Ashraf F. Alqudah

Refugees face enormous levels of stress post migration. These levels of stress put the refugees at risk for psychological and physical problems to add to their already existing burdens. Resiliency is known to reduce risk for stressors and increase ability to deal with burdens refugees face. 86 Iraqi refugees in Jordan participated in this study through 7 Non-Governmental Organizations (NGOs) working with Iraqi refugees in Jordan. Participants filled out the Connor-Davidson Resilience Scale (CD-RISC) and the Marlowe-Crowne Social Desirability Scale – Short Form (MC-SDS-SF). Results showed moderate resiliency levels amongst Iraqi refugees in Jordan. No differences between refugees’ gender, age, and marital status were found. But differences between educational levels were found, indicating significantly higher resiliency scores for participants of higher educational levels. Results also showed that spiritual influence was the highest contributor to the refugees’ resiliency. Implications of these results are discussed.

Purpose: Studies in the United States have found that patients' sex, race, and age influence the pain assessment and treatment decisions of laypeople and medical professionals. However, there is limited research as to whether people of other nationalities make pain management decisions differently based on demographic characteristics. Therefore, the purpose of the following study was to compare pain assessment and treatment decisions of undergraduate students in Jordan and the United States as a preliminary examination of nationality as a potential proxy for cultural differences in pain decisions. Methods: Virtual human (VH) technology was used to examine the influences of patients' sex (male or female), race (light-skinned or dark-skinned), and age (younger or older) on students' pain management decisions. Seventy-five American and 104 Jordanian undergraduate students participated in this web-based study. Results: American and Jordanian students rated pain intensity higher in females and older adults and were more likely to recommend medical help to these groups, relative to males and younger adults. Furthermore, Jordanian participants rated pain intensity higher and were more likely to recommend medical help for all patient demographic groups (ie, sex, race, age) than American participants. Conclusion: This is the first cross-national study that compares pain decisions between undergraduate students. The results suggest that sex, race, and age cues are used in pain assessment and treatment by both Americans and Jordanians, with Jordanians more likely to rate pain higher and recommend medical help to patients. Additional research is needed to determine the cultural determinants of these differences.

Peer reviewed article authored by (Laura D Wandner, Lauren A Stutts, Ashraf F Alqudah, et al ). Read article or submit your manuscript for publishing.

This study examined the influence of Virtual Humans’ (VH) sex and race on participants’ ratings of pain intensity, pain unpleasantness, pain-related negative mood, pain coping, and recommendations for medical help. Seventy-five undergraduates viewed a series of VHs and provided computerized visual analog scale (VAS) ratings for the five domains listed above. Mixed model ANOVA analyses showed that participants of both sexes and races viewed female VHs as experiencing greater pain intensity, greater pain unpleasantness, a greater number of pain-related negative moods, poorer coping skills, and a greater need to seek medical help for their pain. Participants of both races rated Caucasian VHs as experiencing more negative moods and poorer coping skills do deal with their pain. The novel computerized VH technology used herein allowed for the standardization of pain expression across sexes and races of VH stimuli, thus allowing us to remove the influence of biases when creating the study stimuli. This is a notable advantage over other research methodologies in this line of inquiry. Several future research and education applications of this VH technology are discussed.

Pain assessment is subject to bias due to characteristics of the individual in pain and of the observing person. Few research studies have examined pain assessment biases in an experimental setting. This study employs innovative virtual human technology to achieve greater experimental control. A lens model design was used to capture decision-making policies at the idiographic and nomothetic level. Seventy-five undergraduates viewed virtual humans (VH) that varied in sex, race, age, and pain expression. Participants provided computerized ratings with Visual Analogue Scales on the VH's pain intensity, pain unpleasantness, negative mood, coping, and need for medical treatment. Idiographic analyses revealed that individuals used pain expression most frequently as a significant cue. Nomothetic analyses showed that higher pain expression VH and female VH were viewed as having higher pain intensity, higher pain unpleasantness, greater negative mood, worse coping, and a greater need to seek medical treatment than lower pain expression VH and male VH, respectively. Older VH were viewed as having worse coping and a greater need to seek medical treatment than younger VH. This innovative paradigm involving VH technology and a lens model design was shown to be highly effective and could serve as a model for future studies investigating pain-related decision making in healthcare providers.