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Narratives in Health and Risk Messaging  

Julie E. Volkman

In health and risk communication, evidence is a message feature that can add credibility, realism, and legitimacy to health and risk messages. Evidence is usually defined into two types: statistical or narrative. Statistical evidence employs quantifications of events, places, phenomena, or other facts, while narrative evidence involves stories, anecdotes, cases, or testimonials. While many health and risk messages employ statistical or factual information, narrative evidence holds appeal for health and risk communication for its utility in helping individuals learn their risks and illnesses through stories and personal experiences. In particular, narratives employed as evidence in a health or risk message especially hold value for their ability to communicate experiences and share knowledge, attitudes, beliefs, and ideas about complex health issues, propose behavior change, and assist individuals coping with disease. As a result, the personal experiences shared, whether they are from first-hand knowledge, or recounting another’s experience, can focus attention, enhance comprehension for risks, and recall of health and risk information. Furthermore, readers engage with the story and develop their own emotional responses which may align with the purpose of the health and risk message. Narratives, or stories, can occur in many ways or through various points of view, but the stories that “ring true” to readers often have a sense of temporality, coherence, and fidelity. As a result, formative research and pre-testing of health and risk messages with narratives becomes important to understand individual perceptions related to the health issue and the characters (or points of view). Constructs of perceived similarity, interest, identification, transportation, and engagement are helpful to assess in order to maximize the usefulness and persuasiveness of narratives as evidence within a health and risk message. Additionally, understanding the emotional responses to narratives can also contribute to perceptions of imagery and vividness that can make the narrative appealing to readers. Examining what is a narrative as evidence in health and risk messages, how they are conceptualized and operationalized and used in health and risk messages is needed to understand their effectiveness.


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.


Types of Explanations in Health and Risk Messaging  

Katherine E. Rowan

Explanations designed to teach, rather than to support scientific claims in scholarly works, are essential in health and risk communication. Patients explain why they think their symptoms warrant medical attention. Clinicians elicit information from patients and explain diagnoses and treatments. Families and friends explain health and risk concerns to one another. In addition, there are websites, brochures, fact sheets, museum exhibits, health fairs, and news stories explaining health and risk to lay audiences. Unfortunately, research on this important discursive goal is less extensive than is research on persuasion, that is, efforts to gain agreement. One problem is that explanation-as-teaching has not been carefully conceptualized. Some confuse this communication goal and discursive type with its frequent verbal and visual features, such as simple wording or diagrams. Others believe explanation-as-teaching does not exist as a distinctive communication goal, maintaining that all communication is solely persuasive: that is, designed to gain agreement. Explanation-as-teaching is a distinct and important health communication goal. Patient involvement in decision making requires that both clinicians and patients understand options underlying health-care choices. To explore types of explanation-as-teaching, research provides (a) several ways of categorizing health and risk explanations for lay audiences; (b) evidence that certain textual and graphic features overcome predictable confusions, and (c) illustrations of each explanation type. Additionally, explanation types succeed or fail in part because of the social or emotional conditions in which they are presented so it is important to note research on conditions that support patients, families, and clinicians in benefiting from explanations of health and risk complexities and curricula designed to enhance clinicians’ explanatory skill.


Language Attitudes  

Marko Dragojevic

Language attitudes are evaluative reactions to different language varieties. They reflect, at least in part, two sequential cognitive processes: social categorization and stereotyping. First, listeners use linguistic cues (e.g., accent) to infer speakers’ social group membership(s). Second, based on that categorization, they attribute to speakers stereotypic traits associated with those inferred group membership(s). Language attitudes are organized along two evaluative dimensions: status (e.g., intelligent, educated) and solidarity (e.g., friendly, pleasant). Past research has primarily focused on documenting attitudes toward standard and nonstandard language varieties. Standard varieties are those that adhere to codified norms defining correct usage in terms of grammar, pronunciation, and vocabulary, whereas nonstandard varieties are those that depart from such norms in some manner (e.g., pronunciation). Standard and nonstandard varieties elicit different evaluative reactions along the status and solidarity dimensions. Status attributions are based primarily on perceptions of socioeconomic status. Because standard varieties tend to be associated with dominant socioeconomic groups within a given society, standard speakers are typically attributed more status than nonstandard speakers. Solidarity attributions tend to be based on in-group loyalty. Language is an important symbol of social identity, and people tend to attribute more solidarity to members of their own linguistic community, especially when that community is characterized by high or increasing vitality (i.e., status, demographics, institutional support). As a result, nonstandard language varieties can sometimes possess covert prestige in the speech community in which they are the speech norms. Language attitudes are socialized early in life. At a very young age, children tend to prefer their own language variety. However, most (if not all) children gradually acquire the attitudes of the dominant group, showing a clear status preference for standard over nonstandard varieties around the first years of formal education and sometimes much earlier. Language attitudes can be socialized through various agents, including educators, peers, family, and the media. Because language attitudes are learned, they are inherently prone to change. Language attitudes may change in response to shifts in intergroup relations and government language policies, as well as more dynamically as a function of the social comparative context in which they are evoked. Once evoked, language attitudes can have myriad behavioral consequences, with negative attitudes typically promoting prejudice, discrimination, and problematic social interactions.


Norm Talk and Intergroup Communication  

Sucharita Belavadi

Norms are regularized patterns of attitudes and behavior that characterize a group of individuals, separate the group from other groups of individuals, and prescribe and describe attitudes and behaviors for group members. Relying on social identity theory and self-categorization theory, the role played by group norms within groups and the processes by which such norms are promulgated within groups are discussed. Norm talk or the communication of normative information within groups is explored, as a major proportion of communication within groups is dedicated to clarifying ingroup identities and group attributes such as attitudes and behaviors that characterize the group. Group members can glean normative information by attending to norm talk for instance, by listening to the content of fellow group members’ communications, from their behavior, and from influential or prototypical sources within the group. According to self-categorization theory, once individuals categorize themselves as members of a salient group or category, they represent normative information cognitively as ingroup prototypes. Prototypes are a fuzzy set of group attributes (such as attitudes and behaviors that characterize the group) and simultaneously minimize differences within groups while maximizing differences between groups. Thus, clear group prototypes help create distinct identities that are clearly demarcated from other groups. Group members should be especially attentive to information that flows from prototypical sources within groups—such as leaders and ingroup media sources—while efforts should be made to differentiate from marginal or deviant members who deviate from the prototype and reduce clarity of ingroup prototypes. The processes through which attending to information communicated by different sources within groups—both prototypical and non-prototypical—help group members seek normative information and clarification of ingroup prototypes are discussed.


Rhetorical Approaches to Health and Medicine  

Jennifer A. Malkowski, J. Blake Scott, and Lisa Keränen

Rhetoric, commonly understood as the art, practice, and analysis of persuasion, has longstanding connections to medicine and health. Rhetorical scholars, or rhetoricians, have increasingly applied rhetorical theories, concepts, and methods to the texts, contexts, discourses, practices, materials, and digital and visual artifacts related to health and medicine. As an emerging interdisciplinary subfield, the rhetoric of health and medicine seeks to uncover how symbolic patterns shape thought and action in health and medical texts, discourses, settings, and materials. In practice, rhetoricians who study health and medicine draw from the standard modes of rhetorical analysis, such as rhetorical criticism and rhetorical historiography, as well as from social science methods—including participant observation, interviewing, content analysis, and visual mapping—in order to deepen understanding of how language functions across health and medical objects, issues, and discussions. The objects of analysis for rhetorical studies of health and medicine span medical research, education, and clinical practice from laboratory notes to provider–patient interaction; health policymaking and practice from draft policies through standards of care; public health texts and artifacts; consumer health practices and patient advocacy on- and offline; public discourses about disease, death, bodies, illness, wellness, and health; online and digital health information; popular entertainments and medical dramas; and alternative and complementary medicine. Despite its methodological breadth, rhetorical approaches to science and medicine consistently involve the systematic examination and production of symbolic exchanges occurring across interactional, institutional, and public contexts to determine how individuals and groups create knowledge, meanings, identities, understandings, and courses of action about health and illness.


Sequence Organization  

Chase Wesley Raymond

The adjacency pair is the most basic and normatively accountable sequential structure in interaction. This structure can be expanded through pre-sequences, insert-sequences, and post-expansions, which can be seen to be relevantly oriented to by interactants themselves. Various forces drive this normative organization, including issues related to epistemics, intersubjectivity, progressivity, and affiliation. Larger structures—for example, sequences of sequences, overall structural organization, and storytelling—also exist in interaction but are nonetheless composed of smaller units of talk. While potentially open to a certain amount of cultural variation, sequence organization exists cross-linguistically and cross-culturally as a general structural feature of human social interaction.



Nathan A. Crick

Poststructuralism represents a set of attitudes and a style of critique that developed in critical response to the growth and identification of the logic of structural relations that underlie social institutions—whether they exist in terms of politics, economics, education, medicine, literature, or the sciences. Poststructuralism should therefore not be thought of as a distinct philosophy that exists separately as its own “structure”—a proposition that would undermine its most fundamental attitudes. Rather, post-structuralism should be thought of as developing or arising only in response to pre-existing structures and, as a set of attitudes, helping us better understand, interpret, and alter our social environment by calling established meanings into question, revealing the points of ambiguity and indeterminacy inherent in any system, rejecting the rationalistic piety that all systems are internally coherent and circle around an unchanging center, showing how discourses are carriers of power capable of turning us into subjects, and placing upon us the burden of ethical responsibility that accompanies the acceptance of freedom. Although post-structuralism by its very nature as a set of attitudes denies any attempt at comprehensive definition, this essay examines three of the major postructuralist thinkers in order to relate their thought to the study of communication. First, following Derrida, post-structuralist thought invites a critical deconstruction of any discourse that presents itself as completely coherent, centered, and rational. Post-structuralist approaches thus do not argue against a position by harnessing counterarguments drawing on a different set of principles. Rather, it deconstructs a discourse by occupying it and exposing the gaps, contradictions, paradoxes, and deferments, thus revealing its established hierarchies, binaries, logical conclusions, and principles to be far more loosely structured and poly-vocal than its advocates wish to present them. Second, following Barthes, poststructuralism refuses to locate any single point of origin of any text that can ground its meaning—particularly by pointing to some ground of the author. Although not denying that writers exist, Barthes refuses to identify the meaning of a text with the author’s biography and intentions, instead inviting multiple interpretations from the perspective of individual readers who encounter the text as a unique event. Therefore, just as discourses do not have a unified structure, neither do individual texts or the authors that produce them. Lastly, following Fouacult, poststructuralism invites an inquiry into how discourses, texts, and acts of communication are always implicated in relations of power that act upon possible actions. Following the first two propositions, poststructuralism does not analyze these relations of power as completely structured and determinate, however. Power relations are always within a dynamic relationship with acts of resistance, thereby constantly leaving space for freedom and possibility.


Language and Culture  

Ee Lin Lee

Language is an arbitrary and conventional symbolic resource situated within a cultural system. While it marks speakers’ different assumptions and worldviews, it also creates much tension in communication. Therefore, scholars have long sought to understand the role of language in human communication. Communication researchers, as well as those from other disciplines (e.g., linguistics, anthropology, psychology, and sociology), draw on each other’s works to study language and culture. The interdisciplinary nature of the works results in the use of various research methods and theoretical frameworks. Therefore, the main goal of this essay is to sketch the history and evolution of the study of language and culture in the communication discipline in the United States. Due to space constraints only select works, particularly those that are considered landmarks in the field, are highlighted here. The fundamentals of language and the development of the Sapir–Whorf hypothesis in leading to the formation of the language and social interaction (LSI) discipline are briefly described. The main areas of LSI study—namely language pragmatics, conversation analysis, discourse analysis, and the ethnography of communication—are summarized. Particular attention is paid to several influential theories and analytical frameworks: the speech act theory, Grice’s maxims of implicatures, politeness theory, discursive psychology, critical discourse analysis, the ethnography of speaking, speech codes theory, and cultural discourse analysis. Criticisms and debates about the trends and directions of the scholarship are also examined.



Nathan A. Crick

When John Dewey announced that communication was the most wonderful of all affairs, he recognized the centrality of communication within the tradition of American pragmatism. In other traditions of philosophy, such as idealism or empiricism, communication certainly played a role, but usually it was a secondary function of transmitting ideas from one mind to another. In idealism, ideas were discovered through intuitive revelation of the whole and only later expressed through transcendent eloquence, whereas in empiricism, particular data was attained purely by the senses and communication served a kind of documentary function of fact gathering. Pragmatism, however, inverted this traditional hierarchy. By arguing that the meaning of our ideas was only found in their effects and consequences in experience, particularly those consequences brought about through shared experience, pragmatists made communication both the origin and consummation of knowledge—regardless if that knowledge was practical, scientific, aesthetic, or social. Consequently, pragmatists believed that improving the quality of communication practices was central to improving not only the state of knowledge but the quality of our experience living together in a common world.