Providers are encouraged to view patients with chronic disease as ??partners?? in their care, and to collaborate with them in developing care plans. Yet there is little guidance in how collaboration should occur, and little evidence that collaborative care improves patient outcomes. Related models and measures of patient centred care and shared decision making have not been developed specifically for the context of chronic disease care. This thesis aimed to develop a theoretical understanding of how providers and patients make decisions in chronic disease care planning, how patients experience involvement in care planning, and to develop a measure of patient involvement. It consists of two studies: a qualitative study to develop a grounded theory of decision-making in diabetes care planning, and a scale development and psychometrics study. The qualitative study involved 29 providers and 16 patients with diabetes. It found that providers were concerned with a process described as ??managing patient involvement to do the right thing??, while patients were concerned with ??being involved to make sure care is appropriate??. This led to the theory of ??delivering respectful care??, a grounded theory that integrates provider and patient perspectives by showing how providers and patients can resolve their concerns while achieving mutually acceptable outcomes. Central to this theory is the process of finding common ground, while the key conditions are provider responsiveness and an ongoing, trusting and respectful provider-patient relationship. The Collaborative Care Planning Scale (CCPS), based on these findings, is a patient self-report scale that measures patients?? perceptions of involvement in care planning. After piloting the CCPS was tested amongst 166 patients with diabetes. Exploratory factor analysis resulted in a 27-item scale comprising two factors: ??receiving appropriately personalised care?? and ??feeling actively involved in decision-making??. Psychometrics tests revealed the CCPS has adequate internal consistency and test-retest reliability, and findings support construct validity. ??Delivering respectful care?? enriches understanding of the nature of collaboration in chronic disease care, and identifies those elements necessary to ensure patients receive best possible care. The CCPS provides the means for measuring what patients say they value, and is thus an important measure of quality chronic disease care.

This research investigated the relationship of predisposing attributes of preretirees to the perceived importance of locational preferences during the first ten years of retirement. Multiple regression analyses and a Chi-square test were used to determine if seven predisposing attributes were related to ten locational preferences. Data were analyzed from a age-stratified random sample of 1003 preretirees age 40-65 in the three western states of Idaho, Oregon, and Utah. The data were collected in a mail survey in 1990 by the Western Regional Agricultural Experiment Station Committee (W-176). Gender, education, and income were significantly related to respondents' perceived importance of low cost of living. Females, individuals with lower income, and those with less education indicated a higher perceived importance for low cost of living. Gender and income were significantly related to respondents' perceived importance of employment opportunities. Employment opportunities were more important for females and individuals with lower income. Older respondents and females indicated a greater importance for convenience and care amenities. Older respondents, females, and respondents who had not moved, placed more importance on close proximity to family. Females and respondents with higher levels of education indicated greater importance for personal enrichment opportunities. The perceived importance of recreation was greater for males, younger respondents, and respondents with higher income and education. As age increased, the perceived importance for warm temperatures increased. Health was significantly related to perceived importance of accessible medical facilities, but there was no significant difference in health status and desired types of medical services. The findings of this study may assist policy makers, community planners, and the business sector in understanding the heterogeneous nature of the aging population. It may also assist in responsive long-range planning in accommodating future elderly. / Graduation date: 1994

Thesis (Ph. D.)--Virginia Commonwealth University, 2006. / Prepared for: School of Social Work. Bibliography: leaves 278-297. Also available online via the Internet.

Risk based audit (RBA) approaches represent a major trend in current audit methodology. The approach is based on risk analysis used to identify business strategy risk. The RBA has created a new set of research issues that need investigation. In particular, this approach has important implications for risk identification and risk assessment. The success of the RBA approach is contingent on understanding what factors improve or interfere with the accuracy of these risk judgments. I examine how budget constraints and decision aid use affect risk identification and risk assessment. Unlike previous budget pressure studies, I cast budget constraints as a positive influence on auditors. I expect more stringent budget constraints to be motivating to the auditor as they provide a goal for the auditor to achieve. I also expect budget constraints to induce feelings of pressure leading to the use of time-pressure adaptation strategies. When auditors have use of a decision aid, they take advantage of these motivational goals and/or use beneficial adaptive strategies. Overall, I find that auditor participants tend to be more accurate when identifying financial statement risks compared to business risks. Budget constraints have no effect on risk identification for financial or business risks; they also have no effect on financial risk assessments. On the other hand, business risk assessments are improved by implementing more stringent budget constraints, but only when a decision aid is also provided. Budget constraints can affect performance through a goal theory route or a time-pressure adaptation route. I investigate the paths through which budget constraints improve business risk assessments under decision aid use. I find that budget constraints directly affect performance, supporting a goal theory route. However, I do not find that budget constraints are mediated by perceived budget pressure as expected. Auditors appear to use a positive adaptive strategy to respond to perceived budget pressure, however perceived budget pressure is not induced by providing a more stringent budget.

The current study provides evidence that individuals tend to adopt an integrative choice strategy when making sequential decisions under conditions of uncertainty. This contrasts with prior literature which proposes that decisions are made one at a time in isolation from one another (Camerer et al., 1997). By creating an experimental work task where only wage quality and feedback are manipulated, the resulting changes in intertemporal substitution between work and leisure are observed. In Experiments 1 3, a positive relationship between wages and time spent working that did not depend on task experience was observed. These results suggest that decisions are being made in consideration of other decisions, as isolated decisions would yield a negative relationship between wages and time spent working. In Experiment 4 these results were mitigated by the difficulty in differentiating between low and high wage quality days. These findings are taken to suggest that the results of prior studies are primarily due to self-control issues that subjects faced, which are not present in the present study.

In the domain of reasoning and decision making, some dual-process theorists have suggested that people are highly efficient at detecting conflicting outputs engendered by competing intuitive and analytic processes (De Neys & Glumicic, 2008; De Neys, Vartanian & Goel, 2008). For example, De Neys and Glumicic (2008) demonstrated that participants’ reason longer about problems that are characterized by a conflict between a stereotypical personality description and a base-rate probability of group membership. Crucially, this increase occurred even when participants gave the nominally erroneous stereotypical response (i.e., “neglecting” the base-rate probability), indicating that their participants detected that there was a conflict and, as a result, engaged in slow, analytic processing to resolve it. However, this finding, and much of the additional support for the efficient conflict detection hypothesis, has come from base-rate neglect problems constructed with probabilities (e.g., 995 doctors and 5 nurses) that were much more extreme than typically used in studies of base-rate neglect. I varied the base-rate probabilities over five experiments and compared participants’ response time for conflict problems with non-conflict problems. It was demonstrated that the integral increase in response time for stereotypical responses to conflict problems was fully mediated by extreme probabilities. I conclude that humans are not as efficient at detecting when they are engaging in biased reasoning as De Neys and colleagues have claimed.

This study will examine how the structure of preferences of group members in a decision-making group, as well as the information they have, affects the collection and the processing of information by individual members of a decision making group. Structure of preferences in this study will represent each individual group members’ preference towards a particular course of action. Using an experimental method of analysis, this study will examine how the preference structure of a group affects what and how much information a group member will analyze before making a decision. I hypothesize that the structure of the group members’ preferences should affect the subjects’ search and process of information. This study aims to answer the following questions; do group preferences affect the search and processing of information? Do group members thoroughly survey the objectives and alternatives in the decision making process?

Concurrent construction, in which multiple construction activities are carried out concurrently or overlapping, is a method developed to reduce time-to-market and increase the value of the project to the owner or user. When overlapping activities, the additional cost for overlap is affected by the interaction between overlapped activities which is affected by the construction work methods used. Thus concurrent planning of construction projects can lead to a benefit for the owner through investigating the interactions between work methods under overlap and finding the best degrees of overlap. However, the determination of the best solution from all the possible combinations of multiple methods and degrees of overlap is affected by the decisionmaking approach: by a centralized decision-maker (e.g., the project manager) with less accurate information about cost estimates or by a decentralized decision-maker(s) (e.g., subcontractors) with a myopic viewpoint. The objective of this dissertation is to compare the solutions from the two decision-making approaches and to identify the conditions in which one approach is preferred to the other. Thus project owners can benefit from choosing a better approach for concurrent planning under their own conditions. A Monte Carlo simulation model for each decision-making approach was developed: an algorithm for finding the best solution was developed by heuristic methods. Several parameters were incorporated into the models to reflect different conditions for the decision-making approaches: number of activities, number of methods, the project manager’s solution capacity, the uncertainty in the project manager’s knowledge and attitudes towards risk. The comparison of the two approaches was implemented with random cost under different conditions. Furthermore, the model was applied to a hypothetical construction project. From the simulations the major conclusions include: (1) The decentralized approach becomes preferred with more activities; (2) Considering more methods provides more potential for higher benefit to the owner in the decentralized approach; (3) The decentralized approach is recommended under risk-averse attitude and high uncertainty in the project manager’s knowledge.

One psychosocial variable, human mate selection, has been studied extensively within the field of evolutionary psychology. A question of interest is how sexual/reproductive decision-making (i.e., dating, marrying, and childbearing) might be influenced by an individual’s perception of his/her genetic risk and other psychosocial variables. There is a paucity of empirical studies within the literature exploring this specific relationship. This partially mixed, sequential mixed methods study addresses how individual perception of genetic risk (PGR) influences or predicts sexual/reproductive intentions and decision-making. A systematic review of the literature was conducted by searching for English language, peer-reviewed, empirical studies in Cambridge Scientific Abstracts databases (N=26). Next, students from three Southwestern universities were recruited for focus groups and responded to 15 open-ended questions (N=86). Transcripts were audiotaped, transcribed verbatim and analyzed using holistic-content analysis. Based on the literature review and qualitative findings, a 138-item, web-based instrument was designed and tested at two Southwestern universities (N=2,576). Survey data were analyzed using non-parametric univariate analyses and multiple regression. Approximately 50 demographic, individual/familial psychosocial and genetic testing-related factors influenced the relationship between PGR and sexual/reproductive decision-making in reviewed studies. Individual psychosocial factors (e.g., intention, attitudes) represented 65.8% of all findings. Participants in the qualitative phase exhibited moderate health literacy when interpreting and discussing genetic risk information. A number of factors including age, gender, religion, individual/family values, and exposure to genetic concepts/technology appeared to influence sexual/reproductive decision-making. Demographic, Health Belief Model (HBM) and Theory of Planned Behavior (TPB) variables predicted the relationship between PGR and dating, marital, and childbearing intention in the quantitative phase. TPB variables were the strongest predictors of intention accounting for 33.1-38.7% of variance. Positive family norms were the single best predictor of dating and marital intention. Age was the best predictor of childbearing intention. Further research is needed to understand how young adults incorporate genetic risk perceptions into sexual/reproductive decision-making. Mixed methods and longitudinal study designs, and structural equation modeling are recommended for use in future studies. Study findings affirm a need for health educators to consider adopting genomic competencies; creating theory-based curricula/interventions; and forming partnerships with genetic specialists and local/regional health departments.

Risk based audit (RBA) approaches represent a major trend in current audit methodology. The approach is based on risk analysis used to identify business strategy risk. The RBA has created a new set of research issues that need investigation. In particular, this approach has important implications for risk identification and risk assessment. The success of the RBA approach is contingent on understanding what factors improve or interfere with the accuracy of these risk judgments. I examine how budget constraints and decision aid use affect risk identification and risk assessment. Unlike previous budget pressure studies, I cast budget constraints as a positive influence on auditors. I expect more stringent budget constraints to be motivating to the auditor as they provide a goal for the auditor to achieve. I also expect budget constraints to induce feelings of pressure leading to the use of time-pressure adaptation strategies. When auditors have use of a decision aid, they take advantage of these motivational goals and/or use beneficial adaptive strategies. Overall, I find that auditor participants tend to be more accurate when identifying financial statement risks compared to business risks. Budget constraints have no effect on risk identification for financial or business risks; they also have no effect on financial risk assessments. On the other hand, business risk assessments are improved by implementing more stringent budget constraints, but only when a decision aid is also provided. Budget constraints can affect performance through a goal theory route or a time-pressure adaptation route. I investigate the paths through which budget constraints improve business risk assessments under decision aid use. I find that budget constraints directly affect performance, supporting a goal theory route. However, I do not find that budget constraints are mediated by perceived budget pressure as expected. Auditors appear to use a positive adaptive strategy to respond to perceived budget pressure, however perceived budget pressure is not induced by providing a more stringent budget.