Corrine I. Voils

Putting the brakes on prejudice: on the development and operation of cues for control.

A model concerning the establishment and operation of cues for control was developed and tested to understand how control can be exerted over (automatic) prejudiced responses. Cues for control are stimuli that are associated with prejudiced responses and the aversive consequences of those responses (e.g., guilt). In Experiments 1 and 2, 3 events critical to the establishment of cues occurred: behavioral inhibition, the experience of guilt, and retrospective reflection. In Experiment 3, the presentation of already-established cues for control did, as expected, produce behavioral inhibition. In Experiment 4, participants were provided with an experience in which cues could be established. Later presentation of those cues in a different task resulted in behavioral inhibition and less racially biased responses.

Implicit associations as the seeds of intergroup bias: how easily do they take root?

Three experiments provided evidence that intergroup bias occurs automatically under minimal conditions, using the Implicit Association Test (IAT). In Experiment 1, participants more readily paired in-group names with pleasant words and out-group names with unpleasant words, even when they were experienced only with the in-group and had no preconceptions about the out-group. Participants in Experiment 2 likewise showed an automatic bias favoring the in-group, even when in-group/out-group exemplars were completely unfamiliar and identifiable only with the use of a heuristic. In Experiment 3, participants displayed a pro-in-group IAT bias following a minimal group manipulation. Taken together, the results demonstrate the ease with which intergroup bias emerges even in unlikely conditions.

Measuring quality of life at the end of life: validation of the QUAL-E.

OBJECTIVES To validate the QUAL-E, a new measure of quality of life at the end of life. METHODS We conducted a cross-sectional study to assess the instruments psychometric properties, including the QUAL-Es associations with existing measures, evaluation of robustness across diverse sample groups, and stability over time. The study was conducted at the VA and Duke University Medical Centers, Durham, North Carolina, in 248 patients with stage IV cancer, congestive heart failure with ejection fraction < or = 20%, chronic obstructive pulmonary disease with FEV1 < or = 1.0 1, or dialysis-dependent end stage renal disease. The main outcome measures included QUAL-E and five comparison measures: FACIT quality of life measure, Missoula-VITAS Quality of Life Index, FACIT-SP spirituality measures, Participatory Decision Making Scale (MOS), and Duke EPESE social support scales. RESULTS QUAL-E analyses confirmed a four-domain structure (25 items): life completion (alpha = 0.80), symptoms impact (alpha = 0.87), relationship with health care provider (alpha = 0.71), and preparation for end of life (alpha = 0.68). Convergent and discriminant validity were demonstrated with multiple comparison measures. Test-retest reliability assessment showed stable scores over a 1-week period. SIGNIFICANCE OF RESULTS The QUAL-E, a brief measure of quality of life at the end of life, demonstrates acceptable validity and reliability, is easy to administer, performs consistently across diverse demographic and disease groups, and is acceptable to seriously ill patients. It is offered as a new instrument to assist in the evaluation of the quality and effectiveness of interventions targeting improved care at the end of life.

Social Support and Locus of Control as Predictors of Adherence to Antidepressant Medication in an Elderly Population

OBJECTIVE The authors examined whether social support and locus of control (LOC), either individually or jointly, would be associated with subsequent self-reported medication adherence and treatment barriers in a sample of depressed elderly patients. METHODS A group of 85 elderly patients with major depression was enrolled in the Mental Health Clinical Research Center for the Study of Depression in Later Life at Duke University and treated with a standardized algorithm. During the course of the study, participants completed measures of social support and internal locus of control (LOC). A little more than 1 year later, they completed general measures of medication adherence and treatment barriers. RESULTS Increasing subjective and instrumental social support and non-family interaction were associated with greater adherence among patients high in internal LOC but not among patients low in internal LOC. Less instrumental social support was associated with more treatment barriers among patients low in internal LOC but not among patients high in internal LOC. CONCLUSION The relationship between social support and antidepressant medication adherence is moderated by beliefs about control over ones illness.

Mapping the Mixed Methods–Mixed Research Synthesis Terrain:

Mixed methods–mixed research synthesis is a form of systematic review in which the findings of qualitative and quantitative studies are integrated via qualitative and/or quantitative methods. Although methodological advances have been made, efforts to differentiate research synthesis methods have been too focused on methods and not focused enough on the defining logics of research synthesis—each of which may be operationalized in different ways—or on the research findings themselves that are targeted for synthesis. The conduct of mixed methods–mixed research synthesis studies may more usefully be understood in terms of the logics of aggregation and configuration. Neither logic is preferable to the other nor tied exclusively to any one method or to any one side of the qualitative/quantitative binary.

Making Sense of Qualitative and Quantitative Findings in Mixed Research Synthesis Studies.

The synthesis of qualitative and quantitative research findings is increasingly promoted, but many of the conceptual and methodological issues it raises have yet to be fully understood and resolved. In this article, we describe how we handled issues encountered in efforts to synthesize the findings in forty-two reports of studies of antiretroviral adherence in HIV-positive women in the course of an ongoing study to develop methods to synthesize qualitative and quantitative research findings in common domains of health-related research. Working with these reports underscored the importance of looking past method claims and ideals and directly at the findings themselves, differentiating between aggregative syntheses in which findings are assimilated and interpretive syntheses in which they are configured, and understanding the judgments involved in designating relationships between findings as confirmatory, divergent, or complementary.

Proneness to Prejudiced Responses: Toward Understanding the Authenticity of Self-Reported Discrepancies

Three studies investigated the authenticity of prejudice-related discrepancies. A comprehensive discrepancy questionnaire was developed (Study 1), which yielded small as well as large discrepancy scores. Study 2 indicated that discrepancy scores were stable, and personality could not account for the relation between discrepancies and their affective consequences. In Study 3, low-prejudice participants responded to jokes about Blacks under high or low distraction. Behavioral validation for self-reported discrepancies was found, such that participants with larger discrepancies evaluated the jokes more favorably under high than low distraction, but participants with smaller discrepancies provided equally unfavorable evaluations in both distraction conditions. Implications for understanding peoples abilities to avoid potentially prejudiced responses and their self-insight into such abilities are discussed.

Improving the measurement of self-reported medication nonadherence

OBJECTIVE Medication nonadherence is a significant clinical problem in chronic disease management. Self-report measures have inadequate reliability and poor distributional properties. We demonstrate how two fundamental measurement issues have limited the usefulness of self-reported medication nonadherence measures and offer recommendations for improving measurement. STUDY DESIGN AND METHODS We reviewed existing self-report measures of medication nonadherence in the context of hypertension, one of the most common chronic conditions in which medication nonadherence is a paramount concern. We evaluated these measures with regard to two issues: (1) conflation of causal indicators (which give rise to a latent construct) and effect indicators (which are determined by a latent construct), and (2) a lack of evidence regarding the stability of nonadherence over time. RESULTS Nonadherence measurement could be improved by using effect indicators to assess the extent of nonadherence and causal indicators to assess reasons for nonadherence. Moreover, nonadherence should be assessed longitudinally, so that recent developments in statistical modeling can illuminate the extent to which medication nonadherence is transient vs. stable. CONCLUSION Attention to these measurement issues can improve the assessment of self-reported nonadherence, thereby allowing more accurate conclusions to be drawn about medication-taking behavior and informing the development of improved interventions that target medication nonadherence.

A systematic review comparing antiretroviral adherence descriptive and intervention studies conducted in the USA

Abstract We examined the extent to which studies aimed at testing interventions to improve antiretroviral adherence have targeted the facilitators of and barriers known to affect adherence. Of the 88 reports reviewed, 41 were reports of descriptive studies conducted with US HIV-positive women and 47 were reports of intervention studies conducted with US HIV-positive persons. We extracted from the descriptive studies all findings addressing any factor linked to antiretroviral adherence and from the intervention studies, information on the nature of the intervention, the adherence problem targeted, the persons targeted for the intervention, and the intervention outcomes desired. We discerned congruence between the prominence of substance abuse as a factor identified in the descriptive studies as a barrier to adherence and its prominence as the problem most addressed in those reports of intervention studies that specified the problems targeted for intervention. We also discerned congruence between the prominence of family and provider support as factors identified in the descriptive studies as facilitators of adherence and the presence of social support as an intervention component and outcome variable. Less discernible in the reports of intervention studies was specific attention to other factors prominent in the descriptive studies, which may be due to the complex nature of the problem, individualistic and rationalist slant of interventions, or simply the ways interventions were presented. Our review raises issues about niche standardization and intervention tailoring, targeting, and fidelity.

Initial validation of a self-report measure of the extent of and reasons for medication nonadherence

BackgroundSelf-report measures of medication nonadherence confound the extent of and reasons for medication nonadherence. Each construct is assessed with a different type of psychometric model, which dictates how to establish reliability and validity. Objectives:To evaluate the psychometric properties of a self-report measure of medication nonadherence that assesses separately the extent of nonadherence and reasons for nonadherence. Research Design:Cross-sectional survey involving the new measure and comparison measures to establish convergent, discriminant, and predictive validity. The new measure was readministered 2–21 days later. Subjects:A total of 202 veterans with treated hypertension were recruited from the Durham Veterans Affairs Medical Center. Measures:A new self-report measure assessed the extent of nonadherence and reasons for nonadherence. Comparison measures included self-reported medication self-efficacy, beliefs about medications, impression management, conscientiousness, habit strength, and an existing nonadherence measure. Results:Three items assessing the extent of nonadherence produced reliable scores for this sample, &agr;=0.84 (95% confidence interval, 0.80–0.87). Correlations with comparison measures provided evidence of convergent and discriminant validity. Correlations with systolic (r=0.27, P<0.0001) and diastolic (r=0.27, P<0.0001) blood pressure provided evidence of predictive validity. Reasons for nonadherence were assessed with 21 independent items. Intraclass correlations were 0.58 for the extent score and ranged from 0.07 to 0.64 for the reasons. Conclusions:The dual conceptualization of medication nonadherence allowed a stronger evaluation of the reliability and validity than was previously possible with measures that confounded these 2 constructs. Measurement of self-reported nonadherence consistent with psychometric principles will enable reliable, valid evaluation of interventions to reduce nonadherence.