This study explores the phenomenon of the informal medical consultation, a communication event in which an individual asks for medical information, advice, or care from an off-duty health professional with whom the individual has no formal patient-provider relationship. Using surveys and interviews, the study describes these consultations from the perspective of the health care professional and the informal patient. The study explores foundational theories that offer explanations for the phenomenon. The theories considered include social support, decision-making, social exchange, perceived partner responsiveness to needs, and uncertainty management. This study suggests health care providers perceive informal medical consultations to be more problematic than do the informal patients who consult them. The problematic nature of informal consultations increases as the type of request moves from purely informational to a request for treatment. Informal patients do not perceive this distinction. The informal patient’s motivation to pursue an informal consultation instead of a formal consult is affected by the relationship with, trust in, and access to the informal consultant. The willingness of the informal consultant to engage in an informal consultation is affected by the relationship with the informal patient, the type of request made, and perception of risk/benefit for both the provider and the patient. The study supports the idea that informal medical consultations are potentially problematic within the current medico-legal-ethical environment. Alternately, these consultations may be viewed as offering positive contributions to the health and well-being of informal patients. The study suggests translational research is needed to guide health professionals in considering requests for informal medical consultations.

Over the past few years, the rate of elective interventions in pregnancy in the United States, including elective inductions of labor and elective cesarean deliveries, has increased dramatically. While scholars attribute some of the increase in elective interventions to the female patients who request elective procedures from obstetricians, some literature contradicts that notion and suggests physicians are actually the primary perpetuators of the growth in elective procedures. Although pregnant women may seek elective interventions because of desired convenience, physicians can also claim the benefit of convenience in scheduling deliveries. In addition, elective procedures provide physicians greater monetary compensation than labor and deliveries which evolve without intervention. The current dissertation investigates the communicative role of obstetricians in women’s delivery decisions through in-depth interviews with obstetricians practicing in the state of Kentucky (N=28). Guided by the framework of Message Convergence, the study assesses how obstetricians manage uncertainty surrounding patient care and make clinical decisions in the midst of either unclear evidence or competing messages. The study also reveals the ways that physicians utilize their medical expertise to engage in decision-making with patients. In addition, specific scenarios of decision-making regarding delivery are discussed, including patients’ requests and physicians’ provisions of requests; patients’ requests and physicians’ refusals of requests; and physicians’ recommendations for treatment and patients’ refusals of recommendations for treatment. Finally, the internal tensions and conflicts experienced by physicians in the decision-making process with patients are also examined.

The experience of a pelvic exam or Pap smear is something that, while necessary to maintain reproductive health, can be fraught with difficulty for women. Ouj, Igberase, Exe, and Ejikeme (2011) note that “[m]ost women feel a level of discomfort or pain and for some it is embarrassing, dehumanizing, degrading and associated with fear, anxiety and apprehension” (p. 637). However, little recent research has focused on the specific communication surrounding reproductive care for young women. The Internet is a common place for young people to seek health information, understand their own health risks, and seek social support from others. The current study utilizes information gleaned from the archives of an internet message board and sexual education website to examine the way that young women communicate about reproductive health care, risk, and social support with experts and peers in the online community. Results indicate that young women request, seek, and receive several different types of social support in the online community. Further, themes illuminate the complex nature of women’s concerns about potential risk and reproductive care.

Communication processes can be affected by stigma – a negative evaluation of an individual’s attributes that discredits or identifies the individual as not normal (Goffman, 1963). One such communicative process that is affected by stigma is disclosure. Disclosure is when individuals share personal information that reveals something not previously known (Charmaz, 1991). One such group of individuals who may be forced to choose between disclosing (to get accommodations or social support) and avoiding stigma (by not disclosing) is individuals with disabilities (Braithwaite, 1991; Charmaz, 1991). This study focuses on one particular population of individuals with disabilities – those with a hearing loss. Through the use of interactive interviewing and Communication Privacy Management (CPM) theory, this study examines hard of hearing and deaf individuals’ perceptions of both the disclosure process and stigma. CPM examines how and why people conceal or reveal private information, such as hearing loss (Petronio, 1991, 2002). Using CPM, this study poses research questions surrounding how hard of hearing individuals disclose and manage turbulence surrounding their hearing loss. Further, participants’ perceptions and responses to stigma surrounding hearing loss are also examined. Based on the participants’ responses, managing the boundaries surrounding their hearing loss includes considerations of identity, the other person/people in the interaction, risks of not disclosing, timing, and how much to disclose. Further, participants viewed boundary turbulence as positive only when it was helpful; otherwise, they reported a feeling of a loss of control. In examining stigma and other consequences of disclosure, participants talked about being labeled, not being worth others’ time, and being seen as incapable. Finally, participants reported a wide variety of responses to stigma surrounding their hearing loss. In this study, I also discuss the implications of these findings, both theoretical and practical implications, and how they reflect the lives of the deaf and hard of hearing. Finally, I address the directions for future research on this topic as well as the limitations to this study.

Individuals with chronic illnesses must manage long-term uncertainty and decision making as they cope with the ways the illness influences almost every aspect of their lives. In the context of pediatric illnesses, parents assume the burden of uncertainty management and decision making during the diagnosis and treatment of their child’s illness. It is common for children with complex chronic illnesses to see multiple specialists for the treatment of their condition. The first visit to a specialist is often more elaborate than a routine primary care visit. While previous research has explored parents’ decision making and uncertainty management during a child’s diagnosis and during end-of-life care, less is known about these experiences during the long-term management of a chronic illness through the care of multiple specialists. The aim of the current study was to explore uncertainty and decision making during parents’ first visit to a multidisciplinary clinic for the care of their child’s complex chronic illness. Data were collected through survey measures and semi-structured interviews with 30 parents after their first visit to a vascular anomaly clinic at a large Midwestern children’s hospital. The results suggest parents’ communication with the team of specialists helps them reappraise uncertainty, engage in effective uncertainty management, and feel validated in their decision making. However, the findings also indicate that parents face multiple uncertainty management dilemmas, including not wanting certain types of information, feeling overwhelmed by the amount of information they receive, and having different information preferences than their spouses. Ultimately, the results also have important implications for existing uncertainty theories and their application to parents’ uncertainty experiences.

A cancer diagnosis often causes biographical disruption in the lives of young adult (i.e., 18-39; YA) survivors and their close social network members (i.e., familial, plutonic, or romantic relational partners with whom the survivor has a salient relationship; SNM). In order to integrate their illness into their lives, normatively regain balance and equilibrium, and achieve a “new normal” following a cancer diagnosis, YA survivors and their close SNMs must work to reconstruct their biographies by engaging in tangible interpersonal communication processes often used to initiate and maintain relationships. However, YA cancer survivors report facing social struggles due to the biographical disruption of their illness across the trajectory of diagnosis, treatment, and survivorship. To learn more about their unique social experience of cancer, I conducted private, open-ended narrative interviews with 20 YA survivor-close SNM dyads, 1 YA survivor-SNM close triad, and 10 individual YA survivors (N = 51). I used thematic narrative analysis to determine how and why YA cancer survivors and their close SNMs communicate social support messages with romantic partners, family, friends, peers, and one another. By examining the narratives of YA survivors, their close SNMs, and the dyad itself, this dissertation explores the interpersonal communication processes used to initiate and maintain relationships across the illness trajectory by focusing on the barriers and facilitators these individuals experience in the communication of social support. Through their individual narrative accounts, YA survivors explained why and how they perceived various support attempts from others to be positive or negative, and their close SNMs detailed their attempts to navigate the YA’s larger support network and assume the duties inherent in their newly-adopted “top supporter” role. In addition, reports from YAs and their SNMs revealed that they often engaged in mutual pretense, a unique and often unsustainable form of support that occurred between YA survivors and their close SNMs involving topic avoidance and emotional management. Implications for the advancement of interpersonal communication theory and for practical intervention targeting YA patients and survivors, their close SNMs, and medical practitioners are also discussed.

The goal of risk and crisis communication is to reduce and contain the harm inherent in a threat. In order to achieve this goal, risk and crisis scholars call for continued testing of messages surrounding these events; specifically, messages that address the needs of the at-risk message receiver. Previous scholarship suggests that these messages should include adapting and instructing information (Coombs, 2012), and should be designed using pedagogically sound instructional approaches (Frisby, Sellnow, Sellnow, Lane, & Veil, 2011; Sellnow & Sellnow, 2010). In order to meet this call, this dissertation tested an instructionally sound message that includes both adapting and instructing information related to a foodborne illness event including a hypothetical E. coli contamination in ground beef affecting the state of Kentucky. Foodborne illness outbreaks are unique in that they must address those at risk of contamination while simultaneously addressing the needs of those experiencing the crisis (i.e. those already contaminated). The research tested the ability of participants to make positive sense of risk message related to the E. coli outbreak; specifically exploring the effect of augmenting traditional video warning messages with converging Twitter messages and positive sensemaking on behavioral intentions and self-efficacy. Results indicate that individuals who are able to make positive sense of the message, report greater self-efficacy and behavioral intentions in line with message recommendations. Further, individuals who receive an IDEA model message and converging Twitter messages report greater attitudes and beliefs related to the message than individuals who receive a traditional video warning message. These findings indicate a need for continued research on the role of positive sensemaking and the type of message received as they directly affect perceptions of messages and intentions to comply with recommendations.

The implementation of a tobacco-free policy is the leading recommendation among health institutes for reducing the harms associated with tobacco exposure–for both smokers and nonsmokers–on college campuses. Despite the health benefits associated with tobacco-free policies, compliance with these policies remains a serious challenge on college campuses. Interventions aimed at increasing smokers’ willingness to comply with tobacco-free policies are essential for improving public health. Guided by the theory of planned behavior (TPB), the purpose of this study was to (a) investigate the factors associated with tobacco-free policy compliance among undergraduate students and (b) design and evaluate a theory-based campaign aimed at increasing compliance with a tobacco-free campus policy. To achieve these aims the current study was conducted in two phases. Phase One was a qualitative investigation that analyzed focus group data related to messaging strategies for increasing tobacco-free policy compliance. Phase Two was a quantitative investigation that used survey data to explore variables associated with tobacco-free policy compliance and to test the effectiveness of a campus-wide print-based campaign. Results from Phase One suggest various ways to target the TPB variables in messages in order to improve tobacco-free policy compliance. Results from Phase Two suggest the psychological variables and the physical variable of nicotine dependence are not related to tobacco-free policy compliance behaviors; however, social variables, quit attempts, and daily cigarette use are predictors of compliance behaviors. Similarly, the TPB variables had mixed results for relating to tobacco-free policy compliance behaviors. In addition, the campaign materials were supported as effectively improving tobacco-free policy compliance behaviors, both through individual level survey reports of compliance and observed compliance behaviors on campus. Although the campaign materials were designed around the TPB variables and were supported for improving compliance behaviors, above average campaign exposure was only found to improve normative beliefs from pre- to post-intervention. In addition to theoretical and practical implications offered from this study regarding tobacco-free policy compliance behaviors, this study also provides critical insight into the current compliance behaviors on the University of Kentucky’s campus.

In the United States as many as 15% of births occur before 39 weeks because of elective inductions or cesarean sections. This qualitative study employs a grounded theory approach to understand the decisions women make of how and when to give birth. Thirty-three women who were pregnant or had given birth within the past two years participated in key informant or small group interviews. The women’s birth narratives and reflections reveal how they construct the uncertainty of their due dates and how this construction influences their birth decisions. Problematic integration theory is used to analyze this construction and identify points of influence. The results suggest that women construct the uncertainty of due dates as a reason to wait on birth and as a reason to start the process early. The results suggest that information about a baby’s brain development in the final weeks of pregnancy may persuade women to remain pregnant longer. The results demonstrate the utility of using problematic integration theory to understand a medical situation that is the result of epistemological and ontological uncertainty. The analysis suggests the existence of a third type of uncertainty, axiological uncertainty. Axiological uncertainty is rooted in the values and ethics of outcomes.

Although direct-to-consumer (DTC) prescription drug advertising is regulated by the U.S. Food and Drug Administration, content analyses (Baird-Harris, 2009; Frosch, Krueger, Hornik, Cronbolm, & Berg, 2007; Kaphingst, DeJong, Rudd, & Daltroy, 2004; Wilkes, Bell, & Kravitz, 2000) and other studies (Davis, 2000, 2007) have suggested that advertisers may not disclose drug risks to the same extent that they describe drug benefits. This study builds on previous studies by Baird-Harris and Smith and Shaffer (2000) and aims to test the relationship between image congruency in televised DTC advertisements, recall of risks and benefits, and perceived ad persuasiveness. Advertisements for Nexium, Advair, and Lunesta were shown to college students in either their original (i.e., image incongruent) or modified (i.e., image neutral) form. In general, risks were easier to recall with image neutral advertisements (which were considered to be less persuasive), although results were not statistically significant. Gender had a significant interaction effect, suggesting that males and females process risks differently depending on images in a DTC advertisement. Despite its lack of significant findings, this study explores an underdeveloped area of research and provides a model for future studies.