Dissertation Abstract

The Effects of Contingent Versus Noncontingent Instruction on Children's Responses to Selected Radiologic Procedures.

This study investigated the effects of choice in preprocedural instruction on children's responses to intravenous pyelograms (IVP) and voiding cystourethrograms (VCUG). The study was concerned with the following major question: What are the effects of choice in preprocedure instruction on children's (a) search for knowledge during the procedure, (b) behavioral responses during the procedure, and (c) self-reported emotional responses to the procedure? Contingent instruction (C) was defined as an instructional method in which information was provided to children on the basis of their questions and requests. These questions and requests represented choices the children made concerning the information they would like about the upcoming procedure. Noncontingent (NC) instruction was defined as an instructional method in which information was provided to the children on the basis of recommendations from the literature and clinical practice.

The study utilized an experimental design. Subjects (N = 62) included children four through 12 years old who were scheduled for a routine IVP and/or VCUG at a major urban hospital. Subjects were assigned randomly to instruction groups (C = 31, NC = 31). Dependent variables were measured during the radiologic procedure as follows: (a) Manifest Upset Scale, (b) Cooperation Rating Scale, and (c) modified Rose Observation Protocol. Self-report of emotional response, number of post procedure questions, and perception of choice were measured through structured interviews with the children after the procedure.

Results indicated that instruction group was significantly associated with search for knowledge scores (p (LESSTHEQ) .05) and distress scores (p = .1). However the direction of these relationships was opposite that predicted. The noncontingent group was associated with more searching for knowledge and less reported distress. All dependent variables demonstrated this opposite direction. It was concluded that prior to a painful, intrusive radiologic procedure, children respond more positively to a structured teaching approach. Making choices under these circumstances did not have the beneficial effects often attributed to choice. Thus, it appears that structure, as well as choice, deserve consideration in clinical practice.

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