Helen Altman Klein

Recalled Parental Authority Style and Self-Perception in College Men and Women

This study investigated multidimensional self-perceptions of college men and women and the relationships of self-perception to the authority styles of mothers and fathers. Harters Self-Perception Profile and Buris Parental Authority Questionnaire were used. Gender differences were found for several self-perception dimensions. Fathers were viewed as more authoritarian and less authoritative than mothers, and differences in these styles were reported by men and women. Authoritative style was generally correlated to positive self-perceptions and authoritarian style to negative self-perceptions, with several gender differences. Maternal authoritativeness was particularly important for women. Outcomes emphasize the social context of development and the roles of mothers and fathers for men and women.

Everyday Expertise: Cognitive Demands in Diabetes Self-Management

Objective: To assess the relationship between decision making and successful diabetes self-management. Background: Patients with type II diabetes make routine but critical self-management decisions. Method: We conducted cognitive task analysis interviews with 18 patients to examine problem detection, functional relationships, problem-solving strategies, and types of knowledge used to make self-management decisions. We expected that these decision processes would be related to behavioral adherence and glycemic control. Results: Verbal reports displaying problem detection skills, knowledge of functional relationships, and effective problem-solving strategies were all related to better adherence. Problem detection skill was linked to greater glycemic control. Participants differed in declarative and applied knowledge. Conclusion: Diabetes self-management draws on the same cognitive skills found in experts from diverse professional domains. Considering diabetes self-management as a form of expertise may support adherence. Application: Human factors approaches that support professional expertise may be useful for the decision making of patients with diabetes and other chronic diseases.

Self management of medication and Diabetes: cognitive control

The healthcare industry strives to improve the technical work of healthcare providers in hospitals. In contrast, the more common home treatment tasks like managing prescription medications and complying with the complex demands of life-threatening diseases such as Type II Diabetes receive little attention. Treatment and prevention decisions are in the hands of patients and often mismanaged. Available commercial information sheets, designed to support prescription self management, are incompatible with patient perceptual and cognitive capacities. We show that material that is sensitive to the perceptual and cognitive capacities of potential users is more usable and is preferred. A review of existing training for diabetics identified compliance barriers. Many patients do not understand the dynamics that controlled their disease and so make poor decisions. Available training provides rules and procedures, but little about the dynamic demands of maintaining stability within parameters. We explored using control theory and incorporating a mental model of diabetes into rule-based training. This promises to improve the effectiveness of self management. These two naturalistic investigations confirm the importance of field studies and of using patient informants to understand the demands and opportunities that accompany medical self management.

Diabetes Self-Management Education: Miles to Go

This meta-analysis assessed how successfully Diabetes Self-Management Education (DSME) interventions help people with type 2 diabetes achieve and maintain healthy blood glucose levels. We included 52 DSME programs with 9,631 participants that reported post-intervention A1c levels in randomized controlled trials. The training conditions resulted in significant reductions in A1c levels compared to control conditions. However, the impact of intervention was modest shifting of only 7.23% more participants from diabetic to pre-diabetic or normal status, relative to the control condition. Most intervention participants did not achieve healthy A1c levels. Further, few DSME studies assessed long-term maintenance of A1c gains. Past trends suggest that gains are difficult to sustain over time. Our results suggested that interventions delivered by nurses were more successful than those delivered by non-nursing personnel. We suggest that DSME programs might do better by going beyond procedural interventions. Most DSME programs relied heavily on rules and procedures to guide decisions about diet, exercise, and weight loss. Future DSME may need to include cognitive self-monitoring, diagnosis, and planning skills to help patients detect anomalies, identify possible causes, generate corrective action, and avoid future barriers to maintaining healthy A1c levels. Finally, comprehensive descriptions of DSME programs would advance future efforts.

The Relationship Between Children's Temperament and Adjustment to Kindergarten and Head Start Settings

Adjustment to childhood group settings was studied as a function of individual temperament characteristics prior to beginning the group setting. A kindergarten (n = 52) and a Head Start (n = 23) sa...

Correlates of Life Satisfaction Among Military Wives

Military life includes constant change. This study explored the relationship of life satisfaction among military wives with the individual attitudinal and personality variables of perceived social support, locus of control, and temperament. Sixty wives of noncommissioned military personnel were selected as participants. Life satisfaction was found to be related to high levels of perceived social support from family and from friends, to an internal locus of control, and to low levels of emotionality-stress and emotionality-fear. The results supported the role of individual resources for mediating adjustment and enhancing life satisfaction during the changes inherent in military life. Implications for identifying and helping high-risk women emerged.

Multidimensional Self-Perception: Linkages to Parental Nurturance

Childhood experiences are important for developing self-perception. The present study examined the relationship between parental nurturance and Harters (1988) multidimensional domains of self-perception as well as gender differences in patterns of perceived nurturance. We had 207 college students complete the Neemann & Harters Self-Perception Profile for College Students (1986) and Buris Parental Nurturance Scale (1989). Both men and women saw their mothers as more nurturant than they saw their fathers. We found, consistent with previous findings, a positive relationship between parental nurturance and global self-worth. Nurturance also showed a positive relationship with several dimensions of self-perception. This research underscores the importance of nurturance in the development of self-esteem and the usefulness of a multidimensional construct of self-perception.

Type 2 Diabetes Self-Management: Controlling a Dynamic System

People with type 2 diabetes risk disability and early death when they fail to control their blood glucose levels. Despite advances in medicine, pharmacology, human factors, and education, dangerous glucose levels remain endemic. To investigate cognitive barriers to control, we observed American Diabetes Association (ADA) certified training programs; reviewed ADA and National Institute of Health diabetes Web sites; and interviewed patients with type 2 diabetes using a critical decision method. A consistent picture emerged. The prevailing rules and procedures approaches are not preparing patients for the dynamic control task they face. Patients are often unable to understand and use the rules and procedures provided. They are unprepared to detect problems, make sense of dynamic relationships, and manage complex situations. Our results suggest that glucose self-regulation is better conceptualized as a dynamic control challenge requiring complex processes, including problem detection, sensemaking, decision making, and planning/replanning. The mismatch between most patient training and the dynamic demands of glucose regulation helps explain limitations in existing training and poor patient outcomes. We argue that constructs gleaned from naturalistic decision-making research in other complex domains can help many but not all patients develop the cognition necessary for effective blood glucose self-management.

Temperament and Childhood Group Care Adjustment: A Cross-Cultural Comparison.

Abstract The context of childhood group care is important for adjustment because it can provide a good or a poor fit with individual temperament dimensions. This research investigated “ideals” for temperament dimensions, actual temperament scores, and temperament-adjustment relationships in two cultural contexts: Israel and American early childhood group care. American (22) and Israeli (18) caregivers first provided descriptions of their ideal for a young childs temperament and then provided temperament and adjustment descriptions for each of six children actually in their care (132 and 108, respectively). The two groups of caregivers held different ideals for childrens temperament and also judged actual children differently. The relationship of temperament to adjustment differed between the groups. The usefulness of the “fit” concept in understanding adjustment is suggested and the potential of contextual manipulations for extending good fit to a wider range of children is explored.

The Relationship of Temperament to Adjustment in British Infant Schools.

Abstract We tested the influence of cultural setting on the relationship between temperament and adjustment in children. To evaluate patterns of adjustment within the British infant school, 30 British infant school teachers provided an ideal temperament profile for adjustment to their school. Their ideal child was seen as low key, flexible, and task oriented. Each teacher also provided actual temperament and adjustment ratings for 6 students. Several relationships between temperament and adjustment emerged from this sample of 180 children. The children were viewed as better adjusted to school if they were higher in persistence, adaptability, and approach and if they were lower in activity. Gender differences in both adjustment and temperament were found.