Commitment Devices to Improve Unhealthy Behaviors—Reply

In Reply Our Viewpoint described commitment devices and argued that they should be more widely used in health care. Commitment devices enforce voluntarily imposed restrictions on people until they have accomplished their goals or enforce voluntarily imposed penalties if they do not accomplish their goals

Commitment Devices: Using Initiatives to Change Behavior

Unhealthy behaviors are responsible for a large proportion of health care costs and poor health outcomes.1 Surveys of large employers regularly identify unhealthy behaviors as the most important challenge to affordable benefits coverage. For this reason, employers increasingly leverage incentives to encourage changes in employees’ health-related behaviors. According to one survey, 81% of large employers provide incentives for healthy behavior change.2 In this Viewpoint, we discuss the potential and limitations of an approach that behavioral science research has shown can be used to influence health behaviors but that is distinct from incentives: the use of commitment devices (Table).

Holding the Hunger Games Hostage at the Gym: An Evaluation of Temptation Bundling

We introduce and evaluate the effectiveness of temptation bundling—a method for simultaneously tackling two types of self-control problems by harnessing consumption complementarities. We describe a field experiment measuring the impact of bundling instantly gratifying but guilt-inducing “want” experiences (enjoying page-turner audiobooks) with valuable “should” behaviors providing delayed rewards (exercising). We explore whether such bundles increase should behaviors and whether people would pay to create these restrictive bundles. Participants were randomly assigned to a full treatment condition with gym-only access to tempting audio novels, an intermediate treatment involving encouragement to restrict audiobook enjoyment to the gym, or a control condition. Initially, full and intermediate treatment participants visited the gym 51% and 29% more frequently, respectively, than control participants, but treatment effects declined over time (particularly following Thanksgiving). After the study, 61% of participants opted to pay to have gym-only access to iPods containing tempting audiobooks, suggesting demand for this commitment device

Non–housestaff medicine services in academic centers: Models and challenges

Non–housestaff medicine services are growing rapidly in academic medical centers (AMCs), partly driven by efforts to comply with resident duty hour restrictions. Hospitalists have emerged as a solution to providing these services given their commitment to delivering efficient and high-quality care and the field's rapid growth. However, limited evidence is available on designing these services, including the similarities and differences of existing ones. We describe non–housestaff medicine services at 5 AMCs in order to share our experiences and outline important considerations in service development. We discuss common challenges in building and sustaining these models along with local institutional factors that affect decision making. Keys to success include ensuring an equitable system for scheduling and staffing, fostering opportunities for scholarly activities and academic promotion (defining the “academic hospitalist”), and providing compensation that supports recruitment and retention of hospitalists. With further work hour restrictions expected in the future and increased requests for surgical comanagement, the relationship between AMCs and hospitalists will continue to evolve. To succeed in developing hospitalist faculty who follow long careers in hospital medicine, academic leadership must carefully plan for and evaluate the methods of providing these clinical services while expanding on our academic mission. Journal of Hospital Medicine 2008;3:247–255. © 2008 Society of Hospital Medicine.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/60235/1/311_ftp.pd

Court Cases, Cultural Expertise and ´Female Genital Mutilation' in Europe

This chapter discusses adjudication, expertise, and cultural difference as it appears in criminal court cases concerning female genital cutting (FGM) in the EU, as reported in a 2015 comparative overview. It begins with the distinction between typical and atypical FGM cases; a distinction that connects court cases to the cultural realities of the practicing communities, suggesting that the lack of cultural knowledge can cause unnecessary suffering to families and/or individuals who wrongly undergo prosecution in alleged FGM cases. A contrario, the intervention of experts in FGM court cases could be a positive approach to assessing the legitimacy of public intervention in certain cases

A moral panic? The problematization of forced marriage in British newspapers

This paper examines the British media’s construction of forced marriage as an urgent social problem in a context where other forms of violence against women are not similarly problematised. A detailed analysis of four British newspapers over a ten-year period demonstrates that media reporting of forced marriage constitutes a moral panic in that it is constructed as a cultural problem that threatens Britain’s social order rather than as a specific form of violence against women. Thus, the current problematisation of forced marriage restricts discursive spaces for policy debates and hinders attempts to respond to this problem as part of broader efforts to tackle violence against women

High workload and job stress are associated with lower practice performance in general practice: an observational study in 239 general practices in the Netherlands

Contains fulltext : 80493.pdf (publisher's version ) (Open Access)BACKGROUND: The impact of high physician workload and job stress on quality and outcomes of healthcare delivery is not clear. Our study explored whether high workload and job stress were associated with lower performance in general practices in the Netherlands. METHODS: Secondary analysis of data from 239 general practices, collected in practice visits between 2003 to 2006 in the Netherlands using a comprehensive set of measures of practice management. Data were collected by a practice visitor, a trained non-physician observer using patients questionnaires, doctors and staff. For this study we selected five measures of practice performance as outcomes and six measures of GP workload and job stress as predictors. A total of 79 indicators were used out of the 303 available indicators. Random coefficient regression models were applied to examine associations. RESULTS AND DISCUSSION: Workload and job stress are associated with practice performance.Workload: Working more hours as a GP was associated with more positive patient experiences of accessibility and availability (b = 0.16). After list size adjustment, practices with more GP-time per patient scored higher on GP care (b = 0.45). When GPs provided more than 20 hours per week per 1000 patients, patients scored over 80% on the Europep questionnaire for quality of GP care.Job stress: High GP job stress was associated with lower accessibility and availability (b = 0.21) and insufficient practice management (b = 0.25). Higher GP commitment and more satisfaction with the job was associated with more prevention and disease management (b = 0.35). CONCLUSION: Providing more time in the practice, and more time per patient and experiencing less job stress are all associated with perceptions by patients of better care and better practice performance. Workload and job stress should be assessed by using list size adjusted data in order to realise better quality of care. Organisational development using this kind of data feedback could benefit both patients and GP