Computer-assisted intervention improves patient-centered diabetes care by increasing autonomy support.

Objective: To determine if a patient-centered, computer-assisted diabetes care intervention increased perceived autonomy support, perceived competence (from self-determination theory), and if these constructs mediated the effect of the intervention on ADA/NCQA recommended diabetes care outcomes. Design: A randomized controlled trial of 866 adult type 2 diabetes patients in heterogeneous primary care settings in Colorado. Main Outcome Measures: Perceived autonomy support, perceived competence, patient satisfaction, glycemic control (HbA1c), ratio of total to HDL cholesterol, diabetes distress, and depressive symptoms. Results: The computer-assisted intervention increased patient perception of autonomy support relative to a computer-based control condition ( p = .05). Change in perceived competence partially mediated the effects of increased autonomy support on the change in lipids, diabetes distress, and depressive symptoms. The construct of autonomy support was found to be separate from that of patient satisfaction. Conclusions: A patient-centered, computer-assisted intervention was effective in improving diabetes self-management outcomes, in part, because it increased patients' perception that their autonomy was supported which changed perceived competence. These findings support the self-determination model for health behavior change and the chronic care model and support the further study of the use of these technologies to motivate patients to improve their health outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early predictors of job burnout and engagement.

A longitudinal study predicted changes in burnout or engagement a year later by identifying 2 types of early indicators at the initial assessment. Organizational employees (N = 466) completed measures of burnout and 6 areas of worklife at 2 times with a 1-year interval. Those people who showed an inconsistent pattern at Time 1 were more likely to change over the year than were those who did not. Among this group, those who also displayed a workplace incongruity in the area of fairness moved to burnout at Time 2, while those without this incongruity moved toward engagement. The implications of these 2 predictive indicators are discussed in terms of the enhanced ability to customize interventions for targeted groups within the workplace. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Designing a safer workplace: Importance of job autonomy, communication quality, and supportive supervisors.

The direct and indirect effects of work characteristics on self-reported safe working were investigated in a longitudinal study of frontline manufacturing employees (N?=?161). The work characteristics included job autonomy, role overload, role conflict, supportive supervision, training adequacy, job security, and communication quality. Job autonomy and communication quality were positively associated with safe working after prior levels of these variables were controlled for, and supportive supervision had a lagged positive effect on safe working 18 months later. Additional analyses showed that organizational commitment fully mediated the effect of job autonomy on safe working and partially mediated the effect of communication quality on safe working. The study suggests that work characteristics are important antecedents of safe working. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What is more important for national well-being: Money or autonomy? A meta-analysis of well-being, burnout, and anxiety across 63 societies.

What is more important: to provide citizens with more money or with more autonomy for their subjective well-being? In the current meta-analysis, the authors examined national levels of well-being on the basis of lack of psychological health, anxiety, and stress measures. Data are available for 63 countries, with a total sample of 420,599 individuals. Using a 3-level variance-known model, the authors found that individualism was a consistently better predictor than wealth, after controlling for measurement, sample, and temporal variations. Despite some emerging nonlinear trends and interactions between wealth and individualism, the overall pattern strongly suggests that greater individualism is consistently associated with more well-being. Wealth may influence well-being only via its effect on individualism. Implications of the findings for well-being research and applications are outlined. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Take care! The evaluation of a team-based burnout intervention program for oncology care providers.

In this quasi-experimental study among staff of 29 oncology wards, the authors evaluated the effects of a team-based burnout intervention program combining a staff support group with a participatory action research approach. Nine wards were randomly selected to participate in the program. Before the program started (Time 1), directly after the program ended (Time 2), and 6 months later (Time 3), study participants filled out a questionnaire on their work situation and well-being. Results of multilevel analyses showed that staff in the experimental wards experienced significantly less emotional exhaustion at both Time 2 and Time 3 and less depersonalization at Time 2, compared with the control wards. Moreover, changes in burnout levels were significantly related to changes in the perception of job characteristics over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Work characteristics and sickness absence in burnout and nonburnout groups: A study of Swedish health care workers.

The aim of this study was to search for constellations of work characteristics that discriminate people who experience burnout from those who do not, and also from those who score high in exhaustion but not in disengagement, and vice versa. The study is based on data from 3,719 employees in a County Council in Sweden. Discriminant analysis revealed that four burnout categories (nonburnout, disengaged, exhausted, and burnout) related in different ways to self-reported work characteristics. The proportions of respondents with overtime, sickness absence, and sickness presence were higher in the burnout and the exhausted groups compared with the nonburnout group. The most common professions in the burnout group were, unexpectedly, dental nurses, secretaries, and service staff. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Staff burnout and patient satisfaction: Evidence of relationships at the care unit level.

Research on burnout has thus far focused primarily on the individual; however, in work environments in which teamwork is emphasized, it seems plausible that a meaningful group-level burnout construct could emerge. This theory was tested by examining burnout in psychosocial rehabilitation teams and its effects on patient satisfaction. Three hundred thirty-three staff from 31 behavioral health teams completed the Maslach Burnout Inventory; 405 of the clients they served completed the Consumer Satisfaction Scale. Multilevel analyses (hierarchical linear modeling) confirmed the existence of a meaningful team-level burnout construct. Team-level analyses revealed significant relationships between team burnout and patient satisfaction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differential susceptibility to parenting and quality child care.

Research on differential susceptibility to rearing suggests that infants with difficult temperaments are disproportionately affected by parenting and child care quality, but a major U.S. child care study raises questions as to whether quality of care influences social adjustment. One thousand three hundred sixty-four American children from reasonably diverse backgrounds were followed from 1 month to 11 years with repeated observational assessments of parenting and child care quality, as well as teacher report and standardized assessments of children’s cognitive-academic and social functioning, to determine whether those with histories of difficult temperament proved more susceptible to early rearing effects at ages 10 and 11. Evidence for such differential susceptibility emerges in the case of both parenting and child care quality and with respect to both cognitive-academic and social functioning. Differential susceptibility to parenting and child care quality extends to late middle childhood. J. Belsky, D. L. Vandell, et al.’s (2007) failure to consider such temperament-moderated rearing effects in their evaluation of long-term child care effects misestimates effects of child care quality on social adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Procedural justice as autonomy regulation.

The present research investigated the relation between autonomy (i.e., freedom of choice) and procedural justice. Three studies tested the hypothesis that people would be particularly sensitive to the fairness of decision-making procedures when they experience deprivation of autonomy needs. Study 1 indicated that procedural justice judgments indeed were influenced more strongly by variations in decision-making procedures among participants who experienced little autonomy in their life. In Study 2, these findings were conceptually replicated by manipulating whether participants were provided with choice on an issue that was unrelated to the outcomes of the subsequent decision-making process. Study 3 revealed evidence for the hypothesis in a field setting. It is concluded that procedural justice is functional to regulate basic autonomy needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A dimensional approach to maternal attachment state of mind: Relations to maternal sensitivity and maternal autonomy support.

The aim of this study was to examine the developmental significance of the newly developed dimensional approach to attachment state of mind by investigating its capacity to predict individual differences in the quality of two caregiving behaviors—maternal sensitivity and maternal autonomy support—that are linked to numerous important child outcomes. Seventy-one upper-middle-class, predominantly French-speaking and Caucasian dyads participated in 3 home visits (34 girls). The Adult Attachment Interview (AAI) was administered when the infants were 8 months old, maternal sensitivity was assessed when they were 12 months old, and maternal autonomy support was assessed at 15 months. The results revealed that, above and beyond SES, maternal sensitivity was negatively related to the dismissing dimension of the AAI, whereas maternal autonomy support was negatively linked to the preoccupied/unresolved dimension. In contrast, the traditional AAI categories were not significantly linked to parenting. These results speak to the relevance of using a continuous approach to attachment state of mind when predicting individual differences in specific caregiving behaviors. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Correctional psychologist burnout, job satisfaction, and life satisfaction.

Corrections is a stressful environment, but do correctional psychologists experience greater levels of occupational burnout and life stress than other public sector and nonpublic sector psychologists? Data collected from 203 doctoral level psychologists including correctional (CR; n = 44), Veteran's Affairs (VA; n = 56), public psychiatric hospital (PPH; n = 54), and university counseling centers (CC; n = 49) indicated that CR psychologists do experience significantly more occupational burnout relative to VA and CC psychologists. Furthermore, CR and PPH psychologists reported significantly less job satisfaction than CC psychologists. Although psychologists working in PPH settings reported significantly lower levels of life satisfaction than VA and CC psychologists this was not the case for CR psychologists. Professional identity related to occupational setting emerged as a significant predictor of occupational burnout. Implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuroticism and locus of control as moderators of the relationships of charismatic and autocratic leadership with burnout.

This study examined the moderating role of personality traits in the relationship between leader behavior and burnout. In two samples, employees (N = 91; N = 190) filled out the Maslach Burnout Inventory—General Survey and rated their leader’s autocratic and charismatic leader behavior and their own neuroticism and internal work locus of control. As expected, neuroticism and internal work locus of control moderated the relationship between leader behavior and burnout. Charisma was associated with lower burnout, particularly for individuals low on internal locus. The relationship between autocratic leadership and burnout was positive for neurotic individuals, whereas for emotionally stable individuals this relationship weakened. These results were consistent across two independent samples: one with individual employee ratings of manager’s leadership styles and the other with aggregate ratings of manager’s leadership styles among employees in diverse organizations. Thus, although charismatic and autocratic leader behavior may respectively act to hinder or enhance overload and stress, the relationship between these leadership styles and burnout differs for followers with different traits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Professional burnout in clinical military psychologists: Recommendations before, during, and after deployment.

Clinical military psychologists (CMPs) hold one of the most difficult positions within professional psychology. Given their exposure to a variety of environmental, physical, psychosocial, and emotional stressors, professional burnout (PB) can be a serious issue for CMPs. In order to (a) protect job satisfaction, (b) increase professional confidence, (c) facilitate a long and rewarding military career, and (d) ensure competent care is provided to our clients, a two-pronged approach of CMPs taking care of themselves on the one hand, and the military providing effective assessment, prevention, and intervention, on the other hand, is needed. Such an approach to protecting the military's limited mental health resources could ultimately ensure that service members receive proper care. In this article, the authors discuss the challenges experienced by CMPs as potential contributors to PB during all three phases of the deployment cycle. Several recommendations are offered for addressing such challenges. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Depression and quality of informal care: A longitudinal investigation of caregiving stressors.

This research examined longitudinal associations between caregiving stressors, caregiver depression, and quality of care. Informal caregivers of elderly care recipients were interviewed at baseline (N = 310) and again one year later (N = 213). Hierarchical regression analyses indicated that increases in caregiving stressors (i.e., caregiver physical health symptoms, caregiver activity restriction, and care recipient controlling and manipulative behavior) were related to increased caregiver depression. In turn, increased caregiver depression and decreased caregiver respectful behavior predicted increases in potentially harmful behavior. These results extend previous cross-sectional findings and indicate that changes in caregiving stressors, caregiver depression, and caregiver respect over time may signal that intervention is warranted in order to forestall or prevent poor quality of care. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Evaluating three theory-based interventions to increase physicians' recommendations of smoking cessation services.

Objective: To evaluate three theory-based interventions aimed at increasing the rate at which primary care physicians recommend smoking cessation services to smokers. Design: Primary care physicians (n = 251) were randomized to one of four conditions: (a) information based on social cognitive theory (SCT) targeting outcome expectations, (b) information based on SCT + elaboration likelihood model, (c) feedback based on self-perception theory, or (d) control. Main Outcome Measures: Intentions to recommend and self-reported recommendations of smoking cessation services 1 week postintervention. Results: Data were analyzed using covariance and mean structure analysis. Compared with the control group, only the SCT group reported more frequently recommending services (mean difference = 1.1 recommendations per week, Cohen's d = 0.46) and higher intentions. Mediation analysis was consistent with increased intentions resulting from changes in outcome expectations. There was no evidence that changes in intentions explained self-reported behavior change. Conclusion: The study provides preliminary “proof of principle” for further studies incorporating more robust outcome measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enhancing home-based child care quality through video-feedback intervention: A randomized controlled trial.

In the present randomized controlled trial, the effectiveness of video-feedback intervention to promote positive parenting–child care (VIPP-CC) was tested in home-based child care. Forty-eight caregivers were randomly assigned either to the intervention group or to the control group. Global child care quality improved in the intervention group but not in the control group. The program did not change observed caregiver sensitivity. After the intervention however, caregivers in the intervention group reported a more positive attitude toward sensitive caregiving than caregivers in the control group. The study shows that the family-based intervention can be applied with some minor modifications in a professional group setting as well. The brief VIPP-CC program is an important tool for enhancing quality of home-based child care. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Role conflict and burnout: The direct and moderating effects of political skill and perceived organizational support on burnout dimensions.

Drawing from previous research on the effect of role conflict on burnout and the Conservation of Resources theory, the authors propose that individual differences in political skill and perceptions of organizational support will be negatively related to burnout and will also moderate the relationship between perceived role conflict and burnout. In a sample of 120 professional employees, political skill was associated with less depersonalization and feelings of reduced personal accomplishment and moderated the role conflict-reduced personal accomplishment relationship. Perceived organizational support was associated with less emotional exhaustion and depersonalization and moderated the role conflict-emotional exhaustion relationship. Implications of results are discussed and directions for future research are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social networks and partner stress as predictors of adherence to medication, rehabilitation attendance, and quality of life following acute coronary syndrome.

Objective: This study examined whether social network size and partner stress predicted medication adherence, cardiac rehabilitation attendance, and quality of life 12 months following hospitalization for an acute coronary syndrome (ACS). Design: ACS patients (N = 193, M age = 60.6 years, SD = 11.4 years, 23% female) were recruited shortly following admission to 4 local hospitals. A prospective design was employed with follow-up data collected 12 months following hospital admission. Main Outcome Measures: Data were gathered on social network size and partner stress. The main outcomes assessed at 12 months were medication adherence, cardiac rehabilitation attendance, and quality of life (Short Form 36). Results: Partner stress predicted medication nonadherence, odds ratio: 2.89, (95% CI = 1.21, 6.95). ACS patients with large social networks were more likely to attend rehabilitation, odds ratio: 3.42, (95% CI = 1.42, 8.25). Analyses were adjusted for age, gender, clinical risk scores, readmission/recurrence, and negative affectivity. Both partner stress and smaller social network size were associated with poorer quality of life. Conclusion: Social network size and partner stress may partly exert their influence on coronary heart disease morbidity and mortality through recovery behaviors and maintenance of quality of life. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Organizational stages and processes of change for continuous quality improvement in health care.

This article provides an overview of the transtheoretical model of change (TTM, or stage model) and how it can guide the development of stage-matched interventions to increase physicians' readiness for continuous quality improvement (CQI) in health care. In addition, this article describes the development and initial validation of two TTM measures—stages and processes of change—designed to assess the extent to which hospitals are engaging in activities that can facilitate individual providers' movement through the stages of change for CQI. 299 Ss participated in the study. A majority (57%) of informants reported that their organizations were in the maintenance stage for CQI. Organizational-level processes of change differed significantly across the stages: Hospitals in the precontemplation stage tended to use the processes least, and hospitals in the maintenance stage tended to use them most. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sources of social support and burnout, job satisfaction, and productivity.

Social support has been identified as an important correlate of a variety of work outcomes. Support from different sources, including family, coworkers, and supervisors, was examined in 211 traffic enforcement agents (92 men, 119 women). Outcomes included subjective variables (burnout and job satisfaction) and an objective measure of productivity (number of summonses). Support was negatively associated with burnout and positively associated with satisfaction and productivity. A cluster of support variables accounted for 7% of the variance in burnout and productivity and 12% of the variance in job satisfaction. Family support was more closely associated with burnout than with satisfaction or productivity, whereas immediate supervisor support was related to satisfaction and productivity but not burnout. Results suggest that support may be associated with work-related outcomes through multiple pathways. (PsycINFO Database Record (c) 2010 APA, all rights reserved)