Overdue choices : how information and role in decision-making influence women's preferences for induction for prolonged pregnancy

Background: Enabling women to make informed decisions is a crucial component of consumer-focused maternity care. Current evidence suggests that health care practitioners’ communication of care options may not facilitate patient involvement in decision-making. The aim of this study was to investigate the effect of specific variations in health caregiver communication on women’s preferences for induction of labor for prolonged pregnancy. Methods: A convenience sample of 595 female participants read a hypothetical scenario in which an obstetrician discusses induction of labor with a pregnant woman. Information provided on induction and the degree of encouragement for the woman’s involvement in decision-making was manipulated to create four experimental conditions. Participants indicated preference with respect to induction, their perceptions of the quality of information received, and other potential moderating factors. Results: Participants who received information that was directive in favor of medical intervention were significantly more likely to prefer induction than those given nondirective information. No effect of level of involvement in decision-making was found. Participants’ general trust in doctors moderated the relationship between health caregiver communication and preferences for induction, such that the influence of information provided on preferences for induction differed across levels of involvement in decision-making for women with a low trust in doctors, but not for those with high trust. Many women were not aware of the level of information required to make an informed decision. Conclusions: Our findings highlight the potential value of strategies such as patient decision aids and health care professional education to improve the quality of information available to women and their capacity for informed decision-making during pregnancy and birth. (BIRTH 39:3 September 2012)

Whole life cycle costing and quality satisfaction : public housing floor material

Most commonly, residents are always arguing about the satisfaction of sustainability and quality of their high rise residential property. This paper aim is to maintain the best quality satisfaction of the floor materials by introducing the whole life cycle costing approach to the property manager of the public housing in Johor. This paper looks into the current situation of floor material of two public housings in Johor, Malaysia and testing the whole life cycle costing approach towards them. The cost figures may be implemented to justify higher investments, for examples, in the quality or flexibility of building solutions through a long-term cost reduction. The calculation and the literature review are conducted. The questionnaire surveys of two public housings were conducted to make clear the occupants’ evaluation about the actual quality conditions of the floor material in their house. As a result, the quality of floor material based on the whole life cycle costing approach is one of the best among their previous decision making tool that was applied. Practitioners can benefit from this paper as it provides information on calculating the whole life costing and making the decisions for floor material selection for their properties.

Decision-making about hormone replacement therapy by women in England and Scotland

OBJECTIVE: The aim of this study was to explore women's decision-making about the balance of risks and benefits of taking hormone replacement therapy (HRT) based on the latest evidence from the Women's Health Initiative (WHI) trial of combined HRT. METHODS: Women aged 50-69 years, who were eligible for the Women's International Study of long Duration Oestrogen after Menopause (WISDOM) trial, were invited to participate in one of eight focus groups. Participants were asked to discuss their views about taking HRT based on the latest international evidence. RESULTS AND CONCLUSIONS: Eighty-two women participated overall. Qualitative content analysis was applied to the discussion transcripts. Women regarded the decisions they make about taking HRT as highly personal, and, for women currently taking HRT, the overwhelming reason for continuation was perceived improvement in quality of life regardless of either the risks or the benefits in the longer term.

Factors influencing funding decisions by elected politicians at the state/provincial level : a case study of public libraries in Canada

The purpose of this study was to determine factors (internal and external) that influenced Canadian provincial (state) politicians when making funding decisions about public libraries. Using the case study methodology, Canadian provincial/state level funding for public libraries in the 2009-10 fiscal year was examined. After reviewing funding levels across the country, three jurisdictions were chosen for the case: British Columbia's budget revealed dramatically decreased funding, Alberta's budget showed dramatically increased funding, and Ontario's budget was unchanged from the previous year. The primary source of data for the case was a series of semi-structured interviews with elected officials and senior bureaucrats from the three jurisdictions. An examination of primary and secondary documents was also undertaken to help set the political and economic context as well as to provide triangulation for the case interviews. The data were analysed to determine whether Cialdini's theory of influence (2001) and specifically any of the six tactics of influence (i.e, commitment and consistency, authority, liking, social proof, scarcity and reciprocity) were instrumental in these budget processes. Findings show the principles of "authority", "consistency and commitment" and "liking" were relevant, and that "liking" were especially important to these decisions. When these decision makers were considering funding for public libraries, they most often used three distinct lenses: the consistency lens (what are my values? what would my party do?), the authority lens (is someone with hierarchical power telling me to do this? are the requests legitimate?), and most importantly, the liking lens (how much do I like and know about the requester?). These findings are consistent with Cialdini's theory, which suggests the quality of some relationships is one of six factors that can most influence a decision maker. The small number of prior research studies exploring the reasons for increases or decreases in public library funding allocation decisions have given little insight into the factors that motivate those politicians involved in the process and the variables that contribute to these decisions. No prior studies have examined the construct of influence in decision making about funding for Canadian public libraries at any level of government. Additionally, no prior studies have examined the construct of influence in decision making within the context of Canadian provincial politics. While many public libraries are facing difficult decisions in the face of uncertain funding futures, the ability of the sector to obtain favourable responses to requests for increases may require a less simplistic approach than previously thought. The ability to create meaningful connections with individuals in many communities and across all levels of government should be emphasised as a key factor in influencing funding decisions.

Linking scientific evidence and decision making : A case study of hand hygiene interventions

We consider how data from scientific research should be used for decision making in health services. Whether a hand hygiene intervention to reduce risk of nosocomial infection should be widely adopted is the case study. Improving hand hygiene has been described as the most important measure to prevent nosocomial infection. 1 Transmission of microorganisms is reduced, and fewer infections arise, which leads to a reduction in mortality2 and cost savings.3 Implementing a hand hygiene program is itself costly, so the extra investment should be tested for cost-effectiveness.4,5 The first part of our commentary is about cost-effectiveness models and how they inform decision making for health services. The second part is about how data on the effectiveness of hand hygiene programs arising from scientific studies are used, and 2 points are made: the threshold for statistical inference of .05 used to judge effectiveness studies is not important for decision making,6,7 and potentially valuable evidence about effectiveness might be excluded by decision makers because it is deemed low quality.8 The ideas put forward will help researchers and health services decision makers to appraise scientific evidence in a more powerful way.

From consumer to community : factors of influence in the purchasing decision making process

The impacts of online collaboration and networking among consumers on social media (SM) websites which are featuring user generated content in a form of product reviews, ratings and recommendations (PRRR) as an emerging information source is the focus of this research. The proliferation of websites where consumers are able to post the PRRR and share them with other consumers has altered the marketing environment in which companies, marketers and advertisers operate. This cross-sectional study explored consumers’ attitudes and behaviour toward various information sources (IS), used in the information search phase of the purchasing decision-making process. The study was conducted among 300 international consumers. The results were showing that personal and public IS were far more reliable than commercial. The findings indicate that traditional marketing tools are no longer viable in the SM milieu.

Modelling, collaboration and integration : a case study for the delivery of public buildings

An evolution in the use of digital modelling has occurred in the Queensland Department of Public Works Division of Project Services over the last 20 years from: the initial implementation of computer aided design and documentation (CADD); to experimentation with building information modelling (BIM); to embedding integrated practice (IP); to current steps towards integrated project delivery (IPD) including the active involvement of consultants and contractors in the design/delivery process. This case study is one of three undertaken through the Australian Sustainable Built Environment National Research Centre investigating past R&D investment. The intent of these cases is to inform the development of policy guidelines for future investment in the construction industry in Australia. This research is informing the activities of CIB Task Group 85 R&D Investment and Impact. The uptake of digital modelling by Project Services has been approached through an incremental learning approach. This has been driven by a strong and clear vision with a focus on developing more efficient delivery mechanisms through the use of new technology coupled with process change. Findings reveal an organisational focus on several areas including: (i) strategic decision making including the empowerment of innovation leaders and champions; (ii) the acquisition and exploitation of knowledge; (iii) product and process development (with a focus on efficiency and productivity); (iv) organisational learning; (v) maximising the use of technology; and (vi) supply chain integration. Key elements of this approach include pilot projects, researcher engagement, industry partnerships and leadership.

Factors affecting marketing decision making with an ethical content : collusive tendering in the construction contract market

Reports of immoral marketing practices i n the construction industry attract political, media and public but not much academic interest. This paper adopts a behavioural perspective and proposes a model for applying marketing ethics concepts and methods in the study of collusion in the construction contract market. An extensive multidisciplinary review of existing literature identified a lack of adequate conceptualisation of the mechanisms and decision making factors of collusive tendering. The process of developing the model is detailed in this paper. The objectives and methodology of the research project that tested the model are also outlined. The paper concludes with a brief note on the contributions and application of the proposed model.

Feminist ethics and menopause : autonomy and decision-making in primary medical care

The construction of menopause as a long-term risk to health and the adoption of discourses of prevention has made necessary a decision by women about medical treatment; specifically regarding the use of hormone replacement therapy. In a study of general practitioners’ accounts of menopause and treatment in Australia, women's ‘choice’, ‘informed decision-making’ and ‘empowerment’ were key themes through which primary medical care for women at menopause was presented. These accounts create a position for women defined by the concept of individual choice and an ethic of autonomy. These data are a basis for theorising more generally in this paper. We critically examine the construct of ‘informed decision-making’ in relation to several approaches to ethics including bioethics and a range of feminist ethics. We identify the intensification of power relations produced by an ethic of autonomy and discuss the ways these considerations inform a feminist ethics of decision-making by women. We argue that an ‘ethic of autonomy’ and an ‘offer of choice’ in relation to health care for women at menopause, far from being emancipatory, serves to intensify power relations. The dichotomy of choice, to take or not to take hormone replacement therapy, is required to be a choice and is embedded in relations of power and bioethical discourse that construct meanings about what constitutes decision-making at menopause. The deployment of the principle of autonomy in medical practice limits decision-making by women precisely because it is detached from the construction of meaning and the self and makes invisible the relations of power of which it is a part.

Menopause as a long-term risk to health : implications of general practitioner accounts of prevention for women’s choice and decision-making

Over the past two decades medical researchers and modernist feminist researchers have contested the meaning of menopause. In this article we examine various meanings of menopause in major medical and feminist literature and the construction of menopause in a semi-structured interview study of general practitioners in rural South Australia. Three discursive themes are identified in these interviews; (i) the hormonal menopause – symptoms, risk, prevention; (ii) the informed menopausal woman; and (iii) decision-making and hormone replacement therapy. By using the discourse of prevention, general practitioners construct menopause in relation to women's health care choices, empowerment and autonomy. We argue that the ways in which these concepts are deployed by general practitioners in this study produces and constrains the options available to women. The implications of these general practitioner accounts are discussed in relation to the proposition that medical and feminist descriptions of menopause posit alternative but equally-fixed truths about menopause and their relationship with the range of responses available to women at menopause. Social and cultural explanations of disease causality (c.f.Germov 1998, Hardey 1998) are absent from the new menopause despite their being an integral part of the framework of the women's health movement and health promotion drawn on by these general practitioners. Further, the shift of responsibility for health to the individual woman reinforces practice claims to empower women, but oversimplifies power relations and constructs menopause as a site of self-surveillance. The use of concepts from the women's health movement and health promotion have nevertheless created change in both the positioning of women as having ‘choices’ and the positioning of some general practitioners in terms of greater information provision to women and an attention to the woman's autonomy. In conclusion, we propose that a new menopause has evolved from a discursive shift in medicine and that there exists within this new configuration, claiming the empowerment of women as an integral part of health care for menopause, the possibility for change in medical practice which will broaden, strengthen, and maintain this position.

Communication ethics in public health

As new diseases and medical conditions emerge, new community groups appear in the public health arena as consumer advocates or lobby groups seeking to affect policy or to represent ‘communities’ formed around these new diseases and conditions. The role of these groups in public health, their political status, and the extent to which they are actually representative are highly problematic for public health. These new constellations of social groups and activities challenge traditional ideas about public health decision-making and demand a rethinking of the constituency and limits of public health. Using discourse theory, symbolic interactionism, and ethological theory, the authors examine one case, exploring the perspectives of various communities on hepatitis C, and explore some issues that this raises for public health.

Decision and reasons for calling an ambulance : patients’ perspective

Background: Demand for pre-hospital emergency care is increasing in Australia as in many other countries. Using posthoc criteria such as triage, diagnosis and admission status, some authors view a considerable number of these as "inappropriate". Yet, calling an ambulance at the time of emergency is rarely studied from the patients’ or their carers’ perspective. This study interviewed patients about the decision, circumstances surrounding and reasons for calling an ambulance in Queensland, Australia. Methods: A cross-sectional survey of patients attending a sample of eight public hospital emergency departments in Queensland was undertaken between March and May 2011. In total, 911 questionnaires were collected (response rate: 67%), of whom 226 (24.8%) had arrived by ambulance. Results: In 35.6% of ambulance arrivals, the decision to request an ambulance was made by the patient; 25% by a doctor; 20% by a family member, friend or carer. Other callers included nurse, people at work or school, and passers-by. Reasons to request an ambulance included urgency (87%) and severity (84%) of the condition. Other reasons included requiring special care (76%), getting higher priority at the emergency department (34%), not having a car (34%), and financial concerns (17%). Decision to request an ambulance varied significantly according to the time of illness onset (e.g. on the day, week before), and location (e.g. home, outside). Conclusion: The decision to call an ambulance is made mostly by non-medical professionals in a perceived emergency situation. They call the ambulance for different reasons but mainly take into account the patient’s welfare and safety. Better understanding of these reasons will affect the direction and effectiveness of demand management strategies.

A public asset management framework for Indonesian local governments

The decentralisation reform in Indonesia has mandated the Central Government to transfer some functions and responsibilities to local governments including the transfer of human resources, assets and budgets. Local governments became giant asset holders almost overnight and most were ill prepared to handle these transformations. Assets were transferred without analysing local government need, ability or capability to manage the assets and no local government was provided with an asset management framework. Therefore, the aim of this research is to develop a Public Asset Management Framework for provincial governments in Indonesia, especially for infrastructure and real property assets. This framework will enable provincial governments to develop integrated asset management procedures throughout asset‘s lifecycle. Achieving the research aim means answering the following three research questions; 1) How do provincial governments in Indonesia currently manage their public assets? 2) What factors influence the provincial governments in managing these public assets? 3) How is a Public Asset Management Framework developed that is specific for the Indonesian provincial governments‘ situation? This research applied case studies approach after a literature review; document retrieval, interviews and observations were collated. Data was collected in June 2009 (preliminary data collection) and January to July 2010 in the major eastern Indonesian provinces. Once the public asset management framework was developed, a focus group was used to verify the framework. Results are threefold and indicate that Indonesian provincial governments need to improve the effectiveness and efficiency of current practice of public asset management in order to improve public service quality. The second result shows that the 5 major concerns that influence the local government public asset management processes are asset identification and inventory systems, public asset holding, asset guidance and legal arrangements, asset management efficiency and effectiveness, and, human resources and their organisational arrangements. The framework was then applied to assets already transferred to local governments and so included a system of asset identification and a needs analysis to classify the importance of these assets to local governments, their functions and responsibilities in delivering public services. Assets that support local government functions and responsibilities will then be managed using suitable asset lifecycle processes. Those categorised as surplus assets should be disposed. Additionally functions and responsibilities that do not need an asset solution should be performed directly by local governments. These processes must be measured using performance measurement indicators. All these stages should be guided and regulated with sufficient laws and regulations. Constant improvements to the quality and quantity of human resources hold an important role in successful public asset management processes. This research focuses on developing countries, and contributes toward the knowledge of a Public Asset Management Framework at local government level, particularly Indonesia. The framework provides local governments a foundation to improve their effectiveness and efficiency in managing public assets, which could lead to improved public service quality. This framework will ensure that the best decisions are made throughout asset decision ownership and provide a better asset life cycle process, leading to selection of the most appropriate asset, improve its acquisition and delivery process, optimise asset performance, and provide an appropriate disposal program.

Enduring powers of attorney : promoting attorneys' accountability as substitute decision makers

Aim The misuse and abuse of Enduring Powers of Attorney (EPAs) by attorneys, particularly in relation to financial decision-making, is a growing concern. This paper explores the opportunities to enhance accountability of attorneys at the time of the execution of the document in Queensland. Method A four stage multi-method design comprised a critical reference group; semi-structured interviews with 32 principals or potential principals, attorneys and witnesses; two focus groups with service providers and a state wide survey of 76 principals, attorneys and witnesses. Results Across all methods and user groups, understanding the role and obligations of the attorney in an EPA was consistently identified as problematic. Conclusions Promoting accountability and understanding can be addressed by greater attention to the role of the attorney in the forms/ guidelines and in the structure and witnessing of the forms, increased direction about record keeping and access to appropriate advice and support.

Strategies for embedding agile decision making in aviation infrastructure

As highlighted by previous work in Normal Accident Theory1 and High Reliability Organisations, 2 the ability of a system to be flexible is of critical importance to its capability to prepare for, respond to, and recover from disturbance and disasters. This paper proposes that the research into ‘edge organisations’3 and ‘agility’4 is a potential means to operationalise components that embed high reliable traits in the management and oversight of critical infrastructure systems. Much prior work has focused on these concepts in a military frame whereas the study reported on here examines the application of these concepts to aviation infrastructure, specifically, a commercial international airport. As a commercial entity functions in a distinct manner from a military organisation this study aims to better understand the complementary and contradictory components of the application of agility work to a commercial context. Findings highlight the challenges of making commercial operators of infrastructure systems agile as well as embedding traits of High Reliability in such complex infrastructure settings.