Exploring the relationship between media coverage and participation in entrepreneurship : initial global evidence and research implications

Using a set of variables measured in the Global Entrepreneurship Monitor (GEM) study, our empirical investigation explored the influence of mass media through national culture on national entrepreneurial participation rates in 37 countries over 4 years (2000 to 2003). We found that stories about successful entrepreneurs, conveyed in mass media, were not significantly associated with the rate of nascent (opportunity searching) or the rate of actual (business activities commenced up to 3 months old) start-up activity, but that there was a significant positive association between the volume of entrepreneurship media stories and a nation&rsquo;s volume of people running a young business (that is in GEM terminology, a business aged greater than 3 but less than 42 months old). More particularly, such stories had strong positive association with opportunity oriented operators of young businesses. Together, these findings are compatible with what in the mass communications theory literature may be called the &lsquo;reinforcement model&rsquo;. This argues that mass media are only capable of reinforcing their audience&rsquo;s existing values and choice propensities but are not capable of shaping or changing those values and choices. In the area covered by this paper, policy-makers are committing public resources to media campaigns of doubtful utility in the absence of an evidence base. A main implication drawn from this study is the need for further and more sophisticated investigation into the relationship between media coverage of entrepreneurship, national culture and the rates and nature of people&rsquo;s participation in the various stages of the entrepreneurial process.<br /

Estimation of a Canadian preference-based scoring algorithm for the Veterans RAND 12-item Health Survey (VR-12): a population survey using a discrete choice experiment

Background: The Veterans RAND 12-item Health Survey (VR-12) is a generic patient-reported outcome measure derived from the widely used SF-36 and SF-12 instruments. The objective of this study was to estimate a Canadian preference-based scoring algorithm for the VR-12, enabling the derivation of health utility values for generating quality-adjusted life years (QALYs). Methods: A discrete choice experiment (DCE) was conducted in a sample of the Canadian population between January and February 2019. Participants—recruited from a consumer research panel—completed an online survey, in English or French, that included 11 DCE questions, each comprising two health profiles. Health profiles were defined using eight VR-12 items and a duration attribute. Using conditional logit regressions, where each level of the respective VR-12 items was interacted with duration, the coefficients were used to estimate health utility values interpretable on a zero (dead) to one (full health) scale. Negative values reflect states considered worse than dead. Results: The survey was completed by 3380 individuals. Across all models, ‘feel downhearted and blue all of the time’ and ‘pain interferes with your normal work extremely’ were associated with the largest health utility decrements. Excluding respondents who provided inconsistent responses (20.3%) had a negligible impact on the results. The recommended model, weighted to match population demographics, has health utility values ranging from -0.589 to 1.000. Interpretation: Health utility values that reflect the preferences of the Canadian population can now be derived from responses to the VR-12. These values can be used to generate QALYs in future analyses

Are We Improving? Update and Critical Appraisal of the Reporting of Decision Process and Quality Measures in Trials Evaluating Patient Decision Aids

BACKGROUND: In 2014, a systematic review found large gaps in the quality of reporting of measures used in 86 published trials evaluating the effectiveness of patient decision aids (PtDAs). The purpose of this study was to update that review. METHODS: We examined measures of decision making used in 49 randomized controlled trials included in the 2014 and 2017 Cochrane Collaboration systematic review of PtDAs. Data on development of the measures, reliability, validity, responsiveness, precision, interpretability, feasibility, and acceptability were independently abstracted by 2 paired reviewers. RESULTS: Information from 273 measures was abstracted, and 109 of these covered the core domains of decision processes (n = 55) and decision quality including informed choice/knowledge (n = 48) and values-choice concordance (n = 12). Very few studies reported data on the performance and clinical sensibility of measures, with reliability (23%) and validity (6%) being the most common. Studies using new measures were less likely to include information about their psychometric performance compared with previously published measures. LIMITATIONS: The review was limited to reporting of measures in studies included in the Cochrane review and did not consult prior publications. CONCLUSION: There continues to be very little reported about the development or performance of measures used to evaluate the effectiveness of PtDAs in published trials. Minimum reporting standards have been published, and efforts to require investigators to use them are needed

Decision aids for people facing health treatment or screening decisions

Copyright \ua9 2024 The Cochrane Collaboration. Published by John Wiley &amp; Sons, Ltd.Background: Patient decision aids are interventions designed to support people making health decisions. At a minimum, patient decision aids make the decision explicit, provide evidence-based information about the options and associated benefits/harms, and help clarify personal values for features of options. This is an update of a Cochrane review that was first published in 2003 and last updated in 2017. Objectives: To assess the effects of patient decision aids in adults considering treatment or screening decisions using an integrated knowledge translation approach. Search methods: We conducted the updated search for the period of 2015 (last search date) to March 2022 in CENTRAL, MEDLINE, Embase, PsycINFO, EBSCO, and grey literature. The cumulative search covers database origins to March 2022. Selection criteria: We included published randomized controlled trials comparing patient decision aids to usual care. Usual care was defined as general information, risk assessment, clinical practice guideline summaries for health consumers, placebo intervention (e.g. information on another topic), or no intervention. Data collection and analysis: Two authors independently screened citations for inclusion, extracted intervention and outcome data, and assessed risk of bias using the Cochrane risk of bias tool. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made (informed values-based choice congruence) and the decision-making process, such as knowledge, accurate risk perceptions, feeling informed, clear values, participation in decision-making, and adverse events. Secondary outcomes were choice, confidence in decision-making, adherence to the chosen option, preference-linked health outcomes, and impact on the healthcare system (e.g. consultation length). We pooled results using mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs), applying a random-effects model. We conducted a subgroup analysis of 105 studies that were included in the previous review version compared to those published since that update (n = 104 studies). We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the certainty of the evidence. Main results: This update added 104 new studies for a total of 209 studies involving 107,698 participants. The patient decision aids focused on 71 different decisions. The most common decisions were about cardiovascular treatments (n = 22 studies), cancer screening (n = 17 studies colorectal, 15 prostate, 12 breast), cancer treatments (e.g. 15 breast, 11 prostate), mental health treatments (n = 10 studies), and joint replacement surgery (n = 9 studies). When assessing risk of bias in the included studies, we rated two items as mostly unclear (selective reporting: 100 studies; blinding of participants/personnel: 161 studies), due to inadequate reporting. Of the 209 included studies, 34 had at least one item rated as high risk of bias. There was moderate-certainty evidence that patient decision aids probably increase the congruence between informed values and care choices compared to usual care (RR 1.75, 95% CI 1.44 to 2.13; 21 studies, 9377 participants). Regarding attributes related to the decision-making process and compared to usual care, there was high-certainty evidence that patient decision aids result in improved participants\u27 knowledge (MD 11.90/100, 95% CI 10.60 to 13.19; 107 studies, 25,492 participants), accuracy of risk perceptions (RR 1.94, 95% CI 1.61 to 2.34; 25 studies, 7796 participants), and decreased decisional conflict related to feeling uninformed (MD -10.02, 95% CI -12.31 to -7.74; 58 studies, 12,104 participants), indecision about personal values (MD -7.86, 95% CI -9.69 to -6.02; 55 studies, 11,880 participants), and proportion of people who were passive in decision-making (clinician-controlled) (RR 0.72, 95% CI 0.59 to 0.88; 21 studies, 4348 participants). For adverse outcomes, there was high-certainty evidence that there was no difference in decision regret between the patient decision aid and usual care groups (MD -1.23, 95% CI -3.05 to 0.59; 22 studies, 3707 participants). Of note, there was no difference in the length of consultation when patient decision aids were used in preparation for the consultation (MD -2.97 minutes, 95% CI -7.84 to 1.90; 5 studies, 420 participants). When patient decision aids were used during the consultation with the clinician, the length of consultation was 1.5 minutes longer (MD 1.50 minutes, 95% CI 0.79 to 2.20; 8 studies, 2702 participants). We found the same direction of effect when we compared results for patient decision aid studies reported in the previous update compared to studies conducted since 2015. Authors\u27 conclusions: Compared to usual care, across a wide variety of decisions, patient decision aids probably helped more adults reach informed values-congruent choices. They led to large increases in knowledge, accurate risk perceptions, and an active role in decision-making. Our updated review also found that patient decision aids increased patients’ feeling informed and clear about their personal values. There was no difference in decision regret between people using decision aids versus those receiving usual care. Further studies are needed to assess the impact of patient decision aids on adherence and downstream effects on cost and resource use