Dealing with being prescribed cardiovascular preventive medication: a narrative analysis of qualitative interviews with patients with recent acute coronary heart disease in Sweden

ObjectiveTo explore how patients with experience of acute coronary heart disease make sense of, and deal with, the fact of being prescribed cardiovascular preventive medication.DesignQualitative interview study.SettingSwedish primary care.ParticipantsTwenty-one participants with experience of being prescribed cardiovascular preventive medication, recruited from a randomised controlled study of problem-based learning for self-care for coronary heart disease.MethodsThe participants were interviewed individually 6–12 months after their hospitalisation for acute coronary disease. A narrative analysis was conducted of their accounts of being prescribed cardiovascular preventive medication.ResultsFour themes shape the patients’ experiences: ‘A matter of living’ concerns an awareness of the will to live linked to being prescribed cardiovascular preventive medication regarded in the light of the recent hospitalisation. In ‘Reconciliation of conflicting self-images’, patients dealt with being prescribed preventive medication through work to restore an identity of someone responsible in spite of viewing the taking of medication as questionable. The status of feeling healthy, while being someone in need of medication, also constituted conflicting self-images. Following this, taking medication was framed as necessary, not as an active choice. ‘Being in the hands of expertise’ is about the seeking of an answer from a reliable prescriber to the question: ‘Is this medication really necessary for me?’ Existential labour was done to establish that the practice of taking cardiovascular preventive medication was an inevitable necessity, rather than an active choice. ‘Taking medicines no longer a big deal’ could be the resulting experience of this process.ConclusionsUnmet existential needs when being prescribed cardiovascular preventive medication seem to be a component of the burden of treatment. A continuous and trustful relationship with the prescribing doctor may facilitate the reconciliation of conflicting self-images, and support patients in their efforts to incorporate their medicines taking into daily life.

Childbirth in Transit

This chapter ethnographically explores childbirth practices at Taljai, a large urban slum on the southern outskirts of Pune city in India. Based on women’s recounting of their personal experiences and social relationships surrounding birth-giving at home, this chapter describes childbirth at Taljai as unstable, mirroring the migrant lives of women. Women’s migrant lives at Taljai are precarious and subject to material paucity and systemic violence, defined by strong internal negotiation and sociability surrounding their birth-giving practices at home. While homebirths are predicated on friendship networks among women, clinical births either indicate individual exclusion from women’s groups at Taljai or women’s active choice to avoid being controlled by other women. This chapter explores the tight gendered sociability surrounding homebirth at Taljai, demonstrating how women amalgamate experiences of self-birthing at home with home-birthing at the slum, instrumentalizing childbirth rituals as a means of social bonding.

Home in question: Uncovering meanings, desires and dilemmas of non-home

What is the opposite of home? Is it necessarily something ‘negative’? Similar questions, far from having a self-evident answer, make for a fruitful entry point for research into the social experience of home. Central to this article is a novel conceptualization of non-home, against the background of the pre-existing criticisms of the normative, romanticized and depoliticized understandings of home. This article draws from fieldwork on the everyday dwelling experience of migrants and asylum seekers to illustrate the volitional dimension of non-home. Not attaching a sense of home to a dwelling place or set of relationships is not merely a consequence of poor housing conditions. It may also involve an active choice – at least at some points of the life course, in certain household conditions. In this sense, non-home is more than a matter of absence, dispossession, reconfiguration or implosion of home. In questioning the normative view of home as inherently positive and desirable, this conceptualization highlights the reciprocal interaction between home and non-home as mutually interdependent constructs.

Effects of Birth Order on Performance and Affective State of Pigs

In pigs, higher birth order is associated with higher pre-weaning mortality. However, knowledge on the effect of birth order on welfare of surviving piglets is limited. The aim of this study was to explore the possible link between birth order and both newborn piglet performance and later affective state. Firstly, the following data were collected in 393 piglets from 27 litters: stillbirth, intactness of the umbilical cord and birth weight. Subsets of piglets were used to measure suckling latency (n = 67) and teat order (n = 21). Secondly, a subset of first-born (n = 9) and last-born (n = 7) piglets were trained to perform an active-choice judgement bias task (JBT). During discrimination training preceding the JBT, the pigs learned to associate two tone cues with the availability of either a large (4 M&M's® Milk Chocolate candies) or small (1 M&M's) reward, provided at two different locations. After training, ambiguous intermediate tones were introduced and the pig's choice of location was scored as either optimistic or pessimistic. Results showed that last-born piglets had a higher birth weight than middle-born piglets, while first-born piglets did not significantly differ from last- or middle-born piglets. They also latched to more caudal teats than first-born piglets. The last-born and first-born piglets showed a similar learning rate during discrimination training, and a similar latency to approach reward locations, and had a similar optimistic bias in the JBT.

CHINA'S "KOREAN WAVE" AND CHINA'S ACTIVE CHOICE FOR THE KOREAN WAVE

Hallyu has gradually exerted greater influence in China and even in the world. Through the development of Korean TV dramas imported to China, and compared to the development of Japanese TV dramas in China, the author found that the development of Korean TV dramas was influenced by the development of the Chinese society and reflected China’s active choose on the import of Korean TV series.

Self-Control Preferences and Status-Quo Bias

In a setting of choice with an observable status quo, we model an agent who struggles with temptation by exercising (costly) self-control, and who views the status quo as a commitment opportunity that allows him to avoid the self-control costs incurred when making an active choice. Our model is rational in that the agent always maximizes the same ex-post utility function; hence, when the standard indirect utility property holds, the model reduces to classic rational choice model. However, when we allow for costly self-control, our theory provides a rationale for three well-documented phenomena that cannot be captured by the standard model: the status-quo bias, the compromise effect, and the satisficing choice procedure (when ignoring the information on the status quo). A notable feature of our theory is that while it relaxes the indirect utility property, it still allows for a complete identification of an agent’s preference relation over menus. This is found to be important in many practical situations.

Consumers' active choice behavior promotes coevolutionary units

Individual behavior, and local context are processes that can influence the structure and evolution of ecological interactions. In trophic interactions, consumers can increase their fitness by actively choosing resources they are able to explore. The effect of active choice on interaction network structure and their coevolution is not well known. Using an individual-based model, we modeled a community of several species that interact antagonistically. The trait of each individual is modelled explicitly and subjected to the interaction pressure. Besides, each consumer can actively choose to interact with resources that maximize its fitness. We show that active consumer choice can generate coevolutionary units, that is, the modules are formed by coevolution and stay stable over time. Besides, inside each module resource traits converge which promotes attack dilution: when resources converge their traits, the pool of options for a consumer increases and the chance of a specific individual being attacked decreases. We also observed that active consumer choice impacts network structure, with networks more modular and specialized and less connected and nested as the number of consumer choices increase. Thus, we emphasize that the consumers'ctive choice behaviour plays an important role in the ecological and evolutionary aprocesses that structure these communities.

How do people choose to be informed? A survey of the information searched for in the choice of primary care provider in Sweden

Background To stimulate quality through choice of provider, patients need to seek and base their decisions on both relevant and reliable information describing providers’ clinical quality. The purpose of this study was first to investigate what types of information and information sources patients turned to in the active choice of primary care provider. Second, it investigated whether a sub-group of patients considered more likely to actively seek information, also sought more advanced information about the clinical quality of providers. Methods Data collection was performed through a web-based survey to the general adult (18+) Swedish population, for a net sample of 3150 respondents. Descriptive statistics were used to study what types of information and information sources respondents used prior to their choice. Multiple regression analysis was employed to examine predictors for seeking relevant and reliable information describing providers’ clinical quality. Results Patients in active choice situations searched for a median of four information types and used a median of one information source. The information searched for was primarily basic information, for instance, how to switch providers and their geographical location. Information sources used were mainly partisan sources, such as providers themselves, and family and acquaintances. The sub-group of individuals more likely to seek information were not found to seek more advanced forms of information. Conclusions Not even the patients considered most likely to seek information prior to their choice of primary care provider, searched for information deemed necessary to make well-informed choices. Thus, patients did not act according to the theoretical assumptions underlying the patient choice reforms, i.e., making informed choices based on clinical quality in order to promote the best providers over inferior ones. The results call for governments and health care authorities to actively assess and develop primary care providers’ clinical quality by means other than patient choice.

Nudging healthcare professionals in clinical settings: a scoping review of the literature

Background Healthcare organisations are in constant need of improvement and change. Nudging has been proposed as a strategy to affect people’s choices and has been used to affect patients’ behaviour in healthcare settings. However, little is known about how nudging is being interpreted and applied to change the behaviour of healthcare professionals (HCPs). The objective of this review is to identify interventions using nudge theory to affect the behaviour of HCPs in clinical settings. Methods A scoping review. We searched PubMed and PsycINFO for articles published from 2010 to September 2019, including terms related to “nudging” in the title or abstract. Two reviewers screened articles for inclusion based on whether the articles described an intervention to change the behaviour of HCPs. Two reviewers extracted key information and categorized included articles. Descriptive analyses were performed on the data. Results Search results yielded 997 unique articles, of which 25 articles satisfied the inclusion criteria. Five additional articles were selected from the reference lists of the included articles. We identified 11 nudging strategies: accountable justification, goal setting, suggested alternatives, feedback, information transparency, peer comparison, active choice, alerts and reminders, environmental cueing/priming, defaults/pre-orders, and education. These strategies were employed to affect the following 4 target behaviours: vaccination of staff, hand hygiene, clinical procedures, prescriptions and orders. To compare approaches across so many areas, we introduced two independent dimensions to describe nudging strategies: synchronous/asynchronous, and active/passive. Conclusion There are relatively few studies published referring to nudge theory aimed at changing HCP behaviour in clinical settings. These studies reflect a diverse set of objectives and implement nudging strategies in a variety of ways. We suggest distinguishing active from passive nudging strategies. Passive nudging strategies may achieve the desired outcome but go unnoticed by the clinician thereby not really changing a behaviour and raising ethical concerns. Our review indicates that there are successful active strategies that engage with clinicians in a more deliberate way. However, more research is needed on how different nudging strategies impact HCP behaviour in the short and long term to improve clinical decision making.