Direct-to-consumer advertising of prescription drugs (DTCA) is a multibillion-dollar industry in the United States, affecting the health-care landscape. DTCA has been controversial, since a major increase in this type of advertising resulted from re-interpretation of existing regulations in the late 20th century. Health and risk communication research can inform many of the controversial issues, assisting physicians, policymakers, and the public in understanding how consumers respond to DTCA. Prior research addresses four major topics: (1) the content of DTCA in different channels, (2) consumers’ perceptions of and responses to DTCA, (3) individual-level factors that affect how consumers respond to DTCA, and (4) message factors that impact consumers’ responses. Such research shows that the presentation of risk and benefits information is generally not balanced in DTCA, likely affecting consumers’ attitudes toward and comprehension of the risk information. In addition, despite consumers’ generally somewhat negative or neutral perceptions of DTCA, this advertising seems to affect their health information seeking and communication behaviors. Finally, a wide range of individual-level and message factors have been shown to have an impact on how consumers process and respond to DTCA. Consumers’ responses, including how they process the information, request prescription drugs from providers, and share information about prescription drugs, have an important impact on the effects of DTCA. The fields of health and risk communication therefore bring theories and methodologies that are essential to better understanding the impact of this advertising.
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Direct-to-Consumer Advertising and Health and Risk Messaging
Kimberly A. Kaphingst
Article
Health Promotion and Risk Reduction in Congregations
Dennis Myers, Terry A. Wolfer, and Maria L. Hogan
A complex web of attitudinal, cultural, economic, and structural variables condition the decision to respond to communications promoting healthy behavior and participation in risk reduction initiatives. A wide array of governmental, corporate, and voluntary sector health-related organizations focus on effective messaging and health care options, increasing the likelihood of choices that generate and sustain wellness. Researchers also recognize the significant and multifaceted ways that religious congregations contribute to awareness and adoption of health-promoting behaviors. These religiously based organizations are credible disseminators of health education information and accessible providers of venues that facilitate wellness among congregants and community members. The religious beliefs, spirituality, and faith practices at the core of congregational cultural life explain the trustworthiness of their messaging, the health of their adherents, and the intention of their care provision.
Considerable inquiry into the impact of religion and spirituality on health reveals substantive correlations with positive psychological factors known to sustain physical and psychological health—optimism, meaning and purpose, hope, well-being, self-esteem, gratefulness, social support, and marital stability. However, the beliefs and practices that create receptivity to health-related communications, care practices, and service provision can also be a deterrent to message impact and participation in healthy behaviors. When a productive relationship between spirituality and health exists, congregational membership offers rituals (e.g., worship, education, mission) and relationships that promote spiritual well-being. Research demonstrates increased life satisfaction and meaning in life, with health risk reduction associated with a sense of belonging, enriched social interactions, and shared experiences.
Congregations communicate their commitment to wellness of congregants and community members alike through offering a variety of congregationally based and collaborative wellness and risk reduction programs. These expressions of investment in individual and community health range across all age, gender, and ethnic demographics and address most of the prominent diagnostic categories. These programs are ordered along three dimensions: primary prevention (health care messaging and education), secondary prevention (risk education), and tertiary prevention (treatment). Applying the dimensions of sponsorship, goal/mission, focus, services, staffing, and intended outcome highlights the similarities and differences among them. Several unique facets of congregational life energize the effectiveness of these programs. Inherent trust and credibility empower adherence, and participation decisions and financial investment provide service availability. These assets serve as attractive contributions in collaborations among congregations and between private and public health care providers.
Current research has not yet documented the best practices associated with program viability. However, practice wisdom in the planning, implementation, and evaluation of congregationally based and collaborative health-related programs suggests guidelines for future investigation. Congregational leaders and health care professionals emphasize well-designed needs assessment. Effective congregational health promotion and risk reduction may be linked to the availability and expertise of professionals and volunteers enacting the roles of planner/program developer, facilitator, convener/mediator, care manager/advocate, health educator, and direct health care service provider.
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Scientific Uncertainty in Health and Risk Messaging
Stephen Zehr
Expressions of scientific uncertainty are normal features of scientific articles and professional presentations. Journal articles typically include research questions at the beginning, probabilistic accounts of findings in the middle, and new research questions at the end. These uncertainty claims are used to construct clear boundaries between uncertain and certain scientific knowledge. Interesting questions emerge, however, when scientific uncertainty is communicated in occasions for public science (e.g., newspaper accounts of science, scientific expertise in political deliberations, science in stakeholder claims directed to the public, and so forth). Scientific uncertainty is especially important in the communication of environmental and health risks where public action is expected despite uncertain knowledge. Public science contexts are made more complex by the presence of multiple actors such as citizen-scientists, journalists, stakeholders, social movement actors, politicians, and so on who perform important functions in the communication and interpretation of scientific information and bring in diverse norms and values.
A past assumption among researchers was that scientists would deemphasize or ignore uncertainties in these situations to better match their claims with a public perception of science as an objective, truth-building institution. However, more recent research indicates variability in the likelihood that scientists communicate uncertainties and in the public reception and use of uncertainty claims. Many scientists still believe that scientific uncertainty will be misunderstood by the public and misused by interest groups involved with an issue, while others recognize a need to clearly translate what is known and not known.
Much social science analysis of scientific uncertainty in public science views it as a socially constructed phenomenon, where it depends less upon a particular state of scientific research (what scientists are certain and uncertain of) and more upon contextual factors, the actors involved, and the meanings attached to scientific claims. Scientific uncertainty is often emergent in public science, both in the sense that the boundary between what is certain and uncertain can be managed and manipulated by powerful actors and in the sense that as scientific knowledge confronts diverse public norms, values, local knowledges, and interests new areas of uncertainty emerge. Scientific uncertainty may emerge as a consequence of social conflict rather than being its cause. In public science scientific uncertainty can be interpreted as a normal state of affairs and, in the long run, may not be that detrimental to solving societal problems if it opens up new avenues and pathways for thinking about solutions. Of course, the presence of scientific uncertainty can also be used to legitimate inaction.
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Health-Related Warning Message Processing
Christopher B. Mayhorn and Michael S. Wogalter
Warnings are risk communication messages that can appear in a variety of situations within the healthcare context. Potential target audiences for warnings can be very diverse and may include health professionals such as physicians or nurses as well as members of the public. In general, warnings serve three distinct purposes. First, warnings are used to improve health and safety by reducing the likelihood of events that might result in personal injury, disease, death, or property damage. Second, they are used to communicate important safety-related information. In general, warnings likely to be effective should include a description of the hazard, instructions on how to avoid the hazard, and an indication of the severity of consequences that might occur as a result of not complying with the warning. Third, warnings are used to promote safe behavior and reduce unsafe behavior. Various regulatory agencies within the United States and around the globe may take an active role in determining the content and formatting of warnings.
The Communication-Human Information Processing (C-HIP) model was developed to describe the processes involved in how people interact with warnings and other information. This framework employs the basic stages of a simple communication model such that a warning message is sent from one entity (source) through some channel(s) to another (receiver). Once warning information is delivered to the receiver, processing may be initiated, and if not impeded, will continue through several stages including attention switch, attention maintenance, comprehension and memory, beliefs and attitudes, and motivation, possibly ending in compliance behavior. Examples of health-related warnings are presented to illustrate concepts. Methods for developing and evaluating warnings such as heuristic evaluation, iterative design and testing, comprehension, and response times are described.
Article
Collective Knowledge for Industrial Disaster Prevention
Sarah Maslen
Since the 1990s there has been an increasing interest in knowledge, knowledge management, and the knowledge economy due to recognition of its economic value. Processes of globalization and developments in information and communications technologies have triggered transformations in the ways in which knowledge is shared, produced, and used to the extent that the 21st century was forecasted to be the knowledge century. Organizational learning has also been accepted as critical for organizational performance. A key question that has emerged is how knowledge can be “captured” by organizations. This focus on knowledge and learning demands an engagement with what knowledge means, where it comes from, and how it is affected by and used in different contexts. An inclusive definition is to say that knowledge is acquired theoretical, practical, embodied, and intuitive understandings of a situation. Knowledge is also located socially, geographically, organizationally, and it is specialized; so it is important to examine knowledge in less abstract terms. The specific case engaged with in this article is knowledge in hazardous industry and its role in industrial disaster prevention.
In hazardous industries such as oil and gas production, learning and expertise are identified as critical ingredients for disaster prevention. Conversely, a lack of expertise or failure to learn has been implicated in disaster causation. The knowledge needs for major accident risk management are unique. Trial-and-error learning is dangerously inefficient because disasters must be prevented before they occur. The temporal, geographical, and social scale of decisions in complex sociotechnical systems means that this cannot only be a question of an individual’s expertise, but major accident risk management requires that knowledge is shared across a much larger group of people. Put another way, in this context knowledge needs to be collective. Incident reporting systems are a common solution, and organizations and industries as a whole put substantial effort into gathering information about past small failures and their causes in an attempt to learn how to prevent more serious events. However, these systems often fall short of their stated goals. This is because knowledge is not collective by virtue of being collected and stored. Rather, collective knowing is done in the context of social groups and it relies on processes of sensemaking.
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Preference Organization
Danielle Pillet-Shore
Conversation analytic research on “preference organization” investigates recorded episodes of naturally occurring social interaction to elucidate how people systematically design their actions to either promote or undermine social solidarity. This line of work examines public forms of conduct that are highly generalized and institutionalized, not the private desires or preferences of individuals.
For each action a person does in interaction—be it sequence-initiating or sequence-responding—there are alternative ways of doing it. These alternatives are not, however, symmetrical or equally valued. Rather, each alternative has different implications for “face,” “affiliation,” and the relationship of the participants involved.
As an example of a sequence-initiating action, in accomplishing the transfer of something of value (e.g., a loan of money, a ride, information about fellow participants) from one person to another, a participant may do the action of offering, or requesting, that valued item. But the interactants do not treat these offering or requesting alternatives as equivalent. Several studies demonstrate that the social action of offering is “preferred” over the action of requesting. Participants display their orientation to actions as “preferred” by producing them straightforwardly—without delay, qualification, or account. Correlatively, participants treat actions as “dispreferred” by withholding, delaying, qualifying, and/or accounting for them. More specifically, when opening face-to-face encounters, participants treat offers of information as valued and thus “preferred” over requests for that information, because such offers engender solidarity by enabling people to feel included (rather than excluded): Offers of information identifying unfamiliar persons are preferred during introduction sequences; and when a newcomer arrives to an already-in-progress interaction, an already-present speaker’s offer of information about the previous activity/topic of that interaction is preferred.
As an example of a sequence-responding action, after a participant issues a request, the addressed-recipient can grant, or refuse, that request. Again, participants do not treat these alternative response types as equally valued. Whereas participants recurrently do the action of granting in the preferred format—as this response is usually affiliative and supportive of social solidarity, they tend to do the action of refusing in the dispreferred format, as this response is most often disaffiliative and destructive of social solidarity.
Preference organization research illuminates how interaction works in both casual and institutional settings. For an example of the latter, during parent-teacher conferences, there is a marked contrast between how parents and teachers do the actions of praising and criticizing students: Whereas teachers design their student-praising utterances in the preferred format, parents treat their articulation of student praise as dispreferred. Correspondingly, whereas teachers treat their student-criticizing utterances as dispreferred, parents routinely produce their student criticisms as preferred. This regular pattern of parent-teacher interaction constitutes an endogenous method for circumventing conflict. Research on preference organization thus empirically demonstrates that human interaction is organized to promote social affiliation at the expense of conflict.
Article
Race, Gender, Class, and Sexuality
Patricia S. Parker, Jing Jiang, Courtney L. McCluney, and Verónica Caridad Rabelo
Difference in human experience can be parsed in a variety of ways and it is this parsing that provides the entry point to our discussion of “race,” “gender,” “class,” and “sexuality” as foci of study in the field of organizational communication. Social sorting of difference has material consequences, such as whether individuals, groups, organizations, communities, and nations have equal and equitable access to civil/participative liberties, food, clean water, health, housing, education, and meaningful work. Communication perspectives enable researchers to examine how difference is produced, sustained, and transformed through symbolic means. That is, communication organizes difference. In the field of organizational communication the communicative organizing of race, gender, class, and sexuality is examined in everyday social arrangements, such as corporate and not-for-profit organizations, communities, and other institutional contexts locally and globally. Topics of central concern in organizational communication difference studies are those related to work and the political economy of work, such as labor, conflicts between public and private domains, empowerment, and agency.
Research on race, gender, class, and sexuality as communicatively structured difference has progressed in the field of organizational communication from early top-down functionalist approaches, to bottom-up and emergent interpretive/critical/materialist methods, to poststructuralist approaches that deconstruct the very notion of “categories” of difference. More complex intersectional approaches, including queer theory and postcolonial/decolonial theory, are currently gaining traction in the field of organizational communication. These advances signal that difference studies have matured over the last decades as the field moved toward questioning and deconstructing past approaches to knowledge production while finding commensurability across diverse theoretical and research perspectives. These moves open up more possibilities to respond to societal imperatives for understanding difference.
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Organizations, Power, and Resistance
Dennis K. Mumby
In the last 30 years or so, the relationship between power and resistance has been theorized as a defining feature of organizations and organizing. While there is little consensus around its definition, a useful starting point for thinking about the organization–power–resistance relationship is to view organizations as political sites of contestation where various stakeholder groups compete for resources—economic, political, and symbolic. Much of the research on power, resistance, and organizations has emerged out of a critical tradition that draws on numerous theoretical and philosophical threads, including Marxism, neo-Marxism, critical theory, poststructuralism, and feminism. Common to these threads are various efforts to link power and resistance to issues of meaning, identity, and discourse processes. In this sense—and particularly in the last 30 years—there have been multiple efforts to theorize power as intimately connected to communication. This connection has become particularly important with the shift from Fordist (bureaucratic, hierarchical, centralized, deskilled) organizational forms to post-Fordist (flexible, flat, dispersed, knowledge-based) organizations that place a premium on decentralized, “consensual” forms of power and control (as opposed to the coercive methods of Fordist regimes). Exploring communicative conceptions of power and resistance shows how these phenomena are closely tied to the regulation of meaning and identities in the contemporary workplace.
Article
Listening
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.
Article
Cybervetting
Brenda L. Berkelaar and Millie A. Harrison
Broadly speaking, cybervetting can be described as the acquisition and use of online information to evaluate the suitability of an individual or organization for a particular role. When cybervetting, an information seeker gathers information about an information target from online sources in order to evaluate past behavior, to predict future behavior, or to address some combination thereof. Information targets may be individuals, groups, or organizations. Although often considered in terms of new hires or personnel selection, cybervetting may also include acquiring and using online information in order to evaluate a prospective or current client, employee, employer, romantic partner, roommate, tenant, client, or other relational partner, as well as criminal, civil, or intelligence suspects. Cybervetting takes advantage of information made increasingly available and easily accessible by regular and popular uses and affordances of Internet technologies, in particular social media. Communication scholars have long been interested in the information seeking, impression management, surveillance, and other processes implicated in cybervetting; however, the uses and affordances of new online information technologies offer new dimensions for theory and research as well as ethical and practical concerns for individuals, groups, organizations, and society.
