency of obtaining Pap tests and with intentions to engage in exercise, the Krantz scores were uncorrelated with preventive health behaviors and intentions. It may be that another variable such as health value moderates these associations.

Psychological health and squash play.

Abstract Regular participation in exercise is believed to promote psychological well-being. In recent years squash has become a popular mode of exercise. This study aimed to investigate the relationship between squash play and certain indices of psychological health. Body concepts, psychosomatic health and type-A behaviour were examined in three groups varying in squash playing ability. The three groups consisted of sedentary (non-exercising) subjects, recreational squash players with a playing frequency of once per week, and county standard players. Each subject completed a batch of five questionnaires: Body Consciousness, Physical Self-Efficacy, Health Opinion Survey, Spielberger Trait Anxiety and the Bortner Type-A Scale. Cross-sectional comparisons showed that the more favourable health profiles tended to belong to the county group, least favourable to the sedentary. This trend was not evident in all the measures. Type-A behaviour, for example, was most pronounced in the county group, suggesting that the personality type associated with coronary risk was found at the higher levels of play.

Preference for type of information in cancer patients receiving radiation therapy

The purpose of this methodologic study is twofold: (a) to determine what types of information (cognitive versus behavioral) patients with cancer who were initiating radiation therapy (RT), preferred; and (b) to test two instruments in obtaining this differentiation of preference of type of information. Using a longitudinal design, 60 patients were interviewed twice, once at the initiation of RT and again (4–7 weeks later) at the completion of RT. The Health Opinion Survey, a general 16-item instrument, and the Health Care Preference Survey, a clinically RT-specific, seven-item instrument, were used to determine the patients' preference for type of information. State-Trait Anxiety and Cancer Health Locus of Control were measured at these two interviews as well. Findings revealed that the majority of patients (n = 38) preferred cognitive information, although this preference decreased significantly over time. Control, anxiety, and demographic variables were significantly associated with the preference for type of information. Complexities of measuring the preferred type of information require further research.

Performance of screening and diagnostic tests. Application of receiver operating characteristic analysis.

Evaluation of psychiatric screening and diagnostic tests has benefited from the application of sensitivity, specificity, the kappa-statistic, and predictive values. These measures derive their meaning from a single criterion threshold. Receiver operating characteristic (ROC) analysis extends assessment of test performance by providing information about all possible pairs of achievable sensitivity and specificity values. The ROC analysis offers a comprehensive means for comparing different tests or different scoring procedures for one test. As a demonstration we used the ROC analysis to evaluate three types of scoring rules for one psychiatric test, the Health Opinion Survey. The demonstration indicated that ROC analysis can profitably take a place among the standard methods for test evaluation in psychiatric research. In addition, ROC analysis can assist clinicians in selecting appropriate test procedures for particular patient populations.

Dimensions of Client Control

The purposes of this study were to identify activities that give patients a sense of control during their hospitalization and to characterize the kinds of people who find control in various ways. Bandura's (1977) social learning theory and the relationship between control and stress formed the theoretical framework; Q methodology was central to implementation and replication of the descriptive design. Consistent with Q methodology, major and replication samples were purposively selected, each consisting of 30 medical-surgical inpatients of both sexes, ranging from 24 to 75 years of age. Instruments used were the Client Control Q Set, Health Opinion Survey (HOS), a demographic data form, and a semi-structured interview. Q factor analysis and the construction of factor arrays resulted in three dimensions of client control in the original data set which replicated and were supported by interview and HOS data. These orthogonal dimensions were: knowing and fulfilling the patient role, being involved in making decisions, and directing interpersonal and environmental components. A theme common to all dimensions was the importance patients attached to having cognitive control over diagnostic tests, surgery, and treatment and to understanding concomitant life-style implications. Identification of the kinds of people who find control in various ways remains elusive, although patients hospitalized for diagnosis and/or treatment of cancer were predominant among those who wanted to be involved in making decisions.