Primary Appraisal Research Articles

Toward a System Theory of Stress, Resilience, and Reintegration.

Military to civilian reintegration is a complex, multidimensional phenomenon warranting holistic perspectives. Complex phenomena require theory to understand and interpret relationships among concepts. Despite the need for theory-driven research, recent nursing reports often lack a theoretical structure. We extracted relevant concepts from the Neuman's Systems Model (stressors, environment, and person) and the Transactional Model of Stress and Coping (primary and secondary appraisal, coping, and adaptation) to form a Conceptual-Theoretical-Empirical model. Exemplar empirical instruments are presented, along with their conceptual and theoretical dimensions. An integrated System Theory of Stress, Resilience, and Reintegration is presented with its utility demonstrated through a research application.

The Distinctive Constitution of Feeling Hurt

Abstract. What is the nature of feeling hurt? This question is answered by systematically reviewing and integrating theories and empirical findings on feeling hurt using Lazarus’ theory of emotion. Following this approach, feeling hurt is constituted by a primary appraisal of an illegitimate devaluation and by a secondary appraisal of low controllability. This appraisal pattern activates an action tendency to withdraw from an interaction. This theory leads to several hypotheses for the appraisal (e.g., that an increase in appraisals of controllability should turn hurt into anger) on facial, bodily, and behavioral expressions as well as on the communicative function of feeling hurt. Furthermore, important conceptual distinctions between a broad and a narrow concept of feeling hurt as well as between feeling hurt as an emotion and a long-term emotional episode of hurt are introduced. Finally, feeling hurt is compared with humiliation, shame, guilt, disappointment, sadness, and anger.

Secondary Traumatic Stress in Foster Carers: Risk Factors and Implications for Intervention

ObjectivesFostering, a professional or semi-professional role that is in increasing demand, involves potential exposure to material related to children’s trauma in a domestic setting. Yet, professional vulnerability to secondary traumatic stress (STS) is under-researched in foster carers, as is the suitability of associated intervention techniques. We therefore investigated incidence of STS and psychological predictors relevant to secondary and primary stress appraisal in UK foster carers.MethodsBritish foster carers (n = 187; 81% female; aged 23–72 years; mean length of experience 9 years) were approached through a range of organizations managing paid foster caring in the UK for a survey study. Self-report measures were obtained on STS, burnout and compassion satisfaction from the Professional Quality of Life (ProQOL) scale, as well as on primary trauma and variables previously recommended for inclusion in training targeting secondary trauma: empathy, resilience and self-care.ResultsHigh levels of STS and burnout were found among foster carers. In multivariate model testing, STS was directly and positively predicted by burnout, compassion satisfaction and primary trauma (R2 = 0.54, p < 0.001). Resilience, empathy and self-care did not show direct associations with STS, but self-care had a significant indirect effect on STS.ConclusionsFindings support the view that STS is a substantial risk factor in foster caring. While self-care is confirmed as a promising factor in intervention, the roles of empathy and resilience are more ambiguous.

ADVANCE CARE PLANNING ASSIGNMENTS IN UNDERGRADUATE COURSES: EXAMINING STRESS APPRAISALS, COPING, AND RESPONSES

A common assignment in undergraduate aging courses requires students to consider or complete advance care plans for themselves. Due to the sensitive nature of this topic, it is important to consider student appraisals of such assignments. Using the transactional model of stress and coping, the current study used content analysis to examine student reactions to considering their own advance care planning. Participants included 151 students, diverse in race/ethnicity, in a Psychology of Aging undergraduate course at a large public university in the United States. Students were first exposed to course material related to death, dying, and bereavement, in addition to detailed advance directive forms, and were subsequently asked to discuss the importance of, and their preparedness for, their own advance care planning via a written assignment. Codes represented primary and secondary appraisals, coping efforts, and responses, and data was analyzed using ATLAS.ti software. Findings suggest that primary appraisals (perception of effect on well-being) ranged from positive to threatening, and secondary appraisals (perception of coping resources) focused on availability of internal and/or external resources. Themes such as traumatic experiences with death, feeling ill-prepared due to lack of knowledge or experience, and welcoming the opportunity to consider completing advance care plans emerged. Overall, results suggest that when designing assignments that require completion of advance care plans among undergraduate students, students should have the opportunity to discuss personal concerns first, and that some initial class activities should focus on preparatory tasks rather than just completion of advance care plans.

Nightmare distress revisited: Cognitive appraisal of nightmares according to Lazarus’ transactional model of stress

Aim of the current research was to newly conceptualize nightmare distress. The special focus was on the appraisal of nightmare distress while applying a theory-driven approach based on Lazarus’ transactional model of stress. It was argued that individuals feel the more distressed the more they feel threatened and harmed by their nightmares (primary appraisal according to Lazarus) and the more they lack of adequate coping skills to deal with the stressor (secondary appraisal). Based on these assumptions, the questionnaire of Cognitive Appraisal of Nightmares (CAN) was challenged empirically in two studies of patients who have experienced distressing nightmares using explorative and confirmative factor analyses (N = 504 and N = 402). Items and scales showed good psychometric properties and plausible correlations. The CAN sum score was more distinct from nightmare frequency than the frequently used Nightmare Distress Questionnaire (NDQ), underpinning that frequency and distress are both different approaches to what patients suffer from. The NDQ was particularly associated with acted out behaviors after a nightmare, while the CAN was particularly associated with physiological and emotional consequences of a nightmare. In order to obtain a multifactorial and theory-driven picture about how individuals appraise their nightmares, the CAN may be convenient.

Identification of processes that mediate the impact of workplace violence on emergency department healthcare workers in the USA: results from a qualitative study

ObjectivesViolence towards emergency department healthcare workers is pervasive and directly linked to provider wellness, productivity and job satisfaction. This qualitative study aimed to identify the cognitive and behavioural processes impacted...

Advancing Our Understanding of Psychological Stress and Coping Among Parents in Organized Youth Sport.

The current study investigated psychological stress among parents of competitive British tennis players. Adopting a multipart concurrent mixed method design, 135 British tennis parents completed a cross sectional online questionnaire to examine their primary appraisals, emotions, and coping strategies associated with self-disclosed stressors. Hierarchical content analysis was conducted on open ended questionnaire responses to identify key stressors and coping strategies, and descriptive and inferential statistics were utilized to explore the differences between various components of the process. The findings revealed a range of organizational, competitive, and developmental stressors. These stressors were predominantly appraised as harm or challenge, and anxiety and anger were the most prominent emotions that the parents experienced. Statistically, parents experienced greater anger in relation to competition (compared to organizational and developmental) stressors, whilst harm appraisal increased negative emotions, and challenge appraisal increased positive emotions. Findings also highlighted how parents used a number of mastery, internal regulation, and goal withdrawal coping strategies, which varied statistically in degrees of reported effectiveness. The contribution of these findings to the stress literature and their applied implications are discussed.

Antibiotic Prescribing Quality in Out-of-Hours Primary Care and Critical Appraisal of Disease-Specific Quality Indicators

Outpatient antibiotic use in Belgium is among the highest in Europe. The most common reason for an encounter in out-of-hours (OOH) primary care is an infection. In this study, we assessed all consultations from July 2016 to June 2018 at five OOH services. We described antibiotic prescribing by diagnosis, calculated disease-specific antibiotic prescribing quality indicators’ (APQI) values and critically appraised these APQI. We determined that 111,600 encounters resulted in 26,436 (23.7%) antibiotic prescriptions. The APQI diagnoses (i.e., bronchitis, upper respiratory infection, cystitis, tonsillitis, sinusitis, otitis media, and pneumonia) covered 14,927 (56.7%) antibiotic prescriptions. Erysipelas (1344 (5.1%)) and teeth/gum disease (982 (3.7%)) covered more prescriptions than sinusitis or pneumonia. Over 75% of patients with tonsillitis and over 50% with bronchitis, sinusitis, and otitis media were prescribed an antibiotic. Only for otitis media the choice of antibiotic was near the acceptable range. Over 10% of patients with bronchitis or pneumonia and over 25% of female patients with an acute cystitis received quinolones. The APQI cover the diagnoses for only 57% of all antibiotic prescriptions. As 5.1% and 3.7% of antibiotic prescriptions are made for erysipelas and teeth/gum disease, respectively, we propose to add these indications when assessing antibiotic prescribing quality in OOH primary care.

A realist review of infant feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa: what works for whom and in what contexts

BackgroundThe most recent World Health Organization (WHO) guidelines on Human Immunodeficiency Virus (HIV) and infant feeding promotes exclusive breastfeeding (EBF) in resource limited settings for the prevention of mother to child transmission (PMTCT) of HIV. Literature reveals poor uptake of WHO feeding guidelines, with mixed feeding being a regular practice. In light of the limited success in EBF promotion, a realist review was conducted, analysing the use of feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa, where the majority of HIV childhood infections occur. We considered what mechanisms were at play, for whom and in what circumstances they led to exclusive breastfeeding.MethodsBecause infant feeding counselling is a complex social intervention with a non-linear causal pathway for preventing mother to child HIV transmission, a realist methodology was chosen for this study. Using Pawson’s five stage sequence for conducting realist reviews, the results are presented as a set of identified and refined context-mechanism-outcome (CMO) configurations. These CMO configurations were used to show how particular outcomes occurred in specific contexts due to a generative mechanism and were developed through identifying a review question and program theory, searching for primary studies, quality appraisal, data extraction and data synthesis.ResultsFrom an initial 1010 papers, 27 papers met the inclusion criteria and were used to refine the program theory. Exclusive breastfeeding occurred when a woman was motivated regarding motherhood, had correct learning and understanding about infant feeding practices through counselling, no fear of breastfeeding or the impact of opposing feeding related cultural beliefs, and the support from others to be assertive about their feeding choices when faced with pressure to mix-feed. An additional CMO configuration was added during the refinement of the program theory identifying that mothers needed to not just understand but also prioritize EBF advice over cultural beliefs and stigma.ConclusionThe intended audience for this review are researchers and health care workers in PMTCT, particularly sub-Saharan Africa, who may benefit from the work that has been done to identify contexts for the success and failures of EBF.

A Multigroup Analysis of the Effect of Cognitive Appraisal on Nurses' Psychological Distress.

Cognitive appraisal constitutes an important mechanism in the process of human adaptation to work environment and occupational stress. In this domain, nursing professionals are one of the occupational groups most affected by job stress, suffering high levels of psychological distress. The aims of this study were to analyze the moderator effect of shift work and the type of job contract on the relationship between work cognitive appraisal and nurses' psychological distress and to explore the interaction effect of the two moderator variables on that relationship. A sample comprised of 2,310 Portuguese registered nurses completed a sociodemographic and professional questionnaire: the Primary and Secondary Cognitive Appraisal Scale and the General Health Questionnaire-12. Data were analyzed through structural equation modeling and multigroup analyses considering the following groups: (a) "shift" versus "nonshift work"; (b) "precarious job contract" versus "nonprecarious job contract"; and (c) "shift and precarious" versus "shift and nonprecarious" versus "nonshift and precarious" versus "nonshift and nonprecarious." Data confirmed the invariance for the measurement model, but the structural model presented a significantly worse adjustment for all grouping variables, showing the moderator effect of shift work and job contract and of their interaction. Difference tests in structural path coefficients revealed that shift work moderated the relationship between challenge perception and psychological distress-which was stronger for shift work nurses-and that a higher threat perception was related to greater psychological distress, especially in nurses with a precarious job contract. Among the four categories of interaction between job contract and shift work, cognitive appraisal became central in predicting nurses' mental health, explaining more variance in the group that did shift work and had a nonprecarious job contract. The study results highlight the need to develop occupational health intervention programs to promote nurses' mental health, focusing on reducing work perception as a threat and on making nurses' jobs more challenging and controllable.

Causal effects of challenge and threat appraisals on pain self-efficacy, pain coping, and tolerance for laboratory pain: An experimental path analysis study.

BackgroundPrimary appraisals of pain as a potential threat influence pain perception and coping but comparatively less is known about related effects of challenge appraisals or causal effects of primary appraisals on secondary appraisals of perceived pain coping capacities (e.g., pain self-efficacy).MethodsTo address these gaps, young Chinese women (N = 147) and men (N = 88) were randomly assigned to one of three appraisal conditions prior to engaging in a cold pressor test (CPT): (1) a higher threat appraisal condition featuring task orienting information describing symptoms and consequences of frostbite, (2) a lower threat appraisal condition featuring orienting information about safety of the CPT, or (3) a challenge appraisal condition featuring orienting information describing benefits of persistence despite discomfort for future life satisfaction.ResultsCompared to peers in the higher threat condition, challenge condition cohorts experienced smaller decreases in task-related self-efficacy, more cognitive coping, and less catastrophizing as well as more overall pain tolerance. A path analysis indicated that self-efficacy changes, cognitive coping and catastrophizing fully mediated links of subjective challenge and threat appraisals with pain tolerance.ConclusionsInitial appraisals about the nature of pain influence, not only pain tolerance and coping, but also perceived coping capacities.PerspectiveThrough examining particular theory-based pain appraisal and coping processes, this experiment is the first to identify both perceived coping capacities (pain self-efficacy) and coping responses as factors that explain why appraisals of pain as a challenge or threat have differential effects on pain tolerance.

Consumers acceptance of artificially intelligent (AI) device use in service delivery

This study develops and empirically tests a theoretical model of artificially intelligent (AI) device use acceptance (AIDUA) that aims to explain customers’ willingness to accept AI device use in service encounters. The proposed model incorporates three acceptance generation stages (primary appraisal, secondary appraisal, and outcome stage) and six antecedents (social influence, hedonic motivation, anthropomorphism, performance expectancy, effort expectancy, and emotion). Utilizing data collected from potential customers, the proposed AIDUA model is tested. Findings suggest that customers go through a three-step acceptance generation process in determining whether to accept the use of AI devices during their service interactions. Findings indicate that social influence and hedonic motivation are positively related to performance expectancy while anthropomorphism is positively related to effort expectancy. Both performance and effort expectancy are significant antecedents of customer emotions, which determines customers’ acceptance of AI device use in service encounters. This study provides a conceptual AI device acceptance framework that can be used by other researchers to better investigate AI related topics in the service context.

Communal Coping in Couples With Health Problems.

Prior to the 1990s, the predominant view of stress and coping defined stress as occurring when an individual perceives a situation as a challenge, threat, or loss and evaluates her capacity to respond based on her available resources. As an expansion of this intrapersonal perspective, the last 20 years have seen the emergence of two prominent interpersonal perspectives on stress and coping that account for the importance of social relationships in the coping process: the Systemic Transactional Model (STM) of dyadic coping and communal coping. In this article, I outline these two perspectives and highlight their points of convergence and divergence. I propose that one difference between the models is that communal coping involves an explicit focus on a communal or shared appraisal process, in which relationship partners view a problem or stressor as “ours” rather than “yours” or “mine.” I review existing methods for assessing communal coping (e.g., self-report, language use, behavioral observation) across laboratory, intervention, and real-world settings and summarize empirical evidence for the prognostic significance of communal coping for relationship and health functioning. I propose the utility of incorporating measurement of shared appraisal into future research on dyadic coping with stress, because of its potential to impact health through its influence on primary and secondary stress appraisal processes and physiological stress response systems. Finally, I outline biological and behavioral pathways through which communal coping may influence health as directions for future research.

Primary and secondary disability appraisal – Predictive role of sociodemographic and disability-related variables

Disability appraisal is a cognitive category examined mainly in the context of adjustment to living with disability. Its significance is usually determined as part of stress and coping theory applied in disability studies. The article presents the findings of a study on primary and secondary disability appraisal expressed by people with acquired motor impairments. Participants were people with spinal cord injuries and with lower limb amputation. Primary and secondary disability appraisal was analyzed with consideration of sociodemographic and disability-related variables. The findings suggest that these categories of variables make it possible to explain primary disability appraisal better than secondary disability appraisal. Also, it was found that disability-related variables had greater predictive significance than sociodemographic variables in explaining the intensity of both primary and secondary appraisal. The type of disability, its duration, and a sense of control over the consequences of one's motor impairment play a significant role in determining the intensity of both forms of disability appraisal.

Understanding the Factors that Influence the Primary Appraisal of mHealth Tools in Developing Countries: An Exploratory Case-Study in Nigeria

Shortages of health workers, infrastructural deficiencies, limited access to medical care are just a few of the many barriers to care in developing countries. The integration of smartphones and mobile devices into healthcare systems has been proposed to address some of the physical barriers to care and service delivery. These mHealth solutions extend the reach of medical care into rural areas of developing countries. However, it is not clear how mHealth solutions designed and tested in one developing region can be positively appraised for use in others. This study frames this problem using a coping theory approach based on an exploratory case-study to understand the factors that influence primary appraisal of smartphone-enabled clinical guidelines (mHealth tool) for accessing, classifying and eliciting treatment recommendation for sick children under the age of five by rural healthcare workers (RHCWs). Findings identified a set of factors which are bound as an emerging explanatory positivity model that influence primary appraisal of an mHealth tool in a new context. These factors are the set of individual and social factors that governments, funding bodies and non-governmental organisations should consider before embarking on the introduction of an mHealth tool in rural communities of developing countries. It is envisaged that by understanding the factors that influence primary appraisal, that is, either as an opportunity or a threat, practitioners and organisations will support positive appraisal and minimise the occurrence of negative ones when introducing mHealth tools. These findings have implications for theory, practice, and future research as explained in the concluding section of this paper.

Reducing stress: Social support and group identification

Three studies systematically explored the relationship between social support and group identification in the context of how individuals cope with stress. In Study 1, 101 participants took part in a simulated group task where they either received social support or not under conditions of either high or low demand. Social support was associated with higher group identification, and this mediated the effect of social support on more positive appraisals and task satisfaction. In Study 2, 83 participants were either made aware of their group membership or worked as individuals on a group task under high or low demand. In this study, group membership salience was associated with greater perceived support, which was associated with greater group identification, and subsequently more positive primary and secondary appraisals, more problem-focused coping, and task satisfaction. Study 3 assessed the perceived social support and group identification reported by 71 volleyball team members before and after a game. Results were more consistent with the notion that support and identification were two concurrent perceptions associated with being in a group, rather than identification priming the recognition of support or support increasing identification.

The time courses of runners’ recovery-stress responses after a mountain ultra-marathon: Do appraisals matter?

Objectives: The aim of this study was to: (a) examine the time courses of runners’ recovery-stress states within the month following a demanding Mountain Ultra-Marathon (MUM) race; and (b) explore the role of primary and secondary appraisals in these trajectories. Design: A seven-wave one-month longitudinal design was used with one measurement point within two days before the race to measure appraisals and six time points within the month following the race to assess recovery-stress states experienced by athletes. Method: A multilevel growth curve analysis approach was used among a sample of 29 MUM runners. Results: Recovery-stress states were characterized by distinct trajectories during the month following MUM race. Results of multilevel growth curve analyses showed significant linear increases of general and total recovery, significant linear decreases of general, sport-specific and total stress and a positive quadratic effect of squared time (U shape over time) on specific recovery. Primary appraisal significantly positively predicted levels of sport-specific recovery, total, general and sport-specific stress and significantly negatively predicted total and general recovery. Secondary appraisal significantly negatively predicted total and general stress. Conclusions: This study provided insights into the role played by appraisals on the recovery-stress states experienced by MUM runners the month following a demanding MUM race. Operational strategies were suggested in order to optimize the recovery-stress balance and in turn psychological adaptation processes in response to an ultra-endurance race.

Primary Appraisal Antiretroviral Adherence and Nonadherence among People Living with HIV (PLWH)

HIV is an iceberg phenomenon that still needs a problem solving. The data from the voluntary counselling and testing in Waluyojati General Hospital show that every month about 8–15 new people got HIV infection and Antiretroviral Therapy. Some of them adhered to undergo ARV, but some did not. One of influential factors for adherence to ARV is individual factor which consists of primary appraisal includes perceived susceptibility, severity, benefit, barrier and motivational relevance and secondary appraisal includes self-efficacy, perceived control outcome and emotion, and external factors. The aim of this study is to describe primary appraisal of antiretroviral adherence and nonadherence among People Living With HIV (PLWH). This study is a qualitative study using a content analysis. This study carried out in-depth interviews with 10 PLWH who received ART for about two weeks-three months. The results show that non adherence to ART is caused by several factors, such as income, perceived susceptibility, perceived severity, perceived barriers. Some of non adherence patients are bored to taking ARV every day and get several side effects, such as nausea and vomitting, erythema, HIV disclosure, fear of stigma. Both patients who adhere and do not to ARVperceived that taking ARV makes them healthy, resistant to be tired, less anxious or hospital care costs, and motivated like people with no HIV infection. Patients who do not adhere to ARV have more perceived barrier than perceived benefit and motivational relevance.

Stress-related laboratory eating behavior in adults with obesity and healthy weight

Stress is an important factor in the progression of irregular eating patterns and has an additional exacerbating impact in people with overweight and obesity. Therefore, in this study, the chewing and food intake was observed after standardized acute stress induction, as well as resting, in people with obesity and healthy weight controls. Twenty-eight women and men with obesity (BMI: 32.76 ± 2.25 kg/m2) were matched with regard to sex and age to 28 people with healthy weight (BMI: 22.58 ± 2.04 kg/m2). After two conditions (Trier Social Stress Test vs. resting condition) the chewing frequency and food intake were measured during a standardized laboratory meal on two separate days. Additionally, for manipulation check of stress induction salivary cortisol and two appraisal questionnaires (Primary Appraisal Secondary Appraisal, Visual Analogue Scale) were used. People with obesity showed after stress and resting condition a lower chewing frequency in contrast to healthy weight controls (F(1, 54) = 12.816, p ≤ .001). Thereby, both groups demonstrated a higher chewing frequency after the stress induction than after the resting condition (F(1, 54) = 7.436, p ≤ .01). There was no difference between the healthy weight controls and the people with obesity in food intake. In conclusion, the present data indicate a possible ‘obese eating style’ with regard to chewing performance. Furthermore, the demonstrated higher chewing frequency after stress induction, in people with obesity and people with healthy weight, might be a stress reduction strategy.

Is Commuting the Missing Link? Daily Spillover from Commute-to-Work and Work-to-Commute and Home

Commuting as a research topic has not received a great deal of attention from researchers (for a recent exception see Zhou et al., 2017) and there is much that we do not understand well. The set of studies that form this symposium, each one drawing on a daily diary methodology that aims to capture life as it is lived (Ohly, Sonnentag, Niessen, & Zapf, 2010), seek to generate knowledge on this topic and in particular to examine the spillover process from commute into work and from work into commute and then home. The studies contribute to organizational research by showing the importance of commuting as a key topic for any researcher seeking to understand daily variation in employee performance and wellbeing, and the spillover between work and home domains. More generally, the studies contribute to current debates about the utility of self-regulation theory (e.g. Hagger et al., 2010, 2016). On the one hand, there is some support for the role of ego depletion and the limited strength model of self-control (Muraven & Baumeister, 2000) in explaining spillover, even once fatigue, cognitive and affective factors are taken into account. On the other hand, several proposed effects were not observed and also this model does not seem to fully account for some of the spillover effects observed; here the role of primary appraisals seems to be particularly useful as an additional theoretical explanation. Collectively the studies further highlight a set of practical problems that organizations may do well to manage. The effect of morning commutes on emotional exhaustion and performance Presenter: Michal Biron; U. of Haifa Presenter: Renee De Reuver; reuver Everyday incivility on public transport as an antecedent of instigated workplace aggression Presenter: Dana Unger; U. of East Anglia, Norwich Business School Presenter: Anne-Grit Albrecht; Leuphana U. Lüneburg Presenter: Katrin Boettcher; Berlin School of Economics and Law The adverse effects of daily commuting to and from work on employees ego depletion Presenter: Wladislaw Rivkin; Aston Business School Presenter: Stefan Diestel; Leibniz-Research Centre for Working Environment & Human Factors Presenter: Klaus-Helmut Schmidt; Leibniz-Research Centre for Working Environment & Human Factors Self-regulation theory and the spillover of work demands on commuting driving behaviour Presenter: Michael Clinton; King's College London Presenter: Rebecca Hewett; Rotterdam School of Management, Erasmus U. Presenter: Neil Conway; Royal Holloway, U. of London Presenter: Damian Poulter; U. of Greenwich Presenter: Philip Terry; U. of Kingston Presenter: Fatima Felisberti; Kingston U. Presenter: Amy Montague; U. of Kingston