Objective Individuals are often defensive toward health messages that suggest they are putting their health at risk because such messages threaten their self-competence and integrity. Although self-affirmation can facilitate prevention behaviors in response to health messages, effects are variable. We examined whether disease prevention focus might strengthen self-affirmation's effects in response to disease prevention messages, given that prevention-focused individuals are likeliest to be persuaded by those messages after self-affirmation attenuates defensiveness. Design In Study 1, participants were self-affirmed before a message about sexually transmitted infections. In Studies 2 and 3, individuals were self-affirmed prior to a message about alcohol and cancer risk. Main Outcome Measures Studies assessed intentions to use condoms, intentions to reduce alcohol, and willingness to drink alcohol in specific scenarios. Results In Study 1, self-affirmation facilitated condom use intentions among those higher in prevention focus. In Studies 2 and 3, self-affirmation facilitated lower willingness to consume alcohol among those high in prevention focus. A meta-analysis across the three studies indicated that self-affirmation improved intentions and willingness under high, but not low, prevention focus (d = 0.20,p= .003). Conclusion These findings demonstrate that health prevention-focus can strengthen self-affirmation's effects, thereby improving responsiveness to health communications about behaviors that increase disease risk.

This brief is one in a series examining mental health public awareness campaigns' messages, consistency of messaging in their materials, and tools used to deliver content to audiences. This brief discusses materials from Recovery Month.

This brief is one in a series examining mental health public awareness campaigns' messages, consistency of messaging in their materials, and tools used to deliver content to audiences. This brief discusses materials from the Make the Connection.

This brief is one in a series examining mental health public awareness campaigns' messages, consistency of messaging in their materials, and tools used to deliver content to audiences. This brief discusses materials from the Veterans Crisis Line.

More than 2.7 million service members have deployed since 2001, and many who return report mental health challenges. This report describes a cross-agency evaluation of four public awareness campaigns that aim to overcome negative perceptions and promote awareness of mental health disorders and their treatment: the Real Warriors Campaign, Make the Connection, National Recovery Month, and awareness materials related to the Veterans Crisis Line.

This brief describes the results of an interim evaluation that examined the scope, content, and dissemination of mental health public awareness campaigns. RAND researchers conducted a comprehensive evaluation of four such efforts.

This brief is one in a series examining mental health public awareness campaigns' messages, consistency of messaging in their materials, and tools used to deliver content to audiences. This brief discusses materials from the Real Warrior Campaign.

Patient narratives have emerged as promising vehicles for making health care more responsive by helping clinicians to better understand their patients' expectations, perceptions, or concerns and encouraging consumers to engage with information about quality. A growing number of websites incorporate patients' comments. But existing comments have fragmentary content, fail to represent less vocal patients, and can be manipulated to "manage" providers' reputations. In this article, we offer the first empirical test of the proposition that patient narratives can be elicited rigorously and reliably using a five-question protocol that can be incorporated into large-scale patient experience surveys. We tested whether elicited narratives about outpatient care are complete (report all facets of patient experience), balanced (convey an accurate mix of positive and negative events), meaningful (have a coherent storyline), and representative (draw fulsome narratives from all relevant subsets of patients). The tested protocol is strong on balance and representativeness, more mixed on completeness and meaningfulness.

For two decades, various initiatives have encouraged Americans to consider quality when choosing clinicians, both to enhance informed choice and to reduce disparities in access to high-quality providers. The literature portrays these efforts as largely ineffective. But this depiction overlooks two factors: the dramatic expansion since 2010 in the availability of patients' narratives about care and the growth of information seeking among consumers. Using surveys fielded in 2010, 2014, and 2015, we assessed the impact of these changes on consumers' awareness of quality information and sociodemographic differences. Public exposure to any quality information doubled between 2010 and 2015, while exposure to patient narratives and experience surveys tripled. Reflecting a greater propensity to seek quality metrics, minority consumers remained better informed than whites over time, albeit with differences across subgroups in the types of information encountered. An education-related gradient in quality awareness also emerged over the past decade. Public policy should respond to emerging trends in information exposure, establish standards for rigorous elicitation of narratives, and assist consumers' learning from a combination of narratives and quantified metrics on clinician quality.

We conducted a simulated clinician-choice experiment, comparing choices and decision-making processes of participants (N = 688) randomized among four experimental arms: a conventional website reporting only quantitative performance information, a website reporting both qualitative (patient comments) and quantitative information, the second website augmented by a decision aid (labeling of patient comments), and the decision-aided website further augmented by the presence of a trained navigator. Introducing patient comments enhanced engagement with the quality information but led to a decline in decision quality, particularly the consistency of choices with consumers' stated preferences. Labeling comments helped erase the decline in decision quality, although the highest percentage of preference-congruent choices was seen in the navigator arm. Engagement with the quality information and satisfaction with choices available were likewise highest in the navigator arm. Findings held for high- and low-skilled decision makers. Thus, navigator assistance may be a promising strategy for equitably promoting higher quality choices in information-rich contexts.

This study was conducted to determine the feasibility of conducting a cost–benefit evaluation of federally-funded media campaigns encouraging mental health help-seeking among United States military personnel and veterans. To calculate the necessary sample size for the evaluation, we obtained campaign costs, and determined the number of treatment seekers needed for the campaign to break even with its cost and the associated population change that an evaluation would need to detect. The sample size needed for an evaluation with 80% power was greater than the total population of U.S. military personnel and veterans. Given that the necessary sample size exceeds the population to be sampled, an appropriately powered outcome evaluation is not feasible. Other programs that would be cost effective with extremely small effect sizes should not be subject to underpowered and thus inaccurate empirical outcome evaluation.

Policy Points Narratives about patients' experiences with outpatient care are essential for quality improvement because they convey ample actionable information that both elaborates on existing domains within patient experience surveys and describes multiple additional domains that are important to patients. The content of narrative feedback from patients can potentially be translated to improved quality in multiple ways: clinicians can learn from their own patients, groups of clinicians can learn from the experience of their peers' patients, and health system administrators can identify and respond to patterns in patients' accounts that reflect systemic challenges to quality. Consistent investment by payers and providers is required to ensure that patient narratives are rigorously collected, analyzed fully, and effectively used for quality improvement.CONTEXTFor the past 25 years, health care providers and health system administrators have sought to improve care by surveying patients about their experiences. More recently, policymakers have acted to promote this learning by deploying financial incentives tied to survey scores. This article explores the potential of systematically elicited narratives about experiences with outpatient care to enrich quality improvement.METHODSNarratives were collected from 348 patients recruited from a nationally representative Internet panel. Drawing from the literature on health services innovation, we developed a two-part coding schema that categorized narrative content in terms of (a) the aspects of care being described, and (b) the actionability of this information for clinicians, quality improvement staff, and health system administrators. Narratives were coded using this schema, with high levels of reliability among the coders.FINDINGSThe scope of outpatient narratives divides evenly among aspects of care currently measured by patient experience surveys (35% of content), aspects related to measured domains but not captured by existing survey questions (31%), and aspects of care that are omitted from surveys entirely (34%). Overall, the narrative data focused heavily on relational aspects of care (43%), elaborating on this aspect of experience well beyond what is captured with communication-related questions on existing surveys. Three-quarters of elicited narratives had some actionable content, and almost a third contained three or more separate actionable elements.CONCLUSIONSIn a health policy environment that incentivizes attention to patient experience, rigorously elicited narratives hold substantial promise for improving quality in general and patients' experiences with care in particular. They do so in two ways: by making concrete what went wrong or right in domains covered by existing surveys, and by expanding our view of what aspects of care matter to patients as articulated in their own words and thus how care can be made more patient-centered. Most narratives convey experiences that are potentially actionable by those committed to improving health care quality in outpatient settings.

The U.S. Air Force asked the RAND Corporation to assist its development and validation of gender-neutral tests and standards for battlefield airmen (BA) specialties. The Air Force has conducted an extensive validation study of occupational relevance of physical fitness tests and standards. Following the fitness test validation study, one enlisted specialty (Tactical Air Control Party [TACP]) and one officer BA specialty (Air Liaison Officer [ALO]) moved forward with an implementation plan to further evaluate a set of recommended tests and continuation standards. This study describes RAND's assistance to the Air Force on two fronts: (1) conducting a preliminary evaluation of potential issues and concerns that might influence implementation effectiveness and (2) developing a framework for evaluating the implementation of occupationally relevant and specific tests and standards. This work provides the foundation for ongoing review and evaluation of Air Force fitness tests and standards, which are designed to ensure that airmen are capable of performing critical physical tasks associated with their assigned specialties.

BackgroundPublic reports on healthcare quality typically include complex data. To lower the cognitive burden of interpreting these data, some report designers create summary, or roll-up, measures combining multiple indicators of quality into one score. Little is known about how the availability of roll-ups affects clinician choice.ObjectiveTo determine how presenting quality scores at different levels of aggregation affects patients' clinician choices.DesignWe conducted a simulated clinician-choice experiment, randomizing participants to three versions of a public reporting website and comparing their clinician choices. One version aggregated all clinician-level quality measures into roll-ups, the second provided disaggregated (drill-down) scores only, and the third offered both roll-ups and drill-downs.ParticipantsFive hundred fifty panelists drawn from a probability-based Internet panel.Main MeasuresWe assessed the amount of effort participants exerted by tracking the length of time spent on the website and the number of concrete actions taken on the website (e.g., clicking items). We evaluated decision quality by measuring whether participants selected a clinician who performed more poorly than others and incongruence between participants' stated preferences for dimensions of quality and their chosen clinician's performance on those dimensions.Key ResultsParticipants seeing drill-downs alone (mean=14.9) or with roll-ups (mean=19.2) took more actions than those who saw roll-ups alone (mean=10.5) (ps<0.05). However, participants seeing only drill-downs made poorer choices than those who saw roll-ups alone or with drill-downs. More participants seeing drill-downs chose a clinician who was outperformed (36.3% versus 23.4% [roll-up] and 25.6% [drill-down + roll-up], ps<0.05) and made choices incongruent with stated preferences (51.2% versus 45.6% [roll-up] and 47.5% [drill-down + roll-up], ps<0.05). The distinction between roll-up and drill-down was somewhat stronger for sicker participants.ConclusionsOur results suggest that roll-ups in healthcare quality reports, alone or as a complement to drill-downs, can help patients make better decisions for themselves.

Introduction:Many service members experiencing symptoms of mental health conditions do not receive mental health care for these symptoms. The stigma associated with having a mental health condition or seeking treatment is often cited as a specific barrier to mental health care. However, study results bearing on the question of whether and how stigma may reduce treatment-seeking have been inconsistent.Methods:We searched 10 databases for sources published between 2004 and 2014 that prospectively linked stigma to treatment-related outcomes (such as treatment seeking, retention, and reports of symptoms) using longitudinal data and predictive models. The searches yielded 2,409 sources. After reviewing titles and abstracts for relevance, we retained 15 sources to undergo full-text review.Results:Overall, this review illustrates that evidence exploring the direct effect of stigma on treatment-related outcomes is still scant. We identified two studies whose outcomes conflict when it comes to stigma and treatment-initiation and utilization, and three studies found no relationship between stigma and treatment-initiation and utilization. One study suggested that the relationship between stigma and experience of symptoms is nuanced and may depend on the type of stigma and types of symptoms considered. Meager evidence was available to inform the relationship between stigma and treatment duration, attrition, and quality of life/functioning. The evidence was not sufficient to draw conclusions about the state of these relationships. No conclusions could be made about the direct impact of stigma on treatment-related outcomes among military service members given that only two studies explored this relationship among military service members.Conclusion:Current research does not provide a true understanding of the degree to which mental illness stigma affects treatment-related outcomes for service members experiencing mental health challenges. This understanding could only be developed through a longitudinal study assessing prospectively whether stigma affects treatment-utilization in the military. Should such a study show that stigma reduces treatment-utilization, the military would need to consider whether changes to their current approaches to stigma reduction are warranted.

Consumers choosing a health-care provider have access to diverse information including narratives by patients about their prior experiences. However, little research has examined how narratives might improve or impede the use of information about the quality of providers’ performance. This paper describes a conceptual framework for examining mechanisms by which narrative information might influence consumer judgments and decisions about providers. We conducted a conceptual review of risk communication and behavioral decision research. We synthesized the literature to form the foundation of a conceptual framework for assessing how narrative information about provider quality impacts consumer decisions about providers. We identified four key characteristics of narratives (convey emotion; explain logic; provide relational information; and capture naturalistic experience) that may address four consumer needs (avoid surprise and regret; recognize dominant options; motivate to act or not act; and make multi-attribute tradeoff decisions). We also identified three main functions of narratives (provide a simple, powerful cue; imbue quality information with meaning; and stimulate cognition and behavior) in four decision contexts (short-term treatments; external disruptions; chronic illness; problematic experiences). A rigorous research program can be derived from the conceptual framework to generate evidence-based recommendations about whether and how patient narratives might encourage: (1) more reasoned decisions; (2) consistency with a patient’s own values/preferences; and (3) engagement with provider quality information. Research results can be used then to develop robust guidance for health communicators reporting diverse and often incommensurate performance metrics.

Objective: This article describes the National Institute for Occupational Safety and Health's (NIOSH) development of a conceptual framework for worker well-being. While well-being research is growing, there is a need to translate theoretical concepts into practical models for measurement and action. Methods: Multidisciplinary literature reviews informed development of the worker well-being framework and major domains and subdomains. An expert panel helped prioritize constructs for measurement. Results: The framework includes five domains and 20 subdomains and conceptualizes worker well-being as a subjective and objective phenomenon inclusive of experiences both within and beyond work contexts. Conclusion: Well-being is a positive and unifying concept that captures multiple factors that contribute to workers’ health and quality of life. This work lays the foundation for larger well-being measurement efforts and will provide tools for NIOSH partners to help workers flourish.

Mental illness stigma disproportionately affects help seeking among youth, men, and ethnic minorities. As part of a comprehensive statewide initiative to reduce mental illness stigma and discrimination in California, a broad set of contact-based educational programs were widely disseminated. This study examined whether the effects of contact-based educational programs varied depending on the age, gender, and race-ethnicity of participants.

Objective: This article describes the National Institute for Occupational Safety and Health's (NIOSH) development of a conceptual framework for worker well-being. While well-being research is growing. there is a need to translate theoretical concepts into practical models for measurement and action. Methods: Multidisciplinary literature reviews informed development of the worker well-being framework and major domains and subdomains. An expert panel helped prioritize constructs for measurement. Results: The framework includes five domains and 20 subdomains and conceptualizes worker well-being as a subjective and objective phenomenon inclusive of experiences both within and beyond work contexts. Conclusion: Well-being is a positive and unifying concept that captures multiple factors that contribute to workers' health and quality of life. This work lays the foundation for larger well-being measurement efforts and will provide tools for NIOSH partners to help workers flourish.