Background. CRC risk can be reduced though lifestyle modification and regular screenings. Providing CRC risk feedback that promotes preventive behaviors to those at average risk has the potential to significantly reduce CRC morbidity and mortality. Purpose. The purpose of this dissertation was to examine the impact of CRC risk assessment feedback among adults aged 50-75 with no personal or family history of the disease. The specific aims were to: (1a) test personalized (vs. generic) risk assessment feedback on individuals’ risk perceptions and intentions to engage in three risk-reducing behaviors (e.g., physical activity, diet, and screening); (1b) determine if the provision of CRC risk information influences breast cancer risk perceptions and mammography intentions; (2a) examine individuals’ accuracy of perceived lifetime risk of CRC; (2b) assess whether improved accuracy following risk assessment was associated with changes in behavioral intentions; and finally, (3) evaluate the use of a unique sampling procedure designed to increase diversity of survey respondents. Methods. A pre-post parallel, two arm randomized controlled trial examined the effects of providing CRC risk assessment feedback that included lifetime risk estimates and information about CRC risk factors that was either personalized (treatment) or generic (control). N=419 average risk adults between the ages of 50-75 were recruited from a commercial online panel. Results. There were no differences in risk perception between study arms. Overall participants, perceived lifetime risk of CRC lowered at post-test and seemingly produced a spillover effect in lowered perceived lifetime risk of breast cancer among females. CRC screening intentions increased in both study arms and mammography intentions increased in the control arm. Accuracy of lifetime risk improved at post-test, but was not associated with changes in intentions to perform risk reducing behaviors. Quota sampling acquired a targeted and diverse sample quickly and efficiently. Conclusion. Communicating CRC risk information to average risk adults can improve CRC risk perception accuracy and enhance colorectal and mammography screening intentions. Risk assessment feedback did not consistently influence intentions to improve diet and physical activity.

The availability of online support communities creates new opportunities for caregivers of children affected by health conditions to manage their illness-related uncertainty. This dissertation includes two studies that examined the presence of uncertainty management behaviors in online interactions among parents (caregivers) of children with clubfeet, and empirically tested the applicability of the uncertainty management theory to online behaviors. The Uncertainty Management Theory provided the theoretical foundation for both studies. For the first study, a content analysis of messages exchanged in an online support community dedicated to parents of children with clubfeet was conducted. Most messages were authored by women. The majority of the emotions expressed in the messages were positive. The most frequent information-seeking behaviors were direct questioning and self-disclosure. Information exchanges as a strategy to manage uncertainty included names of health care professionals and medical information. Five major types of social support (informational, tangible, network, esteem, and emotional) were identified. Informational support was the most frequent type of support provided, followed by emotional and esteem support. A third of the messages included combinations of two or more types of social support. For the second study an online survey was distributed using a snow-balling technique. Based on the survey data structural equation modeling was used to empirically test the uncertainty management framework. Positive relationships were identified between knowledge and information seeking, information seeking and social support, social support and sense of virtual community, uncertainty and stress. The results suggested that the uncertainty management theory may need to be adapted for use in online contexts. Uncertainty seems to be an important part of the experience of parents caring for children with clubfoot. Online communities dedicated to these parents represent a promising setting for studying illness-related uncertainty and its potential causes. Such studies can be a critical source of information to inform priorities for research and practice. This dissertation is the first step in better understanding the audience and provides an initial exploration of uncertainty management and communication processes present in an online support community. As we learn more about the parent audience, the importance of communicating with them becomes increasingly clear.

Prescribed self-management behaviors have been found to be important factors affecting the rates of morbidity and mortality in multiple medical conditions including chronic diseases such as diabetes, a condition that disproportionately affects high health risk populations such as African Americans. This study focused on understanding health behaviors, beliefs, and associated factors such as support systems and access to care that played a role in diabetes self-management and glucose control. The study also explored diabetes self-management education and its role in diabetes self-management. The research conducted in Pinellas and Hillsborough counties in Florida, included twenty-five African American women between the ages of forty-six and eighty-seven, with self-identified diabetes mellitus (type 2 diabetes). The study also included seven diabetes self-management educators consisting of nutritionists, a nurse educator, physicians, and an exercise physiologist--key members of the diabetes self-management team. Additionally, five diabetes education programs were observed. Methods included semi-structured qualitative interviews, with direct and participant observation of the Diabetes Intervention Prevention Program (DIPP), the St. Petersburg Free Clinic Diabetes Program, and the Morton Plant Meese/Joslin Diabetes Program in Pinellas County. Hillsborough County sites included the USF Diabetes Program, and University Community Hospital's Diabetes Care Program. Site selection included a cross-section of program types: non-clinic/community-based, community-based clinic, hospital-based, and university clinic-based. The study also utilized a thirty-nine question survey designed to elicit information about self-management beliefs and behaviors. Results revealed several self-management behavioral variables affecting glucose control: (1) nutritional/dietary changes, (2) exercise, (3) medication use, (4) blood glucose monitoring, (5) physician-patient interaction, (6) support systems, and (7) patient education/knowledge. Results also identified access to care as a contributor to self-management. Two models of diabetes self-management emerged from the findings: a model of balanced self-management held by the diabetes educators and self-management programs, and a model of Interruption practiced by the women. Recommendations highlighted the need for the awareness of socio-cultural factors affecting self-management, the elimination of barriers affecting access to care, improvement in physician-patient interaction, provision of culturally aware patient education, and stronger community and family support systems.

This dissertation documents the joys and terrors of caring for my father throughout my twenties and early thirties. The story is autoethnographic and demonstrates the value of narrative research in fostering understandings of self, other, and the world around us. I call this reflexive practice of writing narrative education because as I engaged in it, I learned what it means to care, and how mental health and illness factor into the ways in which care is expressed and provided in my own relationships and beyond. In addition, throughout the story I was a member of the academic community, which makes caring more than an act or behavior, but a concept to unpack, an ideograph. This dissertation begins with the goal to write my story and learn from it so others might learn from it as well. While the narrative portion of my dissertation focuses on story and the craft of creative nonfiction, the final chapters present a discussion of narrative ethics and the writing process. I also delve into concepts of care, family, and community to shed light on the narrative and create a space for reflection.

This dissertation presents a comprehensive qualitative study of the decision-making aspects of emergency department (ED) triage at a large urban Trauma I hospital in the Southeast. Specifically, this study addresses the following research questions: (1) What do triage nurses perceive as the primary role of the triage process? (2) How do triage nurses interpret patient performances? These questions are explored through illuminating the intricacies of triage decision-making by the use of semi-structured interviews and observations. The findings of this study indicate: (1) a better understanding of the triage decision- making process yielding more practical insights related to the informal, emergent, and often improvisational ways patients are received, categorized, and treated was needed, and (2) providing a clearer understanding of the processes involved in sorting patients may provide much-needed insight regarding clinical concerns and/or issues regarding patient categorization, adverse clinical events, and excessive patient wait times. These findings are of particular importance due to the widespread overuse of EDs for nonemergent care. Essentially, EDs are designed for patients to visit due to an alteration in their physical and/or mental state. Once a patient enters the ED, a medical professional is tasked with the responsibility of interpreting the physical and/or mental state of the patient, which is generally achieved by interpreting the patient story - the precipitating event that brought them into the ED. What this study contributes to the literature is a deeper understanding of the communicative processes that ED triage nurses leverage to make sense of patient stories.

<p>This is a study about hiv/aids communication between low- and non-educated women andhiv/aids organisations in Uganda. The purpose of the thesis is to define potential disturbance inthe communication using three organisations and 9 women as examples. The research is made with qualitative methods and most of the data is collected through field studies and group interviews.</p><p>The result of the study is that there are a lot of disturbance causing problems in the communication between the women and the organisations. Most of the disturbances can be connected to the women’s limited access to media exposure. It is also a problem that the interviewed women are more or less isolated in their villages, which mean they are directly excluded from all the information activities placed on billboards, posters, fairs, and events thattake place in the city centre or elsewhere. Even though there are a lot of community based information activities arranged by the organisations, these women will not be reached since most of the activities take place in schools where they don’t have access.The poor level of education results in two problems, first, the women cannot read and will therefore not access any print material and second, their English skills are not good enough to understand the meaning of the majority of the information material.It is pointed out that all disturbances are not communication problems. One of them is the gender inequality in Uganda. The gender roles and structures are too unequal and dominating that even if the women, despite all disturbances, receive information it is often impossible for her to implement the knowledge without consensus from her man.</p>

This case study investigates the co-construction communication patterns that emerged during an Human Immunodeficiency Virus (HIV) intervention designed to reduce negative and critical self-talk. The transcripts of eight sequential acupressure and behavioral (SAB) counseling intervention sessions between a therapist and two medically nonadherent HIV-infected women were analyzed using Giorgi's (1989, 1994, 1997, 2006) phenomeonlogical method of inquiry. The analysis revealed three major themes: "assessing the present," "reviewing the past," and "forging the future," and eight subthemes: "safe atmosphere," "disclosure," "negotiating meaning," "releasing the past," "breaking the past-to-present pattern," "reducing uncertainty," "generating options," and "projecting images." Prior to the intervention sessions, the women reported experiencing negative and critical self-talk and inconsistent medication adherence. Self-talk and illness narrative modifications were evident within and across sessions as the therapist used sequential acupressure and behavioral counseling techniques. During the one month follow-up, the participants reported no experience of negative and critical self-talk and described actions taken toward goals discussed and imagined during the intervention such as medication adherence, exercise, and reenrollment in school. The co-construction themes that emerged in the intervention were consistent with findings in the comforting message literature with specific parallels to the factor analysis findings of Bippus (2001). This work lends support to comforting message research and suggests that distinctions between everyday comforting messages and chronic illness support strategies may be more similar than anticipated. Other study conclusions include clinical and practical implications for people working with HIV-infected individuals.

This study examined a specific and controversial issue in health communication: the complementary and alternative medicine (CAM). Recent studies have shown that both online newsgroups and traditional newspapers have involved in communicating CAM information, but research has not answered whether there are differences between the new and old media. From the perspective of uses and gratifications, this study first investigated that how people are using newsgroups to solve CAM-related problems. Then contents of newsgroup messages and newspaper stories were analyzed to do the comparison in topics, source types, efficacy claims, and CAM categories. The results showed that both similarities and differences existed between the two media.

Lymphoedema is a chronic health condition characterized by the accumulation of lymphatic fluid in the subcutaneous tissues resulting in arm swelling and can significantly affect physical and psychological health and QOL. Although significant research on lymphoedema has developed over the past decade, the literature reveals that there are gaps in knowledge on framing the illness, communication, and effective practices to improve the QOL for individuals living with lymphoedema. This research contributes to this growing field of research through a qualitative investigation of twelve women's reported understandings, experiences, and perceptions of lymphoedema using Brown’s (1995) theory of framing disease and illness. Semi-structured interviews were conducted with women living with lymphoedema to determine the impact of health messaging, to explore the ways in which these women made sense of conflicting messages on exercise, and to better understand how barriers to the effective adoption and integration of good management practices can be overcome.

Lymphoedema is a chronic health condition characterized by the accumulation of lymphatic fluid in the subcutaneous tissues resulting in arm swelling and can significantly affect physical and psychological health and QOL. Although significant research on lymphoedema has developed over the past decade, the literature reveals that there are gaps in knowledge on framing the illness, communication, and effective practices to improve the QOL for individuals living with lymphoedema. This research contributes to this growing field of research through a qualitative investigation of twelve women's reported understandings, experiences, and perceptions of lymphoedema using Brown’s (1995) theory of framing disease and illness. Semi-structured interviews were conducted with women living with lymphoedema to determine the impact of health messaging, to explore the ways in which these women made sense of conflicting messages on exercise, and to better understand how barriers to the effective adoption and integration of good management practices can be overcome.