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The concept of ambiguity tolerance (TA), variously called Uncertainty Avoidance, Ambiguity Avoidance, or Intolerance, can be traced back nearly 70 years. It has been investigated by many different types of researchers from clinical and differential, to neuro- and work psychologists. Each sub-discipline has tended to focus on how their variable relates to beliefs and behaviors in their area of expertise, from religious beliefs to reactions to novel products and situations. The basic concept is that people may be understood on a dimension that refers to their discomfort with, and hence attempts to avoid, ambiguity or uncertainty in many aspects of their lives. There have been many attempts to devise robust and valid measures of this dimension, most of which are highly inter-correlated and require self-reporting. There remains a debate as to whether it is useful having just one or more dimensions/facets of the concept. Using these tests, there have been many correlational studies that have sought to validate the measure by looking at how those high and low on this dimension react to different situations. There have also been some, but many fewer, experimental studies, which have tested very specific hypotheses about how TA is related to information processing and reactions to specific stimuli. There is now a welcomed interest by neuroscientists to explore the concept from their perspective and using their methodologies. These studies have been piecemeal, though most have supported the tested hypotheses. There has been less theoretical development, however, of the concept attempting to explain how these beliefs arise, what sustains them, and how, why, and when they may change. However, the concept has continued to interest researchers from many backgrounds, which attests to its applicability, fecundity, and novelty.

Beginning with phone calls to an emergency psychiatric hospital and suicide prevention center, the roots of Conversation Analysis (CA) are embedded in systematic analyses of routine problems occurring between ordinary persons facing troubling health challenges, care providers, and the institutions they represent. After more than 50 years of research, CA is now a vibrant and robust mode of scientific investigation that includes close examination of a wide array of medical encounters between patients and their providers. Considerable efforts have been made to overview CA and medicine as a rapidly expanding mode of inquiry and field of research. Across a span of 18 years, we sample from 10 of these efforts to synthesize important priorities and findings emanating from CA investigations of diverse interactional practices and health care institutions. Key topics and issues are raised that provide a unique opportunity to identify and track the development and maturity of CA approaches to medical encounters. Attention is also given to promising new modes of research, and to the potential and challenges of improving medical practices by translating basic and rigorous empirical findings into innovative interventions for medical education. A case is made that increasing reliance on CA research can positively impact training and policies shaping the delivery of humane and quality medical care.

Health literacy—defined as the ability of an individual to obtain, process, understand, and communicate about health information—contributes significantly to health outcomes and costs to the U.S. health-care system. Approximately one-quarter to one-half of U.S. adults struggle with health information, which includes understanding patient education materials, reading medication labels, and communicating with health-care providers. Low health literacy is more common among the elderly, those who speak English as a second language, and those of lower socioeconomic status. In addition to conceptualizing health literacy as an individual-level skill, it can also be considered an organizational or community-level ability. Increased attention to the field of health literacy has resulted in debates about the definition and the best ways to assess health literacy; there is also a strong and growing movement within the field of health literacy research and practice to frame health literacy less as a deficit to overcome and more as an approach to empowering patients and improving outcomes. As health-care providers have recognized the importance of health literacy, workshops, and training programs have been developed and evaluated to improve the care of low-health-literate patients. Similarly, health promotion professionals have developed best practices for reaching low-health-literate audiences with traditional and new digital media, which can also increase access for patients with hearing or visual impairments. Additionally, recent policy changes in the United States, including those related to the Affordable Care Act, contribute to a greater focus and regulation of factors that impact health literacy. Researchers and practitioners together are advancing understanding of health literacy, its relationship to health outcomes and health-care costs, and improved strategies for improving the health of lower health literate patients. Development and review of health literacy pieces can aid in shared decision making and provide insights for patients on various health-care services.

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).

In today’s media-saturated environment, individuals may be exposed to hundreds of media messages on a wide variety of topics each day. It is impossible for individuals to attend to every media message, and instead, they engage in the phenomenon of selective exposure, where certain messages are chosen and attended to more often than others. Health communication professionals face challenges in creating messages that can attract the attention of targeted audiences when health messages compete with more entertaining programming. In fact, one of the greatest obstacles for health campaigns is a lack of adequate exposure among targeted recipients. Individuals may avoid health messages completely or counterargue against persuasive attempts to change their health-related attitudes and behaviors. Once individuals have been exposed to a health message, their current mood plays an important role in the processing of health information and decision making. Early research indicated that a positive mood might actually be detrimental to information processing because individuals are more likely to process the information heuristically. However, recent studies countered these results and suggested that individuals in positive moods are more likely to attend to self-relevant health information, with increased recall and greater intent to change their behaviors. Since mood has the ability to influence exposure to health messages and subsequent message processing, it is important for individuals to be able to manage their mood prior to health information exposure and possibly even during exposure. One way individuals can influence their moods is through media use including TV shows, movies, and music. Mood management theory predicts that individuals choose media content to improve and maintain positive moods and examines the mood-impacting characteristics of stimuli that influence individuals’ media selections. Therefore, an individual’s mood plays an important role in selection of any type of communication (e.g., news, documentaries, comedies, video games, or sports). How can health message designers influence individuals’ selection and attention to health messages when negative moods may be blocking overtly persuasive attempts to change behaviors and a preference for entertaining media content? The narrative persuasion research paradigm suggests that embedding health information into entertainment messages may be a more effective method to overcome resistance or counterarguing than traditional forms of health messages (e.g., advertisements or articles). It is evident that mood plays a complex role in message selection and subsequent processing. Future research is necessary to examine the nuances between mood and health information processing including how narratives may maintain positive moods through narrative selection, processing, and subsequent attitude and/or behavior change.

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.

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.

Emotions are an important part of how audiences connect with health and risk messages. Feelings such as fear, anger, joy, or empathy are not just byproducts of information processing, but they can interact with an individual’s perception and processing of the message. For example, emotions can attract attention to the message, they can motivate careful processing of the message, and they can foster changes in attitudes and behavior. Sometimes emotions can also have counterproductive effects, such as when message recipients feel pressured and react with anger, counterarguments, or defiance. Thus, emotion and cognition are closely intertwined in individuals’ responses to health messages. Recent research has begun to explore the flow and interaction of different types of emotions in health communication. In particular, positive feelings such as joy and hope have been found to counteract avoidant and defensive responses associated with negative emotions such as fear and anger. In this context, research on health communication has begun to explore complex emotions, such as a combination of fear and hope, which can highlight both the severity of the threat, and individuals’ self-efficacy in addressing it. Empathy, which is characterized by a combination of affection and sadness for the suffering of others, is another example of a complex emotion that can mitigate defensive responses, such as anger and reactance, and can encourage insight and prosocial responses.

A majority of the extant literature in health and risk message processing focuses—for obvious reasons—on social influence and compliance-gaining. Interpersonal and relational issues with doctors and patients are a secondary focus. In contrast, research that specifically addresses comprehension of health and risk messaging is somewhat scant. However, other domains (e.g., cognitive psychology, reading studies) offer models and studies of comprehension that address message processing more generally. This material can usefully inform research in a health and risk context. An important aspect of any communicative event is the degree to which that event allows interactivity. This can be described in terms of a continuum from static messaging to dynamic messaging. Message features may affect simple comprehension (in the former case) and active understanding (in the latter case) of messaging along this continuum. For static messaging, text features are the dominant focus; for dynamic messaging, how communicators cooperate, collaborate, and adjust their behavior relative to each other’s knowledge states is the focus. Moderators of these effects, which include sources’ dual goals informing and influencing targets, are also important to consider. Examples of this include direct-to-consumer-advertising (DTCA) of pharmaceutical medicines and pharmaceutical companies, which must meet the demands of the government regulatory bodies (e.g., fair and balanced presentation of benefits and risks) while simultaneously influencing the message processing experience of the target to minimize negative perceptions of their products. Impediments to creating understanding can arise in both the highly interactive setting of the face-to-face doctor-patient context as well as more static messaging situations such as PSAs, pamphlets, and pharmaceutical package inserts. Making sense of message comprehension in health and risk communication is complex, and it is complex because it is broad in scope. Health and risk communication runs the gamut of static to dynamic messaging, employing everything from widely distributed patient information leaflets and public service announcements, to interactive web pages and massively connected social networking sites, to the highly interactive and personalized face-to-face meeting between doctor and patient. An equally comprehensive theoretical and methodological tool box must be employed to develop a thorough understanding of health and risk communication.