Perceptions Of Appropriateness Research Articles

How the experiences of implementation support recipients contribute to implementation outcomes.

There is a growing body of literature on the activities and competencies of implementation support practitioners (ISPs) and the outcomes of engaging ISPs to support implementation efforts. However, there remains limited knowledge about the experiences of implementation support recipients who engage with ISPs and how these experiences shape the trajectory of implementation and contribute to implementation outcomes. This study aimed to extend the research on ISPs by describing the experiences of professionals who received implementation support and inform our understanding of the mechanisms by which ISPs produce behavior change and contribute to implementation outcomes. Thirteen individuals with roles in supporting implementation efforts at a private foundation participated in semi-structured interviews. Data were analyzed using qualitative narrative analysis and episode profile analysis approaches. Iterative diagramming was used to visualize the pathway of experiences of implementation support recipients evidenced by the interview data. The majority of recipients described how positive experiences and trusting relationships with ISPs increased acceptance of implementation science throughout the foundation and increased the perception of implementation science as both an appropriate and feasible approach for strengthening the impact of foundation strategies. As perceptions of appropriateness and feasibility increased, recipients of implementation support described increasing knowledge and application of implementation science in their funding engagements and internal foundation strategies. Finally, recipients reported that the application of implementation science across the foundation led to sustained implementation capacity and better outcomes. The experiences of implementation support recipients described in this paper provide a source for further understanding the mechanisms of change for delivering effective implementation support leading to better implementation quality. Insights from these experiences can enhance our understanding for building implementation capacity and the rationales for evolving approaches that emphasize the dynamic, emotional, and highly relational nature of supporting others to use evidence in practice.

Holding Back or Letting Go? The Effect of Emotion Suppression on Relationship Viability in New Venture Teams

Drawing on emotion regulation theory, this study investigates if and how emotion suppression informs relationship viability within new venture teams (NVTs) when such teams face obstacles. In particular, we use a dyadic approach to examine the suppressor’s authenticity and team members’ perceptions of appropriateness as mediators in the link between emotion suppression and relationship viability. A round-robin study with 93 respondents nested in 37 NVTs, which generated 167 observations, provides empirical support for the theoretically derived model by showing that both authenticity and appropriateness fully mediate the relationship between emotion suppression and relationship viability. In particular, the findings show that the negative indirect effect of emotion suppression on relationship viability via authenticity is larger than the positive indirect effect via appropriateness. A follow-up study after two years indicates that relationship viability and emotion suppression significantly predict venture survival. Together, these findings make ample contributions to the literature and provide interesting opportunities for further research.

Patients' experiences of behaviour change interventions delivered by general practitioners during routine consultations: A nationally representative survey.

BackgroundConsistent with the ‘Making Every Contact Count’ UK public health policy, general practitioners (GPs) are expected to provide patients with behaviour change interventions opportunistically. However, there is a belief widely held among GPs that patients neither want or need such interventions. We aimed to understand the following: (a) the characteristics of people attending GP appointments, (b) patients' needs for health behaviour change, (c) perceptions of appropriateness and helpfulness of interventions, and (d) factors associated with recall of receipt of interventions.MethodsCross‐sectional nationally representative online survey of UK adults who had attended GP clinics in the preceding four weeks (n = 3028). Data were analysed using descriptive statistics and binary logistic regression.Results94.5% (n = 2862) of patients breached at least one health behaviour guideline, and 55.1% reported never having had a conversation with their GP about health behaviours. The majority of patients perceived intervention as appropriate (range 84.2%‐87.4% across behaviours) and helpful (range 82.8%‐85.9% across behaviours). Being male (OR = 1.412, 95% CI 1.217, 1.639), having a long‐term condition (OR = 1.514, 95% CI 1.287, 1.782) and a higher number of repeat GP visits (OR = 1.016, 95% CI 1.010, 1.023) were among factors associated with recall of receipt of interventions.ConclusionsPatients perceived behaviour change intervention during routine GP consultations as appropriate and helpful, yet there are variations in the likelihood of receiving interventions according to sociodemographic factors. GPs could adopt a more proactive approach to behaviour change in patient consultations with the broad approval of patients.Patient or public contributionThe questionnaire was piloted among a convenience sample prior to distribution.

Factors influencing perceived appropriateness of concessioner activity in Grand Teton National Park

Concessioner-provided services are integral to the national park visitor experience, and date back to the origins of the National Park Service (NPS). With visitation across NPS units growing steadily over time, services provided by these public–private partnerships will likely only increase in importance. Despite the critical role of concessioners, concerns exist regarding the presence of for-profit entities within national parks. While private businesses may be more responsive to consumer wants and needs, their presence raises questions regarding equity, resource protection, and over-commercialization, while potentially eroding public perceptions of ownership and investment in these protected areas. With this in mind, the purpose of the present study was to assess factors that may influence visitors’ perceptions of appropriateness regarding current and future concessioner activities, using data from visitors to Grand Teton National Park (GRTE). Regression analysis found no significant predictors of perceived appropriateness of current concessioner activity. Several significant predictors of anticipated appropriateness of future concessions activities emerged, however. Respondents who believed that there would be more concessioner activity in the future felt that such an increase would lead to an inappropriately high amount of commercial activity at GRTE. In addition, social liberalism, economic conservatism, and place identity were also related to a belief that there would be inappropriately high levels of concessioner activity in the future. Place dependence, knowledge regarding the role of concessioners at GRTE, and trust in GRTE were not significant predictors. Implications for future research, as well as for decisionmakers, are discussed.

Factors influencing perceived appropriateness of concessioner activity in Grand Teton

Concessioner provided services are integral to the national park visitor experience, and with visitation across NPS units growing steadily, services provided by these public-private-partnerships will likely only increase in importance. Despite this, concerns exist regarding the presence of for-profit entities within national parks. While private businesses may be more responsive to consumers, their presence raises questions regarding equity, access, and perceptions of ownership. The purpose of this study was to assess factors that may influence visitor’s perceptions of appropriateness regarding (a) current and (b) future concessioner activities within Grand Teton National park (GTNP). Regression analyses indicate the importance of personal values, rather than actual experiences (positive or negative) with concessions in shaping perceived appropriateness of future concessions activity. Satisfaction with concessions services, amount of concessions activity that respondents perceived in the park in the present, and trust in GTNP were all non-factors in determining anticipated future appropriateness. Instead, a belief that concessions activity would increase, social liberalism, economic conservatism, and place identity with GTNP were related to perceptions that concessioner activity at GTNP would be inappropriately high in the future. Although the regression predicting future beliefs was robust (R2 = 0.43), no variables significantly predicted current beliefs (R2 = 0.05).
 
 Featured photo by Grand Teton on Flickr. https://flic.kr/p/2jf3fa9

Celebrity endorsement in the world of luxury fashion – when controversy can be beneficial

ABSTRACTCan a negatively publicised celebrity endorser ever lead to favourable brand attitudes toward a luxury fashion product (i.e. a perfume)? An online experiment was conducted with a sample of 260 target-relevant female consumers where two factors were manipulated: the brand’s positioning objective (image reinforcement versus revitalisation) and the type of celebrity endorser (naturally versus incidentally controversial). Consumer attitudes towards the luxury fashion brand were generally more positive when the type of celebrity endorser was consistent with the brand’s positioning strategy, that is, when a naturally controversial celebrity endorses a brand with a reinforcement strategy and when an incidentally controversial celebrity endorses a brand with a revitalisation strategy. Furthermore, this effect was mediated by consumers’ appreciation of the celebrity-positioning match-up (i.e. the consistency between the celebrity’s persona and the brand’s strategy) but not by their perceptions of appropriateness (i.e. the traditional match-up hypothesis). Several implications suggested by these findings are developed.

When and Why a Squeakier Wheel Gets More Grease: The Influence of Cultural Values and Anger Intensity on Customer Compensation

When customers express anger, do they gain greater returns, as suggested by the proverb “the squeaky wheel gets the grease”? If so, does the intensity of the squeak matter? In four studies, we explore employee compensation responses to customers who express relatively high- versus low-intensity anger in service-failure settings. The studies demonstrate that the cultural value of power distance (PD) moderates the relationship between emotional intensity and customer compensation: High-PD service employees offer less compensation to customers expressing higher intensity anger, and low-PD service employees offer more to customers expressing higher intensity anger. For high-PD service employees, this relationship between emotional intensity and compensation is mediated by the perceived appropriateness of the anger expression; for low-PD employees, it is mediated by perceived threat. However, when perceptions of threat are mitigated, low-PD service employees offer higher compensation to lower intensity anger, and this effect is mediated by perceptions of appropriateness. This research is the first to examine the effect of anger intensity in service-failure settings. For managers, the findings illuminate the importance of adopting a cultural lens when designing emotion management training programs and when setting practices for compensating angry customers.

Perceptions of Appropriateness of Psychiatric Referrals by Healthcare Professionals in a General Hospital

Objective: We assessed hospital staff recognition of certain psychiatric symptoms and whether they considered it appropriate to refer patients with these symptoms to the consultation-liaison psychiatric service. Methods: An online questionnaire was sent to all healthcare professionals working in the hospital. We presented several vignettes describing the typical symptoms and behaviors of a case of schizophrenia, major depression, generalized anxiety disorder, delirium and dementia. Staff were asked whether they considered it appropriate for a patient with these symptoms to be referred to the psychiatrist. Results: Doctors were significantly more likely to endorse psychiatric referrals for depression (p = 0.023) and schizophrenia (p < 0.001). Although there appeared to be non- significant responses for the remaining conditions, within group analyses suggested that the more experienced staff and foreign born and foreign trained staff were more likely to endorse psychiatric referrals for anxiety, dementia and delirium. Conclusions: Knowledge deficits exist among hospital staff in our hospital. This highlights the possibility of non- detection and non-referral of certain psychiatric comorbidities among patients receiving medical care.

Medical students\u2019 attitudes toward interactions with the pharmaceutical industry: a national survey in Japan

BackgroundThe relationship between students and the pharmaceutical industry has received substantial attention for decades. However, there have been few reports on this issue from East Asia. We aimed to investigate Japanese medical students’ interactions with and attitudes toward the pharmaceutical industry, and to assess the correlation between exposures to a formal curriculum on drug promotion and perceptions of the appropriateness of the physician–industry relationship.MethodWe invited all 80 medical schools in Japan to participate. A cross-sectional anonymous survey was administered to medical students and school staff at the 40 schools that participated. The questionnaire for students assessed interactions with and attitudes toward the pharmaceutical industry. The questionnaire for school staff assessed the formal undergraduate curriculum.ResultsForty of the 80 medical schools in Japan participated. The response rate to the medical student survey was 74.1%, with 6771 evaluable responses. More than 98% of clinical students had previously accepted a small gift of stationery, a brochure, or lunch, and significantly higher percentages of clinical than preclinical students had accepted one or more gifts (P < .001). Among preclinical and clinical students, respectively, 62.7 and 71.9% believed it was appropriate to accept stationery, and 60.5 and 71.0% thought that attending an industry-sponsored lunch did not influence clinical practice. Of the 40 participating schools, 13 (33.0%) had a formal curriculum on drug promotion. A multivariate analysis showed an association between exposure to a formal curriculum and students’ perceptions of the appropriateness of the physician–industry relationship only for gifts of stationery, which were perceived as inappropriate (OR: 0.81, 95% CI: 0.69–0.95, P = .02).ConclusionsMost Japanese medical students interact with the pharmaceutical industry and believe that gift acceptance is appropriate and not influential. This study demonstrated a limited association between students’ perceptions of gift appropriateness and exposure to a formal curriculum.

The role of the dark triad in perceptions of academic incivility

Academic incivility is defined as behavior incongruent with the welfare of the classroom community and may take a number of forms and levels of intensity. This study seeks to determine the relationship between the Dark Triad personalities (Machiavellianism, narcissism, and psychopathy) and perceptions of appropriateness and frequency of academic incivilities. A sample of 519 university students indicated the degree to which each of 20 uncivil academic behaviors was perceived appropriate and how often students perceived those behaviors in the classroom. Factor analysis of the academic incivilities produced six factors: Low Class Engagement, Poor Class Presence, Student Retaliation, Cheating, Class Disruption, and Attempted Domination. Hierarchical linear regression analysis showed that Machiavellianism, and to a lesser extent, narcissism, predicted both perceptions that academic incivilities were appropriate and the frequency of observations of incivilities. Psychopathy had no relationship with either perceptions of appropriateness or frequency of observation.

There is Something I Need to Tell You: Balancing Appropriateness and Efficiency in Modality Choice for Interpersonal Disclosures

An array of communication technology, such as text messaging, social networking sites, and mobile apps, have become the platforms through which many self-disclosures take place. This brings forth questions about which factors determine media selection for self-disclosure, such as media appropriateness and efficiency. Survey participants (N = 598) indicated modality preferences for disclosing hypothetical negative, positive, private, and public scenarios to a friend. For positive or public disclosures, modalities considered most convenient were more likely to be chosen; for negative or private disclosures, participants were more likely to select modalities that were considered most appropriate. Results also show a discrepancy between perceptions of appropriateness and motivations for media selection. These findings present implications for the balance between media appropriateness and efficiency in self-disclosure strategies.

Assessing and improving organizational readiness to implement substance use disorder treatment in primary care: findings from the SUMMIT study

BackgroundMillions of people with substance use disorders (SUDs) need, but do not receive, treatment. Delivering SUD treatment in primary care settings could increase access to treatment because most people visit their primary care doctors at least once a year, but evidence-based SUD treatments are underutilized in primary care settings. We used an organizational readiness intervention comprised of a cluster of implementation strategies to prepare a federally qualified health center to deliver SUD screening and evidence-based treatments (extended-release injectable naltrexone (XR-NTX) for alcohol use disorders, buprenorphine/naloxone (BUP/NX) for opioid use disorders and a brief motivational interviewing/cognitive behavioral –based psychotherapy for both disorders). This article reports the effects of the intervention on key implementation outcomes.MethodsTo assess changes in organizational readiness we conducted pre- and post-intervention surveys with prescribing medical providers, behavioral health providers and general clinic staff (N = 69). We report on changes in implementation outcomes: acceptability, perceptions of appropriateness and feasibility, and intention to adopt the evidence-based treatments. We used Wilcoxon signed rank tests to analyze pre- to post-intervention changes.ResultsAfter 18 months, prescribing medical providers agreed more that XR-NTX was easier to use for patients with alcohol use disorders than before the intervention, but their opinions about the effectiveness and ease of use of BUP/NX for patients with opioid use disorders did not improve. Prescribing medical providers also felt more strongly after the intervention that XR-NTX for alcohol use disorders was compatible with current practices. Opinions of general clinic staff about the appropriateness of SUD treatment in primary care improved significantly.ConclusionsConsistent with implementation theory, we found that an organizational readiness implementation intervention enhanced perceptions in some domains of practice acceptability and appropriateness. Further research will assess whether these factors, which focus on individual staff readiness, change over time and ultimately predict adoption of SUD treatments in primary care.

Parents’ Negative Relational Disclosures and Young Adult Children’s Perceptions of Appropriateness and Feelings of Being Caught

This study tested the degree to which the perceived appropriateness of parents’ negative relational disclosures moderated the association between such disclosures and young adult children’s feelings of being caught between their parents. Participants included 241 young adult children who completed online surveys. Whereas negative relational disclosures received from both mother and father positively predicted children feeling caught, the perceived appropriateness of those disclosures inversely predicted their feelings of being caught. After controlling for divorce status, the positive association between negative relational disclosures and feelings of being caught depended upon the perceived appropriateness of the disclosures for fathers but not for mothers.

Patients and gastroenterologists’ perceptions of treatments for inflammatory bowel diseases: do their perspectives match?

Background: Perceptions of appropriateness of treatments may differ between gastroenterologists (GIs) and inflammatory bowel disease (IBD) patients. The aim of this study was to explore and compare GIs’ and patients’ perceptions of risks and benefits of treatments and prioritization of expected outcomes.Methods: Four vignette cases were drawn from clinical situations and used in three independent focus groups with GIs (n = 7), ulcerative colitis (UC-p, n = 8) and Crohn’s disease patients (CD-p, n = 6). Content analysis was performed based on the conversation transcripts.Results: UC-p agreed more often with GIs’ treatment choices than CD-p. CD-p often considered 5-ASA as a placebo. UC-p saw topical 5-ASA as a temporary solution, neither comfortable nor practical when professionally active. Azathioprine was considered as the treatment for which the risks versus benefits were perceived as the highest. The main risk perceived by patients on anti-TNFs was a potential loss of response. Divergences were observed on 1) stop of treatment: UC-p did not easily concur with stopping a treatment, which differed from GIs’ expectation of patients’ perceptions; CD-p were more prone to consider stopping treatment than GIs, 2) perception of outcomes: physicians had a focus on long-term objective goals. Patients’ expectations were of shorter term and mainly concerned stress management, nutritional advice, and information on the treatments effects.Conclusions: Overall, patients and GIs agreed on perceptions of IBD treatments. GIs seemed more concerned about objective and scientific measures of remission whereas patients focused on quality of life and social outcomes when it came to evaluating a therapy.

Differences in Information Seeking Among Organizational Peers: Perceptions of Appropriateness, Importance, and Frequency

The purpose of this study was to explore the differences that may exist among employees when they are seeking different types of information (i.e., technical, referent, social, appraisal, normative, organizational, and political) from their peers in the workplace. Specifically, this study examined whether employees differed in the perceived appropriateness, importance, and frequency of seeking information from information, collegial, and special peers. Participants were 229 working adults who completed one of three versions (reporting on an information peer, a collegial peer, or a special peer) of a survey packet containing a series of measures. Results indicate that employees generally report that they seek information from special peers rather than from collegial peers or information peers.

Access to personalized medicine: Factors influencing the use and value of gene expression profiling in treatment decision making.

10 Background: Genomic information is increasingly used to personalize health care. One example is gene-expression profiling (GEP) tests that estimate recurrence risk to inform chemotherapy decisions in breast cancer treatment. Recently, GEP tests were publicly funded in Ontario. We assessed the clinical utility of GEP tests, exploring the factors facilitating their use and value in treatment decision-making. Methods: As part of a mixed-methods clinical utility study, we conducted interviews with oncologists (n=14), and focus groups and interviews with breast cancer patients (n=28) who underwent GEP, recruited through oncology clinics in Ontario. Data were analyzed using content analysis and constant comparison. Results: Various factors governing access to GEP have given rise to challenges for patients and oncologists. Oncologists are positioned as gatekeepers of GEP, providing access in medically appropriate cases. However, varying perceptions of appropriateness led to perceived inequities in access and negative impacts on the doctor-patient relationship. Media attention facilitated patient awareness of GEP but complicated gatekeeping. Additional administration burden and long waits for results led to increased patient anxiety and delayed treatment. Collectively, these factors inadvertently heightened GEP’s perceived value for patients relative to other prognostic indicators because of barriers to access. Conclusions: This study delineates the factors facilitating and restricting access to GEP, and highlights the roles of the media and organization of services in GEP’s perceived value and utilization. Results identify a need for administrative changes and practice guidelines to support streamlined and standardized utilization of the test.

Perception of Komfo Anokye Teaching Hospital Emergency Centre staff on acuity of patients” presentation and appropriateness of attendance

Introduction Emergency Centre (EC) overcrowding influences patient outcomes, use of resources, staff morale, and patient satisfaction. Inappropriate attenders contribute to overcrowding in the EC. Patel found that 24.5% of patients who present to EC do not require emergency care in Canada. The EC of Komfo Anokye Teaching Hospital has overcrowding challenges and health workers' perception of causes of overcrowding may inform their approach to care of emergency patients. The aim was to describe EC staff perception of acuity of presentation and appropriateness of attendance of emergency patients. Methods 95 EC staff comprising 34 physicians and 61 nurses were asked to complete a structured questionnaire to assess perceptions of appropriateness of patients presenting to the EC. Staff sampled could participate in the study if they had previously worked or were currently working in the EC. Answers given on the questionnaire were analysed using STATA 11.0. Results 55.8% of staff thought that walk-in patients attended the EC more frequently than referred patients. 50.5% of staff thought that referred patients often presented with acute conditions and a similar number (49.5%) thought that for walk-in patients. 67% of staff had turned patients away from the EC when they felt their attendance was inappropriate. Of these, 84.2% had turned away more walk-in patients than referred patients. 66.2% of staff thought that referred patients, though often appropriate attenders were frequently triaged to lower than expected acuity category. Discussion Staff in this study were not unanimous on the acuity of presentation of walk-in patients and referred patients. Walk-in patients were more likely turned away from the EC. Though perception of staff may hold inherent weakness of objectiveness, this may inform staff attitudes to care for walk-in patients. Negative perceptions of staff on overcrowding in EC could be addressed through staff training and policy directed at reducing EC overcrowding.

Perceptions of Appropriateness of Care in the Intensive Care Unit—Reply

Perceptions of Appropriateness of Care in the Intensive Care Unit—Reply

Perceptions of Appropriateness of Care in the Intensive Care Unit

Perceptions of Appropriateness of Care in the Intensive Care Unit

Canadian Academy of Sport and Exercise Medicine Position Paper: Abuse, Harassment, and Bullying in Sport

Over the past 20 years, there has been an emergence of reported incidents of abuse, harassment, and bullying in Canadian sport (M. Holman, unpublished data, 1995).1-3 In 1994, an Edmonton track coach was charged and convicted of engaging in sexual relations with his female adolescent athletes. In 19