If the price is right : vagueness and values clarification in contingent valuation

The use of willingness to pay to value the benefits of health care is increasing. Much of this work assumes that health preferences are well formed or complete and readily revealed if the right question is asked in the right way. We examined this assumption, seeking evidence in a mixed-methods study that explored the meaning and implications of vague responses to a payment-scale based willingness to pay exercise.

One-half of the sample said that their vagueness meant that their maximum willingness to pay was actually greater than the amount that they had previously said it was. Thirty percent agreed that they would probably pay £10 more than a sum that they had previously said they would most definitely not pay, if they found this to be the cost of the vaccine. Interview data supported the view that the payment scale had failed to elicit the maximum willingness to pay and that some participants used the information on cost to help clarify their values, in contrast to the theory underpinning willingness to pay. The results suggest a need to consider values-clarification in health economic evaluations. Copyright © 2002 John Wiley & Sons, Ltd.

Communication du risque et clarification des valeurs, deux éléments essentiels de la décision partagée : étude descriptive dans cinq unités de médecine familiale du Québec

Cette étude descriptive transversale visait à estimer la proportion de consultations en médecine familiale dans lesquelles sont observées une communication des risques et une clarification des valeurs et des préférences. Au sein de 238 dyades de cliniciens-patients (238 patients et 71 cliniciens), nous avons observé que 63 % (intervalle de confiance [IC] à 95 % : 54 % - 70 %) des consultations comportaient ces deux éléments. Aussi, nous avons observé que six facteurs étaient associés à la présence de ces deux éléments lors de la consultation : 1) les nouvelles options thérapeutiques (rapport de cotes [RC] = 3,54; IC à 95 % : 1,32 - 9,48); 2) les options de traitement (RC = 3,56, IC à 95 % : 1,52 - 8,36); 3) la présence de cinq décisions et plus (RC = 5,00; IC à 95 % : 1,5 - 16,9); 4) report de la décision (RC = 4,92; IC à 95 % : 1,35 - 17,87); 5) la durée de la consultation (RC = 1,03; IC à 95 % : 1,002 - 1,07) et 6) le style de prise de décision collaboratif du clinicien (RC = 8,78; IC à 95% : 1,62 - 47,71). Des interventions ciblant directement les facteurs modifiables sont à considérer en vue d’augmenter la présence de ces deux éléments durant la consultation en médecine familiale.

A model for developing, implementing and evaluating a strategy to improve nursing and midwifery care

Background: Health care organizations world wide are faced with the need to develop and implement strategic organizational plans to meet the challenges of modern health care. There is a need for models for developing, implementing and evaluating strategic plans that engage practitioners, and make a measurable difference to the patients that they serve. This article describes the development of such a model to underpin a strategy for nursing and midwifery in an acute hospital trust. An integrated model: The processes for strategy development (values clarification, critical companionship and focus groups) are discussed, together with the development of processes for implementation, based upon a modification of the PARIHS (Promoting Action on Research Implementation in Health Services) conceptual framework. Finally, the methods for evaluating the strategy (a pre-test/post-test approach measuring the quality of nursing care, the degree to which the organization supports professional nursing care, the leadership styles of ward managers, and patient satisfaction with care) are described. Conclusion: The model is offered as one that may be of use to others who wish to develop an integrated approach to strategic change; an approach in which the development, implementation and evaluation of strategic plans are informed by the core values of nurses and midwives.

Health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia : a systematic literature review of qualitative and quantitative data.

BACKGROUND: Unsafe abortions are a serious public health problem and a major human rights issue. In low-income countries, where restrictive abortion laws are common, safe abortion care is not always available to women in need. Health care providers have an important role in the provision of abortion services. However, the shortage of health care providers in low-income countries is critical and exacerbated by the unwillingness of some health care providers to provide abortion services. The aim of this study was to identify, summarise and synthesise available research addressing health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia. METHODS: A systematic literature search of three databases was conducted in November 2014, as well as a manual search of reference lists. The selection criteria included quantitative and qualitative research studies written in English, regardless of the year of publication, exploring health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia. The quality of all articles that met the inclusion criteria was assessed. The studies were critically appraised, and thematic analysis was used to synthesise the data. RESULTS: Thirty-six studies, published during 1977 and 2014, including data from 15 different countries, met the inclusion criteria. Nine key themes were identified as influencing the health care providers' attitudes towards induced abortions: 1) human rights, 2) gender, 3) religion, 4) access, 5) unpreparedness, 6) quality of life, 7) ambivalence 8) quality of care and 9) stigma and victimisation. CONCLUSIONS: Health care providers in sub-Saharan Africa and Southeast Asia have moral-, social- and gender-based reservations about induced abortion. These reservations influence attitudes towards induced abortions and subsequently affect the relationship between the health care provider and the pregnant woman who wishes to have an abortion. A values clarification exercise among abortion care providers is needed.

Contingent valuation in health care and the persistence of embedding effects without the warm glow

This paper reports a test of the presence of embedding effects in a health care contingent valuation study. A within-subject, mixed qualitative–quantitative approach was used to identify and explain the presence of embedding in estimates of willingness to pay for vaccinations. Embedding effects persisted despite controlling for known causes and did so even among respondents who perceived the effect to be anomalous. Results from the qualitative interviews suggest that embedding effects arise for varied reasons but might be indicative of incomplete preferences. It is questionable, however, whether survey techniques can be better designed to encourage values clarification.

La Educación en Ciencias como un llamado a la acción

Este artículo considera que tanto la educación en Ciencia, Tecnología, Sociedad y Ambiente (CTSA) como las formas convencionales de la enseñanza de problemas socio-científicos (PSC) son inadecuadas para satisfacer las necesidades e intereses de los y las estudiantes que se enfrentan con demandas, problemas y asuntos de la vida contemporánea. Se defiende un acercamiento educativo mucho más politizado, con un mayor énfasis en la crítica social, la clarificación de valores y la acción socio-política, a través de un enfoque basado en problemas que puede convivir con el currículo convencional basado en disciplinas. Para ello, es necesario que la confrontación de cuestiones, la consideración de los valores subyacentes y la acción sean totalmente integrados al currículum

La Educación en Ciencias como un llamado a la acción

Este artículo considera que tanto la educación en Ciencia, Tecnología, Sociedad y Ambiente (CTSA) como las formas convencionales de la enseñanza de problemas socio-científicos (PSC) son inadecuadas para satisfacer las necesidades e intereses de los y las estudiantes que se enfrentan con demandas, problemas y asuntos de la vida contemporánea. Se defiende un acercamiento educativo mucho más politizado, con un mayor énfasis en la crítica social, la clarificación de valores y la acción socio-política, a través de un enfoque basado en problemas que puede convivir con el currículo convencional basado en disciplinas. Para ello, es necesario que la confrontación de cuestiones, la consideración de los valores subyacentes y la acción sean totalmente integrados al currículum

La Educación en Ciencias como un llamado a la acción

Este artículo considera que tanto la educación en Ciencia, Tecnología, Sociedad y Ambiente (CTSA) como las formas convencionales de la enseñanza de problemas socio-científicos (PSC) son inadecuadas para satisfacer las necesidades e intereses de los y las estudiantes que se enfrentan con demandas, problemas y asuntos de la vida contemporánea. Se defiende un acercamiento educativo mucho más politizado, con un mayor énfasis en la crítica social, la clarificación de valores y la acción socio-política, a través de un enfoque basado en problemas que puede convivir con el currículo convencional basado en disciplinas. Para ello, es necesario que la confrontación de cuestiones, la consideración de los valores subyacentes y la acción sean totalmente integrados al currículum

Terapia de aceptación y compromiso en un caso de tras¬torno mixto de ansiedad y depresión en una paciente con cáncer

This paper introduces the case of a woman with breast cancer who had developed a mixed depressive-anxiety disorder with avoidance behaviors. The patient presented depressive symptoms like listlessness, insomnia, weeping, food disorders and hopelessness though. Also, she exhibited physiological arousal and restlessness feelings. Additionally, the patient had an avoidance patron behavior in relation with all stimulus she believed could hurt her. Based on the Acceptance and Commitment Therapy (ACT) the intervention planted the following objectives: the patient will learn to accept her illness and the emotional distress that she was experiencing, also, the patient will recover the other areas of her life that she had abandoned. The treatment was developed in 14 sessions. The therapist used these techniques: creative hopelessness, disabling verbal functions, values clarification and loss of control over private events. In the results, it was observed a positive change in the behavior of the patient as well as a decrease in emotional distress that was his reason for initial consultation

Characterisation of sugarcane juice particles that influence the clarification process

Problems associated with processing whole sugarcane crop can be minimised by removing impurities during the clarification stage. As a first step, it is important to understand the colloidal chemistry of juice particles on a molecular level to assist development strategies for effective clarification performance. This paper presents the composition and surface characteristics of colloidal particles originating from various juice types by using scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM-EDX), X-ray photoelectron spectroscopy (XPS) and zeta potential measurements. The composition and surface characteristics of colloidal juice particles are reported. The results indicate that there are three types of colloidal particles present viz., an aluminosilicate compound, silica and iron oxide, with the latter two being abundant. Proteins, polysaccharides and organic acids were identified on the surface of particles in juice. The overall particle charge varies from –2 mV to –6 mV. In comparison to juice expressed from burnt cane, the zeta potential values were more negative with juice particles originating from whole crop. This in part explains why these juices are difficult to clarify.

Characterisation of sugarcane juice particles that influence the clarification process

Problems associated with processing whole sugarcane crop can be minimised by removing impurities during the clarification stage. As a first step, it is important to understand the colloidal chemistry of juice particles on a molecular level to assist development of strategies for effective clarification performance. This paper presents the composition and surface characteristics of colloidal particles originating from various juice types by using scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM-EDX), X-ray photoelectron spectroscopy(XPS) and zeta potential measurements. The composition and surface characteristics of colloidal juice particles are reported. The results indicate that there are three types of colloidal particles present, viz. an aluminosilicatecompound, silica and iron oxide, with the latter two being abundant. Proteins, polysaccharides and organic acids were identified on the surface of particles in juice. The overall particle charge varies from -2 mV to -6 mV. In comparison to juice expressed from burnt cane, the zeta potential values were more negative with juice particles originating from whole crop. This in part explains why these juices are difficult to clarify.

Postmaterial values and age: The case of Australia

Inglehart's thesis of value change is one of the most widely discussed accounts of social and political change in advanced Western nations. This article offers a critique of Inglehart's thesis and a clarification of the Australian case. While critics of Inglehart have attacked the validity of his values measures, or sought to improve them, we use Inglehart's own values index to show that even if-as Inglehart claims-his measures are valid, the age/values predictions do not hold as the theory suggests in Australia. In a recent article, Inglehart and Abramson (1999, 673) cite Australia among a group of '28 high-income' countries that exhibit 'stronger relationships between values and age' than found in the United States. We dispute Inglehart and Abramson's findings in relation to Australia. We show that the relationship between age and values in Australia, like the United States, is very weak, highlight the problematic nature of assuming a linear relationship between age and values without evidence, and discover a new non-linear relationship between values and birth cohorts in Australia that has implications for the study of values research internationally.