Negative Outcome Expectancies Research Articles

Healthcare provider counseling to quit smoking and patient desire to quit: The role of negative smoking outcome expectancies

AimsThe U.S. Public Health Service Clinical Practice Guideline on treating tobacco use and dependence recommends providing advice to quit to every tobacco user seen in a healthcare setting. However, the mechanism through which counseling encourages patients to quit has not been adequately studied. This study tests whether the association between receiving healthcare provider counseling and desire to quit is accounted for by negative health and psychosocial outcome expectancies of smoking. MethodsData were collected online from 721 adult smokers who had seen a healthcare provider in the past 12 months. Associations between counseling to quit, negative outcome expectancies of smoking, and desire to quit were tested, as well as whether outcome expectancies and desire to quit differed by type of counseling (counseling only vs. counseling plus assistance) and level of smoking. ResultsBivariate associations indicated a stronger desire to quit among patients receiving counseling, particularly when it included healthcare provider assistance to quit. SEM results indicated that the association between counseling and desire to quit was fully accounted for by patients' negative health and psychosocial outcome expectancies for smoking. These associations were found across levels of smoking in the case of health expectancies, but were limited to moderate and heavy smokers in the case of psychosocial expectancies. ConclusionResults suggest that the time devoted to counseling patients about smoking should include providing some assistance to quit, such as recommending a product, prescription or program. Regardless of smoking level, this counseling should incorporate techniques to elicit patients' negative health and psychosocial expectancies of smoking.

Psychometric properties and factor structure of the adapted Self-Regulation Questionnaire assessing autonomous and controlled motivation for healthful eating among youth with type 1 diabetes and their parents.

The purpose of this cross-sectional study was to examine the psychometric properties of 2 adapted Self-Regulation Questionnaire (SRQ) measures assessing youth with type 1 diabetes motivation internalization for healthful eating and their parents motivation internalization for providing healthy meals for the family. External validity of the adapted SRQ was evaluated with respect to healthy eating attitudes (healthful eating self-efficacy, barriers, and outcome expectations) assessed by questionnaire, diet quality (Healthy Eating Index-2005 [HEI-2005]; Nutrient-Rich Foods Index 9.3 [NRF9.3]; Whole Plant Food Density [WPFD]) assessed by 3-day food records, and body mass index assessed by measured height and weight in youth with type 1 diabetes (N=136; age 12.3±2.5years) and their parents. Exploratory factor analysis with varimax rotation yielded a 2-factor structure with the expected autonomous and controlled motivation factors for both youth and parents. Internal consistencies of subscales were acceptable (α=.66-.84). Youth autonomous and controlled motivation were positively correlated overall (r=0.30, p<.001); however, in analyses stratified by age (<13 vs. ≥13years), the correlation was not significant for youth ≥13years. Autonomous motivation was significantly associated (p<.001) with greater self-efficacy (youth: r=0.39, parent: r=0.36), positive outcome expectations (youth: r=0.30, parent: r=0.35), and fewer barriers to healthful eating (youth: r=-0.36, parent: r=-0.32). Controlled motivation was positively correlated with negative outcome expectations for parents (r=0.29, p<.01) and both positive (r=0.28, p<.01) and negative (r=0.34, p<.001) outcome expectations for youth. Autonomous motivation was positively associated (p<.05) with diet quality indicators for parents (NRF9.3 r=0.22; WPFD r=0.24; HEI-2005 r=0.22) and youth ≥13years (NRF9.3 r=0.26) but not youth <13years. Among parents, but not youth, body mass index was associated negatively with autonomous motivation (r=-.33, p<.001) and positively with controlled motivation (r=.27, p<.01). Findings provide initial support for the SRQ in this population and suggest potential developmental differences in the role of motivation on healthful eating among children, adolescents, and adults.

Microaggressions and Ethnic Identity in the Career Development of Latina College Students

Counseling psychologists have noted the importance of examining the intersection of sociocultural identity and vocational psychology. In our study, we considered this intersection in a sample of 202 Latina college and graduate students from a perspective informed by social cognitive career theory. We examined how ethnic identity and experiences of self-reported microagressions were related to career decision self-efficacy and outcome expectations, including relationships to both positive and negative outcome expectations in our model. Findings indicated that higher endorsement of ethnic identity was positively related to career decision self-efficacy and to negative outcome expectations, whereas higher endorsement of experiences of microaggressions was related to lower career-decision self-efficacy, greater negative outcome expectations, and lower positive outcome expectations. Career decision self-efficacy was associated with lower negative outcome expectations and higher positive outcome expectations. Indirect relationships and two alternative models were also explored. We discuss implications for future research and career counseling with Latinas.

Feasibility of mobile health game “Fume” in supporting tobacco-related health literacy among early adolescents: A three-armed cluster randomized design

ObjectiveNew interventions supporting health literacy and a tobacco-free lifestyle in adolescence are needed to narrow the widening gap in existing health inequalities. Health games offer potential and could be utilized for example in school healthcare, but more research is needed to increase the understanding of the effects of game elements in health interventions. The aim of this feasibility study is to determine the short-term effectiveness of the tobacco-related mobile health game Fume and a non-gamified website in comparison with a no-intervention control group, regarding tobacco-related health literacy among 10–13-year-old early adolescents. In addition, we compare the demand for and acceptability of Fume to that of the website. MethodsIn total, 151 early adolescents participated in this single-blinded, three-armed cluster randomized trial. The participants from three municipalities in southwest Finland were randomly allocated between a group with access to the health game Fume (n = 61), a group with access to the website (n = 47), and a group with no intervention (n = 43). The intervention groups first participated in a 20-min training session with Fume/the website, and then had two weeks to use Fume/the website based on their own interest. Short-term effectiveness was measured by primary (anti-smoking self-efficacy) and secondary (smoking outcome expectations, attitudes towards tobacco use, tobacco-use motives, motivation to decline tobacco use in the future, and knowledge about tobacco) outcomes derived from the theory-based determinants of tobacco-related health literacy and evaluated with self-assessment questionnaires at baseline and post-intervention (after a two-week follow-up). For evaluating the demand, the actual use of Fume/the website was tracked during the two-week period. Regarding acceptability, the raised interest towards Fume/the website and opinions about the interventions were evaluated post-intervention. Differences were tested with the McNemar, Fisher exact, and non-parametric tests. ResultsStatistically significant favorable changes during the study period were found for positive (P = 0.002) and negative (P = 0.02) smoking outcome expectations and attitudes towards cigarette smoking (P = 0.01) within the group using Fume. No statistically significant changes were detected within the website or control groups. Statistically significant differences were not found for the change in outcome variables among the three groups. The number of visits (P < 0.001), number of separate visit days (P < 0.001) and total duration of use (P < 0.001) were larger for the group using Fume than for that using the website. Fume sparked more interest in early adolescents than the website did (P < 0.001). There were no statistically significant differences in opinions about Fume and those regarding the website. ConclusionsThe intervention with embedded game elements, the health game Fume, was found to be more feasible as a tobacco-related health education intervention than the non-gamified website among early adolescents in light of demand and acceptability (raised interest). Even though no change in anti-smoking self-efficacy was found, the results of this feasibility study demonstrated favorable short-term changes with Fume in some other theory-based determinants of tobacco-related health literacy.

Cultural Adaptation and Psychometric Properties of Social Cognitive Scales Related to Substance Use Behavior in Iranian Adolescents

Background: Using cultural-adapted scales and inventories is important both in research and treatment. There is not an Iranian version of social cognitive scales related to substance use behavior. Objectives: The aim of this research was to examine factorial validity and reliability of the Iranian version of social cognitive scales related to adolescent substance use behavior. Patients and Methods: This study was cross-sectional research using astratified, two stage, cluster sampling based on the popuation of different areas of Isfahan city in Iran. 720 adolescents aged 14 to 18years old completed the questionnairs: European Drug Abuse Prevention (EUDAP) and The Peer Influence Scale. The translation and back-translation, and cultural adaptation with face and content validity, were done in the first step. Factorial and construct validity were assessed in 3 steps, including: item analysis, explanatory analysis and confirmatory factor analysis. Reliability was also assessed with Cronbach's alph. Results: In the cultural adaption, some of the items were changed or removed according to the experts’ view. The EFA in the cross sectional study showed appropriate loading items and revealed a 23-item scale with 5 factors including: refusal self-efficacy, negative and positive outcome expectancies, intention, and peer influence, which was in line with the original questionnaires. The result of confirmatory factor analysis showed appropriate fit indices for 5 factor model including (x2 = 522, df = 144, x2/ df = 3.6, RMSEA = 0.06, CFI = 0.94, IFI = 0.94, and NFI = 0.92). Internal consistency was found to be in the range of 0.74 to 0.89 for all subscales. Conclusions: The results of this study indicate that the Persian version of social cognitive determinant appears to be a psychometrically robust instrument and could significantly predict substance use behavior in Iranian adolescents.

Role of parental and environmental characteristics in toddlers\u2019 physical activity and screen time: Bayesian analysis of structural equation models

BackgroundGuided by the Socialization Model of Child Behavior (SMCB), this cross-sectional study examined direct and indirect associations of parental cognitions and behavior, the home and neighborhood environment, and toddlers’ personal attributes with toddlers’ physical activity and screen time.MethodsParticipants included 193 toddlers (1.6 ± 0.2 years) from the Parents’ Role in Establishing healthy Physical activity and Sedentary behavior habits (PREPS) project. Toddlers’ screen time and personal attributes, physical activity- or screen time-specific parental cognitions and behaviors, and the home and neighborhood environment were measured via parental-report using the PREPS questionnaire. Accelerometry-measured physical activity was available in 123 toddlers. Bayesian estimation in structural equation modeling (SEM) using the Markov Chain Monte Carlo algorithm was performed to test an SMCB hypothesized model. Covariates included toddlers’ age, sex, race/ethnicity, main type of childcare, and family household income.ResultsIn the SMCB hypothesized screen time model, higher parental barrier self-efficacy for limiting toddlers’ screen time was associated with higher parental screen time limiting practices (β = 0.451), while higher parental negative outcome expectations for limiting toddlers’ screen time was associated with lower parental screen time limiting practices (β = − 0.147). In turn, higher parental screen time limiting practices was associated with lower screen time among toddlers (β = − 0.179). Parental modeling of higher screen time was associated with higher screen time among toddlers directly (β = 0.212) and indirectly through the home environment. Specifically, higher screen time among parents was associated with having at least one electronic device in toddlers’ bedrooms (β = 0.146) and, in turn, having electronics in the bedroom, compared to none, was associated with higher screen time among toddlers (β = 0.250). Neighborhood safety was not associated with toddlers’ screen time in the SEM analysis. No significant correlations were observed between the SMCB variables and toddlers’ physical activity; thus, no further analyses were performed for physical activity.ConclusionsParents and their interactions with the home environment may play an important role in shaping toddlers’ screen time. Findings can inform family-based interventions aiming to minimize toddlers’ screen time. Future research is needed to identify correlates of toddlers’ physical activity.

Developmental relations between alcohol expectancies and social norms in predicting alcohol onset.

Expectations about alcohol's effects and perceptions of peers' behaviors and beliefs related to alcohol use are each shown to strongly influence the timing of drinking onset during adolescence. The present study builds on prior work by examining the conjoint effects of within-person changes in these social-cognitive factors on age of adolescent drinking onset. We related youths' alcohol status (i.e., alcohol-naive, initiation during study, prior initiation) to increases in positive and negative alcohol outcome expectancies (AOEs), as well as increases in perceived peer/close friend alcohol use and acceptance, during adolescence. We also investigated whether changes in AOEs and perceived social norms prospectively predicted alcohol onset in alcohol-naïve adolescents. Participants were 1,023 adolescents aged 12.2 years on average at enrollment (SD = 0.98), 52% female, participating in an ongoing longitudinal survey on substance use and health behaviors. Positive AOEs, close friends' norms, and same-age peer norms increased linearly, whereas negative AOEs decreased linearly. Changes were attenuated for participants who remained alcohol-naïve and increased for participants who experienced initiation during the study. Furthermore, we found associations between individual changes in AOEs and perceived social norms. Finally, survival models revealed that onset of alcohol use was prospectively predicted by stronger initial positive AOEs, as well as increases in close friends' norms and decreases in negative AOEs over time. These findings emphasize codevelopment of AOEs and perceived social norms, coinciding with, and predictive of, onset of alcohol use, and point toward a unique role for within-individual changes in identifying youth at risk for early onset of alcohol use. (PsycINFO Database Record

Preparedness for natural hazards: testing an expanded education- and engagement-enhanced social cognitive model

This study sought to answer the question “do factors in a model of ‘engaged education’ predict preparedness for natural hazards?” The sample consisted of 291 participants, recruited via university student and snowball sampling strategies. Participants completed an online questionnaire containing predictor measures linked to an expanded social cognitive model of preparedness for hazards: indices that assessed positive outcome expectancy, negative outcome expectancy, trust, distrust, confidence, empowerment, collective efficacy, responsibility, participation and education. Criterion measures included indices measuring intentions to prepare and preparedness behaviours. Results indicated that the measure of preparedness, modified for an Australian context, showed good reliability. Australian participants had lower levels of preparedness compared to New Zealand participants. Neither the original or expanded social cognitive model was a good predictor of intentions to prepare or preparedness behaviour, and a more parsimonious model of individual factors best predicted preparedness for natural hazards. These individual factors were negative outcome expectancy, personal responsibility for preparedness and children participating in a hazards education program. Adults participating in emergency-related training were also found to predict having a safety plan. The research also considered trust and confidence in social media, and distrust of government. The implications for preparedness practice and further research are discussed, along with the limitations and recommendations for future research.

"Fear of the Known and Unknown": Factors Affecting Participation Following Knee Replacement Among Persons With Participation Restriction.

Evidence suggests that more than 30% of patients post-total knee replacement (TKR) are living with participation restrictions, yet little is known about their perceptions of and factors contributing to these restrictions. The purpose of this study was to identify emergent or recurring themes behind participation restrictions after TKR. Nineteen participants between 50 and 85 years old reporting participation restrictions 1 to 5 years post-TKR completed semistructured qualitative interviews about their participation experience after TKR. Participants provided background information in written questionnaires. Data collected from in-person interviews were analyzed qualitatively using a grounded theory approach. Participants discussed 3 major themes with regard to participation post-TKR: (1) limiting activities requiring long-distance walking due to continued knee impairments, (2) avoiding activities with negative or unknown outcome expectancies, and (3) using problem solving to identify strategies to participate in important activities. An unknown or negative outcome expectancy, particularly with regard to activities requiring long-distance walking, may lead to participation restrictions in some patients post-TKR. As participants reported using self-efficacy and coping strategies to improve participation, further physical rehabilitation or interdisciplinary rehabilitation incorporating the identified strategies may be effective with some patients post-TKR.

Alcohol Outcome Expectancies Mediate the Relationship Between Social Anxiety and Alcohol Drinking in University Students: The Role of Gender

College alcohol drinking is a public health concern worldwide. A line of research indicates that higher social anxiety is associated with more severe college drinking. However, other studies reveal a protective role of social anxiety against alcohol drinking in college students. Attempting to reconcile contradictory findings, we examined the hypothesis that there are multiple antagonistic pathways that could explain the social anxiety-college drinking relationship. In addition, there may be individual difference variables that moderate these processes. Furthermore, it was expected that the processes could vary as a function of the alcohol drinking outcomes examined. Expectancy theory emphasizes the role of alcohol outcome expectancies in alcohol drinking. Thus, in the present study we tested whether global positive and negative alcohol outcome expectancies partially mediate the relationship between social anxiety, alcohol consumption, and alcohol-related problems in a sample of 245 university students. We also examined the moderating role of gender in these mediating processes. Results revealed parallel but oppositional processes. Higher social anxiety was associated with heavier alcohol drinking and more serious alcohol-related problems via stronger positive alcohol outcome expectancies. However, the mediating role of positive alcohol outcome expectancies varied as a function of gender. It appears that in female students the mediating effect of positive alcohol outcome expectancies was stronger than in male students. On the other hand, higher social anxiety had a protective role against alcohol consumption but not against alcohol-related problems via stronger negative alcohol outcome expectancies. Finally, there was an inverse direct relationship between social anxiety and alcohol consumption.

A biosocial cognitive model of cannabis use in emerging adulthood

ObjectivesThe aim of this study was to test a new theoretical model of cannabis use incorporating biologically-based personality traits and social cognition. This biosocial cognitive theory (bSCT) has robust support in alcohol studies, but has not been applied to cannabis. The model proposes two pathways linking dimensions of impulsivity to cannabis use. The first predicts that the association between Reward Sensitivity (SR) and cannabis use is mediated by positive outcome expectancies. The second predicts that the relationship between Rash Impulsiveness (RI) and cannabis use is mediated by cannabis refusal self-efficacy. An extended version of this model was also tested and included a third pathway linking Punishment Sensitivity (SP) to cannabis use via higher negative outcome expectancies. MethodParticipants were 252 18-to-21-year-olds who completed questionnaires assessing cannabis use, personality and social cognition. Theoretical models were tested using structural equation modeling. ResultsThe bSCT model provided a good fit to the data (CFI=0.95; RMSEA=0.07; SRMR=0.06). Positive cannabis expectancies and refusal self-efficacy partially mediated the association between SR and cannabis use (p<0.05). Cannabis refusal self-efficacy fully mediated the relationship between RI and cannabis use (p<0.05). The addition of a third SP pathway did not improve model fit. ConclusionsConsistent with alcohol studies, the association between impulsivity and cannabis use is largely mediated by social cognition. The bSCT may provide novel insights to inform prevention and treatment of problematic cannabis use.

Addressing Outcomes Expectancies in Behavior Change.

Individuals commonly seek help for problem health behaviors, such as excessive drinking, smoking, and weight gain. Yet, there is a high rate of recidivism in these behaviors because outcome expectancies are either too high, negative outcome expectancies are not considered, or outcome expectancies are not properly addressed. Healthcare providers are recommended to list the outcome expectancy for the problem behavior and corresponding treatment for their patient. Through the process it is important to acknowledge both the positive and negative outcomes of engaging in the problem behavior. Healthcare providers are then encouraged to have their patient identify the goals and objectives that will assist in achieving the desired outcome. By recognizing and addressing outcome expectancies, it is more likely that the patient will be less resistant to the healthcare provider's recommendations to change problematic behavior.

The prospective relationship between distress tolerance and cigarette smoking expectancies in adolescence.

The current study examined the prospective relationship between distress tolerance (DT) and positive and negative cigarette smoking outcome expectancies, which are reliable predictors of the onset and maintenance of smoking behaviors. Data from a longitudinal study (N = 204) examining risk behaviors in adolescence were used to assess whether DT predicts individual differences in rate of change in smoking outcome expectancies over 4 annual assessment waves through adolescence. Adolescents (mean age at first wave: 13.03 years; SD = 0.88 years) completed a behavioral task assessing DT at baseline and a self-report measure of adolescent smoking expectancies annually across 4 years. Latent growth curve models were estimated to test our hypotheses. Results showed that DT at baseline did not significantly predict initial levels of negative affect reduction (NAR) expectancies, but NAR expectancies increased more quickly over time for adolescents with lower DT. Moreover, as hypothesized, DT did not prospectively predict significant changes in smoking expectancies outside of the domain of NAR, including negative physical feelings, negative social impression, and boredom reduction expectancies. These findings suggest that DT is a useful indicator of adolescent expectancies about the consequences of cigarette smoking, particularly those focused on reducing negative affect. Thus, DT may be an important target for preventing smoking initiation among adolescents via this putative mechanism. Theoretical and clinical implications are discussed within the context of observed effect sizes. (PsycINFO Database Record

Relationship Between Attitudes and Beliefs and Physical Activity in Older Adults With Knee Pain: Secondary Analysis of a Randomized Controlled Trial.

ObjectiveTo investigate how attitudes and beliefs about exercise relate to physical activity behavior in older adults with knee pain attributable to osteoarthritis (OA).MethodsWe conducted secondary data analyses of a randomized controlled trial of exercise interventions (ISRCTN: 93634563). Participants were adults ≥45 years old with knee pain attributable to OA (n = 514). Crude and adjusted cross‐sectional and longitudinal associations between baseline Self‐Efficacy for Exercise (SEE), Positive Outcome Expectations for Exercise (POEE), Negative Outcome Expectations for Exercise scores, and physical activity level, at baseline, 3 months, and 6 months (measured by self‐report using the Physical Activity Scale for the Elderly [PASE]), and important increases in physical activity level (from baseline to 6‐month followup) were investigated using multiple linear and logistic regression.ResultsCross‐sectional associations were found between SEE and PASE scores (β = 4.14 [95% confidence interval (95% CI) 0.26, 8.03]) and POEE and PASE scores (β = 16.71 [95% CI 1.87, 31.55]), adjusted for sociodemographic and clinical covariates. Longitudinal associations were found between baseline SEE and PASE scores at 3 months (β = 4.95 [95% CI 1.02, 8.87]) and 6 months β = 3.71 (0.26, 7.16), and baseline POEE and PASE at 3 months (β = 34.55 [95% CI 20.13, 48.97]) and 6 months (β = 25.74 [95% CI 11.99, 39.49]), adjusted for baseline PASE score and intervention arm. However, no significant associations with important increases in physical activity level were found.ConclusionGreater exercise self‐efficacy and more positive exercise outcome expectations were associated with higher current and future physical activity levels. These may be targets for interventions aimed at increasing physical activity.

Early alcohol use with parental permission: Psychosocial characteristics and drinking in late adolescence

The earliest experiences with alcohol for many children occur in the family context with parental supervision. The current study examined individual and sociocultural characteristics associated with early (prior to age 13years) sipping and tasting alcohol with parental permission in two longitudinal community samples. Early sipping/tasting was also tested as a predictor of frequency and quantity of alcohol use, and alcohol-related problems seven years later in late adolescence. Early sipping/tasting with parental permission was associated with a sociocultural context supportive of alcohol use (e.g., parental alcohol use, permissive rules about alcohol use in the home, parental attitudes about underage drinking, perceived peer norms), adolescent sensation seeking and disinhibition (e.g., surgency, externalizing behavior) and appraisals of alcohol (negative outcome expectancies and negative implicit alcohol associations). Early sipping/tasting predicted increased frequency and quantity of alcohol consumption, and increased alcohol-related problems in late adolescence, even after controlling sociocultural and individual difference variables. Findings suggest that early sipping/tasting with parental permission is not benign and is a viable target for preventive interventions.

Algorithms and Dehumanization in Hiring

Organizations are beginning to implement technologically advanced algorithms to help make decisions, including deciding who to hire. While using algorithms to evaluate prospective employees offers many potential benefits to organizations, doing so may have consequences for these applicants. Across four experiments, we investigated people’s responses to artificially intelligent algorithms, as opposed to other humans, evaluating them for work. We find that people feel more mechanistically dehumanized when an algorithm, rather than a person, evaluates them (Experiment 1). This perceived dehumanization, in turn, produces more negative outcome expectations following an algorithms’ evaluation, compared to an identical evaluation conducted by a human (Experiment 2). While people generally prefer humans to algorithms because of algorithms’ dehumanizing qualities, this preference reverses among people anticipating discrimination, because they believe algorithms–by virtue of this same dehumanization–disregard irrelevant personal qualities (Experiments 3a and 3b). We discuss implications for when and how organizations should implement artificially intelligent evaluation systems.

Sexual Coercion in the College Population: A Form of Risk-Taking Behavior.

The purpose of this study was to examine whether a decision-making model of risk-taking behavior, specifically impulsivity, positive and negative outcome expectation, and sensation seeking, can be extended to motivation for perpetration of sexual coercion. Participants included 276 sexually active college students between the ages of 18 and 25 years old who completed a set of questionnaires: (a) Sexual Experiences Survey, (b) Sensation Seeking Scales, (c) Cognitive Appraisal of Risky Events, (d) Barratt Impulsiveness Scale, and (e) Reckless Behavior Questionnaire. Multiple regression analyses were utilized to examine the relationship between these decision-making models and sexually coercive behaviors. General risk-taking behaviors were positively correlated with acts of sexual coercion, r = .16, p < .01. The predictor variables accounted for a significant amount of the variance in sexual coercion, R2 = .11, F(4, 246) = 7.57, p < .01. Only sensation seeking contributed unique variance to our model of sexual coercion, β = .27, t = 4.06, p < .01. Interventions to reduce sexual coercion may be more successful if they target those high in risk-taking. Similarly, prevention efforts informed by research on how to engage and hold the attention of sensation seeking youth may be more successful.

Assessing vocational outcome expectancy in individuals with serious mental illness: a factor-analytic approach

Background: Self-determination theory (SDT) and self-efficacy theory (SET) can be used to conceptualize self-determined motivation to engage in mental health and vocational rehabilitation (VR) services and to predict recovery. To incorporate SDT and SET as a framework for vocational recovery, developing and validating SDT/SET measures in vocational rehabilitation is warranted. Outcome expectancy is an important SDT/SET variable affecting rehabilitation engagement and recovery.Aims: The purpose of this study was to validate the Vocational Outcome Expectancy Scale (VOES) for use within the SDT/SET vocational recovery framework.Methods: One hundred and twenty-four individuals with serious mental illness (SMI) participated in this study. Measurement structure of the VOES was evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).Results: Both EFA and CFA results supported a two-factor structure: (a) positive outcome expectancy, and (b) negative outcome expectancy. The internal consistency reliability coefficients for both factors were acceptable. In addition, positive outcome expectancy correlated stronger than negative outcome expectancy with other SDT/SET constructs in the expected directions.Conclusions: The VOES is a brief, reliable and valid instrument for assessing vocational outcome expectancy in individuals with SMI that can be integrated into SDT/SET as a vocational rehabilitation engagement and recovery model in psychiatric rehabilitation.

One year results of a randomized controlled trial on radial Extracorporeal Shock Wave Treatment, with predictors of pain, disability and return to work in patients with subacromial pain syndrome.

Radial Extracorporeal Shock Wave Therapy (rESWT) is increasingly used to treat patients with subacromial pain syndrome despite conflicting evidence of its effectiveness. Better knowledge regarding prognostic factors may contribute to the improvement in treatment and prognosis for the patients. The first aim of this study was to evaluate the effect of rESWT in addition to supervised exercises in patients with subacromial pain syndrome after one year. The second aim was to identify predictors of pain and disability and work status after one year in this patient group. A randomized, double-blind, sham-controlled trial. An outpatient shoulder clinic of a University hospital. Patients aged 25 to 70 years, with subacromial pain syndrome lasting at least three months were included and randomly assigned to receive either rESWT and supervised exercises or sham rESWT and supervised exercises. The Shoulder Pain and Disability Index (SPADI) and work status were assessed after one year. We screened 265 patients and enrolled 143; 74 were allocated to receive sham rESWT and exercises, and 69 were allocated to receive rESWT and exercises. After one year, no differences were found for the SPADI Score (mean difference -1.6, 95% confidence interval (CI) -10.2 to 7.0, P=0.71). Subgroup analysis of patients with calcification in the rotator cuff demonstrated no significant additional effect of rESWT to supervised exercises (mean difference -6.3, 95% CI -22.4 to 9.8, P=0.44). Marital status (single), frequent use of pain medication, not working at baseline, negative outcome expectations, low self-reported general health status and few supervised exercise sessions predicted a poor outcome on SPADI after one year. Radial ESWT was not superior to sham rESWT in addition to supervised exercises in the long term for patients with subacromial pain syndrome. The identified predictors for pain, disability and work should be assessed in future studies and addressed by clinicians in order to improve the effectiveness of supervised exercises. Radial ESWT should not be recommended for patients with subacromial pain syndrome. Clinicians should assess patient`s outcome expectations, and if possible reduce the use of pain medication and sick leave in this patient group.

Modelling the contribution of negative affect, outcome expectancies and metacognitions to cigarette use and nicotine dependence

BackgroundBoth positive smoking outcome expectancies and metacognitions about smoking have been found to be positively associated with cigarette use and nicotine dependence. The goal of this study was to test a model including nicotine dependence and number of daily cigarettes as dependent variables, anxiety and depression as independent variables, and smoking outcome expectancies and metacognitions about smoking as mediators between the independents and dependents. MethodsThe sample consisted of 524 self-declared smokers who scored 3 or above on the Fagerstrom Test for Nicotine Dependence (FTND: Uysal et al., 2004). ResultsAnxiety was not associated with either cigarette use or nicotine dependence but was positively associated with all mediators with the exception of stimulation state enhancement and social facilitation. Depression, on the other hand, was found to be positively associated with nicotine dependence (and very weakly to cigarette use) but was not associated with either smoking outcome expectancies or metacognitions about smoking. Only one smoking outcome expectancy (negative affect reduction) was found to be positively associated with nicotine dependence but not cigarette use. Furthermore one smoking outcome expectancy (negative social impression) was found to be positively associated with cigarette use (but not to nicotine dependence). All metacognitions about smoking were found to be positively associated with nicotine dependence. Moreover, negative metacognitions about uncontrollability were found to be positively associated with cigarette use. ConclusionsMetacognitions about smoking appear to be a stronger mediator than smoking outcome expectancies in the relationship between negative affect and cigarette use/nicotine dependence. The implications of these findings are discussed.