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Despite community health centers (CHCs) having many potential benefits, their utilisation rate is still low in urban China. Using the health belief model, the study conducted cross-sectional survey to examine factors that affected individuals' intentions to use primary care services in China. This study on 942 participants from Shanghai revealed that low cost had insignificant effect on the choice of CHCs once other key factors were accounted for. Older age, greater perceived susceptibility to contracting common diseases and more benefits of individualised care greatly increased the likelihood of using primary care services. Perceived low competencies of medical personnel along with outdated medical facilities had significant negative relationships with the intention of choosing CHCs. Based on these findings, some policy recommendations are proposed such as promoting education on prevalence of common diseases, recruiting qualified medical personnel, increasing professional training and cooperation, updating medical facilities, and offering high-quality individualised care in order to improve efficiency of primary care utilisation.

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The literature on human delay discounting behavior is dominated by experimental paradigms, which do not impose actual delays. Given that waiting may be aversive even on short timescales, we present a novel delay discounting paradigm to study differences in delay discounting behavior either when real waiting is involved, or not. This paradigm retains the fundamental trade-off between rewards received versus their immediacy. We used hierarchical Bayesian modeling to decompose and test models that separate discounting and subjective time perception mechanisms. We report 2 experiments that also explore the magnitude effect and gain-loss asymmetry. In both experiments, we found greater discounting and nonlinear (convex) time perception in the online waiting task, which required waiting after each choice, compared to a control condition where waiting was deferred until the end of the experiment. Discounting was also measured by a parameter of a hyperbolic-type model and related to reversals of preference between initial desire to wait and then not doing so. These results from our novel paradigm support the emerging view that subjective time perception plays an important role in intertemporal choice in addition to discounting tendencies. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

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Despite widespread attempts to educate consumers about the dangers of sugar, as well as the advent of nutritional labeling, individuals still struggle to make educated decisions about the foods they eat, and/or to use the Nutrition Facts Panel. This study examined the effect of visual aids on judgments of sugar quantity in popular drinks, and choices. 261 volunteers at four different locations evaluated 11 common beverages. Key measures were estimates of sugar in the drinks, nutrition knowledge, and desire to consume them. In the experimental condition, participants viewed beverages along with test tubes filled with the total amount of sugar in each drink; the control condition had no sugar display. Both groups were encouraged to examine the Nutrition Facts Panel when making their evaluations. Correlational analyses revealed that consumers exposed to the visual aid overestimated sugar content and the length of time needed to exercise to burn off the calories; they also had lower intentions to consume any of the beverages. Individuals asserting to use the Nutrition Facts Panel (NFP) in general were also less likely to admit using it in this particular study (r = -2, p = 0.001). This study suggests that a simple visual aid intervention affected judgments and choices towards curtailing sugar intake. This has implications for labeling format implementation.

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The study examined the two-factor structure of decision difficulty proposed by Cheng and González-Vallejo (2017) in new domains, and the role of numeracy in relation to these factors. Using the measurement methodology of 'mouse' (cursor) movements, participants' temporal and spatial measures were recorded when making decisions in the domains of intertemporal, gamble, and consumer choices. Task manipulations designed to affect difficulty included the sign of the payoffs (gains vs. losses), the similarity of the attribute values being compared, and attribute importance. A psychometric analysis of the measures revealed three orthogonal components, two of which, conflict and wavering, described decision difficulty. The conflict component was most affected by changes in the sign of the payoffs of intertemporal and gamble choices, with greater means observed in the loss than in the gain context. By contrast, the wavering component was most affected by changes of the similarity between the options' attributes, with greater means when the options were more similar. The study also found that choosing the long-term advantageous options in an intertemporal choice task; choosing the riskier gain and safer loss in a gamble choice task; and choosing the more expensive/better-quality hotel in a consumer choice task demonstrated greater conflict and/or wavering. The study further found that numeracy, or the degree to which individuals are able to use and interpret numbers, was negatively related to the conflict component. Taken together, the study demonstrated that decision difficulty varied with contextual changes, and action-dynamic measures reflected different facets of decision difficulty.

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Current food labels include comprehensive nutritional information, but evaluations of their effects on judgments of nutritional quality and food choice are scarce. Building on previous empirical research that demonstrated that amount and complexity of information is negatively related to judgment accuracy, this study used an experimental design to evaluate nutritional information labels of varying complexity. Lens model analysis (Brunswik, 1952; Cooksey, 1996; Hammond, 1955; Stewart, 1976) was used to study the judgment process. Nutrition judgment accuracy was assessed by comparing nutrition judgments to a nutrition expert criterion (NuVal®) in three package labeling conditions. The conditions were: no nutritional information highlighted; nutrients highly related to nutritional quality highlighted using a front-of-package (FOP) label; and nutrients unrelated to nutritional quality highlighted using a FOP label. Findings indicate a limited role of FOP labeling in increasing judgment accuracy, consistency of nutritional information usage, and food choice. Implications for understanding labeling efforts to improve food choices are discussed.

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The familiarity difference cue has been regarded as a general cue for making inferential judgments (Honda, Abe, Matsuks, & Yamagishi in Memory and Cognition, 39(5), 851-863, 2011; Schwikert & Curran in Journal of Experimental Psychology: General, 143(6), 2341-2365, 2014). The current study tests a model of inference based on familiarity differences that encompasses the recognition heuristic (Goldstein & Gigerenzer, 1999, Goldstein & Gigerenzer in Psychological Review, 109(1), 75-90, 2002). In two studies, using a large pool of stimuli, participants rated their familiarity of cities and made choices on a typical city-size task. The data were fitted with the r-s model (Hilbig, Erdfelder, & Pohl in, Journal of Experimental Psychology: Learning Memory and Cognition, 37(4), 827-839, 2011), which was adapted to include familiarity differences. The results indicated that people used the familiarity difference cue because the participants ignored further knowledge in a substantial number of cases when the familiarity difference cue was available. An analysis of reaction-time data further indicated that the response times were shorter for heuristic judgments than for knowledge-only-based judgments. Furthermore, when knowledge was available, the response times were shorter when knowledge was congruent with a heuristic cue than when it was in conflict with it. Differences between the familiarity difference cue and the fluency heuristic (Schooler & Hertwig, 2005, Psychological Review, 112, 610-628) are discussed.

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UNLABELLED: Consumers' judgments and choices of the nutritional value of food products (cereals and snacks) were studied as a function of using information in the Nutrition Facts Panel (NFP, National Labeling and Education Act, 1990). Brunswik's lens model (Brunswik, 1955; Cooksey, 1996; Hammond, 1955; Stewart, 1988) served as the theoretical and analytical tool for examining the judgment process. Lens model analysis was further enriched with the criticality of predictors' technique developed by Azen, Budescu, & Reiser (2001). Judgment accuracy was defined as correspondence between consumers' judgments and the nutritional quality index, NuVal(®), obtained from an expert system. The study also examined several individual level variables (e.g., age, gender, BMI, educational level, health status, health beliefs, etc.) as predictors of lens model indices that measure judgment consistency, judgment accuracy, and knowledge of the environment. Results showed varying levels of consistency and accuracy depending on the food product, but generally the median values of the lens model statistics were moderate. Judgment consistency was higher for more educated individuals; judgment accuracy was predicted from a combination of person level characteristics, and individuals who reported having regular meals had models that were in greater agreement with the expert's model. CONCLUSIONS: Lens model methodology is a useful tool for understanding how individuals perceive the nutrition in foods based on the NFP label. Lens model judgment indices were generally low, highlighting that the benefits of the complex NFP label may be more modest than what has been previously assumed.

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OBJECTIVE: To compare judgements of nutrition and judgement accuracy when evaluating cereals with the current US Food and Drug Administration (FDA) nutrition facts panel (NFP) and two new proposed NFP based on FDA guidelines. DESIGN: A between-subjects design randomly assigned participants to three NFP conditions (current NFP label and two modified NFP based on FDA proposals). Participants viewed breakfast cereals, and rated each on nutritional quality and on the likelihood of purchasing and consuming it. Participants provided demographic information and responses to questionnaires assessing nutrition/obesity knowledge, concern for healthy eating and nutrient importance. SETTING: USA. SUBJECTS: Two hundred and thirteen adults who completed an online survey (66·2 % female, mean age 37·31 (sd 12·56) years). RESULTS: Judged nutrition quality of cereals was positively correlated with protein, fibre and potassium and negatively correlated with sugars and sodium. This pattern appeared when using the current NFP or the modified versions. Highlighted nutrients in modified NFP formats did not affect their perceived importance. Accuracy of the nutrition quality judgements was measured in relationship to an objectively defined nutrition score, NuVal®. Nutrition judgement accuracy was highest under the current NFP (Spearman's ρ=0·76 for the current NFP; 0·64 and 0·72 for the other formats). Regression analysis showed that nutrition judgement accuracy increased significantly (adjusted R 2=0·13) with obesity knowledge (ß=0·27), age (ß=0·15) and current NFP (ß=0·13). CONCLUSIONS: The current NFP is equally or more effective in conveying nutritional information compared with NFP formats based on the FDA proposal.

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The single parameter hyperbolic model has been frequently used to describe value discounting as a function of time and to differentiate substance abusers and non-clinical participants with the model's parameter k. However, k says little about the mechanisms underlying the observed differences. The present study evaluates several alternative models with the purpose of identifying whether group differences stem from differences in subjective valuation, and/or time perceptions. Using three two-parameter models, plus secondary data analyses of 14 studies with 471 indifference point curves, results demonstrated that adding a valuation, or a time perception function led to better model fits. However, the gain in fit due to the flexibility granted by a second parameter did not always lead to a better understanding of the data patterns and corresponding psychological processes. The k parameter consistently indexed group and context (magnitude) differences; it is thus a mixed measure of person and task level effects. This was similar for a parameter meant to index payoff devaluation. A time perception parameter, on the other hand, fluctuated with contexts in a non-predicted fashion and the interpretation of its values was inconsistent with prior findings that supported enlarged perceived delays for substance abusers compared to controls. Overall, the results provide mixed support for hyperbolic models of intertemporal choice in terms of the psychological meaning afforded by their parameters.

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We elucidate the epistemological futility of using concepts such as unconscious thinking in research. Focusing on Newell & Shanks' (N&S's) use of the lens model as a framework, we clarify issues with regard to unconscious-thought theory (UTT) and self-insight studies. We examine these key points: Brunswikian psychology is absent in UTT; research on self-insight did not emerge to explore the unconscious; the accuracy of judgments does not necessitate the unconscious; and the prescriptive claim of UTT is unfounded.

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Impulsive behavior in heroin-dependent individuals and matched smokers was studied within the framework of temporal discounting. Two well-known effects were examined: the sign and magnitude effects (Kirby, 1997). The study also investigated the relationship between cognitive impulsivity and inhibitory control as measured by a Go/No-go task. Fifty-six heroin-dependent patients in the postmethadone treatment stage and an equal number of matched daily smokers participated in the study. The heroin-dependent patients showed higher discount rates in both gain and loss conditions. They also showed no sign effect by demonstrating similar discount rates in gains and losses. Heroin-dependent patients also exhibited a magnitude effect, which was weaker than that observed in smokers. Differential relationships between impulsivity and inhibitory control were found in the two groups. For smokers, decision-making and inhibitory control behaviors pertained to different psychological processes, whereas for heroin-dependent patients, the two behaviors were partially related. Finally, a significant correlation between length of heroin use and temporal discounting with small magnitude was found. The present study advances our understanding of the specific behavioral impulsive patterns in heroin-dependent individuals.

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Proponents of unconscious-thought theory assert that letting the unconscious "mull it over" can enhance decisions. In a series of recent studies, researchers demonstrated that participants whose attention was focused on solving a complex problem (i.e., those using conscious thought) made poorer choices, decisions, and judgments than participants whose attention was distracted from the problem (i.e., those purportedly using unconscious thought). We argue that this finding, rather than establishing the existence of a deliberation-without-attention effect, is explained more compellingly in terms of the well-established distinction between on-line and memory-based judgments. In Experiment 1, we reversed the recent finding by simply changing participants' on-line processing goal from impression formation to memorization. Experiment 2 provided a replication and further established that some cognitive effort appears necessary to produce both the original pattern of results and its reversal, suggesting that such judgments are ultimately a product of conscious, rather than unconscious, thinking.

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Two experiments examined confidence judgments associated with eyewitness memory for events to misinformation [Loftus, E. F. (1975). Leading questions and the eyewitness report. Cognitive Psychology, 7, 560-572]. Participants in each experiment watched videos depicting crimes and either responded to questionnaires (Experiment 1) or read narratives (Experiment 2) containing veridical or non-veridical information. Upon testing for memory performance 24h later, participants exposed to misinformation accepted the misinformation as part of their memory of the events in the videos. In both experiments, confidence judgments of participants subjected to misinformation were high and comparable to those of participants not subjected to misinformation. The relationship between accurate responding and confidence was assessed via calibration analysis [Yates, J. F. (1990). Judgments and decision making. Englewood Cliffs, NJ: Prentice Hall]. Performance on various measures of calibration was generally better for participants who were not exposed to misinformation. We conclude that confidence judgments can depend on factors other than those that improve the accuracy of memory, such as the retrieval fluency of one's memories.

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People often face preferential decisions under risk. To further our understanding of the cognitive processes underlying these preferential choices, two prominent cognitive models, decision field theory (DFT; Busemeyer & Townsend, 1993) and the proportional difference model (PD; González-Vallejo, 2002), were rigorously tested against each other. In two consecutive experiments, the participants repeatedly had to choose between monetary gambles. The first experiment provided the reference to estimate the models' free parameters. From these estimations, new gamble pairs were generated for the second experiment such that the two models made maximally divergent predictions. In the first experiment, both models explained the data equally well. However, in the second generalization experiment, the participants' choices were much closer to the predictions of DFT. The results indicate that the stochastic process assumed by DFT, in which evidence in favor of or against each option accumulates over time, described people's choice behavior better than the trade-offs between proportional differences assumed by PD.

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Evaluation point feedback was used to align confidence judgments with accurate/inaccurate responding to general knowledge questions. Rehearsal of item-answer pairs and three evaluation systems based on a scoring rule had different effects on confidence, accuracy and their relationship. Using standard calibration measures (Yates, J.F., (1990). Judgment and Decision Making. Englewood Cliffs, NJ: Prentice Hall) we found that a point system comprising of both rewarding (positive) and punishing (negative) consequences produced the best performance across levels of knowledge in comparison to all-rewarding and all-penalty rules.

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The reflection effect (D. Kahneman & A. Tversky, 1979) was investigated using the stochastic model of choice developed by C. Gonzalez-Vallejo (2002). The model assumes that individuals make trade-offs among attribute values by relying on a difference variable. The model also specifies a threshold representing individual proclivities to reach to attribute differences. Two experiments demonstrated that changes in risk attitudes, from a gain to a loss situation, depended on the stimuli as well as on individuals' thresholds. Thresholds were generally lower in losses than in gains, indicating a risk-taking tendency. Thresholds were also lower when participants were endowed with greater savings. Model testing revealed better fits for the stochastic model than cumulative prospect theory (A. Tversky &. D. Kahneman, 1992).

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BACKGROUND: The classic sequential processing model of clinical decision making-in which the treatment choice follows and depends on the diagnostic judgment-may in some cases be replaced by a processing model in which the treatment choice depends on an independent assessment of the diagnostic and other cues. The aim of this study was to determine which processing model would better describe physicians' treatment choices in a simulated clinical task. METHODS: Seventy-five US and French primary care physicians were presented twice, in a different order, with the same set of 46 scenarios of 15-month-old children suspected of having acute otitis media (AOM). They rated in one set the probability of AOM and in the other set whether they would treat the child with antibiotics (and how confident they felt in their decision). Linear regression analyses revealed the individuals' 2 judgment policies. Hierarchical discriminant analysis was used to analyze the variance explained in the treatment choice by, 1st, the diagnostic judgment, 2nd, the cues specific to treatment, and 3rd, the cues specific to diagnosis. RESULTS: Even when choosing treatment, the participants placed greatest weight on diagnostic cues, especially the ear findings. Only 28% used the cues that reflected parental issues. For 36%, the diagnostic cues had an effect on the treatment choice independent of the effect (if any) of the diagnostic judgment. CONCLUSION: In deciding how to treat AOM, the majority of the participating US and French primary care physicians followed the classic sequential processing model, but a substantial minority used instead an independent processing model.

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OBJECTIVES: We wanted to discover how parents differ from physicians in making decisions about how to treat a child who may have acute otitis media (AOM). STUDY DESIGN: We used questionnaires that required participants to judge the probability of AOM or choose treatment for 2 sets of 46 paper scenarios of hypothetical children aged 15 months who might have AOM, and they subsequently rated the importance of individual cues and described their attitudes and opinions related to health care and AOM. POPULATION: Convenience samples of 19 US family physicians, 35 French generalists, 21 French pediatricians, 52 US parents, and 86 French parents were included. OUTCOMES MEASURED: The primary outcomes were the judgment policies-the weights placed on each of the scenario cues when making decisions-that were derived for each individual and each group by multiple linear regression. RESULTS: The mean judged probabilities of AOM were nearly the same for all groups: 50% for the US physicians, 51% for the US parents, 52.5% for the French physicians, and 52% for the French parents. The percentages of cases treated with antibiotics did not differ: 53% for US physicians, 45% for US parents, 53% for French physicians, and 51% for French parents. All groups gave greatest weight to the physical examination cues for decisions about both diagnosis and treatment. The parents paid little attention to the cues that reflected parental concerns. CONCLUSIONS: US and French parents were very similar to physicians in their judgments and treatment choices regarding AOM. They appear to be able to adopt the physician's point of view and to be selective in the use of antibiotics.

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The stochastic difference model assumes that decision makers trade normalized attribute value differences when making choices. The model is stochastic, with choice probabilities depending on the normalized difference variable, d, and a decision threshold, delta. The decision threshold indexes a person's sensitivity to attribute value differences and is a free estimated parameter of the model. Depending on the choice context, a person may be more or less sensitive to attribute value differences, and hence delta may be used to measure context effects. With proportional difference used as the normalization, the proportional difference model (PD) was tested with 9 data sets, including published data (e.g., J. L. Myers, M. M. Suydam, & B. Gambino, 1965; A. Tversky, 1969). The model accounted for individual and group data well and described violations of stochastic dominance, independence, and weak and strong stochastic transitivity.

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