Social History Information Research Articles

Mothers\u2019 reproductive and medical history misinformation practices as strategies against healthcare providers\u2019 domination and humiliation in maternal care decision-making interactions: an ethnographic study in Southern Ghana

BackgroundPregnant women can misinform or withhold their reproductive and medical information from providers when they interact with them during care decision-making interactions, although, the information clients reveal or withhold while seeking care plays a critical role in the quality of care provided. This study explored ‘how’ and ‘why’ pregnant women in Ghana control their past obstetric and reproductive information as they interact with providers at their first antenatal visit, and how this influences providers’ decision-making at the time and in subsequent care encounters.MethodsThis research was a case-study of two public hospitals in southern Ghana, using participant observation, conversations, interviews and focus group discussions with antenatal, delivery, and post-natal clients and providers over a 22-month period. The Ghana Health Service Ethical Review Committee gave ethical approval for the study (Ethical approval number: GHS-ERC: 03/01/12). Data analysis was conducted according to grounded theory.ResultsMany of the women in this study selectively controlled the reproductive, obstetric and social history information they shared with their provider at their first visit. They believed that telling a complete history might cause providers to verbally abuse them and they would be regarded in a negative light. Examples of the information controlled included concealing the actual number of children or self-induced abortions. The women adopted this behaviour as a resistance strategy to mitigate providers’ disrespectful treatment through verbal abuses and questioning women’s practices that contradicted providers’ biomedical ideologies. Secondly, they utilised this strategy to evade public humiliation because of inadequate privacy in the hospitals. The withheld information affected quality of care decision-making and care provision processes and outcomes, since misinformed providers were unaware of particular women’s risk profile.ConclusionMany mothers in this study withhold or misinform providers about their obstetric, reproductive and social information as a way to avoid receiving disrespectful maternal care and protect their privacy. Improving provider client relationship skills, empowering clients and providing adequate infrastructure to ensure privacy and confidentiality in hospitals, are critical to the provision of respectful maternal care.

Family History-Taking in Paediatrics: It’s Much More Than Just A Checklist

Abstract BACKGROUND: Family history (FH) is a risk factor for many conditions in pediatric practice; interest has increased in supporting systematic FH taking in this area by identifying core conditions for enquiry and developing point of care tools. There is little published about current practice to inform implementing such changes. OBJECTIVES: To inform future FH taking interventions by identifying pediatricians' perceptions, attitudes, beliefs, and current practices. DESIGN/METHODS: The Theoretical Domains Framework (TDF) was used to develop a comprehensive interview scheme. Semi-structured interviews were conducted with community and hospital-based pediatricians Analysis was by the constant comparison method, using a thematic approach. This study was funded by the Canadian Institutes of Health Research. RESULTS: The data revealed FH taking to be a firmly embedded, but complex aspect of pediatric practice. Participants described FH as part of regular, holistic care, extending to social and interpersonal, as well as clinical purposes; in addition to disease risk assessment, FH information helped clarify diagnosis, and select medication; tailor the overall patient management based on family circumstances; and provide psychosocial support for parents. It was also used as a method to build a relationship with parents/carers. FH and social history information were inextricably linked and often appeared to be the same concept in participants’ minds. Participating pediatricians generally expressed confidence in their FH skills and reported tailoring their approach according to experience, after initial training early in their career. While acknowledging some challenges in ensuring accuracy, they were attuned to nuances in their interactions with parents and children which would affect whether, and what, they were told about illness in the family. Most were not concerned about formal evidence, and would not change their practice except for “good reason”. CONCLUSION: The use of the TDF helped ensure a comprehensive approach to FH taking in pediatric practice. The findings suggest that FH taking in this setting is a complex activity, embedded in routine care. Recommendations for systematic enquiry about specific conditions cannot be seen as a simple additional activity to current practice. Efforts to make FH taking more systematic may founder if they fail to take into account pediatricians’ attitudes, perspectives, and practices. Further studies should explore and seek to confirm and expand our observations.

Predicting depression outcome in mental health treatment: A recursive partitioning analysis

Objective: Recursive partitioning was applied to a longitudinal dataset of outpatient mental health clinic patients to identify empirically factors and interactions among factors that best predicted clinical improvement and deterioration in symptoms of depression across treatment. Method: Sixty-two variables drawn from an initial patient survey and from chart review were included as covariates in the analysis, representing nearly all of the demographic, treatment, symptom, diagnostic, and social history information obtained from patients at their initial evaluations. Trees estimated the probability of participants' having depression at their last assessment, improving to a clinically significant degree during treatment, or developing a new onset of significant depressive symptoms during treatment. Results: Initial pain, the presence of anxiety, and a history of multiple types of abuse were risk factors for poorer outcome, even among patients who did not initially have significant depressive symptoms. Conclusions: By examining multiple-related outcomes, we were able to create a series of overlapping models that revealed important predictors across trees. Limitations of the study included the lack of cross-validation of the trees and the exploratory nature of the analysis

The moderating effect of aggressive problem behaviors in the generation of more positive attitudes toward nursing home residents

This study examined the ability of a social history intervention to generate more positive attitudes toward nursing home patients, and to increase staff members' perceived rewards of care-giving. In contrast to prior studies, residents' problem behaviors were examined as potential moderators in the relationship. Forty-three staff members participated in an experimental, 3 (informational condition: social history, medical, control) × 2 (time: pre-test, post-test) within-subjects factorial design that employed newly admitted residents as target patients. Findings showed that the social history intervention alone did not generate more positive attitudes toward patients or greater rewards of care-giving. Although a larger proportion of target patients manifested other problem behaviors with greater frequently, only aggressive problem behavior was associated with more negative attitudes toward patients. A post-hoc analysis revealed that after statistically controlling for the impact of patients' aggressive behavior, the social history information appeared to allow staff members to maintain more neutral attitudes toward patients. Considerations for the use of social history information in long-term care settings are addressed.

Predicting Recidivism with Social History Information and a Comparison of Their Predictive Power with. Psychometric Variables

Predicting Recidivism with Social History Information and a Comparison of Their Predictive Power with. Psychometric Variables

Placement or placebo: Does additional information change special education placement decisions

The effect of relevant information on the decision to place pupils in special education services was investigated. Ten placement decision committees were given information on 12 referred pupils, half of which included social history information on the pupil and orthogonally half of which were recommended for special education services by an outside psychologist. Analysis of the committee's 120 decisions revealed no significant relationship either between the psychologist's recommendation and the committee's decisions or between the presence of social histories and the committee's decisions. The results are discussed in terms of information advocacy within the committees.

Delinquency, personality tests and relationships to measures of guilt and adjustment.

The validity of personality tests designed by Quay (1966) to differentiate within a heterogeneous delinquent population were evaluated with 115 delinquent adolescents. The personality tests were: the Personal Opinion Inventory based on a self-rated questionnaire; the Case History Scale, based on social history information; and the Behavior Rating Scale, based on ratings of institutional behavior. The results indicate that the Psychopathic and Neurotic factors of the Case History and Behavior Rating Scales have some modest multitrait-multimethod validity. These tests, generally, have more predictive validity than the Personal Opinion Inventory. The Neurotic factors of the three tests were reinterpreted as measuring maladjustment and as being independent of guilt. The Psychopathic factor seems to be related to poor institutional adjustment and aggressive behavior. The Socialized and Immature factors appear to have poor validities.

Getting Under Way

Traditionally the social worker helps the psychiatrist by interviewing families, and contacting agencies or individuals for social history information. This helps in establishing the facts about the patient’s social and economic condition and in determining the diagnosis. However, in the 24-bed psychiatric ward of this general hospital, we have found that by integrating casework skills with the program of the total hospital team, psychiatric social workers can offer additional essential service. The hospital is a public one, and our service is geared to emergency and acute illness. Our patients are often transients rather than residents. The maximum stay is three months, the average 25 days. The psychiatric social work staff consists of three trained psychiatric social workers who give part time to the ward and part time to two psychiatric out-patient clinics; they work under a qualified psychiatric casework supervisor. In addition they have a regular program of consultation with staff and resident psychiatrists. They attend ward rounds and staff meetings. On admission each patient is assigned to a social worker as well as to a resident psychiatrist. The social worker, in his routine work of establishing contacts with families, friends, ministers, employers, landlords and social agencies, is also establishing relationships which can be of real value. The patient’s family are helped with their feelings of guilt or anxiety about his illness. They are more ready to accept the need to sign legal papers for treatment or for commitment to the State hospital if this is necessary. When a patient is transferred to the State hospital, we urge families and friends to keep in touch with him through mail and visits, and to be ready to help him when he returns to the community. Families are encouraged to keep in touch with our Social Service workers following the patient’s discharge, so that we may help them with any probWith the arrival of our architect, Mr. Alston G. Guttersen, and the first meeting of a consultant committee of psychiatrists and architects, the Hospital Architectural Study Project is now under way. First steps involve the collection of plans and specifications on recent and proposed mental hospital construction, and the accumulation of bibliographic material. Enlargement of the consulting group to the study is awaiting acceptances from the psychiatrists and architects approached. The architects are being appointed by the President of the American Institute of Architects, which is cooperating with us in this project. Plans for dissemination of the material to be developed include the use of several pages of MENTAL HOSPITALS each month for descriptive matter, cuts and plates. The circulation of this magazine, therefore, is to be extended to interested architects in addition to the present distribution to mental hospital personnel and mental health authorities. The preparation of loose-leaf bulletins to form a constantly up-to-date manual on mental hospital design, construction and equipment is also contemplated. Architectural journals have expressed an interest in running progress reports on the proj-