Conspiracy theories are ubiquitous when it comes to explaining political events and societal phenomena. Individuals differ not only in the degree to which they believe in specific conspiracy ...theories, but also in their general susceptibility to explanations based on such theories, that is, their conspiracy mentality. We present the Conspiracy Mentality Questionnaire (CMQ), an instrument designed to efficiently assess differences in the generic tendency to engage in conspiracist ideation within and across cultures. The CMQ is available in English, German, and Turkish. In four studies, we examined the CMQ's factorial structure, reliability, measurement equivalence across cultures, and its convergent, discriminant, and predictive validity. Analyses based on a cross-cultural sample (Study 1a; N = 7,766) supported the conceptualization of conspiracy mentality as a one-dimensional construct across the three language versions of the CMQ that is stable across time (Study 1b; N = 141). Multi-group confirmatory factor analysis demonstrated cross-cultural measurement equivalence of the CMQ items. The instrument could therefore be used to examine differences in conspiracy mentality between European, North American, and Middle Eastern cultures. In Studies 2-4 (total N = 476), we report (re-)analyses of three datasets demonstrating the validity of the CMQ in student and working population samples in the UK and Germany. First, attesting to its convergent validity, the CMQ was highly correlated with another measure of generic conspiracy belief. Second, the CMQ showed patterns of meaningful associations with personality measures (e.g., Big Five dimensions, schizotypy), other generalized political attitudes (e.g., social dominance orientation and right-wing authoritarianism), and further individual differences (e.g., paranormal belief, lack of socio-political control). Finally, the CMQ predicted beliefs in specific conspiracy theories over and above other individual difference measures.
Abstract
In lottery gambling, the common phenomenon of risk aversion shows up as preference of the option with the higher win probability, even if a riskier alternative offers a greater expected ...value. Because riskier choices would optimize profitability in such cases, the present study investigates the visual format, with which lotteries are conveyed, as potential instrument to modulate risk attitudes. Previous research has shown that enhanced attention to graphical compared to numerical
probabilities
can increase risk aversion, but evidence for the reverse effect — reduced risk aversion through a graphical display of
outcomes
— is sparse. We conducted three experiments, in which participants repeatedly selected one of two lotteries. Probabilities and outcomes were either presented numerically or in a graphical format that consisted of pie charts (Experiment 1) or icon arrays (Experiment 2 and 3). Further, expected values were either higher in the safer or in the riskier lottery, or they did not differ between the options. Despite a marked risk aversion in all experiments, our results show that presenting outcomes as graphs can reduce — albeit not eliminate — risk aversion (Experiment 3). Yet, not all formats prove suitable, and non-intuitive outcome graphs can even enhance risk aversion (Experiment 1). Joint analyses of choice proportions and response times (RTs) further uncovered that risk aversion leads to safe choices particularly in fast decisions. This pattern is expressed under graphical probabilities, whereas graphical outcomes can weaken the rapid dominance of risk aversion and the variability over RTs (Experiment 1 and 2). Together, our findings demonstrate the relevance of information format for risky decisions.
In this study, we examined participants' choice behavior in a sequential risk‐taking task. We were especially interested in the extent to which participants focus on the immediate next choice or ...consider the entire choice sequence. To do so, we inspected whether decisions were either based on conditional probabilities (e.g., being successful on the immediate next trial) or on conjunctive probabilities (of being successful several times in a row). The results of five experiments with a simplified nine‐card Columbia Card Task and a CPT‐model analysis show that participants' choice behavior can be described best by a mixture of the two probability types. Specifically, for their first choice, the participants relied on conditional probabilities, whereas subsequent choices were based on conjunctive probabilities. This strategy occurred across different start conditions in which more or less cards were already presented face up. Consequently, the proportion of risky choices was substantially higher when participants started from a state with some cards facing up, compared with when they arrived at that state starting from the very beginning. The results, alternative accounts, and implications are discussed.
Background: Changing addictive behavior is a complex process with high demands on motivation. The Transtheoretical Model of Behavior Change provides a theoretical framework for explaining and ...predicting behavioral change, although its predictive value for addiction is somewhat inconsistent.
Objective: The aim of the present study is to extend the Transtheoretical Model of Behavior Change by investigating not only treatment motivation but also the predictive value of the type of drinking-related treatment goal. Additional predictors, such as substance-related and sociodemographic variables, are also included in analyses seeking to predict return to drinking during relapse prevention treatment for alcohol use disorder.
Methods: In this observational study, 99 inpatients from a treatment center for alcohol use disorder were recruited. Treatment motivation was assessed in accordance with the Transtheoretical Model of Behavior Change, drinking-related treatment goal through a self-report questionnaire, and substance-related and sociodemographic variables via the clinic information system. Associations between the potential predictors and covariates were explored using stepwise logistic regression.
Results: During treatment, 42.6% of participants had at least one relapse. Scoring higher on the action dimension at admission (OR = 0.81, p = .04) and being employed (OR = 0.37, p = .02) were significant predictors of abstinence during treatment.
Conclusions: This study confirms that treatment motivation contributes to the prediction of treatment outcome, even when controlling for other variables. In future research, the underlying mechanisms of treatment motivation should be further explored.
Most models of risky decision making assume that all relevant information is taken into account (e.g., von Neumann and Morgenstern, 1944; Kahneman and Tversky, 1979). However, there are also some ...models supposing that only part of the information is considered (e.g., Brandstätter et al., 2006; Gigerenzer and Gaissmaier, 2011). To further investigate the amount of information that is usually used for decision making, and how the use depends on feedback, we conducted a series of three experiments in which participants choose between two lotteries and where no feedback, outcome feedback, and error feedback was provided, respectively. The results show that without feedback participants mostly chose the lottery with the higher winning probability, and largely ignored the potential gains. The same results occurred when the outcome of each decision was fed back. Only after presenting error feedback (i.e., signaling whether a choice was optimal or not), participants considered probabilities as well as gains, resulting in more optimal choices. We propose that outcome feedback was ineffective, because of its probabilistic and ambiguous nature. Participants improve information integration only if provided with a consistent and deterministic signal such as error feedback.
In lottery gambling, the common phenomenon of risk aversion shows up as preference of the option with the higher win probability, even if a riskier alternative offers a greater expected value. ...Because riskier choices would optimize profitability in such cases, the present study investigates the visual format, with which lotteries are conveyed, as potential instrument to modulate risk attitudes. Previous research has shown that enhanced attention to graphical compared to numerical probabilities can increase risk aversion, but evidence for the reverse effect — reduced risk aversion through a graphical display of outcomes — is sparse. We conducted three experiments, in which participants repeatedly selected one of two lotteries. Probabilities and outcomes were either presented numerically or in a graphical format that consisted of pie charts (Experiment 1) or icon arrays (Experiment 2 and 3). Further, expected values were either higher in the safer or in the riskier lottery, or they did not differ between the options. Despite a marked risk aversion in all experiments, our results show that presenting outcomes as graphs can reduce — albeit not eliminate — risk aversion (Experiment 3). Yet, not all formats prove suitable, and non-intuitive outcome graphs can even enhance risk aversion (Experiment 1). Joint analyses of choice proportions and response times (RTs) further uncovered that risk aversion leads to safe choices particularly in fast decisions. This pattern is expressed under graphical probabilities, whereas graphical outcomes can weaken the rapid dominance of risk aversion and the variability over RTs (Experiment 1 and 2). Together, our findings demonstrate the relevance of information format for risky decisions.
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Background Guidelines promote shared decision-making (SDM) for anticoagulation in patients with atrial fibrillation. We recently showed that adding a within-encounter SDM tool to usual care (UC) ...increases patient involvement in decision-making and clinician satisfaction, without affecting encounter length. We aimed to estimate the extent to which use of an SDM tool changed adherence to the decided care plan and clinical safety end points. Methods and Results We conducted a multicenter, encounter-level, randomized trial assessing the efficacy of UC with versus without an SDM conversation tool for use during the clinical encounter (Anticoagulation Choice) in patients with nonvalvular atrial fibrillation considering starting or reviewing anticoagulation treatment. We conducted a chart and pharmacy review, blinded to randomization status, at 10 months after enrollment to assess primary adherence (proportion of patients who were prescribed an anticoagulant who filled their first prescription) and secondary adherence (estimated using the proportion of days for which treatment was supplied and filled for direct oral anticoagulant, and as time in therapeutic range for warfarin). We also noted any strokes, transient ischemic attacks, major bleeding, or deaths as safety end points. We enrolled 922 evaluable patient encounters (Anticoagulation Choice=463, and UC=459), of which 814 (88%) had pharmacy and clinical follow-up. We found no differences between arms in either primary adherence (78% of patients in the SDM arm filled their first prescription versus 81% in UC arm) or secondary adherence to anticoagulation (percentage days covered of the direct oral anticoagulant was 74.1% in SDM versus 71.6% in UC; time in therapeutic range for warfarin was 66.6% in SDM versus 64.4% in UC). Safety outcomes, mostly bleeds, occurred in 13% of participants in the SDM arm and 14% in the UC arm. Conclusions In this large, randomized trial comparing UC with a tool to promote SDM against UC alone, we found no significant differences between arms in primary or secondary adherence to anticoagulation or in clinical safety outcomes. Registration URL: https://www.clinicaltrials.gov; Unique identifier: clinicaltrials.gov. Identifier: NCT02905032.
Abstract
Background
Trial recruitment of Black, indigenous, and people of color (BIPOC) is key for interventions that interact with socioeconomic factors and cultural norms, preferences, and values. ...We report on our experience enrolling BIPOC participants into a multicenter trial of a shared decision-making intervention about anticoagulation to prevent strokes, in patients with atrial fibrillation (AF).
Methods
We enrolled patients with AF and their clinicians in 5 healthcare systems (three academic medical centers, an urban/suburban community medical center, and a safety-net inner-city medical center) located in three states (Minnesota, Alabama, and Mississippi) in the United States. Clinical encounters were randomized to usual care with or without a shared decision-making tool about anticoagulation.
Analysis
We analyzed BIPOC patient enrollment by site, categorized reasons for non-enrollment, and examined how enrollment of BIPOC patients was promoted across sites.
Results
Of 2247 patients assessed, 922 were enrolled of which 147 (16%) were BIPOC patients. Eligible Black participants were significantly less likely (
p
< .001) to enroll (102, 11%) than trial-eligible White participants (185, 15%). The enrollment rate of BIPOC patients varied by site. The inclusion and prioritization of clinical practices that care for more BIPOC patients contributed to a higher enrollment rate into the trial. Specific efforts to reach BIPOC clinic attendees and prioritize their enrollment had lower yield.
Conclusions
Best practices to optimize the enrollment of BIPOC participants into trials that examined complex and culturally sensitive interventions remain to be developed. This study suggests a high yield from enrolling BIPOC patients from practices that prioritize their care.
Trial registration
ClinicalTrials.gov
(NCT02905032).
Shared decision making (SDM) implementation remains challenging. The factors that promote or hinder implementation of SDM tools for use during the consultation, including contextual factors such as ...clinician burnout and organizational support, remain unclear. We explored these factors in the context of a practical multicenter randomized trial evaluating the effectiveness of an SDM conversation tool for patients with atrial fibrillation considering anticoagulation therapy.
In this cross-sectional study, we recruited clinicians who were regularly involved in conversations with patients regarding anticoagulation for atrial fibrillation. Clinicians reported their characteristics and burnout symptoms using the two-item Maslach Burnout Inventory. Clinicians were trained in using the SDM tool, and they recorded their perceptions of the tool's normalization potential using the Normalization MeAsure Development (NoMAD) survey instrument and verbally reflected on their answers to these survey questions. When possible, the training sessions and clinicians' verbal responses to the conversation tool were recorded.
Our study comprised 183 clinicians recruited into the trial (168 with survey responses and 112 with recordings). Overall, clinicians gave high scores to the normalization potential of the intervention; they endorsed all domains of normalization to the same extent, regardless of site, clinician characteristics, or burnout ratings. In interviews, clinicians paid significant attention to making sense of the tool. Tool buy-in seemed to depend heavily on their ability to see the tool as accurate and "evidence-based" and their perceptions of having time in the consultation to use it.
While time in the consultation remains a barrier, we did not find a significant association between burnout symptoms and normalization of an SDM conversation tool. Possible areas for improving the normalization of SDM conversation tools in clinical practice include enabling collaboration among clinicians to implement the tool and reporting how clinicians elsewhere use the tool. Direct measures of normalization (i.e., observing how often clinicians access the tool in practice outside of the clinical trial) may further elucidate the role that contextual factors, such as clinician burnout, play in the implementation of SDM.
ClinicalTrials.gov, NCT02905032. Registered on 9 September 2016.
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