Interactional theory: its utility in explaining drug use behavior among African-American and Puerto Rican youth.
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Acculturation↗
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Strategies and conditions for teaching theoretical nursing: an international perspective.
How, when, and why to teach nursing theory are still central questions for nurse educators. The questions are restated and generalized to the whys, and hows, and the whens to incorporate theoretical nursing rather than nursing theory in nursing education. Process and strategies for teaching theoretical nursing are compared and contrasted with those related to research. We propose the use of similar strategies and add several essential conditions related to theoretical nursing. In teaching theoretical nursing, educators are expected to develop an environment that values theory and ways by which a theoretical identity is facilitated and fostered in students. Critical and reflective thinking as well as the role modelling of local models of excellence are central ingredients in the development of nurses who are committed to using and developing theories. One approach in incorporating theory in curricula is to identify central components and goals such as historical analyses, domain boundaries, theory utilization, process and strategies for theory development and testing. Once components are identified, faculty can make a decision about where to incorporate them. We have proposed several approaches that incorporate theoretical nursing in undergraduate and graduate programmes.
Curriculum↗
Applying voting theory in natural resource management: a case of multiple-criteria group decision support.
Voting theory has a lot in common with utility theory, and especially with group decision-making. An expected-utility-maximising strategy exists in voting situations, as well as in decision-making situations. Therefore, it is natural to utilise the achievements of voting theory also in group decision-making. Most voting systems are based on a single criterion or holistic preference information on decision alternatives. However, a voting scheme called multicriteria approval is specially developed for decision-making situations with multiple criteria. This study considers the voting theory from the group decision support point of view and compares it with some other methods applied to similar purposes in natural resource management. A case study is presented, where the approval voting approach is introduced to natural resources planning and tested in a forestry group decision-making process. Applying multicriteria approval method was found to be a potential approach for handling some challenges typical for forestry group decision support. These challenges include (i) utilising ordinal information in the evaluation of decision alternatives, (ii) being readily understandable for and treating equally all the stakeholders in possession of different levels of knowledge on the subject considered, (iii) fast and cheap acquisition of preference information from several stakeholders, and (iv) dealing with multiple criteria.
Conservation of Natural Resources↗
John Dewey's unknown critique of marginal utility doctrine: instrumentalism, motivation, and values.
During the late nineteenth century, marginal utility theory became the dominant ideology of the new academic discipline of economics. This article explicates and discusses previously unexamined lecture notes prepared in 1913 by John Dewey on marginal utility doctrine. After briefly characterizing the state of marginal utility doctrine, Dewey's criticisms are shown to derive from his instrumentalism and general theory of value. In Dewey's view, marginalism privatized value and by doing so induced moral agnosticism, a condition of permanently suspended judgment regarding individual and social needs that was likely to undermine the foundations of a democratic community since it immunizes value against collective appraisal by public bodies. Moreover, while marginal utility theory represented a serious concerted attempt to deal with substantive problems of value in economics and the economy, to Dewey it was ultimately a form of apologetics for the existing mode of social relations.
Economics↗
Affiliation patterns among cancer patients.
Affiliation preferences of 150 cancer out-patients were assessed in the waiting-room and day-to-day life. Results indicated the vast majority avoided fellow patients, preferring to be alone or with healthy people. Similarly, patients tended to avoid the topic of illness in their social contacts. Moreover, those desiring to be with the healthy displayed the highest levels of negative emotion. Finally, avoidance of fellow patients was higher among males, the elderly, and the more highly educated. Overall, the findings were inconsistent with the thesis that those under stress seek out others in similar straits, as suggested by Schachter's emotional comparison theory or Will's downward comparison theory. Rather, they support Rofé's utility theory of stress and affiliation.
Adolescent↗
Computer-assisted quality of life assessment for clinical trials.
A patient's quality of life is difficult to assess. Most methods designed to evaluate quality of life for clinical trials are time consuming, subject to varied interpretation among patients and assessors, and apply scales with only a limited relationship to utility theory. We have developed a HyperCard program, incorporating animated graphics, to (1) improve the speed of collection and collation of data, (2) improve understanding between patients and assessors, and (3) incorporate utility theory-based assessments. We assessed the quality of life of 25 patients with end-stage renal disease receiving hemodialysis using a traditional paper-based presentation and, eight months later, repeated the assessment with a computer-assisted presentation. Each presentation incorporated five techniques for evaluating quality of life: the Campbell Index of Well-being, the Kaplan-Bush Index of Well-being, categorical scaling, standard gamble, and time tradeoff. The computer program improved the speed of collation of data for statistical analysis, provided a consistent interface among patients for utility assessments, and showed stable reporting of patient's well-being. These findings suggest that further development of computer-assisted assessments of patients' quality of life for clinical trials is warranted.
Clinical Trials as Topic↗
Effects of anxiety on analogical reasoning: a test of three theoretical models.
Three mediational theories of anxiety and performance, namely, cue utilization theory (Easterbrook, 1959), attentional theory (Mandler & Sarason, 1952; Wine, 1971), and working memory capacity theory (M. W. Eysenck, 1979), were compared for their efficacy in explaining anxiety-induced performance decrements on a task of analogical reasoning. One hundred two subjects who varied in their trait and state anxiety levels completed 100 geometric analogies under either relaxed (reassurance, non-time-limited) or stressed (ego-threat, time-limited) conditions. Response time and error rate data for nine levels of task complexity (1-, 2-, and 3-element analogies with zero, one, or two transformations per element) were analyzed by means of multivariate analysis of variance. Results in the relaxed condition supported attentional theory in that the more anxious subjects were both slower and less accurate than were the less anxious subjects. In the stressed condition, none of the three anxiety-performance theories was supported. More anxious subjects were faster but made more errors than did less anxious subjects. Thus in the stressed condition, performance differences suggested differences in speed-accuracy trade-off strategies rather than differences in processing abilities. The limitations of attentional theory and the need to study the effects of anxiety and time stress on information processing are discussed.
Achievement↗
Withholding information from cancer patients as a physician's decision under risk.
When cancer is diagnosed, the physician may face a dilemma regarding disclosure of information to the patient. While he or she may feel a responsibility to maintain the patient's hope, even through the withholding of information, there is a risk involved: if treatment fails, the patient will eventually know the truth. Patients who would rather live their final days in peace rather than undergo unpleasant treatment of an uncertain nature may be furious and frustrated that they have been deprived of this liberty, ending their lives feeling worse than they would have had they been told the truth at the outset. The author applies three theories of decision making under uncertainty (expected utility theory, prospect theory, and regret theory) to the physician's problem of whether and to what extent to withhold information from a cancer patient, deriving comparative predictions with regard to the relationships between the physician's behavior and illness, patient, and physician characteristics. The results help explain why physicians whose norm of behavior is full disclosure sometimes opt to withhold information and why junior physicians are more likely to disclose the truth than their senior colleagues, as well as the empirical findings that physicians tend to disclose more truthful information to patients the greater the severity of illness and the more inquisitive the patient.
Decision Theory↗
[Utility assessment in clinical decision making].
In clinical decision analysis a quantitative value is attached to a longevity or a life quality by means of utility assessment. The actual value of the utility can determine the result of the decision analysis. In this article utility theory is briefly discussed. Four kinds of utility tests (direct scaling methods, the basic reference gamble, the time trade-off test and additive conjoint measurement) are introduced on the basis of an example and their pros and cons are discussed. It is concluded that additive conjoint measurement has the best formal infrastructure, but that the test method is not always easily applicable.
Choice Behavior↗
Behavioral aspects of clinical trials. An integrated framework from behavior theory.
A less-than-optimal proportion of patients with cancer are entered into National Cancer Institute-sponsored clinical trials. This article reviews the literature on accrual in oncology clinical trials to characterize the extent of the problem, identify reasons for low accrual, and suggest ways to promote accrual. Four well known theories of health behavior (the Health Belief Model, Subjective Expected Utility Theory, Protection Motivation Theory, and the Theory of Reasoned Action) point to central concepts involved in understanding patient health-related behavior: (1) the probability that an unwelcomed health event will happen to a patient, (2) the severity of that event if it does occur, (3) the effectiveness of a particular behavior (such as taking part in a clinical trial) to modify the severity, and (4) the cost of adopting that behavior. These concepts form a framework for integrating the available information about accrual to clinical oncology trials. Patient and physician factors previously related to clinical trials suggest specific recommendations for increasing accrual to clinical oncology trials.
Clinical Trials as Topic↗
A multiplicative model of the utility of survival duration and health quality.
Survival duration and health quality are fundamentally important aspects of health. A utility model for survival duration and health quality is a model of the subjective value of these attributes. We investigate the hypothesis that the utility (subjective value) of survival duration and health quality is determined by a multiplicative model. According to this model, there are separate subjective scales for the utility of survival duration and health quality. If F(Y) equals the utility of surviving Y years, and G(Q) equals the utility of living in health state Q, then the multiplicative model proposes that F(Y)G(Q) equals the utility of surviving Y years in health state Q. This model provides a simple explanation for several intuitively compelling relationships. First, the distinction between better-than-death and worse-than-death health states corresponds to the assignment of positive or negative utilities to different health states. Second, a zero duration of survival removes any reason to prefer one health state over any other, just as multiplying the utility of health quality by zero eliminates differences between the utilities of different health states. Third, the subjective difference between Y years in pain and Y years free from pain increases as Y increases as if the difference in utility between pain and no pain were being multiplied by the utility of surviving Y years. A critical prediction of the multiplicative model is the hypothesis that preferences between gambles for health outcomes satisfy a property called utility independence. Individual analyses revealed that most subjects satisfy utility independence, thereby supporting the multiplicative utility model. Some subjects appear to violate a fundamental assumption of utility theory: They appear to violate the assumption that a single utility scale represents both the ordinal preference relations between certain outcomes and the subjective averaging that underlies the utility of gambles. The violation is inferred from an inconsistency between preferences for multiattribute outcomes when they are viewed as certain outcomes and when they are viewed as the outcomes of gambles.
Activities of Daily Living↗
Deriving welfare measures from discrete choice experiments: inconsistency between current methods and random utility and welfare theory.
Discrete choice experiments (DCEs) are being used increasingly in health economics to elicit preferences for products and programs. The results of such experiments have been used to calculate measures of welfare or more specifically, respondents' 'willingness to pay' (WTP) for products and programs and their 'marginal willingness to pay' (MWTP) for the attributes that make up such products and programs. In this note we show that the methods currently used to derive measures of welfare from DCEs in the health economics literature are not consistent with random utility theory (RUT), or with microeconomic welfare theory more generally. The inconsistency with welfare theory is an important limitation on the use of such WTP estimates in cost-benefit analyses. We describe an alternative method of deriving measures of welfare (compensating variation) from DCEs that is consistent with RUT and is derived using welfare theory. We demonstrate its use in an empirical application to derive the WTP for asthma medication and compare it to the results elicited from the method currently used in the health economics literature.
Activities of Daily Living↗
Receiving Two Consequences: Tests of Monotonicity and Scale Invariance.
The present study investigated two behavioral properties of decision making. Participants were presented two alternatives, each of which yielded two consequences jointly (joint receipt, JR). Monotonicity of JR states that choices remain invariant when the same lottery is adjoined to both of the original alternatives. The data failed to reject monotonicity of JR. Scale invariance states that choices remain invariant under proportionate (scale) changes of the lottery consequences. This property was not rejected for three of four classes of JR lotteries having a common consequence, but it was rejected for two of three classes of binary lotteries and for two of the four classes of general JR lotteries. We conclude that scale invariance does not hold in general. The implication of these findings for utility theory, testing its fundamental assumptions, and determining the functional form of utility is discussed. Copyright 2000 Academic Press.
Journal Article↗
Preferences for outcomes in economic evaluation: an economic approach to addressing economic problems.
In this paper we critically appraise the appropriateness and validity from an economic perspective of alternative preference-based approaches to measuring outcomes in economic evaluations of health care interventions. We describe the properties of an outcome measure for economic evaluation to make it compatible with the principles of economics when applied to the problem of resource allocation. We also describe the difference and similarities between the psychometric and the economic approaches for the measurement of outcome. Using these properties we critically appraise the use of QALY and HYE methods of measuring individual and social preferences for health outcome. We argue that the most advanced measure currently available that meets these required properties is the HYE. Because the HYE, unlike the QALY, has its foundations in utility theory under uncertainty, it neither assumes particular formulations of the individual utility function, nor is it incompatible with the principles of economics. As such it represents a further stage in the continuing development of methods for economic evaluation of health care programmes.
Evaluation Studies as Topic↗
Acceptable regret in medical decision making.
When faced with medical decisions involving uncertain outcomes, the principles of decision theory hold that we should select the option with the highest expected utility to maximize health over time. Whether a decision proves right or wrong can be learned only in retrospect, when it may become apparent that another course of action would have been preferable. This realization may bring a sense of loss, or regret. When anticipated regret is compelling, a decision maker may choose to violate expected utility theory to avoid regret. We formulate a concept of acceptable regret in medical decision making that explicitly introduces the patient's attitude toward loss of health due to a mistaken decision into decision making. In most cases, minimizing expected regret results in the same decision as maximizing expected utility. However, when acceptable regret is taken into consideration, the threshold probability below which we can comfortably withhold treatment is a function only of the net benefit of the treatment, and the threshold probability above which we can comfortably administer the treatment depends only on the magnitude of the risks associated with the therapy. By considering acceptable regret, we develop new conceptual relations that can help decide whether treatment should be withheld or administered, especially when the diagnosis is uncertain. This may be particularly beneficial in deciding what constitutes futile medical care.
Brain Ischemia↗
A model for plant lighting system selection.
A decision model is presented that compares lighting systems for a plant growth scenario and chooses the most appropriate system from a given set of possible choices. The model utilizes a Multiple Attribute Utility Theory approach, and incorporates expert input and performance simulations to calculate a utility value for each lighting system being considered. The system with the highest utility is deemed the most appropriate system. The model was applied to a greenhouse scenario, and analyses were conducted to test the model's output for validity. Parameter variation indicates that the model performed as expected. Analysis of model output indicates that differences in utility among the candidate lighting systems were sufficiently large to give confidence that the model's order of selection was valid.
Decision Making, Computer-Assisted↗
Social learning theory: strategies for health promotion.
Occupational health nurses can facilitate the design of more effective health promotion programs by utilizing theories of behavior change. Planning a health promotion program based on the Social Learning Theory includes an assessment of personal as well as environmental factors that influence behavior. The motivation of employees to make behavior changes can be enhanced by raising their awareness of the problem, engaging clients in the process of goal setting, and making self-satisfaction conditional on a certain level of performance. Goal setting with attainable subgoals creates and sustains self-motivation, which can lead to larger, future goals. Interpreting the consequences of health behavior can be an incentive for individuals who value the perceived effects of lifestyle changes.
Health Behavior↗
An analysis of migratory systems: 1. Theory.
This is the first of a planned series of three papers in which the authors attempt to combine evolutionary migration models with stochastic utility theory. This first paper deals with the evolution of migratory systems. Such systems are first defined, and the foundations upon which their evolution is based are described. The paper concludes with a discussion of disequilibrium, which is central to the series. "Disequilibrium is related to the concept of a steady state, the existence of which is established for nonlinear migratory systems of the type discussed here."
Demography↗