Claude H. Miller and Reinaldo Cortes Quantip
Within a range of health communication contexts, anger can be either a detriment to the receptivity of health promotion messages when poorly controlled, or a benefit to information processing when appropriately directed. In the former case, anger can disrupt cognitive processing, leading to a range of negative outcomes, including emotional turbulence and a preoccupation with anger-eliciting events that can severely limit the receptivity of health promotion and risk prevention messages. However, when properly directed and elicited in moderation, anger can motivate greater purpose and resolve in response to health threats, stimulate more active processing of health warnings, sharpen focus on argument quality, and direct greater attention to coping-relevant information concerning harmful health risks.
Rachel A. Smith
A premise in health promotion and disease prevention is that exposure to and consequences of illness and injury can be minimized through people’s actions. Health campaigns, broadly defined as communication strategies intentionally designed to encourage people to engage in the actions that prevent illness and injury and promote wellbeing, typically try to inspire more than one person to change. No two people are exactly alike with respect to their risk for illness and injury or their reactions to a campaign attempting to lower their risk. These variations between people are important for health messaging. Effective campaigns provide a target audience with the right persuasive strategy to inspire change based on their initial state and psychosocial predictors for change. It is often financially and logistically unreasonable to create campaigns for each individual within a population; it is even unnecessary to the extent to which people exist in similar states and share psychosocial predictors for change. A challenging problem for health campaigns is to define those who need to be reached, and then intelligently group people based on a complex set of variables in order to identify groups with similar needs who will respond similarly to a particular persuasive strategy. The premise of this chapter is that segmentation at its best is a systematic and explicit process of research to make informed decisions about how many audiences to consider, why the audience is doing what they are doing, and how to reach that audience effectively.
Sandra Petronio and Rachael Hernandez
Have you ever wondered why a complete stranger sitting next to you on a plane would tell you about a recent cancer diagnosis? Why your parents never disclosed that you were adopted, feeling shocked when you accidently find out as an adult? These and many other actions reflect decisions individuals make about managing their private information. Being aware of how individuals navigate decisions to disclose or protect their private information provides useful insights that aid in the development and sustainability of relationships with others. Given privacy plays an integral role in everyone’s life, knowing more about privacy management is critical. communication privacy management (CPM) theory was first introduced by Sandra Petronio in 2002. CPM is evidence-based and accordingly provides a dependable understanding of how decisions are made to disclose and protect private information. This theory uses plain language to understand privacy management in everyday life. CPM focuses on the relationship people have with each other in communicative contexts, such as face-to-face interactions, on social media, and in dyads or groups. CPM theory is based on a communicative-social behavioral perspective and not necessarily a legal point of view. CPM theory illustrates that privacy is not paradoxical but is sustainable through the process of a privacy management system used in everyday life. The theory of CPM has been employed in a number of contexts shedding light on antecedents, mechanisms, and outcomes of private information management. In addition, a number of researchers across multiple countries, such as the Netherlands, United Kingdom, Japan, Kenya, South Korea, and the United States, have used CPM theory in their research investigations. Learning more about the system of private information management allows for a better understanding of how people navigate managing their private information when others are involved. Literature illustrates patterns of privacy management and demonstrates the challenges as well as the positive outcomes of the way individuals regulate their private information.
Sandra Petronio and Maria K. Venetis
Communication privacy management theory (CPM) argues that disclosure is the process by which we give or receive private information. Private information is what people reveal. Generally, CPM theory argues that individuals believe they own their private information and have the right to control said information. Management of private information is not necessary until others are involved. CPM does not limit an understanding of disclosure by framing it as only about the self. Instead, CPM theory points out that when management is needed, others are given co-ownership status, thereby expanding the notion of disclosing information; the theory uses the metaphor of privacy boundary to illustrate where private information is located and how the boundary expands to accommodate multiple owners of private information. Thus, individuals can disclose not only their own information but also information that belongs to others or is owned by collectives such as families.
Making decisions to disclose or protect private information often creates a tension in which individuals vacillate between sharing and concealing their private information. Within the purview of health issues, these decisions have a potential to increase or decrease risk. The choice of disclosing health matters to a friend, for example, can garner social support to cope with health problems. At the same time, the individual may have concerns that his or her friend might tell someone else about the health problem, thus causing more difficulties.
Understanding the tension between disclosing and protecting private health information by the owner is only one side of the coin. Because disclosure creates authorized co-owners, these co-owners (e.g., families, friends, and partners) often feel they have right to know about the owner’s health conditions. The privacy boundaries are used metaphorically to indicate where private information is located. Individuals have both personal privacy boundaries around health information that expands to include others referred to as “authorized co-owners.” Once given this status, withholding to protect some part of the private information can risk relationships and interfere with health needs. Within the scheme of health, disclosure risks and privacy predicaments are not experienced exclusively by the individual with an illness. Rather, these risks prevail for a number of individuals connected to a patient such as providers, the patient’s family, and supportive friends. Everyone involved has a dual role. For example, the clinician is both the co-owner of a patient’s private health information and holds information within his or her own privacy boundary, such as worrying whether he or she diagnosed the symptoms correctly. Thus, there are a number of circumstances that can lead to health risks where privacy management and decisions to reveal or conceal health information are concerned.
CPM theory has been applied in eleven countries and in numerous contexts where privacy management occurs, such as health, families, organizations, interpersonal relationships, and social media. This theory is unique in offering a comprehensive way to understand the relationship between the notion of disclosure and that of privacy. The landscape of health-related risks where privacy management plays a significant role is both large and complex. The situations of HIV/AIDS, cancer care, and managing patient and provider disclosure of private information help to elucidate the ways decisions of privacy potentially lead to health risks.
Spring Chenoa Cooper and P. Christopher Palmedo
Embarrassment, according to Fischer and Tangney, is an “aversive state of mortification, abashment, and chagrin that follows public social predicaments.” It is usually related to our perceptions of how others perceive us as well as their judgments of us, and it is associated with a loss of self-esteem when we perceive that others have judged us as inadequate or incompetent. However, even mere exposure or attention publicly placed on someone can elicit embarrassment (think of someone pointing at you and laughing).
Embarrassment is considered a self-conscious emotion. Self-conscious emotions include those that are evoked by self-reflection and self-evaluation: embarrassment, shame, guilt, and pride. Shame, an intense form of embarrassment, also has structural and larger social contexts, while embarrassment is more individually experienced. Self-conscious emotions play an important role in regulating behavior; they assist us in behaving according to social standards and guide us in responding when those rules are broken. While these emotions provide feedback in social situations, they also provide feedback for anticipated outcomes.
Embarrassment can play an important role in health, both in communication and behavior, and occurs through different forms. Primary embarrassment is the first rush of blood to the face and increased heart rate that usually lasts a few moments. Secondary embarrassment is the after-effect that shapes future behavior. Anticipatory embarrassment is the emotion surrounding the potential for embarrassment in an upcoming situation. Solitary embarrassment is the one that no one actually observes.
Three stigmatized areas of health—mental health, healthcare, and sexual health—may be assessed as case studies through which to understand the literature around embarrassment, as both an affect and an emotion.
John C. Meyer and Steven J. Venette
Humor is ubiquitous in communication and is thus worthy of study as part of messages relating to risks and health. Humor’s widely acknowledged effects invite systematic explanation and application by communication scholars interested in health and risk communication. Humor’s influence upon health and risk messages results from the theories of humor origin (incongruity, superiority, and relief), elements of humor perception (unifying or comic perspectives as opposed to tragic or divisive perspectives), and humor functions in social interactions (identification, clarification, enforcement, and differentiation). Humor can be used in messages to mitigate high ego involvement, high levels of fear, and a low sense of efficacy in terms of ability to respond to risk or health messages. Humor can serve to enhance relationships, allowing for more creative discussion of risks and health improvement, yet also can serve to pointedly tease or express a memorable perspective to capture attention regarding a risk or health issue.
Lily A. Arasaratnam
The phrase “intercultural competence” typically describes one’s effective and appropriate engagement with cultural differences. Intercultural competence has been studied as residing within a person (i.e., encompassing cognitive, affective, and behavioral capabilities of a person) and as a product of a context (i.e., co-created by the people and contextual factors involved in a particular situation). Definitions of intercultural competence are as varied. There is, however, sufficient consensus amongst these variations to conclude that there is at least some collective understanding of what intercultural competence is. In “Conceptualizing Intercultural Competence,” Spitzberg and Chagnon define intercultural competence as, “the appropriate and effective management of interaction between people who, to some degree or another, represent different or divergent affective, cognitive, and behavioral orientations to the world” (p. 7). In the discipline of communication, intercultural communication competence (ICC) has been a subject of study for more than five decades. Over this time, many have identified a number of variables that contribute to ICC, theoretical models of ICC, and quantitative instruments to measure ICC. While research in the discipline of communication has made a significant contribution to our understanding of ICC, a well-rounded discussion of intercultural competence cannot ignore the contribution of other disciplines to this subject. Our present understanding of intercultural competence comes from a number of disciplines, such as communication, cross-cultural psychology, social psychology, linguistics, anthropology, and education, to name a few.
Maria K. Venetis
The degree to which patients are active and communicative in interactions with medical providers has changed in recent decades. The biomedical model, a model that minimizes patient agency in the medical interaction, is being replaced with a model of patient-centered care, an approach that prioritizes the individual patient in their healthcare and treatment decisions. Tenets of patient-centered care support that patients must be understood within their psychosocial and cultural preferences, should have the freedom to ask questions, and are encouraged to disclose health-relevant information. In short, this model promotes patient involvement in medical conversations and treatment decision-making. Research continues to examine approaches to effective patient-centered communication. Two interpersonal processes that promote patient-centered communication are patient question-asking and patient disclosure. Patient question-asking and disclosure serve to inform medical providers of patient preferences, hesitations, and information needs. Individuals, including patients, make decisions to pursue or disclose information. Patients are mindful that the act of asking questions or disclosing information, particularly stigmatized information such as sexual behavior or drug use, could make them vulnerable to perceived negative provider evaluations or responses. Thus, decisions to ask questions or share information, processes essential to the understanding of patient perspectives and concerns, may be challenging for patients. Various theoretical models explain how individuals consider if they will perform actions such as seeking or disclosing information. Research also explains the barriers that patients experience in asking questions or disclosing relevant health information to providers. A review of pertinent research offers suggestions to aid in facilitating improved patient-centered communication and care.
Michael L. Hecht and Michelle Miller-Day
Adolescent substance use and abuse has long been the target of public health prevention messages. These messages have adopted a variety of communication strategies, including fear appeals, information campaigns, and social marketing/branding strategies. A case history of keepin’ it REAL, a narrative-based substance abuse prevention intervention that exemplifies a translational research approach, involves theory development testing, formative and evaluation research, dissemination, and assessment of how the intervention is being used in the field by practitioners. The project, which started as an attempt to test the notion that the performance of personal narratives was an effective intervention strategy, has since produced two theories, an approach to implementation science that focused on communication processes, and, of course, a school-based curriculum that is now the most widely disseminated drug prevention program in the world.
At the core of the keepin’ it REAL program are the narratives that tell the story of how young people manage their health successfully through core skills or competencies, such as decision-making, risk assessment, communication, and relationship skills. Narrative forms not only the content of curriculum (e.g., what is taught) but also the pedagogy (e.g., how it is taught). This has enabled the developers to step inside the social worlds of youth from early childhood through young adulthood to describe how young people manage problematic health situations, such as drug offers. This knowledge was motivated by the need to create curricula that recount stories rather than preaching or scaring, that re-story health decisions and behaviors by providing skills that enable people to live healthy, safe, and responsible lives. Spin-offs from the main study have led to investigations of other problematic health situations, such as vaccination decisions and sexual pressure, in order to address crucial public health issues, such as cancer prevention and sex education, through community partnerships with organizations like D.A.R.E. America, 4-H clubs, and Planned Parenthood.
Graham D. Bodie
Listening is recognized as a multidimensional construct that consists of complex (a) affective processes, such as being motivated to attend to others; (b) behavioral processes, such as responding with verbal and nonverbal feedback; and (c) cognitive processes, such as attending to, understanding, receiving, and interpreting content and relational messages. Research in the communication studies discipline has focused most heavily on the cognitive processes of listening with the least attention afforded to behavioral components. Although several models of listening have been put forward, scholars still struggle with basic notions of how best to define listening for research purposes and how to incorporate listening into mainstream theoretical frameworks. Contemporary scholarship explores intersections between listening and cultural studies research as communication scholars come to participate in larger discussions of the auditory environment. At the start of the 21st century, listening research is just one of the many sites where communication studies is making a contribution to interdisciplinary research across the humanities and social sciences.
Walid A. Afifi
The turn of the 21st century has seen an explosion of frameworks that account for individuals’ decisions to seek or avoid information related to health risks. The four dominant frameworks are Risk Perception Attitude Framework, the Risk Information Seeking and Process model, the Planned Risk Information Seeking Model, and the Theory of Motivated Information Management. A comparison of the constructs within each and an examination of the related empirical tests reveal important insights into (a) factors that have consistently been shown to shape these decisions across these approaches and (b) constructs in need of additional theorizing and empirical testing. Specifically, the analysis suggests that uncertainty, efficacy, affect, risk perceptions, and subjective norms all play crucial roles in accounting for decisions to seek or avoid risk-related information. However, inconsistencies in the direction of influence for uncertainty or information discrepancy, risk perceptions, and negative affect argue for the need for considerably more theoretical clarity and empirical rigor in investigations of the ways in which these experiences shape decision making in these contexts.
Multicommunication means interacting with several people separately but at the same time. Usually multicommunication refers to parallel conversations enabled by communication technologies. The essential element is interactivity: in multicommunication, several mutual, two-way interactions are managed between people. A few adjacent concepts related to multicommunication have also been used in the literature, including multitasking, media or electronic multitasking, polychronicity, and polychronic communication.
Research interest in multicommunication is growing. Whereas the nascent phases of multicommunication research were largely concerned with observing the manifestation and characteristics of the multicommunication phenomenon, defining the concept of multicommunication, and differentiating multicommunication from similar concepts, contemporary research has spread out in many directions. Three main topics can be distinguished in multicommunication research: motivators of multicommunication, management of multicommunication, and consequences of multicommunication. The research contexts for multicommunication to date have been predominantly limited to working life. Very few studies have actually focused on family communication, contacts between friends, or other contexts involving communication in private life.
For their preferred methods in empirical multicommunication research, most scholars to date have used surveys, interviews, diaries, critical incidents, and other self-reports, as well as laboratory experiments. Researchers are beginning to learn quite a bit about the motivators and consequences of multicommunication, as described by employees in the workplace. Multicommunication research would thus benefit from the observation and analysis of natural communication found in actual contexts, settings, and relationships.
Erin M. Hill
Narcissism is a personality trait characterized by perceptions of grandiosity, superiority, and the need for attention and admiration. There has been an increase in focus on examining the development of narcissism and how the trait influences a range of social and health behaviors. A key feature of narcissism is that it is characterized by high self-esteem with a simultaneously fragile ego that requires continual monitoring and manipulation. Therefore, much of the behaviors narcissists engage in are linked to the drive to maintain perceptions of superiority and grandiosity. In the area of health and well-being, narcissism has been positively correlated with psychological health, a relationship that may be accounted for by self-esteem. However, there has been less research on the relationship between narcissism and physical health and well-being. There is some evidence that narcissism is linked to a variety of physical appearance-oriented health behaviors (i.e., behaviors that could affect body weight or other aspects of physical appearance, including eating and exercise). Narcissism has also been positively linked to risk-taking behaviors, including use of substances, as well as risks that could significantly impact others, including sexual behaviors and risky driving. The relationship between narcissism and health is therefore complex, with some positive correlates (e.g., physical activity), but also various health risk behaviors.
In considering how narcissism might interact with health messages, communicators have to keep in mind that narcissists seem to have some deficits in judgment and decision-making, such as overconfidence and a narrow focus on rewards associated with behaviors. Their behaviors tend to be driven by managing their own ego and by drawing attention and admiration from others to maintain perceptions of superiority and grandiosity. In turn, health communicators may need to rely on creative strategies that tap into these domains of narcissism in order to effectively modify health behaviors among narcissistic individuals. Further research on the influence of narcissism in healthcare seeking and related preventive behaviors would also help to provide a more detailed understanding for how the trait influences health decisions, information that would be useful for both health researchers and practitioners.
Brenda L. Berkelaar and Millie A. Harrison
Organizational socialization is the process by which people learn about, adjust to, and change the knowledge, skills, attitudes, expectations, and behaviors needed for a new or changing organizational role. Thus, organizational socialization focuses on organizational membership, which includes how people move from being outsiders to being insiders and how people move between organizational roles within and across organizations over time. To date, research has focused on how employment organizations encourage newcomers to align with existing role expectations via tactics that encourage assimilation. However, organizational socialization is a dynamic process of mutual influence. Individuals can also influence and shape the organization to align with their desires, via personalization tactics. Thus, organizational socialization describes the process by which an individual assumes a new or changing role in ways that meet organizational and individual needs.
Most research on organizational socialization focuses on how newcomers enter paid work environments. Researchers often focus on the tactics organizations use to encourage people to assimilate into the organization during the early or entry stage. Less attention has been given to the later stages of organizational socialization (active participation, maintenance, exit, and disengagement), non-work organizations, and transitions between roles within an organization. However, a growing body of research is considering organizational socialization into volunteer roles, new or changing roles, and later stages of socialization such as exit and disengagement. Scholars and practitioners also increasingly recognize how individual, organizational, contextual, and technological factors (e.g., socioeconomic status, race, gender, new information and communication technologies, time, and boundaries) may alter how organizational socialization works and with what effects—thereby offering insight into the underlying processes implicated in organizational socialization. Future areas of research related to context, time, boundaries, communication, and the ethics of organizational socialization are highlighted.
Self-affirmation theory posits that people are motivated to maintain an adequate sense of self-integrity. It further posits that the self-system is highly flexible such that threats to one domain of the self can be better endured if the global sense of self-integrity is protected and reinforced by self-resources in other, unrelated domains. Health and risk communication messages are often threatening to the self because they convey information that highlights inadequacies in one’s health attitudes and behaviors. This tends to lead to defensive response, particularly among high-risk groups to whom the messages are typically targeted and most relevant. However, self-affirmation theory suggests that such defensive reactions can be effectively reduced if people are provided with opportunities to reinforce their sense of self-integrity in unrelated domains. This hypothesis has generated substantial research in the past two decades.
Empirical evidence so far has provided relatively consistent support for a positive effect of self-affirmation on message acceptance, intention, and behavior. These findings encourage careful consideration of the theoretical and practical implications of self-affirmation theory in the genesis and reduction of defensive response in health and risk communication. At the same time, important gaps and nuances in the literature should be noted, such as the boundary conditions of the effects of self-affirmation, the lack of clarity in the psychological mechanisms underlying the observed effects, and the fact that self-affirmation can be easily implemented in some health communication contexts, but not in others. Moreover, the research program may also benefit from greater attention to variables and questions of more direct interest to communication researchers, such as the role of varying message attributes and audience characteristics, the potential to integrate self-affirmation theory with health communication theories, and the spontaneous occurrence of positive self-affirmation in natural health communication settings.
Kaite Yang and Emily Pronin
Social psychological research on thinking has generally focused on the attitudes, emotions, motivations, and biases that affect thinking and consequent behavior. What has received less attention is the speed of thinking: how quickly thinking occurs and whether thoughts accelerate or slow down. Communication design and processing may take for granted that the structure and reception of messages occur at a certain speed. Recent findings from the psychological study of thought speed shed light on ways that this research may be applied to health communication. Fast and slow rates of thinking are correlated with distinct patterns of affective, cognitive, physiological, and behavioral events. Fast thinking is associated with positive mood, energy, approach motivation, arousal, creativity, and risk-taking. Slow thinking is associated with negative mood and depression, low energy, and cognitive impairment. Potential theories exist for why psychological and physiological experiences are associated with thought speed.
Recent experimental research demonstrates that thought speed can be successfully manipulated to elicit psychological effects, and it can be manipulated independent of thought content. Researchers, healthcare practitioners, and communicators should be aware of the psychological correlates and consequences of thought speed and consider harnessing the effects of thought speed to augment communication. Thought acceleration and deceleration can be integrated into the design and processing of health communication.
Monique Mitchell Turner
In social marketing, the use of guilt appeals can be effective for influencing healthy behaviors. Guilt, being a moral, other-based emotion, can spur people to think of others, act honestly, and be empathetic. Likewise, collective guilt, the feeling that arises when people believe their in-group caused illegitimate harm to others, can lead people to feel positively toward the victimized others and desire policies that will help them. We can see then, that guilt, though often considered “negative” can lead to an array of prosocial, constructive, behaviors. In that vein, a number of researchers have assessed the possibility that guilt based persuasive appeals can induce such positive behaviors.
Clearly, guilt-appeals can be an effective tool for reducing risk (STI testing), increasing prevention practices (encouraging mammograms), and effecting altruistic health-related behaviors (donating blood). In the correct conditions, guilt appeals can induce guilty feelings, lead people to want to “right the wrong,” generate positive attitudes about the message’s advocacy, and intend to engage in a behavior.