The reasoned action approach is a behavioral theory that has been developed since the 1960s in a sequence of reformulations. It comprises the theory of reasoned action; the theory of planned behavior; the integrative model of behavioral prediction; and its current formulation, the reasoned action approach to explaining and changing behavior. Applied to health messages, reasoned action theory proposes a behavioral process that can be described in terms of four parts. First, together with a multitude of other potential sources, health messages are a source of beliefs about outcomes of a particular health behavior, about the extent of social support for performing that behavior from specific other people, and about factors that may hamper or facilitate engaging in the behavior. Second, these beliefs inform attitude toward performing the behavior, perceptions of normative influence, and perceptions of control with respect to performing the behavior. Third, attitude, perceived norms, and perceived control inform the intention to perform the behavior. Fourth, people will act on their intention if they have the required skills to do so and if there are no environmental obstacles that impede behavioral performance.
The theory’s conceptual perspective on beliefs as the foundation of behavior offers a theoretical understanding of the role of health messages in behavior change. The theory also can be used as a practical tool for identifying those beliefs that may be most promising to address in health messages, which makes the theory useful for those designing health message interventions. Reasoned action theory is one of the most widely used theories in health behavior research and health intervention design, yet is not without its critics. Some critiques appear to be misconceptions, such as the incorrect contention that reasoned action theory is a theory of rational, deliberative decision making. Others are justified, such as the concern that the theory does not generate testable hypotheses about when which variable is most likely to predict a particular behavior.
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Reasoned Action As an Approach to Understanding and Predicting Health Message Outcomes
Marco Yzer
Article
Recruiting Opinion Leaders for the United Kingdom ASSIST Programme
Jo Holliday, Suzanne Audrey, Rona Campbell, and Laurence Moore
Addictive behaviors with detrimental outcomes can quickly become embedded in daily life. It therefore remains a priority to prevent or modify these health behaviors early in the life course. Diffusion theory suggests that community norms are shaped by credible and influential “opinion leaders” who may be characterized by their values and traits, competence or expertise, and social position. With respect to health behaviors, opinion leaders can assume a variety of roles, including changing social norms and facilitating behavioral change. There is considerable variation in the methods used to identify opinion leaders for behavior change interventions, and these may have differential success. However, despite the potential consequences for intervention success, few studies have documented the processes for identifying, recruiting, and training opinion leaders to promote health, or have discussed the characteristics of those identified.
One study that has acknowledged this is the effective UK-based ASSIST smoking-prevention program. The ASSIST Programme is an example of a peer-led intervention that has been shown to be successful in utilizing opinion leaders to influence health behaviors in schools. A “whole community” peer nomination process to identify opinion leaders underwent extensive developmental and piloting work prior to being administered in a randomized trial context. Influential students were identified through the use of three simple questions and trained as “peer supporters” to disseminate smoke-free messages through everyday conversations with their peers. In response to a need to understand the contribution of various elements of the intervention, and the degree to which these achieve their aim, a comprehensive assessment of the nomination process was conducted following intervention implementation.
The nomination process was successful in identifying a diverse group of young people who represented a variety of social groups, and whom were predominantly considered suitable by their peers. The successful outcome of this approach demonstrates the importance of paying close attention to the design and development of strategies to identify opinion leaders. Importantly, the involvement of young people during the development phase may be key to increasing the effectiveness of peer education that relies on young people taking the lead role.
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Regulatory Focus and Regulatory Fit in Health Messaging
Ilona Fridman and E. Tory Higgins
Regulatory Focus Theory differentiates between two motivational orientations: promotion and prevention. Promotion-oriented individuals focus on advancements, growth, and making progress toward their hopes and aspirations, whereas prevention-oriented people are more concerned about safety, security, and fulfilling their responsibilities. Promotion-oriented individuals tend to focus on moving toward a better state ensuring gains and improvements. In contrast, prevention-oriented people tend to focus on ensuring against making mistakes and maintaining a current satisfactory state rather than moving to something worse. When individuals pursue desired ends using their preferred means (ensuring gains for promotion, and ensuring against losses for prevention), they experience regulatory fit, which makes them “feel right” about what they are doing. Regulatory fit is associated with strengthening engagement and intensifying evaluative judgments.
The advantages of regulatory fit could be utilized in communications to motivate individuals’ healthy behavior. The messages that encourage healthy behavior could be framed in a way that fits recipients’ personal goal orientations. For instance, to increase motivation among promotion-oriented people for getting vaccinations, the message might state, “A flu vaccine helps you to continue achieving your goals even during a flu season.” This message emphasizes advancements and gains that fit a promotion orientation. To increase motivation among prevention-oriented people to choose healthy options, the messages could instead highlight avoiding losses: “A flu vaccine helps you avoid strength-sapping illness during a flu season.” Past studies on health communications have demonstrated that regulatory fit tends to facilitate participants’ willingness to follow the message and engage in healthy behavior.
Could regulatory non-fit messages also work? When individuals pursue desired ends using non-preferred means—ensure gains for prevention-oriented individuals or ensure against losses for promotion-oriented individuals—they experience regulatory non-fit. Non-fit makes them “feel wrong” about what they are doing. Regulatory non-fit is associated with weakening engagement and de-intensifying evaluative judgments. How might a non-fit health message be helpful?
What if individuals’ initial attitudes toward a healthy option were negative, even anxiety producing, despite that option serving their interests better than alternative options? It would be better if the individuals could thoughtfully consider the potential benefits of the option without their negative feelings rejecting it. For a thoughtful decision to be made, the intensity of the initial negative feelings could be decreased. A regulatory non-fit message, in this case, could be an effective tool. By making people “feel wrong” about their initial reaction, it could weaken their engagement and de-intensify the negative reactions, for example, reduce anxiety about the option. Thus, the regulatory non-fit message could help an individual to reconsider potential advantages of the initially disliked option.
While the ways in which Regulatory Focus and Regulatory Fit theories can be applied to improve health communications are known, important questions remain. For example, are there circumstances when fit or non-fit messages could make people feel that their decision-making autonomy is being threatened? Can fit or non-fit messages create resistance? If so, how can this be avoided? Both fit and non-fit messages are persuasive techniques. Is there a downside to these techniques? What can be done to ensure that these persuasive techniques are not just effective but are also ethical?
Article
Rehabilitation Groups
Toby Raeburn
“Rehabilitation groups” refers to community-based organizations which substantially rely on the work of volunteers to assist people with disabilities towards functional independence. One may differentiate between rehabilitation groups and clinical healthcare services by categorizing clinical services as being predominantly concerned with treatments designed to lower symptoms and cure ill health. Alternatively, rehabilitation groups focus their attention on delivering programs designed to assist people in regaining “functional independence” with or without the ongoing presence of symptoms. Common programs rehabilitation groups deliver are described as including but not being limited to the following:
• Mental health rehabilitation: assisting people with lived experience of mental illness towards social and emotional wellbeing.
• Drug and alcohol rehabilitation: facilitating recovery from abuse of and dependency on psychoactive substances such as alcohol and other drugs.
• Physical health rehabilitation: improving physical and/or neurocognitive functions that have been diminished by ongoing effects of disease or injury.
Major themes of communication influence rehabilitation groups and there are connections between the daily work of rehabilitation groups and the theoretical paradigms that influence them. Theoretical paradigms include social disability theory, recovery-oriented care, person-centered care, and cultural materialism.
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Relational Dialectics Theory
Kristina M. Scharp
Relational dialectics theory (RDT) is a postmodern critical theory of meaning. Based on the writing of Russian philosopher, RDT attunes researchers to the ways that discourses (i.e., ideologies) compete to make meaning of particular semantic objects (e.g., identities, phenomena, processes, etc.). Of note, not all discourses hold the same amount of power. Some discourses are dominant (i.e., centripetal) whereas others are marginalized (i.e., centrifugal). RDT researchers, then, are primarily interested in exploring how these discourses, with unequal power, compete. This focus on the competition of discourses for power and the ability of RDT to call out the ideological forces that disenfranchise some groups while enfranchising others holds promise for practical applications such as debunking misconceptions and better understanding where privilege comes from and how it is perpetuated.
When discourses compete, they might do so within or across a set of utterances. Utterances are turns in talk and serve as the primary unit of analysis in RDT research. Utterances, however, are not standalone entities. Rather, they are connected by different links to form an utterance chain. Some links of the utterance chain pertain to time (what has been said before and what response an utterance can anticipate) whereas the other links of the utterance chain pertain to the relationship level (some pertain to the culture at large whereas other only to an idiosyncratic relationship).
Overall, discursive competition takes place across a continuum of interplay. At one end of the continuum is monologue. Monologue represents the absence of meaning. Next are discursive enactments (i.e., closure) that reinforce the dominant discourse and shut down alternatives (see entry for complete list). Diachronic separation occurs when the dominance of a discourse changes across time. Diachronic separation can take two forms: (a) spiraling inversion or (b) segmentation. Synchronic interplay is next and occurs when two discourses compete within a given utterance. When RDT researchers examine a text for synchronic interplay, they often look to see how a marginalized discourse (a) negates, (b) counters, or (c) entertains the dominant discourse. Finally, on the other end of the continuum of interplay, is dialogic transformation. Dialogic transformation occurs through either (a) discursive hybridity or (b) an aesthetic moment whereby discourses suspend their interplay to create new meanings.
Conducted using RDT’s corresponding method, contrapuntal analysis, researchers using this theory work to disrupt hegemonic, taken-for-granted assumptions about how things are and call attention to voices overlooked in the past. To date, this theory has been taken up primarily by family, interpersonal, and health communication scholars, although many scholars have used this theory throughout the discipline.
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Resistance Induction in the Context of Health Decision Making
Marieke L. Fransen and Saar Mollen
During the past few decades we have witnessed increased academic attention on resistance to persuasion. This comes as no surprise, as people are often persuaded by external forces when making important decisions that may affect their health. Public health professionals, scholars, and other concerned parties have developed numerous trainings, interventions, and regulations to teach or assist people to resist unwanted persuasion, deriving from media exposure (e.g., advertising) or social pressure. The extant literature on resistance induction encompasses strategies such as inoculation, media literacy interventions, trainings on specific persuasive techniques, warnings, and social influence interventions. Although the research findings of the discussed strategies vary in how straightforward they are, they do offer promising avenues for policymakers and health communication professionals. Furthermore, several avenues worthy of further study can be identified.
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Responsibility in Health and Risk Messaging
Amber K. Worthington
Health risk messages may appeal to the responsibility of individuals or members of interdependent dyads for their own or others’ health using many different message strategies. Health messages may also emphasize society’s responsibility for population health outcomes in order to raise support for health policy changes, and these, too, take many different forms. Message designers are inherently interested in whether these appeals to personal, interdependent, and societal responsibility are persuasive. The central question of interest is therefore whether perceptions of responsibility that result from these messages lead to the desired message outcomes. A growing body of empirical research does suggest that there is a direct persuasive effect of perceptions of personal responsibility and interdependent responsibility on health intentions or behaviors, as well as indirect persuasive effects of responsibility on intentions or behaviors via anticipated emotions, specifically regret, guilt, and pride. Research also suggests that perceptions of societal responsibility increase support for public health policy (i.e., the desired message outcome in societal responsibility messages). Important to this area of research is a conceptual definition of responsibility that lends itself toward identifying specific message features that elicit perceptions of responsibility. Specifically, attributions of causation and solution, obligation, and agency are identified as effect-independent message features of responsibility.
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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.
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Rhetorical Construction of Bodies
Davi Johnson Thornton
Communication studies identifies bodies as both objects of communication and producers (or sites) of communication. Communication about bodies—for example, gendered bodies, disabled bodies, obese bodies, and surgically modified bodies—influences bodies at the physical, material level by determining how they are treated in social interactions, in medical settings, and in public institutions. Communication about bodies also forges cultural consensus about what types of bodies fit in particular roles and settings. In addition to analyzing the stakes of communication about bodies, communication studies identifies bodies as communicating forces that cannot be accounted for by standards of reason, meaning, and decorum. Bodies are physical, material, affective beings that communicate because of, not in spite of, their messy, ineffable status. Moreover, communication is an embodied process that involves a range of material supports, including human bodies, technological bodies, and other nonhuman physical and biological bodies. Investigating bodies as communicating forces compels an understanding of communication that is not exclusively rational, meaning-oriented, and nonviolent.
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Rhetorical Dimensions of “Active Shooter” Training Messages
Bradley A. Serber and Rosa A. Eberly
Mass public shootings in the United States have generated increasingly urgent efforts to understand and prevent active shooter scenarios. After the Columbine High School shooting in 1999, government officials tried to no avail to identify a demographic profile of those who might become active shooters. Confronted with the limitations of identifying potential shooters in advance, government officials, mental health professionals, criminologists, and others interested in preventing active shootings have shifted their focus to guns, mental health, and location security. However, the terrain of each of these topics is murky and exposes additional uncertainties. The sheer number of readily available guns, the prohibition of gun violence research by federal public health and justice institutions, and the variance in attitudes toward and laws about guns in the United States inhibit clear and consistent gun policy. Further, linking active shooters with mental illness risks stigmatizing the vast majority of mentally ill individuals who are more likely to be victims than perpetrators of violence. Because different locations vary in design, function, funding, resources, and vulnerabilities, no organization or institution can guarantee total security despite extensive and costly efforts. While political and social changes can lead to incremental and important improvements in each of these areas, the problem of active shootings is large, multifaceted, and evolving. Adding to the urgency is the increasing number of U.S. states voting to allow concealed and/or open carry of firearms on public college and university campuses.
In the absence of certainty and in recognition of contextual differences, government agencies and educational institutions recently have promoted variants of a “run, hide, fight” approach to active shooter situations, and many schools, workplaces, and other sites have subsequently adopted these tactics in their active shooter training messages. From a rhetorical perspective, pentadic analysis (Burke, 1969) of “run, hide, fight” and its variants reveals the complexities of trying to prevent active shootings. “Run” and “hide” demonstrate both the possibilities and challenges associated with the scene, or when and where an active shooting might occur. “Fight” implies the ambiguities of agent and agency, that is, who gets to fight and how, in debates about gun-free zones, concealed and open carry, and on-site and off-site law enforcement. Meanwhile, the multimodal nature and often disturbing content of active shooter training messages sensationalize the act of active shootings, making them seem more real and present despite the low probability of such an event occurring in any particular place at any particular time. Given these complexities, active shooter training messages as a whole illustrate a tension of purpose in that they presumably attempt to alleviate fear while simultaneously producing it. By looking at a variety of government documents and workplace active shooter training messages, this analysis will explore uncertainties, controversies, and lingering questions about the content and consequences of active shooter training messages and how the producers of these messages frame active shooter scenarios as well as efforts to prevent and respond to such occurrences. No previous studies of the rhetorical or communication dimensions of active shooter training have been conducted, and no archives yet exist that cull such training materials for purposes of comparison, contrast, and analysis in the aggregate.
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Rhetoric of Health and Medicine
Justiss Wilder Burry and Lisa Melonçon
This article offers a review of relevant books from 2016 to 2024 to illustrate trends in the field of rhetoric of health and medicine (RHM). This article first traces the history of RHM from an emerging field to an established field within rhetorical studies. One of the markers of success for the field is that RHM, as a field, demonstrates the interdisciplinary nature of the RHM. The article next describes the relevance of rhetoric to the field and then it synthesizes themes and commonalities within RHM scholarship. The article concludes by considering future directions for scholarly inquiry and ways for those new to RHM to learn about and contribute to the field.
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Risk Governance
Rolf Lidskog
Scientific advances, technological development, and changes in risk consciousness have led to stronger demands on society to manage and control various kinds of risks. Risks should be assessed, prevented, controlled, and communicated in order to prevent negative impacts. Risks related to the environment and health are probably some of the most research-dependent examples. It is primarily scientific experts that provide knowledge to authorities, organizations, and citizens about environmental and health risks and thus exert considerable influence on the understanding and management of risk. At the same time, there are actors in society—especially citizen and interest organizations—that question whether risk regulation is reliable and relevant. There are also demands that citizens should have more transparency and control over risk regulation. The current situation is characterized thus by a paradox: Issues relating to environment and health are seen as increasingly expert dependent while citizens simultaneously demand increased influence over them. This development is especially noticeable in the European Union, with its strong emphasis on the rights of citizen and consumers to have access to information about risk and also opportunities to influence their regulation.
In response to this situation, risk governance has been put forward. It refers to a body of ideas for how to more responsibly and efficiently deal with complex risks issues, where there are different interests and standpoints about how to regulate them. Fundamental ideas of risk governance are openness, transparency, participation, inclusion, deliberation, and reflexivity; that experts involved should be open to questioning the situation; should not conceal issues of uncertainty and pluralism (that there exist different legitimate understandings, evaluations, and recommendations); and should be receptive to the input and participation of other stakeholders. This means that risk regulation should no longer be organized into three discrete activities: risk assessment, risk management, and risk communication (aiming at a one-way transfer of knowledge from the regulators to the public).
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Risk Perceptions and Risk Characteristics
Hye-Jin Paek and Thomas Hove
Risk perception refers to people’s subjective judgments about the likelihood of negative occurrences such as injury, illness, disease, and death. Risk perception is important in health and risk communication because it determines which hazards people care about and how they deal with them. Risk perception has two main dimensions: the cognitive dimension, which relates to how much people know about and understand risks, and the emotional dimension, which relates to how they feel about them.
Several theoretical models have been developed to explain how people perceive risks, how they process risk information, and how they make decisions about them: the psychometric paradigm, the risk perception model, the mental noise model, the negative dominance model, the trust determination model, and the social amplification of risk framework. Laypeople have been found to evaluate risks mostly according to subjective perceptions, intuitive judgments, and inferences made from media coverage and limited information. Experts try to base their risk perceptions more on research findings and statistical evidence.
Risk perceptions are important precursors to health-related behaviors and other behaviors that experts recommend for either dealing with or preventing risks. Models of behavior change that incorporate the concept of risk perception include the Health Belief Model, Protection Motivation Theory, the Extended Parallel Process Model, and the Risk Perception Attitude framework.
Public awareness and perceptions of a risk can be influenced by how the media cover it. A variety of media factors have been found to affect the public’s risk perceptions, including the following: (1) amount of media coverage; (2) frames used for describing risks; (3) valence and tone of media coverage; (4) media sources and their perceived trustworthiness; (5) formats in which risks are presented; and (6) media channels and types. For all of these media factors, albeit to varying degrees, there is theoretical and empirical support for their relevance to risk perceptions.
Particularly related to media channels and genres, two hypotheses have emerged that specify different kinds of media influences. The impersonal impact hypothesis predicts that news media mainly influence how people see risks as affecting other individuals, groups, nations, or the world population in general (societal-level risk perceptions). By contrast, the differential impact hypothesis predicts that, while news media influence people’s societal-level risk perceptions, entertainment media have stronger effects on how people see risks as affecting themselves (personal-level risk perceptions).
As the media environment become increasingly diverse and fragmented, future research on risk perception needs to examine more of the influences that various media, including social media, have on risk perception. Also, the accounts of how those influences work need to be further refined. Finally, since people’s risk perceptions lead them to either adopt or reject recommended health behaviors, more research needs to examine how risk perceptions are jointly affected by media, audience characteristics, and risk characteristics.
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Science and Communication
Celeste M. Condit and L. Bruce Railsback
Whether understood as a set of procedures, statements, or institutions, the scope and character of science has changed through time and area of investigation. The prominent current definition of science as systematic efforts to understand the world on the basis of empirical evidence entails several characteristics, each of which has been deeply investigated by multidisciplinary scholars in science studies. The aptness of these characteristics as defining elements of science has been examined both in terms of their sufficiency as normative ideals and with regard to their fit as empirical descriptors of the actual practices of science. These putative characteristics include a set of commitments to (1) the goal of developing maximally general, empirically based explanations certified through falsification procedures, predictive power, and/or fruitfulness and application, (2) meta-methodologies of hypothesis testing and quantification, and (3) relational norms including communalism, universalism, disinterestedness, organized skepticism, and originality. The scope of scientific practice has been most frequently identified with experimentation, observation, and modeling. However, data mining has recently been added to the scientific repertoire, and genres of communication and argumentation have always been an unrecognized but necessary component of scientific practices. The institutional home of science has also changed through time. The dominant model of the past three centuries has housed science predominantly in universities. However, science is arguably moving toward a “post-academic” era.
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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.
Article
Self-Affirmation
Xiaoquan Zhao
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.
Article
Self-Disclosure
Jenny Crowley
Self-disclosure, or revealing information about the self to others, plays an integral role in interpersonal experiences and relationships. It has captivated the interest of scholars of interpersonal communication for decades, to the extent that some have positioned self-disclosure as the elixir of social life. Sharing personal information is the means by which relationships are built and maintained, because effective disclosures contribute to greater intimacy, trust, and closeness in a relationship. Self-disclosure also confers personal benefits, including reduced stress and improved physical and psychological health. Furthermore, disclosing private thoughts and feelings is often a necessary precondition for reaping the benefits of other types of communication, such as supportive communication. Despite the apparent advantages for personal and relational well-being, self-disclosure is not a panacea. Revealing intimate information can be risky, awkward, and incite judgment from close others. People make concerted efforts to avoid self-disclosure when information has the potential to cause harm to themselves, others, and relationships. Research on self-disclosure has primarily focused on dyadic interactions; however, online technologies enable people to share personal information with a large audience and are challenging taken-for-granted understandings about the role of self-disclosure in relating. As social networking sites become indispensable tools for maintaining a large and robust personal network, people are adapting their self-disclosure practices to the features and affordances of these technologies. Taken together, this body of research helps illuminate what is at stake when communicating interpersonally.
Article
Sensation Seeking
Nancy Grant Harrington
Sensation seeking is a biologically based personality trait that is characterized by the need to seek a variety of sensations and experiences and the willingness to take risks to achieve them. There is a large volume of literature on sensation seeking that delineates important conceptual and operational distinctions, including several prominent measures of sensation seeking. Issues related to research design and data analysis include whether researchers treat sensation seeking as an independent or dependent variable, use total scale versus subscale scores in analyses, treat scores as continuous or grouped variables, and consider demographic variables in their analyses. Research may relate sensation seeking to a range of behaviors, from maladaptive behaviors such as substance use and risky sex to more neutral or even adaptive behaviors such as preferences for music and art or preferences for certain careers. Research may establish a genetic basis for sensation seeking and/or associate sensation seeking with neurological and physiological responsiveness. Research also explores the associations of sensation seeking to perceptions of risk, as well as the sex and age of individuals and groups in an international context.
Article
Sexual Orientation and Gender Identity Disclosure in the Medical Context
L. Brooke Friley and Maria K. Venetis
For individuals who identify as LGBTQ+, disclosing sexual orientation and/or gender identity can be a complex and risky conversation. However, in the medical context this conversation frequently becomes a central part of communication between patient and provider. Unfortunately, this conversation can also become a barrier that prevents patients from receiving or even accessing necessary medical care.
LGBTQ+ individuals have reported experiencing significant discrimination in day-to-day life, and more specifically in patient–provider interactions. This discrimination leads LGBTQ+ individuals to avoid seeking necessary medical care and also frequently results in unsatisfactory care and poor health outcomes. This is of concern as LGBTQ+ individuals present with significantly higher rates of health issues and overall higher risks of cancer, chronic illnesses, and mental health concerns.
Unfortunately, many medical providers are unequipped to properly care for LGBTQ+ patients and lack opportunities for education and training. This lack of experience leads many providers to operate medical offices that are unwelcoming or even inhospitable to LGBTQ+ patients, making it difficult for those patients to access inclusive care. This can be of particular concern when the patient’s sexual orientation or gender identity becomes relevant to their medical care, as they may feel uncomfortable sharing that information with a provider.
Patient self-disclosure of sexual orientation or gender identity to a medical provider not only can contribute to a more positive relationship and improved quality of care but also can improve the psychological outlook of an LGBTQ+ individual. However, potential stigmatization can lead to the concealment of sexual orientation or gender identity information. These acts of concealment serve as intentional mechanisms of impression management within the patient–provider interaction.
When LGBTQ+ patients do discuss their sexual orientation or gender identity with a provider, it is most often because the information is directly relevant to their health and disclosure, and therefore becomes essential and often forced. There are instances where LGBTQ+ patients are motivated to disclose to a provider who they believe will respond positively to information about their sexual orientation or gender identity.
Disclosure of sexual orientation or gender identity may be direct in that it is clear and concrete. It may also be indirect in that individuals may use particular topics, such as talking about their partner, to broach the subject. Participants may also use specific entry points in the conversation, such as during taking a medical history about medications, to disclose. Some individuals plan and rehearse their disclosure conversations, whereas others disclose when they feel they have no other choice in the interaction.
Increasing inclusivity on the part of providers and medical facilities is one way to promote comfortable disclosure of sexual orientation or gender identity. Additionally, updating the office environment and policies, as well as paperwork and confidentiality procedures, can also promote safe disclosure. Finally, improvements to training and education for healthcare professionals and office staff can dramatically improve interactions with LGBTQ+ patients. All of these efforts need to make integration of knowledge about how LGTBQ+ individuals can disclose comfortably and safely a central part of program design.
Article
Shame and Guilt
Monique Mitchell Turner
Shame and guilt are distinct emotional experiences that are often confused by lay people as similar. Yet, shame and guilt are aroused by distinct cognitive appraisals and lead to distinct emotional, cognitive, and behavioral outcomes. There are distinctions between shame and guilt in psychology and communication. Differences are correlated with personality and individual proneness for shame and/or guilt.
