Pre-existing Expectations Research Articles

Recycle right: How to decrease recycling contamination with informational point-of-disposal signage

AbstractPlastic pollution represents a grand challenge facing society, yet the amount of plastic being recycled is only about 5%. This recycling crisis has intensified with the growing problem of recycling contamination (i.e., incorrect placement of unrecyclable materials in recycling receptacles). This research investigates the potential for informational point-of-disposal recycling signage to decrease recycling contamination. In a longitudinal field study and three experiments, the authors demonstrate that providing schema-congruent prescriptive information (“Recycle these items”) does not reduce recycling contamination and may inadvertently lead to over-recycling. In contrast, the presence of proscriptive information that is moderately incongruent with established schemas (“Do not recycle these items”) prompts more effortful, piecemeal processing. This encourages individuals to integrate the information into their recycling decisions, diminishing their dependence on pre-existing beliefs and expectations regarding recycling and, consequently, lowering contamination rates. Recycling expertise is found to moderate the effects of point-of-disposal recycling signage. By examining such nuanced recycling communication strategies, this research aims to shift the conversation from “recycle more” to “recycle right.”

The Importance Characteristics for Veterinary Workplace Clinical Training (WCT) in a Distributive Curriculum, from the Perspectives of Students, Academics, and Clinical Supervisors.

Veterinary students, academics, and clinical supervisors are likely to have different perspectives on what it takes to be prepared for workplace clinical training (WCT). Differing expectations could confuse students if they receive conflicting messages about the skills and attributes to which they should aspire. Furthermore, they may struggle to engage with the affordances that workplaces provide for learning if unprepared. Using a survey, we ranked 91 preparedness characteristics and seven preparedness themes for WCT for importance, according to clinical supervisors, academics, and final-year veterinary students before and after undergoing WCT in a UK veterinary school employing a distributive model of WCT. Statistical analyses were used to determine 1) rank alignment and 2) significant differences in characteristic and theme rank among groups. The correlation among characteristic rankings was strongest between students and clinical supervisors, and weakest between clinical supervisors and academics. Honesty, integrity and dependability was the most important characteristic for students and clinical supervisors, whereas students' awareness that perfection is not expected was the most important characteristic for academics. The "knowledge" theme was ranked as significantly more important for academics compared to students pre-WCT. Therefore, differences in the expectations of students starting WCT have been demonstrated in this study. As the educational setting transitions from "classroom to clinic", academics and students must adapt their notions of preparedness to align with conceptions of learning and teaching in the workplace, while supervisors should be mindful of students' pre-existing expectations. Continuous communication and expectation alignment are necessary for a cohesive curriculum strategy.

THEORY OF RECEPTION AND CRITICISM OF FILMS BASED ON THE RECEPTION AND CRITICISM OF THE FILM “ANNA KARENINA” (1997)

The word reception means the acceptance of foreign ideas, norms and values or behaviors. Reception history elaborates the reception that a literary text, a film, or in this case an adaptation of a novel, has found in its audience over time. This paper delves into the core concepts of film reception theory, shedding light on how audiences interpret and actively engage with cinematic narratives. The theoretical part includes different perspectives, recognizing that audience responses are shaped by individual experiences, cultural contexts, and societal influences. This study also delves into the concept of criticism, whether that from the audience or from theorists and critics. This study after the theoretical part of the reception elaborates the reception and criticism of the film Anna Karenina (1997) directed by Bernard Rose. As an adaptation of the novel Anna Karenina by Leo Tolstoy (1887), criticism and reception in this case focuses, among other things, on the stallings and deviations of the adapted story. Additionally this paper addresses the evolving landscape of film reception in the digital age, considering the impact of online communities, social media and interactive platforms on audience engagement. This study aims to contribute to the ongoing discourse on film reception theory by providing insights into the multifaceted nature of audience engagement and its implications for the wider field of film studies. During this study, I came to the conclusion that coded messages and pre-existing expectations also influence the audience’s reception of a film. The coded message is deciphered by the audience based on the knowledge they possess and not the way the producer thought. In this case, the producer too should not convey messages that are not easily decoded by the audience.

Is Visual Prediction Impaired in Adolescents with Autism spectrum Disorder? Event-Related Potentials in a Cued Visual GO/NOGO Task.

Aim: Deviant visual processing has been observed in autism spectrum disorder (ASD), manifesting as decreased P1 and P2 components of visual event-related potentials (ERPs). Alterations have been attributed to a failure of Bayesian inference, characterized by hypo-activation of top-down predictive abilities. To test this hypothesis, we measured the visual negativity (vN) as an ERP index of visual preparation hypothesized to mirror predictive brain activity. Method: ERPs in a cued visual GO/NOGO task in 63 adolescents with ASD (IQ > 70, attention-deficit hyperactivity disorder excluded) were compared with ERPs in a sex- and age-matched group of 60 typically developing (TD) controls. Results: The behavioral variables (omissions, commissions, reaction time, and reaction time variability), as well as ERP components reflecting, among other processes, cognitive control (contingent negative variation, P3 GO, P3 NOGO, N2 NOGO) did not differ between the groups. There were group differences in visually based ERPs. Besides P1 and P2 differences, the vN component differentiated the 2 groups with the highest effect size (d = 0.74).Conclusion: This ERP study lends support to the hypothesis suggesting that a Bayesian hypo-prediction could underlie unique perceptual experiences in individuals with ASD. This could lead to a predisposition to perceive the world with reduced influence and modulation from contextual cues, prior experiences, and pre-existing expectations.

Risk knowledge and risk perception of MCI patients and their caregivers in predictive diagnosis of AD: Findings from the PreDADQoL study

AbstractBackgroundIndividuals with mild cognitive impairment (MCI) and their caregivers face complex probabilistic information when seeking diagnostic work‐up of early detection of Alzheimer’s disease (AD). When counseling about biomarker‐based AD detection and communicating dementia risk, clinicians need to consider the magnitude of cognitive impairment and the numeracy skills of their patients, in order to enable an informed decision‐making. The transnational PreDADQoL project used a mixed‐methods approach to provide data on this topic and was conducted in Germany and Spain.MethodA total of 76 MCI patients and caregivers were recruited and followed‐up over 3 months after a standardized counseling session about predictive AD diagnosis and cerebrospinal fluid (CSF)‐biomarker‐based dementia risk prediction. MCI patients consenting to biomarker testing were scheduled for a disclosure session together with their caregiver, where the individual biomarker profile together with the dementia risk was communicated. Risk communication was facilitated by graphical displays and take‐home material. Questionnaires on numeracy skills such expectations towards the predictive testing were applied. Moreover, a questionnaire and an open question on the risk perception regarding the MCI patient’s risk to develop Alzheimer’s dementia within 5 years were assessed.ResultOn average MCI patients answered 58% of items testing numeracy scale correctly, and caregivers 66%. After counseling on biomarker‐based AD detection and dementia risk prediction a substantial number of patients (25%) and caregivers (40%) expected a precise detection of a disease from the biomarker testing and not a risk prediction. MCI patients perceived their risk of developing Alzheimer’s dementia to be equal or lower as compared to a healthy person. The caregivers‘ risk perception correlated significantly with the communicated risk, however, in MCI patients no correlation between communicated risk and risk perception was detected.ConclusionThe disclosure of dementia risk did not have a major impact on the MCI patients‘ risk perception, whereas the caregivers‘ risk perception correlated significantly with the communicated risk. This study depicts that clinicians should be aware that not all the contents of the counseling and disclosure information may be understood by patients. Furthermore, competing preexisting attitudes, expectations and knowledge of the individuals need to be acknowledged by clinicians when communicating dementia risk.

The effect of peer-to-peer recognition systems on helping behavior: The influence of rewards and group affiliation

Peer recognition systems are an increasingly popular management control tool through which employees can recognize and thank one another. I examine the effectiveness of these systems in motivating employee helping behavior. My theory and experimental findings suggest that group affiliation is a key moderating factor in determining the motivating influence of peer recognition systems. Specifically, I predict and find that the presence of a peer recognition system has a greater positive effect on in-group versus out-group helping. Results suggest this occurs because peer recognition systems, by formalizing the opportunity for social approval, sensitize employees to preexisting social expectations. I also predict that the incremental benefit of adding rewards to a peer recognition system will be greater for out-group versus in-group helping because the rewards will strengthen the perceived value of recognition among out-group members but simply replace in-group members’ social motivation. Statistical support for this prediction is weak, however. My findings provide insight into when peer recognition systems are effective in motivating helping behavior.

The Sea Lady

The Sea Lady

Context and Representation: Data Gathering Methodology for Soundscape Contextual Factors

The contextual dimension of subjective perception plays a crucial role in moderating listener evaluations of soundscapes. While Soundscape indicators are directly measured and have numerically determinable measurement uncertainty, the surveying of subjective perception via soundscape descriptors presents methodological challenges pertaining to an indeterminate range of situational moderators which influence descriptor selection. Variations in subjective assessments by listeners have been shown to be correlated with factors such as perceived relevance of a sound source, whether the acoustic environment meets their pre-existing expectations, and familiarity. This paper addresses these methodological challenges by detailing a new data gathering strategy and analysis process for assessing the "interrelationships between person and activity and place, in space and time" (ISO 12913-1:2014). The methodology explored in this paper lends clarity to the dynamics of subjective evaluation within the surveyed population, by instrumentalizing a multi-level model of individual perception of physical environments, drawn from related studies in workplace sociology, anthropology, and organizational studies. This model of perception enables numerical analysis of written responses from listeners about their environment, revealing contextual factors which can moderate subjective perception of the sounds within the environment. This additional data can be applied to the development of conceptual frameworks during soundscape analysis.

Interrogating Trot, Situating the Boom: New(tro) Nostalgia, Old Songs, and National Identity Performance

Across 2019–2020 a number of South Korean TV competition shows branded their musical identity as “trot.” This term denotes a perceived genre of popular music considered normative to South Korea’s developmentalist decades and thereafter as the music of older generations, yet the surprise success of the TV shows seemingly indicated a younger uptake heralding a “trot boom.” However, in much of their choice of repertoire, the shows transgressed pre-existing expectations of the genre. The notion of a trot boom premised on a reified genre discourse is thus overly reductionist and fails to explain adequately the performed aesthetics and socio-musical phenomenon engendered by the shows. This article problematizes the received narrative(s) of “trot,” while highlighting three alternative trans-genre elements and aesthetic trends that operate in close proximity to trot discourse: “old song” collections, kug’ak (traditional music) fusion, and a discourse of Korean vocal affect. It analyzes the repertoire and performances of three of the most noted trot-branded television series, and juxtaposes them with two further case studies: YouTube channel Chu Hyŏnmi TV and a sample of “old song” collections dating 1969–1989. It argues that all three cases variously intersect and diverge from reified trot, while simultaneously exhibiting their own interrelations collectively bound by performed retro and newtro aesthetics, and national identity discourse.

Acupuncture in Patients Undergoing Cancer Therapy: Their Interest and Belief in Acupuncture is High, But Few are Using It.

Objectives:Since pre-existing expectations, that is, beliefs, in a treatment may modify outcomes, and acupuncture studies often fail to measure expectations, we wanted to investigate the use of acupuncture, interest, and belief in acupuncture effects among patients undergoing cancer therapy.Method:A cross-sectional design, where the participants answered a study-specific questionnaire with questions regarding their use of, interest and belief in acupuncture treatment.Results:A total of 457 patients with cancer (48% men, mean age 65 years) answered the questionnaire. Acupuncture was used by 4 (1%) patients during their cancer therapy, and 368 (83%) expressed an interest in receiving acupuncture. Of the 457 patients, 289 (63%) believed acupuncture to be effective for at least 1 of 17 requested symptoms, most commonly pain (56% of the patients) and muscle tension (40%). They believed acupuncture to be effective for a mean value 3 of the 17 requested symptoms. Women (P < .001), and patients 41 to 65 years (P < .001), expressed a stronger belief in acupuncture effects than others.Conclusions:Men and older patients expressed weaker beliefs in acupuncture effects than other patients, indicating the importance of collecting expectancy data in future randomized sham-controlled acupuncture studies to be able to treat expectancy as an effect-modifier. The high interest and beliefs in acupuncture effects found also indicate that acupuncture should be available for patients with cancer, for side effects where acupuncture has shown to be effective. In a clinical setting, older men might need more encouragement regarding positive expected outcomes of the acupuncture treatment than younger women.

Professional identity transitions, violations and reconciliations among new nurses in low- and middle-income countries

We examine how new nurses construct their professional identity in Low- and Middle-Income Countries (LMICs) when they enter clinical practice and encounter practical norms violating procedural standards. We conducted interviews and focus group discussions with 47 Kenyan nurses. We describe new nurses experiencing ‘shock’ entering nursing practice (working and learning alone while responsible for many patients and doing ‘dirty work’), which contrasted with their idealized image and expectations of nursing and prior training. We explain this transition using theory about identity and identity work, which we argue elucidates nurses' experiences in LMICs. We suggest that nurses' transition into clinical practice violated pre-existing expectations for their professional identities, which then triggered identity work of ‘toughening up’, ‘maturing through experience’, and ‘learning practical norms’. Through this identity work, and finally experiencing satisfaction from caring for and nursing patients back to health, some nurses were able to restore their valued professional identity.Our findings highlight the need for professional educators and healthcare policymakers in LMICs to reconsider the way new healthcare workers are prepared for and socialized into professional practice, acknowledging that nursing practice is often very different to training. We argue for developing formative spaces in which health professionals can safely discuss practical norms deviating from procedural standards. Drawing on such conversations, practical norms benefitting the quality and safety in resource constrained contexts might then be incorporated into care standards and ways found to address practical norms harming of patient care.

Nocebo effects in the treatment of endometriosis.

The current approach to treating endometriosis is often inadequate or intolerable for many patients. Until more effective therapies are available, we should aim to maximize the effectiveness of our current options. Optimization may be possible by reducing nocebo effects, which are the negative therapeutic effects not directly caused by a treatment. Awareness of these effects, how they arise, and the factors influencing them, is invaluable if we aim to limit their magnitude. The unique nature of endometriosis diagnosis and management is especially prone to nocebo effects due to multiple factors, including diagnostic delays, feelings of invalidation, social transmission of expectations, and persistent symptoms despite numerous treatments. This commentary discusses the origins of these effects in people with endometriosis, methods of limiting nocebo effects, and future research directions.Lay summaryThe term ‘nocebo’ describes the undesirable effects of a medication or treatment that patients may experience which are not directly caused by the treatment (e.g. tiredness from a sugar pill). These arise from pre-existing expectations toward a treatment and are influenced by multiple external factors, including past experiences, online media, personal beliefs, and personality factors. Endometriosis is a disease characterized by cells like those from the inside of the uterus growing outside of the uterus. The complex nature of endometriosis diagnosis and management creates an environment where nocebo effects may affect treatment outcomes. We may be able to limit nocebo effects through awareness and simple actions that strengthen patient–doctor relationships. Effective therapeutic relationships with doctors are crucial in limiting negative expectations and are established through empathy, honesty, and support. Therapeutic relationships built on trust may allow healthcare providers to address negative expectations, nocebo effects, and the misinformation affecting endometriosis management.

Critical incidents in anorexia nervosa: perspectives of those with a lived experience

BackgroundAlthough social-emotional difficulties are believed play a key role in anorexia nervosa (AN), there is uncertainty regarding what these difficulties might look like. Previous research has largely focused on a “disease model” of social-emotional processing in AN with little attention paid to positive emotions and experiences. Therefore, the aim of the present study was to obtain a fuller picture of critical life events as identified by those with lived AN experience.MethodsThirty-four participants aged 16–48 with current or past AN completed an online survey describing self-defined positive and difficult critical events. Thematic analysis was used to assess patterns in participants narrative responses.ResultsTwo major themes were identified in the descriptions of positive critical events: Moments of celebration and Unexpected positive outcomes. These major themes revealed increased external focus and some corrective experiences that challenged the participants pre-existing expectations leading to new positive outcomes. Difficult events clustered into life events that were identified as Eating disorder (ED) related and Non-ED related and included the dimensions of relational conflict and feeling unsupported.DiscussionThe findings suggest that although negative emotionality was identified in the accounts of those with lived experience of AN capacity for “big-picture” thinking with and explicit focus on others was also identified. Moreover, an openness to corrective experiences that worked to challenge negative expectations was evident for some participants. Together these findings have scope as targets for further clinical research and treatment interventions.

Exploring the Gendered Effects of the COVID-19 Pandemic on Academic Staff in Tanzania

The outbreak of the COVID-19 pandemic marked a serious interruption in all sectors and on all communities. Like other spaces, university life was severely disrupted. The core activities of academics in areas of teaching, research, service, and consultancy were interrupted with lockdowns requiring academics to work-from-home for extended periods. International evidence quickly began to emerge of the differential gendered experiences of these disruptions. This paper explores the gendered effects of COVID-19 public health policies on academic staff in Tanzania. Utilizing a feminist relational approach, it provides insights into the lived experiences of academic staff around two themes: 1) caring and coping during the COVID crises; and 2) work-life balance. It shares insights from data collected through qualitative methods of interview and discourse analysis. The findings reveal distinct gendered differences in the experiences of staff, with female staff reporting a significant increase in caring responsibilities and decreased time available for research and academic engagement. Pre-existing gender norms and expectations concerning the gendered division of labor in households emerged as a distinctly gendered challenge. As government public health policies pushed responsibilities for care and education back onto households, many female academics experienced significant increases in time required for family and community care, thus affecting their ability to balance their personal and professional roles. Implications of these findings are relevant for the development of gender sensitive and appropriate policy revisions [End Page 61] and future public health measures that may arise.

Eleven-Month-Olds Link Sound Properties With Animal Categories.

We examined 11-month-olds’ tendency to generalize properties to category members, an ability that may contribute to the inductive reasoning abilities observed in later developmental periods. Across three experiments, we tested 11-month-olds’ (N = 113) generalization of properties within the cat and dog categories. In each experiment, infants were familiarized to animal–sound pairings (i.e., dog barking; cat meowing) and tested on this association and the generalization of the sound property to new members of the familiarized categories. After familiarization with a single exemplar, 11-month-olds generalized the sound to new category members that were both highly similar and less similar to the familiarized animal (Experiment 1). When familiarized with mismatched animal–sound pairings (Experiment 2; i.e., dog meowing; cat barking), 11-month-olds did not learn or generalize the sound properties, suggesting that infants have pre-existing expectations about the links between the characteristic sound properties and the animal categories. When familiarized with unfamiliar sound–animal pairings (Experiment 3; i.e., dog-unfamiliar sound), 11-month-olds linked the animals with the novel sounds but did not generalize to new category members. Taken together, these findings highlight the conditions under which young infants generalize properties from one exemplar to other category members.

Too much love will kill you: the development and function of group emotional awareness

Purpose This paper aims to enhance clarity for the conceptualization and measurement of group emotional awareness by defining it as an emergent state. The authors explore the emergence of this state through two studies designed to explore the four characteristics (global, radically novel, coherent and ostensive) of emergent phenomena (Waller et al., 2016). Design/methodology/approach In Study 1, the authors explore in an experimental setting the formation of group emotional awareness and regulation as emergent states as a result of compositional effects (team members’ self-perceptions of their individual emotional awareness capabilities) and group norms regarding emotional awareness. Study 2 uses an experimental design to explore how pre-existing expectations of group emotional awareness, based on previous dyadic interactions between team members, can prevent conflict escalation (from task to relationship conflict) in project teams. Findings Individual perceptions of members’ own abilities and group norms interact in the emergence of group emotional awareness. Group emotion regulation can develop only under an optimal level of emergent group emotional awareness; groups that build emotional awareness norms compensate for their members’ low awareness and develop equally efficient regulatory strategies as groups formed of emotionally aware individuals. However, the conjunction of personal propensity towards awareness and explicit awareness norms blocks the development of regulatory strategies. Group emotional awareness (both as a developed state and as an expectation) reduces the escalation of task to relationship conflict. Originality/value Designing for the exploration of the four characteristics of emergence allowed us to gain new insights about how group emotional awareness emerges and operates too much awareness can hurt, and affective group expectations have the power to shape reality. These findings have strong implications for practitioners’ training of emotional awareness in organizations.

Disruptive Innovation: Family Migration and Gender Justice

Disruptive innovation is in vogue. Think the iPhone, the personal computer, or, in earlier days, the Model T Ford automobile. These disruptive innovations have upended older practices and demands, unlocking new sources of change (and desire) by offering what management guru Clayton Christensen of Harvard Business School calls a “different package of attributes [initially] valued only in emerging markets remote from, and unimportant to, the mainstream.”1 The disruptive in disruptive innovation refers to the ability of these innovations by agents of change to rapidly and dramatically reshape the mainstream in their own image. Families have been innovating, too, enacting new relations and structures of family life as they cross borders and test settled expectations. A central theme advanced by Daphna Hacker’s Legalized Families in the Era of Bordered Globalization is that the law—understood broadly to encompass multiple fields and layers of regulation derived from overlapping or competing sources of authority and identity—is an active, although often invisible, partner in the life of families. It partakes in shaping, enabling, prohibiting, or simply complicating certain practices of their members’ cross-border, transnational, or multinational lived experience. A core motivation that undergirds the book is to make visible the significance of law as a “family-shaping border.”2 To that end, Hacker adopts a “panoramic and contextual analysis of the impact of bordered globalization on families.”3 The book does so marvelously by crossing jurisdictional and disciplinary boundaries as it traces the impact of multiple sources and layers of law on family members. At the same time, the book emphasizes the ability of individuals to reshape and reimagine the familial units to which they belong through their own action: by forming, enlarging, redesigning, and reinterpreting their familial relations in defiance of preexisting norms and expectations. Reading this book can be a dizzying experience. The author presents examples from across the globe, and explores family life in its multiplicity of dimensions: marriage, reproduction, abortion, child nutrition, domestic violence, old age, cross-border movement and citizenship are discussed within the book’s ambitious ambit. Hacker fully acknowledges this abundance of riches. She directs the following comment to those who have braved the experience, stating that “[i]t is my hope that those of you who have read the whole book have been left somewhat overwhelmed. This is deliberate, because one of my goals is to highlight the challenges of empirically and theoretically understanding bordered globalization and professionally assisting families affected by it.” (p. 321).

A systematic study of microdosing psychedelics.

The phenomenon of ‘microdosing’, that is, regular ingestion of very small quantities of psychedelic substances, has seen a rapid explosion of popularity in recent years. Individuals who microdose report minimal acute effects from these substances yet claim a range of long-term general health and wellbeing benefits. There have been no published empirical studies of microdosing and the current legal and bureaucratic climate makes direct empirical investigation of the effects of psychedelics difficult. In Study One we conducted a systematic, observational investigation of individuals who microdose. We tracked the experiences of 98 microdosing participants, who provided daily ratings of psychological functioning over a six week period. 63 of these additionally completed a battery of psychometric measures tapping mood, attention, wellbeing, mystical experiences, personality, creativity, and sense of agency, at baseline and at completion of the study. Analyses of daily ratings revealed a general increase in reported psychological functioning across all measures on dosing days but limited evidence of residual effects on following days. Analyses of pre and post study measures revealed reductions in reported levels of depression and stress; lower levels of distractibility; increased absorption; and increased neuroticism. To better understand these findings, in Study Two we investigated pre-existing beliefs and expectations about the effects of microdosing in a sample of 263 naïve and experienced microdosers, so as to gauge expectancy bias. All participants believed that microdosing would have large and wide-ranging benefits in contrast to the limited outcomes reported by actual microdosers. Notably, the effects believed most likely to change were unrelated to the observed pattern of reported outcomes. The current results suggest that dose controlled empirical research on the impacts of microdosing on mental health and attentional capabilities are needed.

The Influence of Treatment Expectations on Clinical Outcomes and Cortisol Levels in Patients With Chronic Neck Pain: An Experimental Study.

The role of contextual factors like pre-existing treatment expectations has been established. However, the effect of verbally delivered treatment expectations in patient-therapist communication has not been considered, nor has the role of cortisol changes within the placebo/nocebo response in people with chronic neck pain. To examine the effect of verbally delivered treatment expectations on clinical outcomes in physical therapy practice and to determine if changes in cortisol levels are associated with changes in neck pain and disability. Eighty-three patients with chronic neck pain were randomly allocated to 3 different verbally delivered expectations (positive, negative, neutral) during physical therapy interventions. salivary cortisol, pain and disability, and cervical range of motion. Pain significantly improved in the positive (P<0.001) and neutral (P<0.001) expectations groups. For salivary cortisol levels, a significant increase was observed in response to treatment in the neutral (P=0.045) and negative (P<0.001) expectations groups. No significant correlations were found between changes in salivary cortisol levels and the change in pain in the neutral and negative expectations groups. Physical therapists treating people with chronic neck pain should be attentive when communicating the expected treatment effects to their patients. Whereas verbally delivered positive or neutral expectations may be beneficial for pain-related measures, giving negative expectations may result in a lack of a treatment response on pain. Cortisol levels increased in response to verbally delivered neutral and negative expectations, in the absence of a nocebo effect. This questions the presumed role of cortisol in the nocebo effect.

Community perspectives on primary health centers in rural Maharashtra: What can we learn for policy?

Introduction:Primary Health Centers (PHCs) are intended to be the “backbone” of the Indian public health system. Yet, these do not get utilized as frontline institutions for basic curative care. As we embark on comprehensive primary health care initiatives, it is important to understand people's perceptions on PHCs; and design services that cater to their felt needs.Aim:In this paper, we examine explanations that communities give for the use or bypass of PHCs. From these perspectives, we derive some policy directions for improving basic curative care services at PHCs.Methods:This qualitative study is based on data from 14 Focus Group Discussions in a rural area in Maharashtra in the catchment area of 8 PHCs (total 91 community participants). The discussions were coded and analyzed thematically with the aid of a qualitative software.Results:PHCs were not viewed as first-access points for health care, though these were valued for specific services. The limited use of PHCs was attributed to the lack of availability of drugs/services of perceived relevance to communities; prevalent healing norms that mismatched with PHC services; doctor-patient interactions that were colored with mistrust; and widespread poor opinions of public-sector services in health.Conclusions:Currently, there seems to be little in the design of PHC services- that appeals to the “felt” needs of communities. Thus, the proposed Health and Wellness Centers (HWC) initiative resonates with people's expectations. In addition, staff at the periphery must provide “attentive” care and be prepared to contend with pre-existing poor expectations of care.