Understanding the Hawthorne effect

Sedgwick, Philip; Greenwood, Nan

doi:10.1136/bmj.h4672

Cited by 524 publications

(402 citation statements)

References 2 publications

Supporting

Mentioning

357

Contrasting

Unclassified

Order By: Relevance

“…First, a larger sample size would have allowed us to assess the independent contribution of patient characteristics to question-asking behavior through the use of multivariable regression [35], there is always a degree of subjectivity, which we attempted to minimize by training our coders. Third, patient and physician awareness of being audio-recorded may have caused them to subconsciously alter their behavior [38]. However, a previous study suggested audio recording has minimal effects on patient-physician communication [34].…”

Section: Discussionmentioning

confidence: 99%

Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons

Menendez

Hoorn

Mackert

et al. 2017

Clinical Orthopaedics &Amp; Related Research

107

View full text Add to dashboard Cite

Background In the midst of rapid expansion of medical knowledge and decision-support tools intended to benefit diverse patients, patients with limited health literacy (the ability to obtain, process, and understand information and services to make health decisions) will benefit from asking questions and engaging actively in their own care. But little is known regarding the relationship between health literacy and question-asking behavior during outpatient office visits. Questions/purposes (1) Do patients with lower levels of health literacy ask fewer questions in general, and as stratified by types of questions? (2) What other patient characteristics are associated with the number of questions asked? (3) How often do surgeons prompt patients to ask questions during an office visit? Methods We audio-recorded office visits of 84 patients visiting one of three orthopaedic hand surgeons for the first time. Patient questions were counted and coded using an adaptation of the Roter Interaction Analysis System in 11 categories: (1) therapeutic regimen; (2) medical condition; (3) lifestyle; (4) requests for services or medications; (5) psychosocial/feelings; (6) nonmedical/procedural; (7) asks for understanding; (8) asks for reassurance; (9) paraphrase/ checks for understanding; (10) bid for repetition; and (11) personal remarks/social conversation. Directly after the visit, patients completed the Newest Vital Sign (NVS) health literacy test, a sociodemographic survey (including age, sex, race, work status, marital status, insurance status), and three Patient-Reported Outcomes Measurement Information System-based questionnaires: Upper-Extremity Function, Pain Interference, and Depression. The NVS scores were divided into limited (0-3) and adequate (4-6) health literacy as done by the tool's creators. We also assessed whether the surgeons prompted patients to ask questions during the encounter. Results Patients with limited health literacy asked fewer questions than patients with adequate health literacy (5 ± 4 versus 9 ± 7; mean difference, À4; 95% CI, À7 to À1; p = 0.002). More specifically, patients with limited health literacy asked fewer questions regarding medical-care issues such as their therapeutic regimen (1 ± 2 versus 3 ± 4; Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at

show abstract

Section: Discussionmentioning

confidence: 99%

Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons

Menendez

Hoorn

Mackert

et al. 2017

Clinical Orthopaedics &Amp; Related Research

107

View full text Add to dashboard Cite

show abstract

“…Last, we did not ask our patients not to change their habits during the study, which raises the possibility of a Hawthorne effect. 29 We are unable to exclude such an effect caused by patients' own efforts to alleviate their symptoms by changing habits during the study. Nevertheless, we consider it to be unlikely because nearly all patients with chilblains have already tried almost everything to relieve their symptoms.…”

mentioning

confidence: 98%

Nifedipine vs Placebo for Treatment of Chronic Chilblains: A Randomized Controlled Trial

Souwer

Bor

Smits

et al. 2016

The Annals of Family Medicine

View full text Add to dashboard Cite

PURPOSE Nifedipine is commonly prescribed for the treatment of chilblains (pernio, perniosis) on the basis of observational studies and a single small, older clinical trial. We aimed to confirm the proposed superiority of oral nifedipine 60 mg per day over placebo for treatment of chronic chilblains in primary care. METHODSWe performed a randomized, placebo-controlled, double-blind, crossover trial, closely following the design of the older trial. A total of 32 patients with chronic chilblains were randomly assigned to nifedipine (30 mg controlled release twice a day) or placebo. The primary outcome was patient-reported complaints; the secondary outcome was patient-reported disability. Both were assessed from daily ratings on 100-mm visual analogue scales recorded in a diary. We took ambient temperatures into account and checked for a carry-over effect, and monitored for adverse effects.RESULTS After 6 weeks of treatment, mean scores on the visual analogue scale on complaints showed a nonsignificant difference of 1.84 mm (95% CI, -6.67 to 2.99 mm) in favor of nifedipine (P = .44). Mean scores on the visual analogue scale on disability showed a nonsignificant difference of 0.56 mm (95% CI, -2.97 to 4.09 mm) in favor of placebo (P = .75). There was no carry-over effect of prior study treatment. Nifedipine was associated with significantly lower systolic blood pressure and a significantly higher incidence of edema.CONCLUSIONS In our study, nifedipine was not superior to placebo for treating chronic chilblains. These findings contrast with those of the older study and do not support routine use of nifedipine for this condition. 2016;14:453-459. doi: 10.1370/afm.1966. Ann Fam Med INTRODUCTIONC hilblains (pernio, perniosis) are cold-induced, painful or itching lesions on the fingers, feet, ears, or thighs. The condition occurs throughout the world during the winter months when daily mean temperatures drop below the range of 12 o C to 15 o C. 1 The prevalence in the Netherlands as reported by the Netherlands Institute for Health Services Research (NIVEL) varies between 0.9 per 1,000 and 1.7 per 1,000 depending on year-to-year variation and coding issues. The condition is more common among women than men, with respective prevalences of 0.9 to 2.1 per 1,000 vs 0.6 to 1.2 per 1,000 (written information provided by NIVEL).Patients with chilblains report serious restrictions in daily life and feel an urgent need for effective treatment.2 A review of the literature through March 15, 2016 revealed evidence that vitamin D 3 , corticosteroidcontaining cream, nifedipine, and pentoxyfylline, among a wide range of other therapies, are used to treat symptoms of chronic chilblains. 3,4 In an earlier study, we found that vitamin D 3 was not superior to placebo, however.5 Five studies evaluating the effectiveness of nifedipine in patients with chilblains have been published and have concluded that the drug is an effective treatment. These studies included only 1 randomized controlled trial, having 10 patients and conducted in ...

show abstract

“…CBT, GET and rituximab, the use of subjective outcomes (only) involves an important risk of bias, e.g. due to researcher allegiance [36], the Hawthorne effect [37], placebo effects [38] and buy-in effects [39], especially when subjective measures are combined with different cut-off scores for meeting the diagnosis CFS [21] and improvement or recovery [40].…”

Section: Assessment Of Symptoms Based On Questionnaires and Subjectivmentioning

confidence: 99%

An Accurate Diagnosis of Myalgic Encephalomyelitis and Chronic Fatigue Syndrome requires strict Clinical Case definitions and Objective Test Methods

Twisk¹

2017

J Med Diagn Meth

View full text Add to dashboard Cite

Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS) are subject to controversy. Although ME and CFS are often considered to be to be synonymous, the case criteria for ME and CFS define two distinct diseases with partial overlap. ME, recognized as a new clinical entity in the 1950's, is characterized by distinctive muscular, neurological and autonomic symptoms. In contrast the core feature of CFS, introduced in 1988 and redefined in 1994, is chronic fatigue. Some researchers consider CFS to be equivalent to (incapacitating) chronic fatigue (CF). After the introduction of CFS, other criteria for ME, ME/CFS, CFS and CF were introduced and used in research studies, creating obfuscation and controversy. The use of various diagnostic criteria has hampered effective research into ME and CFS.Next to the various diagnostic criteria, the assessment of symptoms is almost always based on questionnaires and subjective measures, e.g. physical functioning. Due to their nature subjective measures are incomparable over time and between patients. Moreover subjective measures introduce a significant risk of bias, for example due to researcher allegiance, the Hawthorne effect, and buy-in effects. Despite the fact that ME and CFS (subtypes) lack a clear etiological explanation (yet), the symptoms can and should be assessed by objective test measures, since subjective measures are ambiguous, incomparable and introduce the risk of bias. Objective test measures can also confirm the seriousness of both ME and CFS.To resolve the diagnostic issues in research studies and clinical practice, a clear distinction between ME and CFS (not ME), based on the original criteria, is crucial.Although the use of objective test methods is more expensive and time-consuming and severe cases cannot be subjected to these tests, considering the (scientific) confusion originating from the use of subjective measures it is essential to assess the symptoms of patients objectively both in clinical practice and research settings.

show abstract

Understanding the Hawthorne effect

Cited by 524 publications

References 2 publications

Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons

Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons

Nifedipine vs Placebo for Treatment of Chronic Chilblains: A Randomized Controlled Trial

An Accurate Diagnosis of Myalgic Encephalomyelitis and Chronic Fatigue Syndrome requires strict Clinical Case definitions and Objective Test Methods

Contact Info

Product

Resources

About