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This article documents RAND's assessment of a program designed to facilitate care coordination for service members and veterans recovering from traumatic brain injuries.

AbstractUnderstanding public media channel preferences can inform preparedness plans, response strategies and long‐term recovery. However, questions remain about how media consumption changes across pre‐crisis, crisis, and post‐crisis phases. Past theories argue that media use may change for several reasons, including during times of societal conflict and challenge. These theories point to the belief that, during a crisis, we expect media channel use to change because media preferences during a crisis will be fundamentally different compared with everyday routines.This paper takes advantage of a survey fielded to Texas residents soon after Hurricane Harvey. Here, we ask the following: (a) "what media channels are most prominent in each crisis phase?" and (b) "do media channel preferences change across crisis phases?". We use simple descriptive statistics and chi‐square tests to describe media channel preferences across the three crisis phases by demographics. Additionally, we use alluvial diagrams to visualize media channel preferences over time. In total, 62% (n = 174) of respondents reported no changes in channel preferences. However, chi‐square tests identified significant differences in media use changes related to a handful of demographic characteristics. These findings are explored alongside theories that would hypothesize likely media use changes across pre‐crisis, crisis and post‐crisis phases.

AbstractGraphs are increasingly recommended for improving decision‐making and promoting risk‐avoidant behaviors. Graphs that depict only the number of people affected by a risk ("foreground‐only" displays) tend to increase perceived risk and risk aversion (e.g., willingness to get vaccinated), as compared to graphs that also depict the number of people at risk for harm ("foreground+background" displays). However, previous research examining these "foreground‐only effects" has focused on relatively low‐probability risks (<10%), limiting generalizability to communications about larger risks. In two experiments, we systematically investigated the moderating role of probability size on foreground‐only effects, using a wide range of probability sizes (from 0.1% to 40%). Additionally, we examined the moderating role of the size of the risk reduction, that is, the extent to which a protective behavior reduces the risk. Across both experiments, foreground‐only effects on perceived risk and risk aversion were weaker for larger probabilities. Experiment 2 also revealed that foreground‐only effects were weaker for smaller risk reductions, while foreground‐only displays decreased understanding of absolute risk magnitudes independently of probability size. These findings suggest that the greater effectiveness of foreground‐only versus foreground+background displays for increasing perceived risk and risk aversion diminishes with larger probability sizes and smaller risk reductions. Moreover, if the goal is to promote understanding of absolute risk magnitudes, foreground+background displays should be used rather than foreground‐only displays regardless of probability size. Our findings also help to refine and extend existing theoretical accounts of foreground‐only effects to situations involving a wide range of probability sizes.

AbstractLarge oil spills are disasters associated with psychological effects for exposed communities. The amount of worry that individuals experience after a disaster may be influenced by many factors, such as the type and extent of exposure to disaster impacts, prior trauma, and sociodemographic characteristics. This study examined the nature and predictors of worry about ongoing impacts of the 2010 Deepwater Horizon (DH) oil spill reported by Gulf of Mexico coastal residents. A random sample of 2,520 adult residents of Gulf of Mexico coastal counties were administered a telephone survey in 2016, including items about persistent worry and exposure to DH impacts, prior trauma, residence at the time of the spill, and sociodemographic characteristics. Respondents varied in the amount of worry they reported about ongoing health, social, and economic impacts. Controlling for sociodemographic characteristics, higher exposure to the DH oil spill was related to higher levels of worry about ongoing impacts, with past traumatic events related specifically to worry about health impacts. Unexpectedly, those who moved into the region after the spill showed similar levels of worry to residents exposed to the spill, and higher levels than residents who did not recall being exposed to the DH oil spill. This study highlights the impact of the DH oil spill on coastal residents many years after the DH disaster. The findings underscore the need to examine multiple pathways by which individuals experience disasters and for risk researchers to close knowledge gaps about long‐term impacts of oil spills within a multi‐dimensional framework.

An adolescent's ability to make effective decisions requires that he or she be able to accurately assess the probability that uncertain events will occur. This ability is referred to as risk perception, a skill that plays an important role in psychological theories of adolescent behavior & human capital formation. The risk perceptions of 3,544 adolescent respondents to the 1997 National Longitudinal Study of Youth are reported. Seventeen questions -- ranging from will you get the flu sometime in the next year, to will you die from any cause in the next year -- are analyzed. The teens are reported to have, for the most part, realistic ideas about how the life events in question will affect them. They also view themselves as being relatively in control of their lives. A disproportionate number, however, are of the opinion that the world is out of control, & that they will die in the near future. It is posited, therefore, that teens' risky behavior can be linked to the fact that many think they are going to die, regardless of the choices they make. 2 Tables, 1 Figure, 2 Appendixes, 21 References. K. A. Larsen

As U.S. service members deploy for extended periods on a repeated basis, their ability to cope with the stress of deployment may be challenged. Many programs are available to encourage and support psychological resilience among service members and families. However, little is known about these programs' effectiveness. This report reviews resilience literature and programs to identify evidence-informed factors for promoting resilience.

AbstractWe conducted a nationally representative survey of parents' beliefs and self‐reported behaviors regarding childhood vaccinations. Using Bayesian selection among multivariate models, we found that beliefs, even those without any vaccine or health content, predicted vaccine‐hesitant behaviors better than demographics, social network effects, or scientific reasoning. The multivariate structure of beliefs combined many types of ideation that included concerns about both conspiracies and side effects. Although they are not strongly related to vaccine‐hesitant behavior, demographics were key predictors of beliefs. Our results support some of the previously proposed pro‐vaccination messaging strategies and suggest some new strategies not previously considered.

As U.S. service members deploy for extended periods on a repeated basis, their ability to cope with the stress of deployment may be challenged. A growing number of programs and strategies provided by the military and civilian sectors are available to encourage and support psychological resilience to stress for service members and families. Though previous research from the field of psychology delineating the factors that foster psychological resilience is available, there has been no assessment of whether and how well the current military resilience programs are addressing these factors in their activities. Further, little is known about the effectiveness of these programs on developing resilience. To assist the Department of Defense in understanding methodologies that could be useful in promoting resilience among service members and their families, the research team conducted a focused literature review to identify evidence-informed factors for promoting psychological resilience. The team also reviewed a subset of military resilience programs to determine the extent to which they included those evidence-informed factors. This article describes the context, approach, and findings from these research activities.

Patient narratives have emerged as promising vehicles for making health care more responsive by helping clinicians to better understand their patients' expectations, perceptions, or concerns and encouraging consumers to engage with information about quality. A growing number of websites incorporate patients' comments. But existing comments have fragmentary content, fail to represent less vocal patients, and can be manipulated to "manage" providers' reputations. In this article, we offer the first empirical test of the proposition that patient narratives can be elicited rigorously and reliably using a five-question protocol that can be incorporated into large-scale patient experience surveys. We tested whether elicited narratives about outpatient care are complete (report all facets of patient experience), balanced (convey an accurate mix of positive and negative events), meaningful (have a coherent storyline), and representative (draw fulsome narratives from all relevant subsets of patients). The tested protocol is strong on balance and representativeness, more mixed on completeness and meaningfulness.

We conducted a simulated clinician-choice experiment, comparing choices and decision-making processes of participants ( N = 688) randomized among four experimental arms: a conventional website reporting only quantitative performance information, a website reporting both qualitative (patient comments) and quantitative information, the second website augmented by a decision aid (labeling of patient comments), and the decision-aided website further augmented by the presence of a trained navigator. Introducing patient comments enhanced engagement with the quality information but led to a decline in decision quality, particularly the consistency of choices with consumers' stated preferences. Labeling comments helped erase the decline in decision quality, although the highest percentage of preference-congruent choices was seen in the navigator arm. Engagement with the quality information and satisfaction with choices available were likewise highest in the navigator arm. Findings held for high- and low-skilled decision makers. Thus, navigator assistance may be a promising strategy for equitably promoting higher quality choices in information-rich contexts.