Is providing choices always a good thing? the backfire effect of providing choices on competence restoration

Grounded in self-determination theory (SDT), the purpose of this research is to investigate the influence of providing choices following competence frustration on one's intrinsic motivation in a follow-up task. Study 1 conducted a between-group EEG experiment with 50 participants and used a component of event-related potentials (ERPs) to represent intrinsic motivation. Study 2 was a behavioural experiment with 149 participants, adopting the self-report method to measure intrinsic motivation. The stimuli and procedure in Study 1 are identical to Study 2. All participants were asked to complete a high-difficult time-estimation (TE) task during sessions 1-2, and a moderate-difficult stopwatch (SW) task during session 3 (no choices in the control group vs. providing choices in the experimental group). In Study 1, we observed a smaller reward positivity (RewP) difference wave in the experimental (vs. control) group during session 3. In Study 2, participants' intrinsic motivation in the experimental (vs. control) group is significantly lower. The results suggest that providing choices impairs the competence-frustrated participants' intrinsic motivation in the follow-up task and hinders competence restoration. Thus, the current research contributes original neuroscientific and subjective evidences for the adverse influence of providing choices on the competence-frustrated individual's intrinsic motivation, and suggests important practical implications.

"I wasn't sure it would work. I was just trying": an ethnographic study on the choice of abortion methods among young women in Kilifi County, Kenya, and Atlantique Department, Benin

BACKGROUND

Despite the increased availability of safe abortion methods in sub-Saharan Africa, women and girls continue to use unsafe abortion methods and procedures to terminate their unwanted pregnancies, resulting in severe complications, lifelong disabilities, and death. Barriers to safe abortion methods include restrictive laws, low awareness of safe abortion methods, poverty, and sociocultural and health system barriers. Nonetheless, there is a paucity of data on the decision-making around and use of abortion methods. This paper aims to provide answers to the following questions: Which abortion methods do women and girls use and why? Who and what influences their decisions? What can we learn from their decision-making process to enhance the uptake of safe abortion methods? We focus our in-depth analysis on the rationale behind the choice of abortion methods used by women and girls in Kilifi County in Kenya and Atlantique Department in Benin.

METHODS

We draw on data collected as part of an ethnographic study conducted between January and August 2021 on lived experiences, social determinants, and pathways to abortion. Data were collected using repeated in-depth interviews with 95 girls and women who had a recent abortion experience. Data from the interviews were supplemented using information from key informant interviews, focus group discussions, and participant observation. Data analysis was conducted through an inductive process.

RESULTS

Our findings reveal that women and girls use various methods to procure abortions, including herbs, high doses of pharmaceutical drugs, homemade concoctions, medical abortion drugs, and surgical abortion methods. Procedures may involve singular or multiple attempts, and sometimes, mixing several methods to achieve the goal of pregnancy termination. The use of various abortion methods is mainly driven by the pursuit of social safety (preservation of secrecy and social relationships, avoidance of shame and stigmatization) instead of medical safety (which implies technical safety and quality).

CONCLUSION

Our findings reaffirm the need for comprehensive access to, and availability of, abortion-related information and services, especially safe abortion and post-abortion care services that emphasize both medical and social safety.

Childbearing, abortion and regret: a response to Kate Greasley

Is moral or other regret for abortion an indicator that abortion may not be morally or prudentially choice worthy? This paper examines the work of Kate Greasley in this area, who offers an explanation of any asymmetry in openness to regret between women who have abortions and women who give birth. The latter, not unlike Derek Parfit's 14-year-old who conceives deliberately, may feel duty-bound not to regret their decision (in their case, to continue their pregnancy) and to affirm the life of their child. In response to Greasley, testimonial evidence of one group cannot be dismissed simply because regret may be less available to another group of decision-makers. Moreover, if moral regret for childbearing is uncommon, this is not because mothers have a moral duty, as Greasley argues, not to regret even a morally mistaken choice to conceive. On the contrary, one must separate the evaluation of choices and of the results of these choices, whether positive or negative. Regret, while not infallible, can elucidate values at stake in choices, and testimonial evidence in the form of regret should be taken more seriously in regard to certain kinds of choice.

Managing food-ecosystem synergies to sustain water resource systems

Measures implemented to restore ecosystem services are widely believed to conflict with food production in the world's irrigated regions because of their competition for scarce water. However, little integrated analysis has been conducted to test this hypothesis. This work tests that hypothesis by presenting results of a basin-scale hydroeconomic analysis linking biophysical, hydrologic, agronomic, ecological, economic, policy, and institutional dimensions of the partially-restored Mesopotamian Marshes of Western Asia. Results serve to partly reject the hypothesis: Here we find that an economically-optimized ecosystem restoration trajectory can be achieved with a minimal loss in food production or farm income where restored wetlands complement important dimensions of food production. Moreover, we find that where water shortage sharing rules can be made more flexible, ecosystem restoration more nearly complements improved food security. Our results point to previously unexplored synergies among food production, ecosystem restoration, and water laws in arid and semi-arid regions internationally.

Whose decision? Caesarean section and women with physical disabilities in Northern Vietnam: A qualitative study

BACKGROUND

Pregnant women with physical disabilities are more likely to have caesarean sections than are women without disabilities. For some women with disabilities, caesarean birth may not be clinically necessary, as they may lack autonomy in decision-making to a greater extent than is the case for other pregnant women.

OBJECTIVE

To explore the relative influence of health staff, family, friends, and the women themselves on key decisions about childbirth of women with physical disabilities in northern Vietnam.

RESEARCH DESIGN/SETTING

A qualitative approach using a phenomenological design was employed. Fifty-six in-depth interviews were conducted with women with physical disabilities who had given birth in the previous three years in two northern provinces in Vietnam (Hanoi and Thaibinh). Twenty-nine women participated in a first interview and 27 completed follow-up interviews several months later. Additionally, semi-structured interviews were conducted with 12 maternal healthcare providers. Interviews were transcribed and thematically analysed.

RESULTS

Twenty-eight of the 29 participants underwent caesarean sections. Two themes were identified: (1) The women reported that caesarean section was mandated by attending doctors "because of their disability". Consistently, the healthcare providers said caesarean section is essential for women with physical disabilities; and (2) The women said that their parents and peers supported caesarean birth. Very few women indicated that they could influence this decision, even though one-third said their personal preference was for vaginal birth.

CONCLUSIONS

Many women with physical disabilities are not given the opportunity to exercise informed choices around childbirth options. Women in Vietnam who live with physical disabilities should be empowered to make informed decisions about childbirth. It is recommended that professional guidelines and training are revised to properly engage women with physical disabilities in joint decision-making for the birth of their children.

Auditory decisions in the supplementary motor area

In human speech and communication across various species, recognizing and categorizing sounds is fundamental for the selection of appropriate behaviors. However, how does the brain decide which action to perform based on sounds? We explored whether the supplementary motor area (SMA), responsible for linking sensory information to motor programs, also accounts for auditory-driven decision making. To this end, we trained two rhesus monkeys to discriminate between numerous naturalistic sounds and words learned as target (T) or non-target (nT) categories. We found that the SMA at single and population neuronal levels perform decision-related computations that transition from auditory to movement representations in this task. Moreover, we demonstrated that the neural population is organized orthogonally during the auditory and the movement periods, implying that the SMA performs different computations. In conclusion, our results suggest that the SMA integrates acoustic information in order to form categorical signals that drive behavior.

Faculty's attitudes and perceptions related to applying motivational principles to their teaching: a mixed methods study

BACKGROUND

It is uncommon for faculty development professionals to assess faculty attitudes towards their teaching responsibilities and their perceived obstacles to teaching effectiveness. The purposes of this study were (a) to document faculty attitudes and practices related to applying motivation principles, and (b) to identify the perceived contextual factors that may shape these attitudes and practices.

METHODS

A sequential explanatory mixed methods design was used. Faculty members (n = 272; 32% response rate) were surveyed about their responsibility for and application of the five motivational principles that are part of the MUSIC Model of Motivation: eMpowerment, Usefulness, Success, Interest, and Caring. Repeated measures ANOVAs and Student's t-tests were computed to detect differences. Subsequently, two focus groups of faculty members (n = 11) interpreted the survey results. We conducted a thematic analysis and used the focus group results to explain the survey results.

RESULTS

Faculty rated their responsibilities for applying principles related to Usefulness, Interest, and Caring significantly higher than they did for Success and eMpowerment. Most faculty also reported that they actually applied Usefulness, Interest, and Caring strategies within the past year, whereas over half of the faculty applied Success strategies and about a third of faculty applied eMpowerment strategies. Focus group participants identified factors that affected their ability to apply eMpowerment strategies, (e.g., offering choices), including students lacking generic skills (e.g., critical thinking, problem-solving), a lack of confidence in their abilities to implement empowering strategies and meet the needs of students, passive students, and large lecture-type courses. Focus group participants cited obstacles to implementing Success strategies (e.g., providing feedback), including difficulty in providing feedback in large courses, lacking time and assistant teachers, limited knowledge of technologies, and lacking skills related to guiding effective student peer feedback.

CONCLUSIONS

Faculty appear adequately prepared to implement some types of motivational strategies, but not others, in part due to contextual factors that can influence their attitudes and, ultimately, their application of these strategies. We discuss how these factors affect attitudes and application of motivational strategies and formulate suggestions based on the results.

Preferences for breast cancer prevention among women with a BRCA1 or BRCA2 mutation

Background

Women with a BRCA1 or BRCA2 mutation have high lifetime risks of developing breast and ovarian cancer. The decision to embark on risk reduction strategies is a difficult and personal one. We surveyed an international group of women with BRCA mutations and measured choices and sequence of breast cancer risk reduction strategies.

Methods

Women with a BRCA1/2 mutation and no previous cancer diagnosis were recruited from the US, Canada, the UK, Australia, and from a national advocacy group. Using an online survey, we asked about cancer-risk reduction preferences including for one of two hypothetical medicines, randomly assigned, and women’s recommendations for a hypothetical woman (Susan, either a 25- or 36-year-old). Sunburst diagrams were generated to illustrate hierarchy of choices.

Results

Among 598 respondents, mean age was 40.9 years (range 25–55 years). Timing of the survey was 4.8 years (mean) after learning their positive test result and 33% had risk-reducing bilateral salpingo-oophorectomy (RRBSO) and bilateral mastectomy (RRBM), while 19% had RRBSO only and 16% had RRBM only. Although 30% said they would take a hypothetical medicine, 6% reported taking a medicine resembling tamoxifen. Respondents were 1.5 times more likely to select a hypothetical medicine for risk reduction when Susan was 25 than when Susan was 36. Women assigned to 36-year-old Susan were more likely to choose a medicine if they had a family member diagnosed with breast cancer and personal experience taking tamoxifen.

Conclusions

Women revealed a willingness to undergo surgeries to achieve largest reduction in breast cancer risk, although this would not be recommended for a younger woman in her 20s. The goal of achieving the highest degree of cancer risk reduction is the primary driver for women with BRCA1 or BRCA2 mutations in selecting an intervention and a sequence of interventions, regardless of whether it is non-surgical or surgical.

Caring for women making unconventional birth choices: A meta-ethnography exploring the views, attitudes, and experiences of midwives

INTRODUCTION

Women can face opposition when exerting autonomous decision-making regarding their birth choices, particularly when the decisions involve going against medical advice and/or outside of national guidelines. Termed 'unconventional birth choices', some research has explored women's reasons and experiences of making such choices, but less is known about the midwives caring for them.

OBJECTIVES

To synthesize existing qualitative literature on the views, attitudes, and experiences of midwives caring for women who make unconventional birth choices.

METHODS

A systematic search and meta-ethnography informed by Noblit and Hare and Schutz was undertaken. Eight databases were searched using predetermined search terms, alongside author, reference, citation chasing, and hand searching. Searches were conducted in July 2016 and updated in October 2017. Qualitative studies published since 1993 in English were included. Included studies were subjected to quality appraisal, conducted independently by two reviewers. Analysis was informed by the interpretative meta-ethnography methods.

MAIN RESULTS

Five studies met the inclusion criteria. Eight subthemes emerged. These resulted in three higher level interpretative themes emerged: perceptions of women's decision making, conflicting tensions as caregivers, ways of working with-woman.

CONCLUSIONS

Midwives can play a pivotal role in ensuring that respectful maternity care includes supporting women in their birthing decisions. Whilst limited research has been undertaken in this area, available insights suggest that midwives' views in this area are situated along a spectrum from 'willingly facilitative' to 'reluctantly accepting'. Views were influenced by context, as well as prior philosophies and values. While further research is needed, this study offers insights into the challenges women can face in seeking unconventional birth choices if they require support from midwives to do so.

What influences birth place preferences, choices and decision-making amongst healthy women with straightforward pregnancies in the UK? A qualitative evidence synthesis using a 'best fit' framework approach

BACKGROUND

English maternity care policy has supported offering women choice of birth setting for over twenty years, but only 13% of women in England currently give birth in settings other than obstetric units (OUs). It is unclear why uptake of non-OU settings for birth remains relatively low. This paper presents a synthesis of qualitative evidence which explores influences on women's experiences of birth place choice, preference and decision-making from the perspectives of women using maternity services.

METHODS

Qualitative evidence synthesis of UK research published January 1992-March 2015, using a 'best-fit' framework approach. Searches were run in seven electronic data bases applying a comprehensive search strategy. Thematic framework analysis was used to synthesise extracted data from included studies.

RESULTS

Twenty-four papers drawing on twenty studies met the inclusion criteria. The synthesis identified support for the key framework themes. Women's experiences of choosing or deciding where to give birth were influenced by whether they received information about available options and about the right to choose, women's preferences for different services and their attributes, previous birth experiences, views of family, friends and health care professionals and women's beliefs about risk and safety. The synthesis additionally identified that women's access to choice of place of birth during the antenatal period varied. Planning to give birth in OU was straightforward, but although women considering birth in a setting other than hospital OU were sometimes well-supported, they also encountered obstacles and described needing to 'counter the negativity' surrounding home birth or birth in midwife-led settings.

CONCLUSIONS

Over the period covered by the review, it was straightforward for low risk women to opt for hospital birth in the UK. Accessing home birth was more complex and contested. The evidence on freestanding midwifery units (FMUs) is more limited, but suggests that women wanting to opt for an FMU birth experienced similar barriers. The extent to which women experienced similar problems accessing alongside midwifery units (AMUs) is unclear. Women's preferences for different birth options, particularly for 'hospital' vs non-hospital settings, are shaped by their pre-existing values, beliefs and experience, and not all women are open to all birth settings.

Transitioning Care Across Various Health Care Organizations

Health care is continuously undergoing evolutionary changes. These changes have been very dramatic for the end users. Instead of simple physician office visits and lengthy hospital stays, we are now faced with short hospital stays, office visits to different specialty providers, and an array of choices around them. With the present highway of choices between illness and wellness, it is important for transitions between these two to be affordable, advantageous to patients, and uncomplicated. This article discusses the choices patients and health care providers must make as the number of care options increase along with the risks and benefits.

Changing choices: disabled and chronically ill people's experiences of reconsidering choices

OBJECTIVES

To increase understanding of disabled and chronically ill people's experiences of revisiting choices by considering events that prompted people to reconsider choices; what factors motivated them to act upon these events and what factors affected their experiences of revisiting choices.

METHODS

A sub-sample of 20 disabled and chronically ill people who took part in a qualitative, longitudinal study exploring choice-making in the context of changing circumstances. Each person was interviewed three times. Analysis focussed on choices that people had been prompted to revisit.

RESULTS

Most choices were about health or social care and were revisited within a year due to: changes in health or social circumstances; poorer than expected outcomes; and external interventions. People were motivated to make changes by a desire to maintain independence and control, but perceived short-term costs of decision-making could act as a deterrent. Experiences of revisiting choices were affected by help from other people and emotional strength.

DISCUSSION

Making and revisiting choices is complex; people need support to engage with the continual cycle of choice-making. People who instigate revisions of their own accord may be particularly vulnerable to lack of support.