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.
Journalism’s “social contract” refers to journalism’s role in democracy, primarily its obligations to inform the public and scrutinize government. The notion of a contract, however, entails the exchange of rights and obligations for mutual benefit. In this exchange, journalism enjoys the rights to free expression and publication, and it is obliged to cover the world fairly and accurately, providing citizens with the information they need to perform their roles as citizens. The notion of a social contract of the press is primarily rooted in liberal philosophy, though there is also a moral side to the contract that can be traced to republican theories of democracy. The question of reciprocity is central to the research on journalism’s social contract, primarily on the relationship between journalists and audiences, an area of research that is gaining traction as networked public spheres grow in importance as new venues of audience participation. Although the notion of a social contract is most visible in discussions of journalism ethics and professional practice, democratic media models also assume that journalism’s social contract constitutes an important conduit of democratic processes. As such, journalism’s social contract largely describes normative dimensions of journalism’s role in society, primarily embedded in notions related to the quality of information and an informed citizenry.
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.
Ashley R. Kennard, Courtney Anderegg, and David Ewoldsen
Knowledge and comprehension are essential components of an individual’s understanding of a health text. Whether reading a health pamphlet or watching a health campaign in the form of a public service announcement (PSA), or watching edutainment programming, individuals gain knowledge about the health topic being discussed. Knowledge, however, can only be retained if the individual can also comprehend the text or video. Often comprehension in a health context focuses on health literacy or the degree to which individuals can process and understand health information in order to make informed health decisions. Health literacy is commonly viewed in terms of the readability (e.g., reading level, complexity) of the health text or script. However, in order for individuals to gain knowledge and use that knowledge appropriately and effectively in making health decisions, individuals need to comprehend or understand what the text is conveying.
Because comprehension is such an important component of gaining and using health knowledge, we must understand how we store health knowledge in memory. A schema is a mental representation that stores knowledge as interrelated pieces of information. Schemas tend to be a fairly static representation of knowledge. A mental model is a more dynamic mental representation in that we use mental models to process, organize, and comprehend incoming information. In a mental model, there is a correspondence between an external entity and the constructed mental model of that entity that allows people to counterfactually manipulate information and engage in problem solving. A situation model is the most contextualized mental representation because it encompasses a specific event or set of interrelated events. There are several ways in which to examine comprehension processes. One way is to examine the most basic level of comprehension by investigating the importance of language and semantic representation of a text. A more complex way to examine comprehension is to view the activation levels of various words or concepts important in creating a representation of the story structure in memory. One model that specifically examines concept activation is the landscape model. The model posits that greater frequency of activation and the strength of activation of a concept determine the concept’s overall activation level. The higher the activation level of a concept in a text or video, the more likely the concept will be included in the mental representation for the text or video and stored in memory. A third way to study comprehension is to examine how concepts change throughout a text and how the concepts relate to one another. The event-indexing model describes how individuals create situation models based on five dimensions of information: time, space, protagonist, causality, and intentionality. Throughout the process of gaining information, the individual updates the situation models for a text on each of the five dimensions. When events have similar dimensions in common, the events are connected in memory; thus, describing health information with similar dimensions in common (e.g., a protagonist the entire way through the text, events happening in the same amount of time) will be better recalled later. Empirical work on comprehension of both text and video messages has demonstrated the landscape model and event-indexing model’s ability to examine comprehension processes based on the format, language, and organization of the information. Health message design can benefit from utilizing these comprehension models to ensure that knowledge is received by the intended audience and comprehended, and thus able to be used in future experiences.
Leadership has fascinated people from antiquity and has been studied extensively by academics for many decades. A variety of theoretical perspectives have taken hold—most notably that of transformational leadership—and have sought to explore the processes whereby leaders influence followers, to delineate the factors that put limits on such influence, and to determine the interrelationship between the attributes that leaders bring to their role and the contexts in which they find themselves. There has also been a growing interest in followership and how the behaviors, cognitions, and emotions of followers both contribute to organizational and group outcomes and help to shape leader behavior. The issue of followership, however, remains very much a nascent area of inquiry within the broader field of leadership studies.
Recently, explicitly communication perspectives have been brought more frequently to bear on leadership studies. This has assumed two main forms. First, “discursive leadership” has looked at both the linguistic mechanisms by which leader action and effects take place and how larger frames of leadership discourse can be said to constitute both broader leader–follower dynamics and our understanding of them. Associated with this, some complexity leadership theorists have stressed the “relational” dynamics implicit to leadership processes as a means of countering what they see as an excessive focus on the traits and actions of individual leaders. These approaches emphasize the importance of context and the relational dynamics between leaders and followers embedded in such contexts. Second, some communication scholars influenced by process theories of organization have begun to sketch out the means whereby communication is central to how organizational actors make, refuse, and enact claims to leadership agency, particularly in contexts where such claims may be contested by many. The role of follower dissent and power relations more generally is viewed as a crucial area of inquiry.
Accordingly, communication approaches to leadership have adopted a variety of theoretical perspectives. Many scholars from communication backgrounds have researched communication processes whereby leaders influence others. More recently, critically oriented communication scholars have explored the often conflicted dynamics between leaders and followers, focusing on such issues as power, domination, and control and their implications for leadership theory. Both explicitly and implicitly, these have therefore challenged dominant leadership perspectives, particularly but not exclusively that of transformational leadership.
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.
Rocio Garcia-Retamero, Dafina Petrova, Adam Feltz, and Edward T. Cokely
Graphical displays generally facilitate the communication of complex information and are ubiquitous in media. Unfortunately, people differ in their ability to extract data and meaning from graphical representations of quantitative information (i.e., graph literacy). This means that for some people, even well-designed, simple graphs will cause confusion and misunderstanding. Research on the psychology of graph comprehension focuses on two instruments that efficiently assess fundamental graph literacy among diverse adults. The Objective Graph literacy scale is a well-established instrument with good psychometric properties that measures skill via cognitive performance testing (e.g., interpreting and evaluating various graphs). The recently developed Subjective Graph Literacy scale is a brief self-report of graph literacy that can outperform the objective test in notable ways, while reducing text anxiety. Emerging applications in clinical research and practice, including computerized decision aids, can personalize content as a function of one’s graph literacy.
Robin L. Nabi
Emotion has been incorporated into media effects research in multiple ways, which can be broadly summarized as considering emotion as a predictor of media selection, an outcome of media exposure, and a mediator of other psychological and behavioral outcomes resulting from media exposure. Specifically, evidence suggests that the desire for particular feeling states influences the media that people choose to consume. Much research also considers the feeling states resulting from exposure, including fright reactions and enjoyment. Finally, there are well-established lines of inquiry into how emotional responses to media influence the processing of those messages in terms of attention, processing depth, and cognitive and behavioral outcomes. More contemporary research is extending these research programs, examining how emotional media messages are socially shared with others as well as the positive emotional effects that may emerge in response to media exposure.
Soyoon Kim and Brian G. Southwell
Typical discussion about the success of mediated health communication campaigns focuses on the direct and indirect links between remembered campaign exposure and outcomes; yet, what constitutes information exposure and how it is remembered remain unclearly defined in much health communication research. This problem mainly stems from the complexity of understanding the concept of memory. Prolific discussions about memory have occurred in cognitive psychology in recent decades, particularly owing to advances in neuroimaging technologies. The evolution of memory research—from unitary or dichotomous perspectives to multisystem perspectives—has produced substantial implications for the topics and methods of studying memory. Among the various conceptualizations and types of memory studied, what has been of particular interest to health-communication researchers and practitioners is the notion of “encoded exposure.” Encoded exposure is a form of memory at least retrievable by a potential audience member through a conscious effort to recollect his or her past engagement with any particular unit of campaign content. While other aspects of memory (e.g., non-declarative or implicit memory) are certainly important for communication research, the encoded exposure assessed under a retrieval condition offers a critical point at which to establish the exposure-outcome link for the purpose of campaign design and evaluation. The typical methods to assess encoded exposure include recall and recognition tasks, which can be exercised in various ways depending on retrieval cues provided by a researcher to assess different types and levels of cognitive engagement with exposed information. Given that encoded exposure theoretically relies on minimal memory trace, communication scholars have suggested that recognition-based tasks are more appropriate and efficient indicators of encoded exposure compared to recall-based tasks that require a relatively high degree of current-information salience and accessibility. Understanding the complex nature of memory also has direct implications for the prediction of memory as one of the initial stages of communication effects. Some prominent message-level characteristics (e.g., variability in the structural and content features of a health message) or message recipient-level characteristics (e.g., individual differences in cognitive abilities) might be more or less predictive of different memory systems or information-processing mechanisms. In addition, the environments (e.g., bodily and social contexts) in which people are exposed to and interact with campaign messages affect individual memory. While the effort has already begun, directions for future memory research in health communication call for more attention to sharpening the concept of memory and understanding memory as a unique or combined function of multilevel factors.
Mental models of health risks are the causal beliefs that comprise one’s inference engines for the interpretation and prediction of health and illness experiences and messages. Mental models of health risks can be parsed into a handful of common elements, including beliefs about causes, consequences, and cures as well as identifying information such as symptoms and timing. Mental models research deriving from a risk and decision analysis framework emphasizes exposure sources and pathways as part of causal thinking as well as how interventions may reduce or increase the risk. Mental models can be developed as a function of one’s goals or the problem in a specific context, rather than as coherent, stable knowledge structures in long-term memory. For this reason they can be piecemeal and inconsistent in the absence of expertise or experience with the risk. Derived often by analogy with more familiar risks, mental models of health risks can lead to effective health behaviors but also to costly inaction or misplaced action. Assessing mental models of hazardous processes can contribute to the design of effective risk communications by identifying the concrete information message recipients need to cope with health risks, thereby making or strengthening common-sense links between risk and action representations. Although a wide variety of research methods are used to investigate mental models, achieving this level of specificity requires attention to substantive details. Researchers are beginning to better understand the interactions between mental models of risk and their social, cultural, and physical contexts, but much remains to explore.
Message Recipient Psychological Characteristics: Incurious and Curious Motives to Learn about Health Risks
Successfully conveying information about the risk of potential threats to an individual’s physical and mental health is a serious challenge for healthcare practitioners. Adding to the challenge is the role of individual differences in people’s tendencies to want to learn (or in their choice to passively avoid) new information. These characteristic motives can be both curious and incurious in nature and interact with the perceived locus of the relevant health threat, which must be taken into account first. Some health threats are relatively “external,” and involve addressing the potential risk of an undesired event (e.g., developing illness, encountering relationship troubles). Research indicates that individuals who view external threats as “controllable” are more likely to respond positively to relevant information, but perception of control alone does not determine whether health-relevant information is likely to be sought or acted on. Besides perceived controllability, individual differences in incurious worry reduction motives (IWRM) play an important role as well. Two different kinds of IWRM have been identified: focus on distress (IWRM-FD) and focus on relief (IWRM-FR). Dispositional tendencies toward IWRM-FD are associated with greater willingness to seek out information when risk is perceived as low (i.e., information about the potential external threat is expected to make one feel better), but a tendency to passively avoid any information when risk is considered high (i.e., information is expected to intensify distress). In contrast, tendencies toward IWRM-FR reflect wanting more information about potential threats when risk is believed to be high, while passively avoiding news when perceived risk is low. In regard to coping with perceived risk, IWRM-FD scores predict avoidant coping, whereas IWRM-FR levels are associated with proactive coping and seeking others’ advice.
Other risks are more “internal,” and involve threats to an individual’s certainty about his or her self-concept, purpose in life, or the wisdom of past behavior; in short, an “identity crisis.” Such threats underlie wondering things like “Who am I, really?” and are associated with less self-awareness, lower self-esteem, and greater overall distress. In response to internal threats, intrapersonal curiosity (InC) motivates individuals to engage in introspective self-exploration that may help them to clarify, to elaborate on, and to improve their understanding of their self-concept. Recent research has found that individual differences in InC are positively associated with IWRM, suggesting that dealing with identity crises involves the desire to better know oneself, as well as wishing to mitigate worries about experiencing self-doubt.
Bearing the above in mind, research on individual differences in tendencies to avail oneself of different coping strategies indicates that proactive coping (e.g., positive reframing, seeking advice) tends to result in beneficial outcomes, such as personal growth and improved health, but some proactive strategies are “double-edged” and may lead to some negative outcomes as well. In particular, proactive strategies like acceptance of one’s limitations or discussing them with others when seeking social support were helpful, but they also had the potential to leave individuals feeling less sure of themselves. These findings suggest that practitioners who wish to more effectively communicate information about risk of potential health threats should consider whether the nature of the threat is internal or external, the role of individual differences in IWRM and InC, and how to help their patients to focus on the positive benefits of acceptance (i.e., identify solvable problems) and seeking social support (i.e., acquiring useful advice) over the negative aspects (i.e., admitting limitations).
Simon Zebregs and Gert-Jan de Bruijn
Meta-analyses are becoming increasingly popular in the field of health and risk communication—meta-analyses allow for more precise estimations of the magnitude of effects and the robustness of those effects across empirical studies in a particular domain. Despite its popularity, most scholars are not trained in the basic methods involved with meta-analyses. There are advantages to meta-analysis in comparison to other forms of research synthesis. An overview of the methods involved in conducting and reporting meta-analytical research is helpful.
However, the methods involved with meta-analyses are not as clear-cut as they may first appear. Numerous issues must be considered and various arbitrary decisions are required during the process. These issues and decisions relate to various topics such as inclusion criteria, the selection of sources, quality assessments for eligible studies, and publication bias. Basic knowledge of these issues and decisions is important for interpreting the outcomes of a meta-analysis correctly.
Metaphor equates two concepts or domains of concepts in an A is B form, such that a comparison is implied between the two parts leading to a transfer of features typically associated with B (called source) to A (called target). Metaphor is evident in written, spoken, gestural, and pictorial modalities. It is also present as latent patterns of thought in the form of conceptual mappings between domains of experience called conceptual metaphor. Metaphor is found commonly in a variety of health and risk communication contexts, including public discourse, public understanding and perceptions, medical encounters, and clinical assessment. Often metaphor use is beneficial to achieving desired message effects; however, sometimes its use in a message can lead to unintended undesirable effects. There is a general consensus, although not complete agreement, that metaphors in messages are processed through engagement with corresponding conceptual mappings. This matching process can be taken as a general principle for design of metaphor-based health and risk messages.
Matthew Bost and Matthew S. May
Michael Hardt and Antonio Negri are among the most powerful theorists of communication and social change under present-day global capitalism. In their Empire trilogy and other individual and collaborative works, Hardt and Negri argue for the fundamentally communicative nature of contemporary power. Their analyses demonstrate the ways that media technology, global flows of finance capital, and the contemporary shift to economies based on information and affective or emotional labor create new, more complex networks of oppression and new possibilities for more democratic social change. Hardt and Negri’s work, therefore, shifts the focus of critical communication and cultural theory from attaining or challenging political power within the nation-state and invites scholars to rethink sovereignty as empire: an interconnected global phenomenon appertaining to capitalism in the late 20th and early 21st centuries. They furthermore reimagine dissent as a constitutive process of resistance and mutual aid through which the multitude simultaneously withdraws from empire and composes itself through the social communication of struggles across time and space. Hardt and Negri’s work has been taken up in communication studies to theorize the materiality of communication; the labor performed in cognitive, communication, and service industries; contemporary media audiences and reception; and historical and contemporary social movements, from the Industrial Workers of the World to the Arab Spring and Occupy Wall Street.
Michel Foucault, who was born in 1926 into an upper-middle-class family, came of age in post-World War II Paris, studied with Louis Althusser, and rose to intellectual prominence in the 1970s, died on June 25, 1984. The near celebrity status that he acquired during his lifetime has multiplied since his death as the Foucault of disciplinary power has been supplemented with the Foucault of neoliberalism, biopolitics, aesthetics of the self, and the ontology of the present. These different forms of Foucauldian analysis are often grouped into three phases of scholarship that include the archeological, the genealogical, and the ethical. The first period, produced throughout the 1960s, focuses on the relationship between discourse and knowledge; the second period, developed throughout the 1970s, zeroes in on diverse structures of historically evolving power relations; and, the Foucault that emerged in the 1980s explores technologies of the self or the work of the self on the self. This well-recognized periodization highlights the triangulated structure of associations among knowledge, power, and subjectivity that animated his work. Because a number of decentered relations, something he called governmentality, are woven through everyday experience, Foucault questioned the assumption that communication takes place between autonomous, self-aware individuals who use language to negotiate and organize community formation and argued instead that this web of discourse practices and power relations produces subjects differentially suited to the contingencies of particular historical epochs.
Although a critical consensus has endorsed this three-part taxonomy of Foucault’s scholarship, the interpretation of these periods varies. Some view them through a linear progression in which the failures of one moment lay the groundwork for the superseding moment: his discursive emphasis in the archeological phase gave way to his emphasis on power in the genealogical phase which, in turn, gave way to his focus on subjectivity in the ethical phase. Others, such as Jeffrey Nealon, understand the shifts as “intensifications” (p. 5) wherein each phase tightens his theoretical grip, triangulating knowledge, power, and subjectivity ever more densely. Still others suggest that the technologies of the self that undergird Foucault’s ethical period displace the leftist orientation of his early work with a latent conservatism. Regardless of where one lands on this debate, Foucault’s three intellectual phases cohere around an ongoing analysis of the relationships among knowledge, power, and subjectivity—associations at the heart of communication studies.
Focused on how different subjects experience the established “regime of truth,” Foucault’s historical investigations, while obviously diverse, maintain a similar methodology, one he labeled the history of thought and contrasted with the history of ideas. As he conceives it, the history of ideas attempts to determine the origin and evolution of a particular concept through an uninterrupted teleology. He distinguishes his method, the history of thought, through its focus on historical problematization. This approach explores “the way institutions, practices, habits, and behavior become a problem for people who have certain types of habits, who engage in certain kinds of practices, and who put to work specific kinds of institutions.” In short, he studies how people and society deal with a phenomenon that has become a problem for them. This approach transforms the narrative of human progress into a history broken by concrete political, economic, and cultural problems whose resolution requires reconstituting the prevailing knowledge–power–subject dynamics. Put differently, Foucault illuminates historical breaks and the shifts required for their repair. Whereas the history of ideas erases the discontinuity among events, he highlights those differences and studies the process by which they dissolve within a singular historical narrative. Glossing his entire oeuvre, he suggests that his method can address myriad concerns, including “for example, about madness, about crime, about sex, about themselves, or about truth.” An overarching approach that intervenes into dominant narratives in order to demonstrate their silencing effects, the history of thought undergirds all three of Foucault’s externally imposed periods. Each period explores knowledge, power, and subjectivity while stressing one nodal point of the relationship: archeology stresses knowledge formation; genealogy emphasizes power formation; and the ethical period highlights subject formation. This strikingly original critical approach has left its mark on a wide range of theorists, including such notable thinkers as Gilles Deleuze, Giorgio Agamben, Michael Hardt, Antonio Negri, Donna Haraway, and Judith Butler, and has influenced critical communication scholars such as Raymie McKerrow, Ronald Greene, Kendell Phillips, Jeremy Packer, and Laurie Ouellete.
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.
Holley A. Wilkin
When it comes to health and risk, “place” matters. People who live in lower-income neighborhoods are disproportionately affected by obesity and obesity-related diseases like heart disease, hypertension, and diabetes; asthma; cancers; mental health issues; etc., compared to those that live in higher-income communities. Contributing to these disparities are individual-level factors (e.g., education level, health literacy, healthcare access) and neighborhood-level factors such as the socioeconomic characteristics of the neighborhood; crime, violence, and social disorder; the built environment; and the presence or absence of health-enhancing and health-compromising resources. Social determinants of health—for example, social support, social networks, and social capital—may improve or further complicate health outcomes in low-income neighborhoods.
Social support is a type of transaction between two or more people intended to help the recipient in some fashion. For instance, a person can help provide someone who is grieving or dealing with a newly diagnosed health issue by providing emotional support. Informational support may be provided to someone trying to diagnose, manage, and/or treat a health problem. Instrumental support may come in the help of making meals for someone who is ill, running errands for them, or taking them to a doctor’s appointment. Unfortunately, those who may have chronic diseases and require a lot of support or who otherwise do not feel able to provide support may not seek it due to the expectation of reciprocity. Neighborhood features can enable or constrain people from developing social networks that can help provide social support when needed. There are different types of social networks: some can enhance health outcomes, while others may have a more limiting or even a detrimental effect on health. Social capital results in the creation of resources that may or may not improve health outcomes.
Communication infrastructure theory offers an opportunity to create theoretically grounded health interventions that consider the social and neighborhood characteristics that influence health outcomes. The theory states that every neighborhood has a communication infrastructure that consists of a neighborhood storytelling network—which includes elements similar to the social determinants of health—embedded in a communication action context that enables or constrains neighborhood storytelling. People who are more engaged in their neighborhood storytelling networks are in a better position to reduce health disparities—for example, to fight to keep clinics open or to clean up environmental waste. The communication action context features are similar to the neighborhood characteristics that influence health outcomes. Communication infrastructure theory may be useful in interventions to address neighborhood health and risk.
Amanda J. Dillard and Erin M. Ellis
When individuals are asked whether they will someday own their own home, enjoy a productive career, or develop a myriad of diseases, many are optimistic. Generally, they think they will experience more good than bad outcomes in life and they view themselves as more likely than similar others to experience the good things and less likely than others to experience the bad things. In the area of health behavior and communication, there are three primary types of optimism that have been defined and operationalized: (1) Dispositional optimism is the generalized positive expectancy that one will experience good outcomes. (2) Comparative optimism refers to the belief that one is either more likely than others to experience positive events or less likely than others to experience negative events. (3) Unrealistic optimism refers to an underestimation of one’s actual risk of experiencing some negative event. Although the three types of optimism may be correlated, their associations may be modest. Also, unlike dispositional optimism, which is an individual difference, comparative and unrealistic optimism are often risk perceptions about specific events and therefore can be defined as accurate or inaccurate. For this reason, the latter two types of optimism have sometimes been labeled the optimistic bias. Research on all three varieties of optimism affords opportunities to understand how optimism influences information processing in a health message or one’s behavioral intentions following the message.