Stacey R. Finkelstein

When Healthy Food Makes You Hungry

Do subtle cues for imposed healthy eating make consumers hungry? Imposed healthy eating signals that the health goal was sufficiently met, and thus it increases the strength of the conflicting motive to fulfill one’s appetite. Accordingly, consumers asked to sample an item framed as healthy later reported being hungrier and consumed more food than those who sampled the same item framed as tasty or those who did not eat at all. These effects of healthy eating depend on the consumer’s perception that healthy eating is mandatory; therefore, only imposed healthy eating made consumers hungrier, whereas freely choosing to eat healthy did not increase hunger.

Tell Me What I Did Wrong: Experts Seek and Respond to Negative Feedback

A large proportion of marketing communication concerns feedback to consumers. This article explores what feedback people seek and respond to. We predict and find a shift from positive to negative feedback as people gain expertise. We document this shift in a variety of domains, including feedback on language acquisition, pursuit of environmental causes, and use of consumer products. Across these domains, novices sought and responded to positive feedback, and experts sought and responded to negative feedback. We examine a motivational account for the shift in feedback: positive feedback increased novices’ commitment, and negative feedback increased experts’ sense that they were making insufficient progress.

A new model for nurse practitioner utilization in primary care: increased efficiency and implications.

BACKGROUND Nurse practitioners (NPs) play an important role in providing quality primary care. However, little is known about organizational processes that best utilize NPs in care delivery and what kind of resources and support NPs need to deliver quality care within their organizations. In primary care settings, NPs often receive little support from ancillary personnel compared with physicians. PURPOSE The aim of this article was to compare the productivity and cost efficiency of NP utilization models implemented in primary care sites with and without medical assistant (MA) support. METHODOLOGY/APPROACH We develop queueing models for these NP utilization models, of which the parameters are extracted from literature or government reports. Appropriate analyses are conducted to generate formulas and values for the productivity and cost efficiency. Sensitivity analyses are conducted to investigate different scenarios and to verify the robustness of findings. FINDINGS The productivity and cost efficiency of these models improve significantly if NPs have access to MA support in serving patients. On the basis of the model parameters we use, the average cost of serving a patient can be reduced by 9%-12% if MAs are hired to support NPs. Such improvements are robust across practice environments with different variability in provider service times. Improving provider service rate is a much more effective strategy to increase productivity compared with reducing the variability in provider service times. PRACTICE IMPLICATIONS To contain costs and improve the utilization of NPs in primary care settings, MA assistance for NPs is necessary.

Motivation Resulting from Completed and Missing Actions

Abstract This chapter asks, when does motivation increase as a result of attending to accomplishments and when does it increase as a result of attending to their absence? We propose that attention to accomplishments increases motivation among uncommitted and inexperienced individuals by increasing their goal commitment. In contrast, attention to lack of accomplishments increases motivation among committed and experienced individuals by increasing their perceived need to make progress on a goal. We document parallel influences of attention to completed and missing actions on the pursuit of personal and shared goals, and document similarities between the types of information on completing versus missing actions that individuals include in the feedback they seek and give to each other and how they respond to this information.

Development and psychometric testing of the Nurse Practitioner Primary Care Organizational Climate Questionnaire.

Background:Policy makers and healthcare organizations are calling for expansion of the nurse practitioner (NP) workforce in primary care settings to assure timely access and high-quality care for the American public. However, many barriers, including those at the organizational level, exist that may undermine NP workforce expansion and their optimal utilization in primary care. Objectives:This study developed a new NP-specific survey instrument, Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ), to measure organizational climate in primary care settings and conducted its psychometric testing. Methods:Using instrument development design, the organizational climate domain pertinent for primary care NPs was identified. Items were generated from the evidence and qualitative data. Face and content validity were established through two expert meetings. Content validity index was computed. The 86-item pool was reduced to 55 items, which was pilot tested with 81 NPs using mailed surveys and then field-tested with 278 NPs in New York State. SPSS 18 and Mplus software were used for item analysis, reliability testing, and maximum likelihood exploratory factor analysis. Results:Nurse Practitioner Primary Care Organizational Climate Questionnaire had face and content validity. The content validity index was .90. Twenty-nine items loaded on four subscale factors: professional visibility, NP–administration relations, NP–physician relations, and independent practice and support. The subscales had high internal consistency reliability. Cronbach’s alphas ranged from.87 to .95. Discussion:Having a strong instrument is important to promote future research. Also, administrators can use it to assess organizational climate in their clinics and propose interventions to improve it, thus promoting NP practice and the expansion of NP workforce.

Feeding Strategies Derived from Behavioral Economics and Psychology Can Increase Vegetable Intake in Children as Part of a Home-Based Intervention: Results of a Pilot Study

BACKGROUND Behavioral economics and psychology have been applied to altering food choice, but most studies have not measured food intake under free-living conditions. OBJECTIVES To test the effects of a strategy that pairs positive stimuli (ie, stickers and cartoon packaging) with vegetables and presents them as the default snack. DESIGN A randomized controlled trial was conducted with children who reported consumption of fewer than two servings of vegetables daily. Children (aged 3 to 5 years) in both control (n=12) and treatment (n=12) groups received a weeks supply of plainly packaged (ie, generic) vegetables, presented by parents as a free choice with an alternative snack (granola bar), during baseline (Week 1) and follow-up (Week 4). During Weeks 2 and 3, the control group continued to receive generic packages of vegetables presented as a free choice, but the treatment group received vegetables packaged in containers with favorite cartoon characters and stickers inside, presented by parents as the default choice. Children in the treatment group were allowed to opt out of the vegetables and request the granola bar after an imposed 5-minute wait. STATISTICAL ANALYSIS General Linear Model repeated measures analysis of variance was conducted to compare vegetable and granola bar intake between control and treatment groups across the 4-week study. Both within- and between-subjects models were tested. RESULTS A time×treatment interaction on vegetable intake was significant. The treatment group increased vegetable intake from baseline to Week 2 relative to control (P<0.01), but the effects were not sustained at Week 4 when the treatment was removed. Granola bar intake decreased in the treatment group at Week 2 (P≤0.001) and Week 3 (P≤0.005) relative to baseline. CONCLUSIONS Parents were able to administer feeding practices derived from behavioral economics and psychology in the home to increase childrens vegetable intake and decrease intake of a high-energy-density snack. Additional studies are needed to test the long-term sustainability of these practices.

Appointment reminder systems and patient preferences: Patient technology usage and familiarity with other service providers as predictive variables

This study had two aims: to measure patient preferences for medical appointment reminder systems and to assess the predictive value of patient usage and familiarity with other service providers contacting them on responsiveness to appointment reminder systems. We used a cross-sectional design wherein patients’ at an urban, primary-care clinic ranked various reminder systems and indicated their usage of technology and familiarity with other service providers contacting them over text messages and e-mails. We assessed the impact of patient usage of text messages and e-mails and patient familiarity with other service providers contacting them over text messages and e-mails on effectiveness of and responsiveness to appointment reminder systems. We found that patient usage of text messages or e-mails and familiarity with other service providers contacting them are the best predictors of perceived effectiveness and responsiveness to text message and e-mail reminders. When these variables are accounted for, age and other demographic variables do not predict responsiveness to reminder systems.

Dissociation from beloved unhealthy brands decreases preference for and consumption of vegetables

Many people form strong bonds with brands, including those for unhealthy foods. Thus, prompting people to dissociate from beloved but unhealthy food brands is an intuitively appealing means to shift consumption away from unhealthy options and toward healthy options. Contrary to this position, we demonstrate that dissociating from unhealthy but beloved brands diminishes peoples interest in consuming vegetables because the dissociation depletes self-regulatory resources. Across three experimental studies, we manipulate dissociation from two beloved brands both implicitly (studies 1-2) and explicitly (study 3) and observe effects on both preference for vegetables (studies 2-3) and actual vegetable consumption (study 1). In study 1, participants consumed fewer vegetables following dissociation from (vs. association with) a beloved candy brand. Study 2 demonstrates that the effect of depletion on preference for vegetables is more pronounced for those who strongly identify with the brand, as these individuals are most depleted by the dissociation attempt. Finally, study 3 illustrates that the difficulty experienced when trying to dissociate from beloved brands drives the observed effects on vegetable preference and consumption for those who strongly (vs. weakly) identify with the brand.

Helping lower income parents reduce the risk of food waste resulting from children's aversion to healthier food options: Comment on Daniel (2016).

We reflect on Daniels (2016) finding that a challenge to improving the diets of lower income children is parental worry over food waste that results from childrens rejection of healthier food options such as vegetables. This finding has important implications because previous research has indicated novel foods that have a bitter or sour flavor profile (as is the case with many vegetables) must be introduced to children several times before these foods are accepted. We suggest research-based techniques that parents could utilize to reduce the risk of costly food waste, and discuss obstacles that could impede well-intended parents from reaching their goals of improving their childrens diets.

When open access might not work: Understanding patient attitudes in appointment scheduling.

Background: Open-access (OA) systems aim to reduce delays to care. However, recent evidence suggests that OA systems might reduce patient satisfaction and result in poorer patient experiences due to patients’ inability to obtain appointments with their usual care provider. We conducted a series of experiments to explore the role of risk attitudes, an individual difference variable that measures preferences for risky options, in patients’ perception of OA systems. Purpose: The aim of the study was to investigate the relationship between patient’s risk attitudes and attitudes toward OA systems and demonstrate whether patients’ attitudes toward OA systems will vary as a function of their risk attitudes. Methodology: Three separate experiments were conducted to assess the relationship between patient risk attitudes and their attitudes about OA systems. Study 1 (patient population) explored the aforementioned relationship. We explored two potential moderators for this effect: how salient the tradeoff is between delays to care and quality of care (Study 2; online population) and the severity of the patient’s health condition (Study 3; patient population). Results: Compared to risk-averse patients, risk-seeking patients have more favorable attitudes toward OA systems (a 1-point increase in risk attitudes on a 7-point scale resulted in a 0.44-point boost in attitudes toward OA systems on a 7-point scale). This relationship holds even when the tradeoff between access to care and quality of care is made salient (e.g., a practice informs patients they can have a same-day appointment but are unlikely to see their regular provider) and when people consider having a minor health condition. This relationship is attenuated when patients imagine having a serious medical condition because speedy access to care becomes a top priority. Conclusion: Risk-seeking patients have more favorable attitudes toward OA systems. Practice Implications: Risk-seeking patients are primarily driven by speed to access at the potential expense of continuity of care. Organizations that better understand patient motives in scheduling medical appointments can introduce more effective interventions and positively impact patient experiences of care.