The purpose of this thesis is to determine through focus groups and individual interviews the identity gaps experienced by young adult smokers, the strategies they enact to minimize or avoid identity gaps, and contexts in which layers of identity are aligned in order to target those sites in future smoking cessation health campaign messages. Engaging in stigmatized health behaviors, like smoking, impacts the messages individuals receive from other people and the media about their health, identity, and behaviors, and the way they communicate about themselves. Michael Hecht's (1994) communication theory of identity (CTI) explains the process of enacting and shaping identities through communication and provides the framework of this thesis. Identities consist of four interpenetrating layers: enacted, personal, relational, and communal. When there is a discrepancy between layers an identity gap occurs. Identity gaps are associated with uncomfortable dissonance and negative communication outcomes. However, identity gaps also present opportunities for targeted health messages that draw attention to dissonance as a motivational tactic and offer behavior change strategies to decrease gaps. I conducted four focus groups and ten interviews focusing on the daily experiences of 20 young adult smokers. Identity gaps emerged involving all four layers of identity, though personal-enacted, enacted-relational, and personal-relational identity gaps were reported most frequently. Strategies to manage identity gaps included lying about smoking, hiding the behavior of smoking, and gauging others' reactions prior to disclosing smoking status. Participants voiced contexts and relationships in which layers of identity aligned, including around other college-age individuals and friends. Theoretical and practical implications of these findings are offered, including suggestions for health messages and interventions targeting management strategies and contexts where identity is aligned in order to decrease their efficacy and thus increase the magnitude of the already pervasive identity gaps young adults smokers experience in the hopes of motivating behavior change.

Följande kandidatuppsats undersöker hur en elektronisk hälsoapplikation kan utformasför att öka medvetenheten om den personliga dagliga hälsan, fokuserat på huden och atthålla den frisk. Det sker genom att en prototyp har utformats där användaren genombilder samt text får instruktioner för att utföra en självkontroll. Prototypen innehållerockså en bildregistrering där användaren kan ladda upp bilder på en leverfläck ochgenom registreringen kan om leverfläcken utvecklas över tid. Syftet med prototypen äratt undersöka om en elektronisk hälsoapplikation utformad med fokus på återkopplingkan göra det möjligt för en person som inte är utbildad inom ämnet att undersöka sinhud samt se och följa förändring i en leverfläck genom bildanalys. Detta undersöktesgenom två tester. Ett frågeformulär där svarspersonen fick försöka avgöra om enleverfläck var frisk eller inte. Ett användartest där testpersonen fick testa bildanalysen,det som testades var om personen kunde ladda upp en bild samt se skillnad i bildernagenom bildregistreringen.Resultatet visar att majoriteten av enkätsvaren var korrekta svar, närmare bestämt 76,9procent. Personerna kunde identifiera om leverfläcken var frisk eller sjuk med hjälp avinformationen som tilldelades. Resultatet av användartesten visade att personerna kundeladda upp en bild på webbplatsen och sedan förstå bildanalysen. / This bachelor thesis examins how a electronic health application can be made toincrease awareness about personal daily health, with focus on individual skin andkeeping it healthy. This was made by creating a prototype where the user get usefulinformation on how to perform a self examination through text and images. Theprototype also contains functionality that allows the user to upload images of a moleand by an image registration follow possible changes over long periods of time. Thepurpose of the prototype is to investigate if an electronic health application with focuson feedback can make it possible for a person who is not educated in this area to examinthe skin and also discover possible changes over time with the image registration. Twotests were made to examin if this was possible. The first test was an questionnaire wherethe respondet tried to determine if a mole was healthy or not. The second test was a usertest where the test person got to try out the functionality with image registration in theprototype. The person got to upload an image and see the differences through the imageregistration.The results showed that the majority of the collected repsonses from the quetsionnairewas correct, with a percentage of 76,9 correct answers. The respondent could identify ifthe mole was healthy or not through the information that was presented. The results ofthe user test showed that all test persons could perform and understand the functionalityof uploading an image and then analyze the results throgh image registration.

In this thesis, I have focused on the uses of video, or nonbroadcast television, as an instructional tool within three different contexts, i.e., the uses of video in medical, corporate and industrial settings. Within this exploration, several problems have come to light. First, there is a need for higher education to train students in the field of nonbroadcast education, not only for broadcast students and new career opportunities, but also for students of business, medicine, art, and other career areas. As the uses of video become more widespread, so it becomes necessary to educate those who are likely to come in contact with video tape in a business environment. Secondly, and in the same context as the first problem, executives of organizations who already use video must be educated in the limitations of the medium. In becoming more familiar with the capabilities and limitations of video, executives help their media specialists (those in charge of the video departments) produce better quality productions with fewer headaches, while training their employees with better long term results.

Introduction: E-cigarettes have been marketed as smoking cessation aids and harm reduction strategies. Prior regional surveys found that physicians are recommending them to patients despite the lack of evidence supporting these industry claims. Yet, little is known about physicians’ beliefs regarding e-cigarettes and whether these beliefs are associated with them recommending e-cigarette use in clinical practice. Methods: This three-manuscript dissertation used a mixed-methods approach including both qualitative and quantitative research methods. The aims were to: (1) Uncover the factors associated with primary care physicians’ (PCPs) decisions to recommend e-cigarettes to their patients for tobacco use cessation; (2) Estimate the prevalence of PCPs who recommend e-cigarettes to their patients as a tobacco use cessation aid; (3) Estimate the influence of factors identified in Aim 1 on PCPs’ decisions to recommend e-cigarettes to their patients for tobacco use cessation; (4) Evaluate the conceptual model which demonstrates the factors contributing to PCPs’ decisions to recommend e-cigarettes to their patients for tobacco use cessation. Results: Study 1 found that PCPs expressed a lack of information about e-cigarette safety and efficacy along with skepticism about the role of e-cigarettes in tobacco control in general and in smoking cessation in particular. However, once a patient initiates a discussion with them, PCPs seem to be endorsing patients’ interests in using e-cigarettes, as well as recommending e-cigarettes to particular types of patients who smoke for both smoking cessation and as a harm reduction strategy. Study 2 found that over three-quarters (82.7%, n=220) of PCPs reported previously discussing e-cigarettes with their patients. Overall, 57.8% (n=155) reported previously recommending e-cigarettes to an adult patient who smoked. Among those recommending e-cigarettes, the majority reported recommending them for smoking cessation and harm reduction (71.6%, n=111), 18.8% for smoking cessation only, and 9.6% for harm reduction only. The likelihood of recommending e-cigarettes to patients was associated with considering their patients’ interest in using e-cigarettes, PCP’s belief that e-cigarettes can help in quitting smoking, and PCP’s belief that e-cigarettes limit secondhand smoke exposure for others. Study 3 found that PCPs intend to recommend e-cigarettes for smokers with prior unsuccessful quit attempts (mean=3.63, ±2.1), followed by heavy smokers wanting to quit (3.57, ±2.2), and heavy smokers refusing to quit (mean=3.50, ±2.2). The mean for PCPs’ recommendation intentions was 3.04 (±2.0) for light smokers wanting to quit, and 3.01 (±1.9) for light smokers refusing to quit. Nevertheless, these recommendation intentions were driven by PCPs’ beliefs and perceptions of e-cigarette benefit and harm; however, these intentions varied by patients’ tobacco use profile. Discussion: Findings across the three studies highlight the significance of PCPs’ beliefs in driving their recommendations of e-cigarettes versus evidence based knowledge, as well as, the importance of patients’ factors and interest in using e-cigarettes for PCPs’ recommendations for e-cigarette use.

Master of Science / Department of Journalism and Mass Communications / Nancy Muturi / This study was designed to explore how Alzheimer’s caregivers use Facebook support groups. Specifically it describes what kinds of activities caregivers engage in when in Facebook support groups, explores the motivation behind participation, and details perceived advantages and disadvantages of the groups. Whether Facebook support groups are considered a primary and accurate source of disease information was also explored. The study was qualitative in nature and consisted of 20 caregiver interviews, conducted via phone and Skype. Guided by uses and gratifications theory (Katz, Blumler & Gurevitch, 1974), the study employed six research questions to fully explore the experiences of caregivers in Facebook support groups. Generally speaking, the study identified the primary theme of community, and three subthemes including context, advice and emotional release/support. There were also significant findings on the primacy and accuracy of information. The ability to more fully understand these themes in the context of the caregiver experience will provide health care professionals with a foundation on which they can build effective ways to tap existing Facebook support groups and bolster support as the Alzheimer’s epidemic grows exponentially between now and 2050.

Master of Science / Department of Journalism and Mass Communications / Nancy Muturi / Health disparities are prevalent among ethnic minorities, including immigrants in the United States. These disparities come in the form of low health insurance, low social economic status, ethnic discrimination, language and cultural barriers. As ethnic minorities, international students also suffer from numerous health problems that are associated with their lower social, economic and immigration status when they come to the United States. Health communication is an effective tool for increasing health literacy and for reducing health disparities. Applying the uses and gratification theory and the staged model of trust, the study was conducted among 120 American students and 135 international students to examine the extent to which access to health information, the type of information accessed, how they use it, and how they determine what trustworthy information is differed between the two groups. Key findings indicate that nutrition is the most common health topic accessed online by college students regardless of place of origin. Though both groups access online health information with the same motivation of information, they use online health information in different situations. Source credibility is the most important factor for college students in determining trustworthy health websites, and government websites and other health organization websites were found to be more trustworthy. The study also provides both theoretical and practical implications, which include consideration of ethnic backgrounds in disseminating health information through online channels and understanding the needs and motivation for people’s access to health information and how they use it to be able to meet those needs. In designing health communication campaigns that target college students, the study proposes that the differences between native-born and international students need to be taken into consideration.

Trata-se de um estudo transversal de natureza compreensiva. Teve como objetivo discutir os aspectos comunicacionais da relação enfermeiro-usuário na atenção básica, tendo em vista o princípio do vínculo. Teve como base as produções científicas sobre comunicação terapêutica em saúde. O método utilizado foi a triangulação de métodos. O processo compreendeu três momentos distintos: no primeiro, a aplicação do Inventário de Problemas Éticos na Atenção Primária à Saúde (IPE-APS) para uma primeira visão dos enfrentamentos e conflitos nas relações entre os enfermeiros e usuários, e que serviu para a triagem das unidades/sujeitos para a etapa seguinte; no segundo, a observação do atendimento de enfermagem com base em um roteiro sobre os aspectos comunicacionais (verbais e não-verbais); e no terceiro, entrevista aberta, com as enfermeiras cujo atendimentos foram observados, na sequência da observação. A análise permitiu evidenciar o uso da comunicação terapêutica pela enfermeira através da utilização de seus elementos como a empatia, a escuta receptiva, respeito e o acompanhamento do paciente em suas reflexões discutidos no marco teórico desta pesquisa. Em vista do que foi percebido nas condutas das enfermeiras, desvela-se que a comunicação deve ser percebida como base para o cuidar em enfermagem mas, entretanto, por alguns momentos, é apenas entendida como algo inerente à prática e como processo mútuo de troca de informações técnicas a fim de estabelecer um plano terapêutico ao paciente. / It is a comprehensive research that aimed to discuss communicational aspects of primary-care patient-nurse relationship, focusing on bond and therapeutic communication. Data collection used a triangulation of methods with distinct stages: (i) application of the Inventory of Ethical Problems in Primary Health Care (IPE-APS) to an overview of ethical issues in nurse-patient relation and to select the services and nurses for observation of nursing care actions. The observation focus was communication aspects (verbal and nonverbal) during the care action. After observation, nurses should talk about their communication in the action. The analysis used the elements of therapeutic communication: empathy, receptive listening, respect and accomplish of patients in their thoughts, feelings, fear, and believes. The results pointed out that the nurses realize the importance of communication for their actions, however, they consider it inherent to nurse practice and as an exchange of technical information to get patients accomplish to treatments.

Philosophiae Doctor - PhD / The thesis explores the role of semiotic structuring of health information in relation to language, multimodality and health literacy and the affordances for agentive participation among consumers of two leading South African medical schemes - Discovery Health Medical Scheme (Discovery Health) and the Government Employees Medical Scheme (GEMS). The focus is on who has access to health information, how this information is constructed and what the semiotic health habitat looks like for citizen-consumers. Through a virtual ethnographic approach the thesis explores the design of genres of health information artefacts: application forms, application guides, a comic book, and a variety of website images. The choice to study the commercial package of a private health industry is aimed at finding and defining codes of practice in health communication that could be replicable in the public health sector. A new perspective emerging out of the thesis is how semiotic structuring of style, stance-taking, and choice of registers affects reading positions, and how these determine with what voice citizenconsumers can engage with this information.

Objectives: To assess and compare interprofessional and interpersonal communication self-efficacy beliefs of medical, nursing and pharmacy students before and after participation in a communication skills course. Method: Using self-efficacy as a theoretical framework, a 37-item survey instrument was developed based on Interprofessional Education Collaborative (IPEC) Core Competencies and course learning objectives. Medical, nursing, and pharmacy students voluntarily completed the survey instrument before and after the required course. Nonparametric tests were employed to examine matched pre- and post-assessments within colleges and to explore differences in self-efficacy beliefs across college. Results: A response rate of 87% (168/193) was achieved. Overall, nursing students entered the course with higher self-efficacy beliefs as compared to medical and pharmacy students. Pharmacy students indicated particularly low self-efficacy beliefs regarding their ability to communicate with other health professionals (p=0.009) and contribute to healthcare teams (p=0.002). Matched pre/post analyses indicated statically significant increases in student self-efficacy beliefs across all colleges. After the course, pharmacy students continued to perceive a relative lack of confidence in their ability to develop positive relationships with other health care providers as compared to medical and nursing students (p=0.02). Implications: Our findings suggest that completion of an interprofessional communications course was associated with a positive effect on self-efficacy beliefs aligned with IPEC competencies across all colleges. Pharmacy students, in particular, noted significant improvements in self-efficacy beliefs across multiple domains. Research is being conducted to examine relationships between validated observational assessments and student self-perceptions.

Background. This study (part of a larger grant-funded omnibus study) examines the roles of mothers in Southern Central Appalachia regarding family health communication. Methods. This presentation is based on a secondary analysis (Thorne, 1994) of existing qualitative data sets from two (2) previous studies of women living in Southern Central Appalachia. In the first study, Kelly Dorgan (primary investigator), Sadie Hutson (co-principle investigator), and Kathryn Duvall (researcher) collected the stories of 29 women cancer survivors from Northeast Tennessee and Southwest Virginia via a mixed methods approach. In the second study, Sadie Hutson (primary investigator) and Kelly Dorgan (co-investigator) investigated communication and cultural issues that may influence HPV and HPV vaccine perceptions and uptake behaviors in the region. We recruited 38 women between 18-50 years to participate in a single individual interview or focus group session. Results. The secondary analysis has yielded preliminary results about the role of “mother” in health communication within family systems. These results challenge us to reconceptualize traditional characterizations of the “Appalachian Mother.” The role of mother as related to family health communication is a complex one. Specifically, there are “many mother” roles, including informational, instrumental, and emotional. Ultimately, women who identify as mothers appear to serve as decision guides, informational agents and health communication specialists within families. Significance. This paper further explores the illness and wellness in Southern Central Appalachia, as well as the question of “Appalachian distinctiveness.”