Interaction Analysis System Research Articles

Genetic counselor implicit bias and its effects on cognitive and affective exchanges in racially discordant simulations.

Previous studies have linked clinicians' implicit racial bias with less patient-centered communication between healthcare providers and patients in a variety of healthcare contexts. The current study extends this research by exploring the influence of implicit racial bias in genetic counselors' (GCs') facilitation of simulated clients' cognitive and emotional processing during genetic counseling sessions. We conducted a secondary analysis of a nationally representative sample of genetic counseling sessions of White and ethnic and/or racial minority (Black and Latinx) simulated clients with a subset of 60 GCs who had completed a Race Implicit Association Test (IAT). Linguistic Inquiry Word Count (LIWC) was applied to session transcripts to identify word use by the simulated client consistent with emotional and cognitive processing. The Roter Interaction Analysis System (RIAS) was used to link GC statements consistent with facilitation of emotional and cognitive processing, as used in previous studies. Multiple linear regression analyses were performed to relate LIWC and RIAS variables to GC IAT scores, client race/ethnicity, and statistical interaction between GC IAT scores and client race/ethnicity. GCs used more cognitive facilitation strategies with ethnic and/or racial minority than with White clients (p=.04). There were no statistically significant associations between GCs' pro-White implicit bias and GCs' facilitation of cognitive and emotional processing or clients' use of positive, negative, or cognitive process words. While implicit bias may affect some communication processes, our analysis did not show a relationship between GC IAT score and how GCs help clients process emotional or cognitive information conveyed during a session. It is also possible that the LIWC measure of cognitive and emotional processing is not a sensitive enough measure to capture an implicit bias effect if indeed one is present.

Does a renal diet question prompt sheet increase the patient centeredness of renal dietitian outpatient consultations?

ObjectiveEffective communication is fundamental to helping patients change behaviour. Few studies have operationalised how to quantify and improve the patient centeredness of communication during the dietitian outpatient consultation. We sought to evaluate the impact of a renal diet question prompt sheet (QPS) on patient centeredness (PC) in dietitian outpatient clinics and describe the impact of a renal diet QPS on the volume and pattern of communication between dietitians (n = 4) and patients/carers (n = 24, n = 11). MethodsThe Roter Interaction Analysis System was used to compute a PC index, the volume communication (number of questions and utterances) and categorise dietitian communication. ResultsThe QPS was associated with significant improvements in the PC of communication (p = 0.004 and p = 0.001), without increasing the volume of communication. The QPS was also associated with an increase in the total number of questions asked (p < 0.0001) especially from patients (p = 0.0009); and an increase in the volume of communication devoted to education and counselling (p < 0.0001). ConclusionsThis study describes a promising intervention to increase the patient centeredness of dietetic consultations in an outpatient setting. Practice implicationsWhilst simple in design, the use of a QPS had a large effect on how patients and carers interact with the dietitian in the outpatient setting.

Teacher-student interaction in a special school for students with developmental disabilities in Chinese context

This paper analyzes interactions between teachers and students with developmental disabilities in a special education school in China, which is still the main educational placement for the disabled in China. Video observation data collected from six students in second grade and one teacher, were coded by an improved Flanders Interaction Analysis System (iFIAS). Results indicate that the teacher played the dominant role in the class while her/his instruction was student-oriented, several evidence-based strategies were used to motivate students’ engagement, including questioning, timely feedback, reinforcement, game teaching, students’ self-determination. Few peer interactions happened due to homogeneous grouping. Besides, the frequency of interaction patterns between teachers and students with developmental disabilities (DD) of different learning ability was similar while the interaction patterns were different. There were more non-academic interactions between the teacher and students with most serious disabilities in the class than others, while there existed more cognitive extension-partial and full interactions between teachers and students with least serious disabilities in the class than others. The results shed light on how teachers interact with students who have DD, and how interactions can be differentially delivered to students with DD of various learning abilities.

Performance Improvement Algorithms in Big Data Analysis

Abstract This article describes the study results of development methods and algorithms for performance improvement in the big data analysis and training of machine learning models. The data growing and complexity problem describing complex processes require new approaches and tools for the scientific and technical community. In the course of research, the algorithms for analysis of heterogeneous medical and law records were performed. The performance improvement in classification, clustering and graph calculation problems were solved. With using CUDA it was possible to get more than 95 times performance. The usage of high-performance technologies is important in the analysis of electronic records because it provides an adequate response to the process of analysis of large scale of data from information systems. This study shows how to speed up the calculations on the example of most basic and widespread machine learning tasks. The results of the study can be used to develop a new generation of decision support systems, interactive data analysis systems and methods for eScience

Effects of a Proactive Interdisciplinary Self-Management Program on Patient Self-Efficacy and Participation During Practice Nurse Consultations: A Randomized Controlled Trial in Type 2 Diabetes.

BackgroundNowadays, patients with chronic conditions such as type 2 diabetes mellitus (T2DM) need and want to be more active participants in their health care. This study aimed to investigate the effects of the Proactive Interdisciplinary Self-Management (PRISMA) training program on participation during consultations with practice nurses and self-efficacy of patients with T2DM in general practice.MethodsWithin a randomized controlled trial, patients were followed for 6 months. They received either PRISMA in addition to usual care or usual care only. Self-efficacy was assessed using the 5-item Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) scale. Consultations were video-recorded and analyzed using the Roter interaction analysis system. Multilevel analysis was carried out.ResultsNo differences in the PEPPI-5 were found between the intervention (n = 101) and control groups (n = 102) (U = 1,737.5, z = -0.2, P = 0.8). In addition, the groups did not differ in patient participation. However, patients who attended the PRISMA program expressed more counselling utterances (B = 0.22; standard error (SE) = 0.09).ConclusionsPRISMA did not result in higher self-efficacy or patient participation during the consultation with practice nurses at 6 months. Possibly, two training sessions are insufficient and a more powerful intervention might be needed. However, the study showed indications that patients counselled themselves more frequently during the consultation. Practice nurses could stimulate patients who are already engaged in self-counselling by further specifying their goals of behavior change.

EgoVis: A Visual Analysis System for Social Networks Based on Egocentric Research

The development of crowd intelligence makes the structure of social network more complex and changeable. Research on social network should be more in-depth and focus on the changes of structure. Ego-network, which represents the relationship between specific individual and the related people, is a hot issue among the research of dynamic social network. The evolution of ego-network is highly dynamic and pluralistic, it is hard to capture its evolutionary pattern over time. To help users analyze the individual characteristics and hidden patterns in multivariate ego-network, we present EgoVis, an interactive visual analysis system for exploring and analyzing complex structural relationships in dynamic network. Based on the task requirements of network evolution analysis, we propose a task taxonomy which is suitable for ego-network research and analysis, design novel visual fonts, and analyze the evolution of dynamic ego-network relations from the three dimensions: overview, subgroup, and detail-ego. Finally, the validity and practicability of EgoVis are verified on DBLP citation network dataset.

Individuation and implicit racial bias in genetic counseling communication

ObjectivesGenetic counselors (GCs) can frame information in either general terms (i.e., population risks) or individual terms (i.e., tailoring to specific client characteristics). We investigated whether informational framing might reflect GCs’ implicit racial bias. MethodsWe analyzed previously videotaped genetic counseling sessions with white and minority (Black and Latino) simulated clients (SCs) and modeled the relationship between sixty GCs’ implicit racial bias, as measured by the Implicit Association Test (IAT), and informational framing (general or individual) as characterized by the Roter Interaction Analysis System. ResultsHigher (more pro-white) IAT scores predicted less informational individuation for minority relative to white SCs. Similarly, higher IAT predicted fewer facilitation and activation statements to minority relative to white SCs. With higher IAT-scoring GCs, minority SCs disclosed less psychosocial and lifestyle information, and asked fewer medical questions (all p < 0.05). ConclusionGCs’ racial implicit bias may be associated with less individualized communication style when counseling minority clients. Practice implicationsFuture research should address whether increasing informational individuation can ameliorate negative consequences of implicit bias and help providers reframe perceptions of minority patients in individual rather than categorical terms.

Patient and clinician communication practices during the DSM-5 cultural formulation interview field trial

Cultural psychiatrists and medical anthropologists have collaborated to help clinicians screen for culture-related issues in patient explanatory models of illness and to enhance the clinical processes of engagement, diagnosis, and treatment planning. This effort prioritises patient perspectives on suffering and healing to counter the trend of symptom-based interviews which assume biologically determined models of mental disorders. The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes the Cultural Formulation Interview (CFI), a semi-structured questionnaire for eliciting patient explanatory models. This paper analyses specific linguistic meanings and practices that could account for patient perceptions of improved rapport with clinicians, clinician perceptions of improving information gathering, and cultural models of health and illness during the DSM-5 field trial piloting the CFI. Twenty-seven audiotapes were analysed through the Roter Interaction Analysis System (RIAS), a standardised method for examining medical interviews based on ethnographic studies of small-group communication. After an introduction with procedural and reassurance statements to orient communication, the CFI’s open-ended questions elicited patients’ opinions on interpersonal, environmental, and biomedical information. Clinicians made facilitation and activation statements for patients to speak more and informed patients about what to expect. Patients constructed cultural models of illness that weaved interpersonal, environmental, and biomedical information. Clinicians and patients made rapport-building statements to each other. A RIAS-derived patient-centred score indicates that CFI sessions addressed patient concerns. Our work offers a way to analyse the discursive construction of culture in health settings and patient-centredness through detailed examinations of linguistic meanings and practices.

PC-FACS

PC-FACS

An analysis of directly observed weight communication processes between primary care practitioners and overweight patients

ObjectiveTo analyse weight-related communication prevalence and processes (content/context) between primary care practitioners (PCPs) and overweight patients within routine primary healthcare consultations. MethodsConsultations between 14 PCPs and 218 overweight patients (BMI ≥ 25 kg/m2) were video recorded. Weight communication was coded using the Roter Interaction Analysis System (RIAS) and the novel St Andrews Issue Response Analysis System (SAIRAS). Communication code frequencies were analysed. ResultsWeight discussion occurred in 25% of consultations with overweight patients; 26% of these had weight-related consultation outcomes (e.g. weight-related counselling and referrals, stated weight-related intention from patients). Weight discussions were more likely to occur if PCPs provided space to patient attempts to discuss weight (p = 0.013). Longer weight discussions (p < 0.001) and contextualising weight as problematic when PCP/patient-initiated weight discussion (p < 0.001) were associated with weight-related consultation outcomes. ConclusionWeight was rarely discussed with overweight patients, however PCP space provision to patient weight-discussion initiation attempts increased weight discussion. When weight was discussed, increased time and/or contextualising weight as a problem increased the likelihood of weight-related consultation outcomes. Practical implicationPCP use of specific communication approaches when discussing, contextualising and responding to patient weight may facilitate weight-related discussion and consultation outcomes and could lead to more effective patient weight management.

Higher BMI associated with shorter visits in male oncology patients: An exploratory analysis

ObjectiveTo determine the potential relationship between measures of patient-provider communication and patient body mass index (BMI) and gender in cancer care. MethodsWe audio-recorded cancer patients’ communication with their clinicians in an academic medical oncology practice from 2012-2014. We coded audio-recordings with the Roter Interaction Analysis System. We then examined whether BMI was associated with patient centeredness, time with doctor, global affect, and patient self-reported communication quality. Univariate associations with BMI were assessed with Chi-square and Kruskal-Wallis tests. A cumulative logit model adjusted for patient and visit characteristics in a multivariable model. ResultsWe recorded 327 patient interactions with 37 clinicians. After adjusting for patient sex, and visit characteristics, visit length, patient-centeredness, global affect (patient or clinician) and satisfaction did not differ. However, higher BMI was associated with shorter visit length, and lower Negative Global Affect (p = 0.03 and p = 0.03, respectively) in men only. ConclusionIn this exploratory analysis, communication characteristics did not vary by patient BMI overall. However, in men, higher BMI was associated with shorter visit length and more negative affect. Those differences did not persist after adjusting for multiple comparisons. Practice ImplicationsPatient body size may contribute to clinical communication in cancer care, particularly for obese men.

THE STUDY OF TEACHER TALK AND STUDENT TALK IN SPEAKING CLASS

The paper concerns with investigating classroom interaction especially the classroom language used by teacher and students in teaching learning process in one Junior High School in Indramayu. Teacher’s talk signals the classroom language that is used by the teacher in the classroom throughout the class periods. Meanwhile, students’ talk signal classroom language that is used by the students. The study employs qualitative interaction analysis method involving fifty nine students and two teachers in two different classrooms. The data are gathered through non-participant observation and video recording. Classroom observations were conducted to gain the data concerning classroom interaction in teaching learning process. The data collecting was separated into twelve categories and analyzed using Flint (Foreign Language Interaction analysis) system adopted from Moscowitz that is widely used to investigate classroom interaction. The findings of this study showed that there are various verbal interactions used in classroom interaction. The data showed that the use of classroom language motivate students to speak and encourage the students to share their idea. But the data also showed that there are many obstacles in using classroom language. So it needs more effort from teachers and students to make classroom language familiar in the classroom.

Numerical fundamentals and interactive computer graphics system for the nonlinear analysis of planar frames

Abstract Recent scientific and computational advances have facilitated the analysis of slender structural systems subject to instability. With the employment of more sophisticated numerical tools and algorithms, it is possible to accurately determine the critical points (limit and bifurcation loads) as well as the post-critical behavior of the structural system. In the computational context, efficient data structures are needed to enable code and graphic interface expansion for the generation of models and visualization of the results obtained. Thus, an interactive object-orientated graphic computational system is presented herein. It has been developed using MATLAB/GUI, with pre-processing, analysis and post-processing capacities for planar structural frames. The nonlinear finite element developed and implemented for the structure modeling is formulated considering second order effects. Therefore, with the computational tool presented, the geometric nonlinear effects and stability of the structural system can be directly addressed, and the visualization of the numerical results are accessed through interactive controls that permit data inclusion and analysis verification. The engineer-designer can see the structural model discretization, the equilibrium path, its deformation configuration, the force and bending moment diagrams at the moment that he runs the program and in each load step. It is also possible to export the images, videos or tables of the obtained numerical results. The example presented demonstrates the capacity of the developed graphic computational system.

Patient-centered communication, patient satisfaction, and retention in care in assisted reproductive technology visits.

To explore the association between patient-centered communication, patients' satisfaction, and retention in care in assisted reproductive technology (ART) visits. ART visits at eight Italian clinics were videotaped and coded using the Roter Interaction Analysis System, which includes a Patient-Centered Index (PCI), a summary "patient-centered communication" ratio. After the visit, patients completed a satisfaction questionnaire (SATQ). After 3months, patients were asked about their retention in care. Spearman correlations and Mann-Whitney tests were used to test associations between the study variables; the open-ended item of SATQ was analyzed through content analysis. Eighty-five visits were videotaped (involving 28 gynecologists and 160 patients). PCI score (μ = 0.51 ± 0.28) revealed a more disease-oriented communication during the visit. Patients reported high levels of satisfaction with the visit and identified in the information provision or in the doctor's humanity or kindness the main reasons of satisfaction. At the follow-up, the majority of the couples declared to have followed the clinicians' recommendations and to have remained related to the ART center. No associations were found among the study variables, except for a lower male satisfaction among couples who declared to have changed ART clinic. Contrary to what was expected, the style of physician-patient communication was not found to be associated with patient satisfaction and retention in care. However, patients were highly satisfied and engaged. The actual meaning of a communication that is "patient-centered" in the ART context might be wider, including the couples' need for information, as suggested by qualitative findings.

Interaction Mechanisms Between the NOX4/ROS and RhoA/ROCK1 Signaling Pathways as New Anti- fibrosis Targets of Ursolic Acid in Hepatic Stellate Cells.

BackgroundStudies have shown that both NOX4 and RhoA play essential roles in fibrosis and that they regulate each other. In lung fibrosis, NOX4/ROS is located upstream of the RhoA/ROCK1 signaling pathway, and the two molecules are oppositely located in renal fibrosis. Currently, no reports have indicated whether the above mechanisms or other regulatory mechanisms exist in liver fibrosis.ObjectivesTo investigate the effects of the NOX4/ROS and RhoA/ROCK1 signaling pathways on hepatic stellate cell (HSC)-T6 cells, the interaction mechanisms of the two pathways, and the impact of UA on the two pathways to elucidate the role of UA in the reduction of hepatic fibrosis and potential mechanisms of HSC-T6 cell proliferation, migration, and activation.MethodsStable cell lines were constructed using the lentiviral transduction technique. Cell proliferation, apoptosis, migration, and invasion were examined using the MTS, TdT-mediated dUTP nick-end labeling, cell scratch, and Transwell invasion assays, respectively. The DCFH-DA method was used to investigate the ROS levels in each group. RT-qPCR and western blotting techniques were utilized to assess the mRNA and protein expression in each group. CoIP and the Biacore protein interaction analysis systems were used to evaluate protein interactions.ResultsThe NOX4/ROS and RhoA/ROCK1 signaling pathways promoted the proliferation, migration, and activation of HSCs. UA inhibited cell proliferation, migration, and activation by inhibiting the activation of the two signaling pathways, but the mechanism of apoptosis was independent of these two pathways. The NOX4/ROS pathway was upstream of and positively regulated the RhoA/ROCK1 pathway in HSCs. No direct interaction between the NOX4 and RhoA proteins was detected.ConclusionThe NOX4/ROS and RhoA/ROCK1 signaling pathways are two critical signaling pathways in a series of behavioral processes in HSCs, and NOX4/ROS regulates RhoA/ROCK1 through an indirect pathway to control the activation of HSCs. Additionally, NOX4/ROS and RhoA/ROCK1 constitute a new target for UA antifibrosis treatment.

The effects of flipped classrooms on undergraduate pharmaceutical marketing learning: A clustered randomized controlled study.

BackgroundRecently, flipped classrooms (FCs) have gradually been used in Chinese higher education settings. However, few studies have focused on the effects of FCs on interdisciplinary curricula. The purpose of this study was to examine the impact of an FC on the engagement, performance, and perceptions of students and on teacher-student interaction in a pharmaceutical marketing course.DesignA clustered randomized controlled study was conducted, with 137 junior-year pharmacy undergraduates using an FC serving as the intervention group, in contrast to students using lecture-based learning (LBL) as the control group. Flanders’ interaction analysis system (FIAS) was used to measure teacher-student interaction, and questionnaires regarding attitudes toward and satisfaction with the teaching model were administered.ResultsThe students in the FC group scored significantly higher than those in the LBL group (88.21±5.95 vs. 80.05±5.59, t = -8.08, p = 0.000) on pharmaceutical marketing. The multiple linear regression results showed that the FC model had a significant impact on student performance (β = 8.16, p<0.0001). The percentages of teacher talk in the FC and LBL groups were 21% and 96%, respectively (χ2 = 2170.274, p = 0.000); however, the percentages of student talk in the FC and LBL groups were 75% and 2.6%, respectively (χ2 = 2012.483, p = 0.000). Compared with the LBL group, most students in the FC group held more positive attitudes toward the teaching model; the mean scores for the 8 attitude attributes in the FC group were significantly higher than those in the LBL group (p = 0.000). There were significant differences in the ratings of satisfaction with teacher-student interaction (p = 0.000), the students’ learning attitude (p = 0.000), the teacher’s preparatory work (p = 0.000), the teaching objective (p = 0.000), and the teaching effect (p = 0.000) between the two groups.ConclusionCompared with LBL methods, implementing the FC model improved student performance, increased teacher-student interaction and generated positive student attitudes toward the experience. As an effective pedagogical model, it can also stimulate pharmacy students’ learning interest and improve their self-learning abilities.

Communication of emotion in home hospice cancer care: Implications for spouse caregiver depression into bereavement.

Family caregivers of cancer hospice patients likely benefit from clinician provision of verbal support and from expression of positive emotions. Our aim was to identify the effects of hospice nurse supportive communication as well as caregiver-nurse exchange of positive emotions on family caregiver depression during bereavement. This prospective, observational longitudinal study included hospice nurses (N=58) and family caregivers of cancer patients (N=101) recruited from 10 hospice agencies in the United States. Digitally recorded nurse home visit conversations were coded using Roter interaction analysis system to capture emotion-focused caregiver-nurse communication and supportive nurse responses. Caregivers completed the Hospital Anxiety and Depression Scale Anxiety Subscale and Geriatric Depression Scale-Short Form at study enrollment and at 2, 6, and 12months after patient death. Caregivers had moderate levels of depression at study enrollment and throughout bereavement. Multilevel modeling revealed that caregiver positive emotion communication and nurse emotional response communication are associated with caregiver depression in bereavement. There was no significant association between caregiver distress communication and depression in bereavement. This is the first study to demonstrate that communication demonstrating emotional expression between cancer spouse caregivers and nurses during home hospice may have implications for caregiver depression up to a year after patient death. Our findings may help identify caregivers who may be coping well in the short term but may struggle more over time.

Factors associated with dairy farmers' satisfaction and preparedness to adopt recommendations after veterinary herd health visits

Herd health and production consultancy are important aspects of the modern dairy veterinary practice; therefore, veterinary farm visits will likely be more successful if veterinary practitioners communicate effectively and meet farmers' expectations. Objectives were to assess dairy farmers' satisfaction with veterinary advisors and their perceived preparedness to adopt veterinary advice. Furthermore, we assessed whether farmers' satisfaction and preparedness to adopt advice were associated with specific predictor variables; that is, general (demographic) factors of veterinarians or farmers, communication tools used by veterinarians, and veterinarians' affective attributes during the farm visit. Audio-video recordings of 14 dairy veterinarians during 70 herd health and production management farm visits were analyzed using the Roter interaction analysis system. Demographic data, farmers' satisfaction, and farmers' preparedness to adopt advice were obtained by using questionnaires. Overall, farmers were satisfied with their veterinarian's communication during farm visits and 58% of farmers felt "absolutely" prepared to follow veterinary recommendations. Based on multivariable regression analysis, farmers' satisfaction was positively associated with their level of education and the amount of talk the veterinarian dedicated to counseling the farmer. However, satisfaction was negatively association with the ratio between veterinarian talk and farmer talk. In addition to various demographic variables, farmers' preparedness to adopt veterinary advice was positively associated with their satisfaction. Other predictor variables for farmers' preparedness to follow recommendations included increased veterinary counseling and frequent herd data discussions, whereas there was a negative relationship between number of farmer questions and dominance of the veterinarian during the farm visit. Identification of factors influencing farmers' satisfaction and preparedness to adopt advice will make veterinary communication more effective and could inform training of veterinarians in communication.

Script of Scripts: A pragmatic workflow system for daily computational research.

Computationally intensive disciplines such as computational biology often require use of a variety of tools implemented in different scripting languages and analysis of large data sets using high-performance computing systems. Although scientific workflow systems can powerfully organize and execute large-scale data-analysis processes, creating and maintaining such workflows usually comes with nontrivial learning curves and engineering overhead, making them cumbersome to use for everyday data exploration and prototyping. To bridge the gap between interactive analysis and workflow systems, we developed Script of Scripts (SoS), an interactive data-analysis platform and workflow system with a strong emphasis on readability, practicality, and reproducibility in daily computational research. For exploratory analysis, SoS has a multilanguage scripting format that centralizes otherwise-scattered scripts and creates dynamic reports for publication and sharing. As a workflow engine, SoS provides an intuitive syntax for creating workflows in process-oriented, outcome-oriented, and mixed styles, as well as a unified interface for executing and managing tasks on a variety of computing platforms with automatic synchronization of files among isolated file systems. As illustrated herein by real-world examples, SoS is both an interactive analysis tool and pipeline platform suitable for different stages of method development and data-analysis projects. In particular, SoS can be easily adopted in existing data analysis routines to substantially improve organization, readability, and cross-platform computation management of research projects.

The role of self-disclosure by peer mentors: Using personal narratives in depression care

ObjectiveSelf-disclosure is recognized as an important aspect of peer support, but little is known about its use by peers. This study aimed to qualitatively understand peer self-disclosure in the context of depression care delivery to older adults. Methods69 audio-recordings of peer-client meetings were coded for self-disclosure using the Roter Interaction Analysis System (RIAS). Peer self-disclosure was defined as a statement describing personal life experience with physical and/or emotional relevance for the client. A total of 3421 discrete statements were organized into 770 disclosure episodes. The episodes were qualitatively analyzed to identify themes related to the content and function of self-disclosure within the peer-counseling context. ResultsPeer self-disclosure was used to 1) counsel through reframing perspectives, modeling positive behaviors, offering coping skills, and sharing mental health resources and health information; 2) establish rapport by emphasizing similarities unrelated to depression; and 3) show empathy and understanding of personal struggles. In addition, self-disclosure rarely only focused on the peer experience without relevance for the client. Conclusions & practice implicationsPeer self-disclosure can be purposively used in depression care delivery with older adults. Training and supervision in appropriate self-disclosure should be provided to peers to ensure purposive use.