Moderation Analyses Research Articles

A Mixed-Methods study of the impact of sex and situational pain catastrophizing on pain sensitivity.

It is well established that catastrophic thinking about pain modulates clinical pain severity, but it may also relate to interindividual differences in the pain experience during procedures. This mixed-methods study investigated the relationship between ratings of situational pain catastrophizing and reported pain sensitivity in the context of receiving a nerve block without sedation, and explored participants' experiences. Healthy volunteers (n = 42) completed baseline psychosocial questionnaires, underwent quantitative sensory testing, and received a lower extremity nerve block, followed by further psychosocial assessment and interviews. Associations of catastrophizing scores with pain sensitivity and procedural site pain were assessed using Spearman's correlations. Interviews were reviewed using an immersion/crystallization approach to identify emergent themes. Greater situational catastrophizing scores were associated with higher pain sensitivity, measured as lower pain threshold and tolerance. Although females exhibited greater pain sensitivity generally, moderation analysis revealed a significant association between situational catastrophizing scores and pain sensitivity only among male participants. Qualitative interviews revealed the importance of participants' emotional responses to pain, and a mismatch of expectation and experience with procedural pain. Males also reported more negative comments about procedural pain. Examination of the variable subjective experience while receiving a nerve block in this experimental lab-based study revealed an important relationship between situational pain catastrophizing scores and pain sensitivity, which was more prominent among male participants. These findings reinforce how insight into individual expectations, emotions, and thought processes may impact pain sensitivity during procedures, and may inform strategies to personalize care, improving patient satisfaction and procedural acceptance.

The Moderating Effect of Profitability and Leverage on The Influence of Eco-Efficiency on Firm Value

This research was conducted because of the emergence of cases of environmental pollution due to excessive production activities and the lack of awareness of business actors towards environmental conservation. Since the emergence of COVID-19 in Indonesia, the demand for medicines and other consumer products has increased. Public demand for companies to continue to care about environmental sustainability to reduce the negative impact of company activities on the environment. One concept that can be applied by management to handle problems that occur between the environment and the company is the concept of eco-efficiency. The purpose of this study is to, first, test the effect of eco-efficiency on firm value, second, test the effect of eco-efficiency on firm value with profitability and leverage as moderating variables. The sample of this research is manufacturing companies in the consumer goods sector listed on the Indonesia Stock Exchange in 2020-2023 using purposive sampling method. This research analysis method uses simple regression analysis and moderating analysis regression (MRA). This study provides evidence that environmental management implemented by the company can significantly provide good company value, besides that the high level of profit earned by the company can moderate the relationship between eco-efficiency and company value with a positive effect but in this study leverage cannot moderate the eco-efficiency relationship.

Rains after the drought: the impact of VAT credit refund on corporate R&D expenditures in China

ABSTRACT This study investigates the impact of a major tax policy reform – the Value Added Tax (VAT) credit refund policy – on corporate R&D expenditures in China. We employ a difference-in-differences approach to analyse the causal effect of the policy and examine potential heterogeneities based on firm features. Our findings reveal a significant and positive effect of the VAT credit refund policy on corporate R&D expenditures, particularly for firms with private ownership, small size, and non-high-tech classification. Additionally, mediation analysis indicates that the policy alleviates financial constraints, facilitating increased R&D investment, while moderation analysis shows a more pronounced impact on firms with lower initial liquidity. These results underscore the significance of addressing internal financial constraints and firm characteristics in designing tax policies to stimulate corporate R&D investment.

The role of cognitive reserve and depression on executive function in older adults: A 10-year study from the Wisconsin Registry for Alzheimer’s Prevention

Objective: The current study examined the longitudinal relationship between cognitive reserve (CR), depression, and executive function (EF) in a cohort of older adults. Methods: 416 participants were selected from the Wisconsin Registry for Alzheimer’s Prevention. They were native English speakers, aged ≥50+, and cognitively unimpaired at baseline, with no history of neurological or other psychiatric disorders aside from depression. Depression was assessed with the 20-item Center for Epidemiologic Studies Depression Scale (CES-D). A composite score, based on the premorbid IQ (WRAT-3 Reading subtest) and years of education was used to estimate CR. Another composite score from four cognitive tests was used to estimate EF. A moderation analysis was performed to evaluate the effects of CR and Depression on EF at follow-up after controlling for age, gender, and APOE risk score. Moreover, a multinomial logistic regression was used to predict conversion to Mild Cognitive Impairment (MCI) from the healthy baseline. Results: The negative relationship between depression and EF was stronger in individuals with higher CR levels, suggesting a possible floor effect at lower CR levels. In the multinomial regression, the interaction between CR and depression predicted conversion to MCI status, indicating that lower CR paired with more severe depression at baseline was associated with a higher risk of subsequent impairment. Conclusions: This study sheds light on the intricate relationship between depression and EF over time, suggesting that the association may be influenced by varying levels of CR. Further studies may replicate these findings in clinical populations.

A Meta-Analysis on Teachers’ Growth Mindset

The concept of growth mindset—an individual’s beliefs that basic characteristics such as intelligence are malleable—has gained immense popularity in research, the media, and educational practice. Even though it is assumed that teachers need a growth mindset and that both teachers and their students benefit when teachers adopt a growth mindset, systematic syntheses of the potential advantages of a growth mindset in teachers are lacking. Therefore, in this article, we present the first meta-analysis on teachers’ growth mindset and its relationships with multiple outcomes (50 studies, 81 effect sizes; N = 19,555). Multilevel analyses showed a small effect across outcomes. Statistically significant small-to-typical positive associations between teachers’ growth mindset and their motivation in terms of self-efficacy and mastery goals were observed in subgroup analyses. No statistically significant relationships were found with teachers’ performance-approach goals, teachers’ performance-avoidance goals, teachers’ performance on achievement tests, or student achievement. Teachers’ growth mindset was related to instructional practices in terms of mastery goal structures but unrelated to performance goal structures. Moderator analyses indicated that the dimensionality of the mindset measure (recoded from a fixed mindset to a growth mindset measure vs. assessed as a growth mindset), item referent and content of the mindset measure, publication status (published vs. unpublished), world region, educational level, and study quality influenced the strengths of some of the relationships. Overall, our findings extend knowledge about teachers’ mindset and add to the evidence base on teacher characteristics and their links to relevant outcomes.

Empathy and Autism: Establishing the Structure and Different Manifestations of Empathy in Autistic Individuals Using the Perth Empathy Scale.

There is a common mischaracterisation that autistic individuals have reduced or absent empathy. Measurement issues may have influenced existing findings on the relationships between autism and empathy, and the structure of the empathy construct in autism remains unclear. The present study sought to address these gaps by examining the structure and psychometric properties of the Perth Empathy Scale (PES) in autistic individuals (N = 239) compared to non-autistic individuals (N = 690). Our moderated non-linear factor analysis revealed that the multidimensional empathy construct manifested similarly in autistic and non-autistic individuals, with the PES displaying good validity and reliability. Moreover, the results revealed that autistic individuals reported reduced cognitive empathy and reduced affective empathy for positive and negative emotions. However, there was greater heterogeneity of empathic tendencies in the autistic sample, indicating that these mean differences may not be generalisable for all autistic individuals. The present study highlights that the PES is suitable for assessing empathy across autistic and non-autistic individuals. This work with the PES also provides greater nuance to our understanding of empathy and autism, and based on these findings, we propose the empathy heterogeneity hypothesis of autism as a new way of describing empathy in autism.

The Moderating Effect of Suggestibility on the Relationship between Body Mass Index and Body Dissatisfaction in Women.

Background: Body dissatisfaction (BD) has been consistently linked to adverse consequences on mental health and overall well-being, and is recognized as a significant contributing factor in the initiation and persistence of eating disorders (EDs). Empirical evidence has demonstrated that an elevated body mass index (BMI) and media influence and pressure about a thin ideal heighten the risk of subsequent BD. Moreover, suggestibility, a propensity to accept and act upon messages without critical evaluation, has been shown to be positively associated with greater susceptibility to the influence of sociocultural messages that endorse the thin ideal. This study aimed to assess whether suggestibility moderates the association between BMI and BD in women. Methods: A total of 117 women completed assessments using the Eating Disorder Inventory-3 (EDI-3) BD subscale and the Suggestibility Inventory, which encompasses a general suggestibility index and a subscale that evaluates susceptibility to influence by others. We conducted moderation analyses employing the PROCESS macro, with BMI as the central predictor, BD as the outcome variable, and suggestibility and its subscale as moderators. Results: The findings revealed statistically significant positive moderating interactions for both the general suggestibility index and susceptibility to influence by others. Specifically, women who exhibited high levels of suggestibility and susceptibility to influence by others demonstrated a more pronounced increase in BD as their BMI increased. Conclusions: These outcomes are in line with the sociocultural model of EDs, suggesting that greater susceptibility to external influences amplifies the impact of societal pressures to conform to thin ideals.

Entrepreneurial orientation, entrepreneurial action learning, and entrepreneurial performance of SMEs in the post-pandamic era: The moderating role of dynamic capabilities

This study aims to examine the relationship between the entrepreneurial orientation, entrepreneurial action learning, and entrepreneurial performance of small and medium-sized enterprises (SMEs) against the backdrop of the post-pandemic era while also exploring the moderating role of dynamic capability. Data from 629 SMEs in Sichuan Province was collected, and a partial least squares structural equation model (PLS-SEM) was employed for data analysis. The results indicate that entrepreneurial orientation has a positive relationship between entrepreneurial action learning, entrepreneurial action learning, and entrepreneurial performance. Entrepreneurial action learning mediates the relationship between entrepreneurial orientation and entrepreneurial performance. The moderation analysis further indicated that dynamic capability is a moderating variable in the relationship between entrepreneurial orientation and entrepreneurial performance and between entrepreneurial action learning and entrepreneurial performance. The practical contribution of this study lies in its provision of specific directions and recommendations for enhancing the entrepreneurial performance of SMEs.

Does Macroeconomic Moderate The Effect of Risk and Diversification on Financial Stability? Evidence from Islamic Commercial Bank

<em><span>Islamic banking's financial stability can improve efficiency and health and be able to withstand shocks originating from internal and external factors. This study analyzes the impact of risk, diversification, and inflation on the financial stability of Islamic banking. By using monthly time series data from 2018–2022, the analysis method used is multiple linear regression and moderate regression analysis (MRA) using the Eviews version 10 application. The results showed that the credit risk variable (NPF) has a significant negative relationship to financial stability (Z-Score). As well as the liquidity risk variable (FDR), financing diversification has a significant positive effect on the financial stability of Islamic banking (Z-Score). Macroeconomic variables (inflation) can strengthen the effect of financing diversification and weaken the effect of liquidity risk (FDR), but inflation cannot moderate the effect of credit risk (NPF) on the financial stability of Islamic banking (Z-Score). This study introduces a new theoretical approach to the conceptual relationship between variables. The findings can serve as a reference for monetary authorities in considering the impact of inflation in setting financial stability policies.</span></em>

Psychometric properties and moderated mediation analysis of the ICIQ-NQOL in Chinese primary care patients with nocturia

BackgroundMany individuals consider nocturia a significant nuisance, leading to a reduced health-related quality of life (HRQOL). However, there has been a lack of psychometrically sound patient-reported outcome measures to assess the impact of nocturia on patients in Chinese contexts. This study aimed to translate, culturally adapt, and validate the International Consultation on Incontinence Questionnaire Nocturia Quality of Life Module (ICIQ-NQOL) for use among primary care patients in Hong Kong, China. Additionally, it sought to investigate the mechanisms that link nocturia and sleep quality with HRQOL by employing moderated mediation analysis.MethodsThe traditional Chinese version of the ICIQ-NQOL was developed through iterative translations, cognitive debriefing interviews, and panel reviews. The psychometric evaluation included assessments of factor structure, convergent validity, concurrent validity, known-group validity, internal consistency, test-retest reliability and responsiveness. Study instruments included the ICIQ-NQOL, International Prostate Symptom Score (IPSS), Pittsburgh Sleep Quality Index (PSQI), and a modified Incontinence Impact Questionnaire-Short Form (IIQ-7).ResultsA total of 419 primary care patients were recruited from general outpatient clinics, among whom 228 experiencing an average of two or more nocturia episodes per night over the past four weeks. Confirmatory factor analysis supported the two-factor structure of the ICIQ-NQOL. Concurrent validity was confirmed by moderate correlations between the IIQ-7 total score and the total score as well as two domain scores of the ICIQ-NQOL (r ranging from 0.43 to 0.49, all p < 0.001). The ICIQ-NQOL also had moderate correlations with the IPSS total symptom score (r ranging from 0.40 to 0.48, all p < 0.001). Convergent validity was supported by moderate correlations between the global PSQI score and the total score as well as two domain scores of the ICIQ-NQOL (r ranging from 0.42 to 0.52, all p < 0.001). Known-group comparisons showed that the ICIQ-NQOL could differentiate between patients with and without nocturia in terms of sleep/energy domain score (p < 0.001), bother/concern domain score (p < 0.001), and total score (p < 0.001), each demonstrating a moderate Cohen’s d effect size. Item-total correlations corrected for overlap exceeded 0.4, and Cronbach’s alpha coefficients were greater than 0.7. Test-retest reliability was confirmed with intraclass correlation coefficients exceeding 0.7 among patients reporting no change in their nocturia symptoms at a 2-week follow-up. Regarding responsiveness, the Cohen’s d effect sizes for differences in domain and total scores between the baseline and 2-week follow-up assessments were greater than 0.3 among patients showing improvement in nocturia. Our moderated mediation analysis indicated that sleep quality significantly moderated the impact of nocturia on HRQOL, with a notably stronger indirect effect among females compared to males.ConclusionsThe ICIQ-NQOL is a reliable and valid instrument for assessing the HRQOL in primary care patients suffering from nocturia. The findings advocate for gender-specific approaches in the management and treatment of nocturia to optimize HRQOL.

How and when does perceived organizational politics undermine employee performance? Examination through the lens of opportunistic silence in Indian HPDOs

PurposeThe main aim of this paper is to explore the influence mechanisms of perceived organizational politics (POP) on employee performance (EP). Drawing on the job demands-resources theory (JD-R), this paper investigates opportunistic silence (OS) as a mediating factor and job level as a moderating effect in the POP-OS-performance relationship.Design/methodology/approachThis study’s data were collected from 203 employees working in Indian high-power distance organizations (HPDOs), such as the military, police and security forces. Mediation and moderation analysis were conducted using PLS-SEM, and the moderated mediation index was calculated using Hayes PROCESS Macro.FindingsThe results indicate that OS fully mediates the POP-performance relationship – specifically, POP as a job demand activates OS, which acts as an energy/resource depleting mechanism and further deteriorates task performance. Interestingly, the overall negative influence of POP and OS on EP was stronger for employees at lower job levels than those at senior job levels.Originality/valueThis paper offers a unique set of findings that enrich the understanding of factors responsible for employees’ performance in the highly political environments of HPDOs. By using the lens of JD-R theory, this paper draws attention towards the tendency of employees to indulge in self-serving behaviours like OS in politically charged contexts which is detrimental to their performance and may also undermine overall organization’s productivity. Furthermore, this paper also highlights the conditional effects exerted by job level in the unique nexus of POP, OS and EP.

PENGARUH KUALITAS AUDIT DAN INTEGRATED REPORTING TERHADAP RELEVANSI NILAI DENGAN VARIABEL PEMODERASI ETIKA BISNIS

This study aims to analyze the influence of audit quality and integrated reporting on value relevance, with business ethics as a moderating variable. The population of this study is manufacturing companies listed on the Indonesia Stock Exchange from 2020 to 2022. A sample of 67 companies was obtained through purposive sampling technique, resulting in 201 research data. Hypothesis testing method used panel data regression with Random Effect Model approach, and for testing the moderating variable used Moderated Regression Analysis (MRA) model. Data analysis was conducted using Eviews version 12. The results of the study show that audit quality does not have a effect on value relevance, integrated reporting has a negative and significant effect on value relevance, the results of the Moderated Regression Analysis (MRA) in the study indicate that business ethics does not have the ability to moderate or weaken the influence of audit quality on value relevance, business ethics as a moderating variable weakens the influence of integrated reporting on value relevance as the dependent variable

Technology use and employee well-being among teachers during Covid-19: moderating effects of school support and detachment from work

PurposeThis study examined whether job and personal resources could buffer the negative effects of technostrain and information and communication technology (ICT) availability demands on employee well-being.Design/methodology/approachThe data were collected among Finnish comprehensive school teachers (n = 323) between December 2020 and February 2021 through an online questionnaire. Hierarchical multiple regression analyses were employed to analyse the main and moderating effects.FindingsThe results indicated that technostrain was positively associated with burnout and negatively associated with work engagement. These associations were stronger than those of ICT availability demands. The moderated regression analyses revealed that psychological detachment buffered the negative effects of technostrain on cynicism and a sense of inadequacy. School support acted as a moderator by buffering the negative impact of technostrain on emotional exhaustion and cynicism. Furthermore, school support was found to be an important job resource in terms of boosting work engagement when ICT availability demands were high.Originality/valueThis study provides insights into the role of resources in buffering possible burdening effects of technology on teacher well-being when adopting online teaching in the context of the Covid-19 pandemic.

Does exposure necessarily lead to misbelief? A meta-analysis of susceptibility to health misinformation.

A meta-analysis was conducted to quantify the overall effect of health misinformation exposure on shaping misbelief. Aggregation of results from 28 individual randomized controlled trial studies (n = 8752) reveals a positive but small average effect, d = 0.28. Moderation analyses suggest that adults who are younger and female tend to develop higher misbelief if exposed to health misinformation. Furthermore, media platform, message falsity, and misbelief measurements also contribute to the exposure effect. These findings offer nuanced but crucial insights into existing misinformation literature, and development of more effective strategies to mitigate the adverse impacts of health misinformation.

Predictors of Health Care Practitioners' Intention to Use AI-Enabled Clinical Decision Support Systems: Meta-Analysis Based on the Unified Theory of Acceptance and Use of Technology.

Artificial intelligence-enabled clinical decision support systems (AI-CDSSs) offer potential for improving health care outcomes, but their adoption among health care practitioners remains limited. This meta-analysis identified predictors influencing health care practitioners' intention to use AI-CDSSs based on the Unified Theory of Acceptance and Use of Technology (UTAUT). Additional predictors were examined based on existing empirical evidence. The literature search using electronic databases, forward searches, conference programs, and personal correspondence yielded 7731 results, of which 17 (0.22%) studies met the inclusion criteria. Random-effects meta-analysis, relative weight analyses, and meta-analytic moderation and mediation analyses were used to examine the relationships between relevant predictor variables and the intention to use AI-CDSSs. The meta-analysis results supported the application of the UTAUT to the context of the intention to use AI-CDSSs. The results showed that performance expectancy (r=0.66), effort expectancy (r=0.55), social influence (r=0.66), and facilitating conditions (r=0.66) were positively associated with the intention to use AI-CDSSs, in line with the predictions of the UTAUT. The meta-analysis further identified positive attitude (r=0.63), trust (r=0.73), anxiety (r=-0.41), perceived risk (r=-0.21), and innovativeness (r=0.54) as additional relevant predictors. Trust emerged as the most influential predictor overall. The results of the moderation analyses show that the relationship between social influence and use intention becomes weaker with increasing age. In addition, the relationship between effort expectancy and use intention was stronger for diagnostic AI-CDSSs than for devices that combined diagnostic and treatment recommendations. Finally, the relationship between facilitating conditions and use intention was mediated through performance and effort expectancy. This meta-analysis contributes to the understanding of the predictors of intention to use AI-CDSSs based on an extended UTAUT model. More research is needed to substantiate the identified relationships and explain the observed variations in effect sizes by identifying relevant moderating factors. The research findings bear important implications for the design and implementation of training programs for health care practitioners to ease the adoption of AI-CDSSs into their practice.

Effects of the Pathways for African American Success Program: Reductions in Adolescent Depression Through the Promotion of Racial Equity-Informed Parenting and Racial Pride

African American adolescents face persistent disparities in depression and related behavioral health outcomes, which have been attributed to experiences with discrimination. The integrative model for the study of stress in Black American families provides a comprehensive perspective on how historical and current discrimination has direct and indirect effects on child behavioral health. Culturally based protective mechanisms (e.g., racial socialization) have been demonstrated to buffer adolescents from the negative effects of discrimination. The Pathways for African American Success (PAAS) program was developed as a scalable eHealth preventive intervention to facilitate parents’ use of strategies to protect their children from exposure to racism and the disproportionate consequences of risk behaviors, which we label as racial equity-informed parenting. Using data from a randomized effectiveness trial of PAAS and following stress and resilience approaches, we tested multiple hypotheses about the nature of discrimination as a source of risk, as well as program-driven improvements in adolescent racial pride as a source of protection. Our risk model indicated adolescent depression was associated with their own (direct) and their parents’ (indirect) experience of discrimination. Mediation analyses showed that program-driven improvements in adolescent racial pride served as a risk reducer/compensatory factor. Findings of moderation analyses, however, showed the negative effects of discrimination, even when racial pride was high. Implications for theory and cultural tailoring of evidence-based preventive interventions are presented.

Understanding the predictors of health professionals' intention to use electronic health record system: extend and apply UTAUT3 model

BackgroundThe implementation of Electronic Health Record (EHR) systems is a critical challenge, particularly in low-income countries, where behavioral intention plays a crucial role. To address this issue, we conducted a study to extend and apply the Unified Theory of Acceptance and Use of Technology 3 (UTAUT3) model in predicting health professionals' behavioral intention to use EHR systems.MethodsA quantitative research approach was employed among 423 health professionals in Southwest Ethiopia. We assessed the validity of the proposed model through measurement and structural model statistics. Analysis was done using SPSS AMOS version 23. Hypotheses were tested using structural equation modeling (SEM) analysis, and mediation and moderation effects were evaluated. The associations between exogenous and endogenous variables were examined using standardized regression coefficients (β), 95% confidence intervals, and p-values, with a significance level of p-value < 0.05.ResultsThe proposed model outperformed previous UTAUT models, explaining 84.5% (squared multiple correlations (R2) = 0.845) of the variance in behavioral intention to use EHR systems. Personal innovativeness (β = 0.215, p-value < 0.018), performance expectancy (β = 0.245, p-value < 0.001), and attitude (β = 0.611, p-value < 0.001) showed significant associations to use EHR systems. Mediation analysis revealed that performance expectancy, hedonic motivation, and technology anxiety had significant indirect effects on behavioral intention. Furthermore, moderation analysis indicated that gender moderated the association between social influence, personal innovativeness, and behavioral intention.ConclusionThe extended UTAUT3 model accurately predicts health professionals' intention to use EHR systems and provides a valuable framework for understanding technology acceptance in healthcare. We recommend that digital health implementers and concerned bodies consider the comprehensive range of direct, indirect, and moderating effects. By addressing personal innovativeness, performance expectancy, attitude, hedonic motivation, technology anxiety, and the gender-specific impact of social influence, interventions can effectively enhance behavioral intention toward EHR systems. It is crucial to design gender-specific interventions that address the differences in social influence and personal innovativeness between males and females.

Inhibition moderates the effect of attentional bias modification for reducing residual depressive symptoms: A randomized sham-controlled clinical trial

ObjectivesResidual symptoms represent risk factor for relapse. Attention bias modification (ABM) may reduce clinical and sub-clinical depressive symptoms, indicating that is may be of relevance when preventing relapse. Current evidence suggests that executive functions may moderate the outcome of interventions targeting depressive symptoms. MethodsWe assessed inhibition and shifting as indicators of executive functioning by means of the Color-Word Interference Test (i.e., “Stroop task”). These baseline characteristics were investigated as moderator of the effect of ABM on depression symptoms in a double-blinded randomized sham-controlled trial of ABM including patients with a history of recurrent depression (N = 301). Inclusion and follow-ups took place from January 2015 to October 2016. The trial was retrospectively registered #NCT02658682 January 2016. ResultsThe moderation analysis was based on the interaction term ABM x Stroop. Scaled inhibition scores ≤10.8, but not shifting ability, moderated the effect of ABM compared to sham on clinician-rated depression (HDRS). The difference from the 15th to the 85th percentile of the inhibition score was about 1 HDRS-point, indicating a small effect size. No moderation was found when self-reported depression and AB were the outcome. Post-hoc power calculation indicates risk of Type-II error. ConclusionWhen targeting depressive symptoms, ABM seems to be somewhat more effective in patients with weak inhibitory control. This suggests that evaluating the level of inhibition in individual patients could provide some information when making decisions about prescribing ABM to reduce residual symptoms, but the clinical implications of this is uncertain due to an overall small effect size attributable to ABM. Future studies should examine whether inhibitory control still is a relevant moderator when comparing ABM to treatment options other than the sham control condition.

Moderating effect of social risk on the relationship between biological risk and child development.

Human development is influenced by the interaction between biological and social factors. This study aimed to verify the moderating effect of social risk on the relationship between biological risk and child development. Data were collected on 201 children, aged 6 to 72 months. The independent variable was measured by the biological risk index, and the moderator variable by the social risk index was assessed by the Denver II test. Linear regression, effect size, and analysis of moderation were used to verify the relationship between BRI and the child development (Denver II), and the moderating effect of the SRI. BRI was negatively associated with child development, the interaction between the BRI and SRI increased the explained variance in the Denver II result to 14%. The SRI was also a significant moderator of the Language and Gross Motor domains. This research evidence that social risk moderates the relationship between biological risk and child development, the more social risk factors, the stronger this relationship becomes. On the other hand, it can be said that some social factors favor child development, even in the presence of biological risk factors.

Electronic Health Record Usability, Satisfaction, and Burnout for Family Physicians

Electronic health record (EHR) work has been associated with decreased physician well-being. Understanding the association between EHR usability and physician satisfaction and burnout, and whether team and technology strategies moderate this association, is critical to informing efforts to address EHR-associated physician burnout. To measure family physician satisfaction with their EHR and EHR usability across functions and evaluate the association of EHR usability with satisfaction and burnout, as well as the moderating association of 4 team and technology EHR efficiency strategies. This study uses data from a cross-sectional survey conducted from December 12, 2021, to October 17, 2022, of all family physicians seeking American Board of Family Medicine recertification in 2022. Physicians perceived EHR usability across 6 domains, as well as adoption of 4 EHR efficiency strategies: scribes, support from other staff, templated text, and voice recognition or transcription. Physician EHR satisfaction and frequency of experiencing burnout measured with a single survey item ("I feel burned out from my work"), with answers ranging from "never" to "every day." Of the 2067 physicians (1246 [60.3%] younger than 50 years; 1051 men [50.9%]; and 1729 [86.0%] practicing in an urban area) who responded to the survey, 562 (27.2%) were very satisfied and 775 (37.5%) were somewhat satisfied, while 346 (16.7%) were somewhat dissatisfied and 198 (9.6%) were very dissatisfied with their EHR. Readability of information had the highest usability, with 543 physicians (26.3%) rating it as excellent, while usefulness of alerts had the lowest usability, with 262 physicians (12.7%) rating it as excellent. In multivariable models, good or excellent usability for entering data (β = 0.09 [95% CI, 0.05-0.14]; P < .001), alignment with workflow processes (β = 0.11 [95% CI, 0.06-0.16]; P < .001), ease of finding information (β = 0.14 [95% CI, 0.09-0.19]; P < .001), and usefulness of alerts (β = 0.11 [95% CI, 0.06-0.16]; P < .001) were associated with physicians being very satisfied with their EHR. In addition, being very satisfied with the EHR was associated with reduced frequency of burnout (β = -0.64 [95% CI, -1.06 to -0.22]; P < .001). In moderation analysis, only physicians with highly usable EHRs saw improvements in satisfaction from adopting efficiency strategies. In this survey study of physician EHR usability and satisfaction, approximately one-fourth of family physicians reported being very satisfied with their EHR, while another one-fourth reported being somewhat or very dissatisfied, a concerning finding amplified by the inverse association between EHR satisfaction and burnout. Electronic health record-based alerts had the lowest reported usability, suggesting EHR vendors should focus their efforts on improving alerts. Electronic health record efficiency strategies were broadly adopted, but only physicians with highly usable EHRs realized gains in EHR satisfaction from using these strategies, suggesting that EHR burden-reduction interventions are likely to have heterogenous associations across physicians with different EHRs.