Decision-making competence in later adulthood is affected by declines in cognitive skills, and age-related changes in affect and experience can sometimes compensate. However, recent findings suggest that age-related changes in motivation also affect the extent to which adults draw from experience, affect, and deliberative skills when making decisions. To date, relatively little attention has been given to strategies for addressing age-related changes in motivation to promote better decisions in older adults. To address this limitation, we draw from diverse literatures to (...) suggest promising intervention strategies for motivating older recipients’ motivation to make better decisions. We start by reviewing the life-span developmental literature, which suggests that older adults’ motivation to put effort into decisions depends on the perceived personal relevance of decisions as well as their self-efficacy (i.e., confidence in applying their ability and knowledge). Next, we discuss two approaches from the health intervention design literature, the mental models approach and the patient activation approach, which aim to improve motivation for decision making by improving personal relevance or by building self-efficacy or confidence to use new information and skills. Using examples from these literatures, we discuss how to construct interventions to motivate good decisions in later adulthood. (shrink)

Background. To inform their health decisions, patients may seek narratives describing other patients' evaluations of their treatment experiences. Narratives can provide anti-treatment or pro-treatment evaluative meaning that low-numerate patients may especially struggle to derive from statistical information. Here, we examined whether anti-vaccine narratives had relatively stronger effects on the perceived informativeness and judged vaccination probabilities reported among recipients with lower numeracy. Methods. Participants from a nationally representative US internet panel were randomly assigned to an anti-vaccine or pro-vaccine narrative, as presented (...) by a patient discussing a personal experience, a physician discussing a patient's experience, or a physician discussing the experiences of 50 patients. Anti-vaccine narratives described flu experiences of patients who got the flu after getting vaccinated; pro-vaccine narratives described flu experiences of patients who got the flu after not getting vaccinated. Participants indicated their probability of getting vaccinated and rated the informativeness of the narratives. Results. Participants with lower numeracy generally perceived narratives as more informative. By comparison, participants with higher numeracy rated especially anti-vaccine narratives as less informative. Anti-vaccine narratives reduced the judged vaccination probabilities as compared with pro-vaccine narratives, especially among participants with lower numeracy. Mediation analyses suggested that low-numerate individuals' vaccination probabilities were reduced by anti-vaccine narratives - and, to a lesser extent, boosted by pro-vaccine narratives - because they perceived narratives to be more informative. These findings were similar for narratives provided by patients and physicians. Conclusions. Patients with lower numeracy may rely more on narrative information when making their decisions. These findings have implications for the development of health communications and decision AIDS. (shrink)

This article illustrates how a collaborative research process can successfully engage an underserved minority community to address health disparities. Pacific Islanders, including the Marshallese, are one of the fastest growing US populations. They face significant health disparities, including extremely high rates of type 2 diabetes. This article describes the engagement process of designing patient‐centered outcomes research with Marshallese stakeholders, highlighting the specific influences of their input on a randomized control trial to address diabetes. Over 18 months, an interdisciplinary research team (...) used community‐based participatory principles to conduct patient‐engaged outcomes research that involved 31 stakeholders in all aspects of research design, from defining the research question to making decisions about budgets and staffing. This required academic researcher flexibility, but yielded a design linking scientific methodology with community wisdom. (shrink)

This work is descriptive observational, with transversal design, was to analyze the time of motor commitment in Physical Education classes in three subsystems of Venezuelan education. The analysis unit consisted of a discretionary sample of 6 Physical Education classes between initial education, basic education and secondary education, at the rate of 2 classes for each subsystem. The number of students participating was 192. For the observation and registration, was used, the temporal variables were recorded, and in the second instance, the (...) classes were recorded considering variables associated with: organization of groups, activities, disposition of materials, use and distribution of physical space. The results confirm the little use of the Physical Education class to favor the motor development; none of the observed classes managed to accumulate 50% of the time of motor commitment, thus confirming the trend of other investigations. (shrink)

Central to Nozick’s Anarchy, State and Utopia is a defense of the legitimacy of the minimal state’s use of coercion against anarchist objections. Individuals acting within their natural rights can establish the state without committing wrongdoing against those who disagree. Nozick attempts to show that even with a natural executive right, individuals need not actually consent to incur political obligations. Nozick’s argument relies on an account of compensation to remedy the infringement of the non-consenters’ procedural rights. Compensation, however, cannot remedy (...) the infringement, for either it is superfluous to Nozick’s account of procedural rights, or it is made to play a role inconsistent with Nozick’s liberal voluntarist commitments. Nevertheless, Nozick’s account of procedural rights contains clues for how to solve the problem. Since procedural rights are incompatible with a natural executive right, Nozickeans can argue that only the state can enforce individuals’ rights without wronging anyone, thus refuting the anarchist. Thanks to Annette Dufner, Arnt Myrstad, Arthur Ripstein, Gopal Sreenivasan, James Sterba, Chloe Taylor, Sergio Tenenbaum, and Shelley Weinberg. Thanks also to Matt Zwolinski and Jonelle DePetro, who commented on earlier versions of the paper at the Central APA 2007 and at the 2006 Illinois Philosophical Association Conference (respectively). Finally, thanks to my graduate students at the University of Illinois at Urbana-Champaign for their active engagement with the ideas during a seminar on liberal theories of justice (fall 2007). (shrink)