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Article

Marcel Zeelenberg

Regret is the prototypical decision related emotion. It is felt when the outcome of a non-chosen alternative is better than the outcomes obtained. Regret is a functional emotion that helps people to correct mistakes. It is also functional because people can anticipate regret beforehand, then choose in such a way as to avoid regret from happening. Researchers in economics proposed regret theory, an alternative to rational choice theory, which takes into account the anticipation of regret and its influence in choice. Researchers in psychology studied how anticipations of regret influence decision making in a variety of domains, including health behaviors. The findings suggest that interventions can be developed that are based on the idea that people are regret averse.

Article

Internet-based services that build on automated algorithmic selection processes, for example search engines, computational advertising, and recommender systems, are booming and platform companies that provide such services are among the most valuable corporations worldwide. Algorithms on and beyond the Internet are increasingly influencing, aiding, or replacing human decision-making in many life domains. Their far-reaching, multifaceted economic and social impact, which results from the governance by algorithms, is widely acknowledged. However, suitable policy reactions, that is, the governance of algorithms, are the subject of controversy in academia, politics, industry, and civil society. This governance by and of algorithms is to be understood in the wider context of current technical and societal change, and in connection with other emerging trends. In particular, expanding algorithmizing of life domains is closely interrelated with and dependent on growing datafication and big data on the one hand, and rising automation and artificial intelligence in modern, digitized societies on the other. Consequently, the assessments and debates of these central developmental trends in digitized societies overlap extensively. Research on the governance by and of algorithms is highly interdisciplinary. Communication studies contributes to the formation of so-called “critical algorithms studies” with its wide set of sub-fields and approaches and by applying qualitative and quantitative methods. Its contributions focus both on the impact of algorithmic systems on traditional media, journalism, and the public sphere, and also cover effect analyses and risk assessments of algorithmic-selection applications in many domains of everyday life. The latter includes the whole range of public and private governance options to counter or reduce these risks or to safeguard ethical standards and human rights, including communication rights in a digital age.

Article

Rocio Garcia-Retamero, Dafina Petrova, Adam Feltz, and Edward T. Cokely

Graphical displays generally facilitate the communication of complex information and are ubiquitous in media. Unfortunately, people differ in their ability to extract data and meaning from graphical representations of quantitative information (i.e., graph literacy). This means that for some people, even well-designed, simple graphs will cause confusion and misunderstanding. Research on the psychology of graph comprehension focuses on two instruments that efficiently assess fundamental graph literacy among diverse adults. The Objective Graph literacy scale is a well-established instrument with good psychometric properties that measures skill via cognitive performance testing (e.g., interpreting and evaluating various graphs). The recently developed Subjective Graph Literacy scale is a brief self-report of graph literacy that can outperform the objective test in notable ways, while reducing text anxiety. Emerging applications in clinical research and practice, including computerized decision aids, can personalize content as a function of one’s graph literacy.

Article

Michael Mackert, Sara Champlin, and Jisoo Ahn

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.

Article

Kathryn E. Anthony, Timothy L. Sellnow, Steven J. Venette, and Sean P. Fourney

Much current scholarship in the realm of information processing and decision making, particularly in the context of health risks, is derived from the logical-empiricist paradigm, involving a strong focus on cognition, routes of psychological processing of messages, and message heuristics. The message convergence framework (MCF), derived heavily from the writings of Perelman and Olbrechts-Tyteca, contributes to this body of literature by emphasizing the fact that people make decisions on health risks while being exposed to arguments from multiple sources on the same topic. The MCF offers an explanation for how people reconcile myriad messages to arrive at decisions. MCF differs from other theories of message processing because of its distinct and unique focus on arguments, messages, and the ways various arguments interact to create “convergence” in individuals’ minds. The MCF focuses on the ways that multiple messages converge to create meaning and influence in the minds of listeners. Convergence occurs when messages from multiple sources overlap in ways recognized by observers, creating perceptions of credibility and influencing their risk decisions. Perelman and Olbrechts-Tyteca explain that convergence occurs when “several distinct arguments lead to a single conclusion.” Individuals assess the strengths and weaknesses of the claims, and according to the scholars, the “strength” of the arguments “is almost always recognized.” Three key propositions focusing on message convergence articulate that audiences recognize message convergence, that they actively seek convergence in matters of concern, such as health risk, and that this convergence is potentially fleeting as new messages are introduced to the discussion. Conversely, Perelman and Olbrechts-Tyteca also discuss message divergence, and the rationale for wanting to intentionally create divergence among interacting arguments. Divergence is particularly appropriate in the realm of health and risk messages when scholars must challenge potentially harmful beliefs or correct misinformation. Some strategies for invoking divergence in include: dissociation, in which the speaker attempts to reframe the argument to create novel understandings; identification of the stock, hackneyed, and obsolete, where the speaker attempts to make existing claims appear commonplace or obsolete to the listener; refutation of fallacies, where the speaker points out the fallacious reasoning of the opponent; clash of interpretation, where the speaker publicly articulates that individuals have understood the convergence to mean different things; weakening through reaction, which involves the speaker’s attempting to incite a reactionary approach by the opponent; and finally, highlighting the consequence of invalid convergence, where the speaker describes the negative outcomes that may occur from following a false convergence based on incorrect information. For message design, environmental scanning enables scholars and practitioners to assess the messages in a particular health-risk context. This assessment can assist practitioners in emphasizing or building convergence among reputable sources and in introducing divergence in cases where misunderstanding or a lack of evidence has contributed to an unproductive perception of convergence. Ultimately, the MCF can assist practitioners in scanning their health-risk environments for opportunities to establish or bolster convergence based on credible evidence and for introducing divergence to challenge inaccurate or misleading interpretations and evidence.

Article

Narcissism is a personality trait characterized by perceptions of grandiosity, superiority, and the need for attention and admiration. There has been an increase in focus on examining the development of narcissism and how the trait influences a range of social and health behaviors. A key feature of narcissism is that it is characterized by high self-esteem with a simultaneously fragile ego that requires continual monitoring and manipulation. Therefore, much of the behaviors narcissists engage in are linked to the drive to maintain perceptions of superiority and grandiosity. In the area of health and well-being, narcissism has been positively correlated with psychological health, a relationship that may be accounted for by self-esteem. However, there has been less research on the relationship between narcissism and physical health and well-being. There is some evidence that narcissism is linked to a variety of physical appearance-oriented health behaviors (i.e., behaviors that could affect body weight or other aspects of physical appearance, including eating and exercise). Narcissism has also been positively linked to risk-taking behaviors, including use of substances, as well as risks that could significantly impact others, including sexual behaviors and risky driving. The relationship between narcissism and health is therefore complex, with some positive correlates (e.g., physical activity), but also various health risk behaviors. In considering how narcissism might interact with health messages, communicators have to keep in mind that narcissists seem to have some deficits in judgment and decision-making, such as overconfidence and a narrow focus on rewards associated with behaviors. Their behaviors tend to be driven by managing their own ego and by drawing attention and admiration from others to maintain perceptions of superiority and grandiosity. In turn, health communicators may need to rely on creative strategies that tap into these domains of narcissism in order to effectively modify health behaviors among narcissistic individuals. Further research on the influence of narcissism in healthcare seeking and related preventive behaviors would also help to provide a more detailed understanding for how the trait influences health decisions, information that would be useful for both health researchers and practitioners.

Article

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

Erina MacGeorge and Lyn Van Swol

Advice is a recommendation for action that includes both suggestions for behavior and ways of feeling and thinking about the problem. It is a ubiquitous phenomenon in personal and professional settings, and functions as a form of both social support and social influence. Advice often improves coping and decision-making outcomes but can also be perceived as intrusive, threaten recipient’s sense of competence and autonomy, and damage relationships. Although advisors often have expertise that can benefit the recipient, advice recipients often discount and underutilize advice, to their disadvantage. Recipients are more likely to utilize advice from advisors they trust, who engender confidence, and who have more expertise or experience. They are also more likely to seek and use it when they have not thought of solutions independently. Recipients who are overconfident, have more expertise, or have more power than an advisor are much less likely to seek and utilize advice. When giving advice, advisors often consider different factors than they would if they were making decisions for themselves, resulting in advice that is more normative and less tailored to individual preferences. Advice can be delivered in a variety of ways, and this stylistic variation has consequences for recipient outcomes. For example, highly direct or blunt forms of advice underscore the advisor’s implicit claim to status and often generate more negative evaluations of the advice and advisor. Advice message content also influences recipients’ advice evaluation. Content that emphasizes efficacy of the action, feasibility, and limitations of the advice tends to improve evaluation and utilization of advice. This research is synthesized in advice response theory (ART), which indicates that advice outcomes are influenced by message content and style, interaction qualities, advisor characteristics, recipient traits, and features of the situation for which or in which advice is sought. Behaviors that co-occur with advice, such as argumentation, emotional support, and planning, also influence outcomes. The sequencing of advice in interaction also matters; the integrated model of advice (IMA) indicates that advice in supportive interactions is best placed after emotional support and problem analysis. The contexts in which advice are given influence the exchange and outcomes of advice. These include personal and professional relationships, in which relational cognitions and professional norms affect the process and outcomes of advising; groups and organizations, in which advising processes become complex due to the multiplicity of relationships, goals, and expectations; cultures, in which advice-seeking and advice-giving varies in perceived appropriateness; and digital environments, which are often valued for advice that is unobtainable elsewhere.

Article

Pamela J. Shoemaker

One of the oldest social science theories applied to the study of communication, the gatekeeping approach emphasizes the movement of bits of information through channels, with an emphasis on decision points (gates) and decision-makers (gatekeepers). Forces on both sides of a gate can either help or hinder the information’s passage through a channel. The gatekeeping process shapes and produces various images of reality, not only because some bits of information are selected and others rejected, but because communication agents put information together in different ways. In addition, the timing and repetition of information can affect the prominence of events or topics and can influence the probability of future information diffusion. Gatekeeping was originally modeled as a series of linear processes within the mass media, but in the late 20th century the flow of information through the mass and social media began to interact. Information is now understood to flow among journalists, among social media users, and among agents of both types of media. All such communication agents are gatekeepers. In addition, we can study these networked interconnections as one level of analysis, with the supra-gatekeepers (such as Facebook or Twitter) adding their own gatekeeping processes over and beyond those of their own clients of the mass media. In addition to looking at various pairwise relationships between gatekeepers, gatekeeping theory should go beyond to instead consider the entire web of gatekeepers as a whole or system. A system is composed of elements (gatekeepers), interactions (relationships among them), and a goal or function. Multiple functions have been proposed by 20th-century scholars (such as socialization, entertainment, or surveillance) for the mass media, but scholars should now consider the function(s) of the gatekeeping system (mass and social media, as well as supra-gatekeepers) as a whole. Although each type of medium can be analyzed as its own system, such analysis would not facilitate new thinking about the various ways in which these partial systems affect one another and how the whole system functions beyond the simple addition of its parts.

Article

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.