Research is necessary to uncover ways to improve adolescent nutrition and reduce obesity rates, particularly in the Appalachian region, which has high rates of food insecurity and adolescent obesity. The current study examines rural cultural norms about food, memorable messages adolescents received about nutrition, and the sources of identified memorable messages. Adolescents shared memorable messages during comprehensive, semi-structured, small group interviews in which participants revealed their individual experiences. Thematic framework analysis is used to present the range and nature of memorable messages about nutrition and to develop strategies for future health campaigns and interventions. This qualitative method of sequential inductive analysis provides transparency of data and resulting interpretations through thematic identification and indexing. Analysis revealed themes of messages that featured critical pieces of the rule-structure of memorable messages – specifically, adherence and consequence regarding nutritional behaviors. Prominent memorable messages of adherence included topics of balance (e.g., MyPlate), type (e.g., junk food), and timing (e.g., “don’t eat after 7 p.m.”). Messages with elements of consequence included communication of short-term (e.g., “breakfast gets your blood flowing) and long-term consequence (e.g., obesity, etc.). Adolescents identified family members, educators, and media as salient sources of memorable messages.

Social media has several advantages over more traditional forms of mass communication, but many non-profit organizations (NPOs) are underutilizing social media as a communication platform. There is limited research on social media use among NPOs in rural Appalachia. The current study fills this gap in the literature by examining social media use among NPOs in rural Appalachian Tennessee. We conducted 20 semi-structured phone interviews with NPO representatives (President, CEO, Executive Directors) in an 8-county region of Appalachian Tennessee. The interviews were transcribed and analyzed using Braun and Clarke’s thematic analysis. Thematic analysis indicated that rurality, organizational capacity, messaging, and social media as a secondary communication strategy were important themes. Fiscal, personnel, and time constraints were limiting factors in terms of NPOs ability to use social media. NPOs used social media primarily to share information with their target audience. While acknowledged as an important feature of social media, NPOs were less likely to use social media to advocate, engage, or mobilize community support. Further data collection is ongoing to confirm these findings and to identify best practices. NPOs in rural Appalachia can use these findings to enhance their communication strategies.

This qualitative research project examined health experiences of female agricultural workers in central Florida. Specifically, this study identified the most common physical and mental health illnesses and issues reported by female agricultural workers, their health-related decision-making processes, methods used to access health-related information, and the challenges they encounter when attempting to access health-related information, support, and services. In total, 21 interviews were conducted with women who had worked for at least one year as an agricultural worker in central Florida. The data was analyzed for emergent themes based on a codebook developed using the IDEA model as a theoretical framework. The results revealed that female agricultural workers realize the relevance and impact of key physical and mental health issues and actively seek information about them and help to treat, as well as prevent them. However, the results also revealed a level of distrust for some medical providers and other information sources, as well as challenges in understanding health-related information due to language and health literacy barriers. They also identified several challenges that hinder them from getting the medical help they needed. These include, for example, financial constraints, immigration status, fear of deportation, and fear of losing their children and their jobs. Finally, this study confirmed the utility of the IDEA model as a framework for examining interview data provided by underrepresented populations regarding health-related topics and issues. It also identified recommendations and ideas for future research that, if carried out, would continue to raise awareness about the community's health communication constraints.

Patient education often aims to activate behaviours for health management. Assumptions of a fundamental desire for information and learning as a pre-requisite for self-management are countered by the fact that some patients refuse or selectively attend to health information. The complex and emotional context surrounding illness and disease may reduce the patient’s openness or willingness to engage with information. Perceptions of a non-compliant, resistant or difficult patient are accompanied with little understanding of the underlying factors. The goal of this research was to explore the cognitive and emotional factors underlying the patient’s readiness to learn or cognitively engage with information regarding diabetes management. This study was conducted using Interpretative Phenomenological Analysis, which draws from the educational experiences of patients with diabetes and interprets their narratives within the context of existing research and theory. A maximum variation sample of 19 adults with Type II diabetes from a primary care clinic and a tertiary care hemodialysis unit participated in an interview. Three main themes emerged: underlying incongruence in knowledge, thoughts and beliefs; relational talking; and negotiating control. Themes converged on the essence of ‘distance’ between the patient’s lifeworld and the disease and its management. When considered in relation to cognitive dissonance and psychological distance theories, psychological adjustment and relational challenges were revealed. Adjustment involved reconciling difference and dissonance at various points during diabetes management. Distance also threatened the adjustment process and in some cases generated defensive reactions. Adjustment and relational challenges have a bearing on the early stages of the learning process. Differentiating the message according to concrete and abstract information may be more conducive to a staged learning process and offer a more tangible understanding of ‘finding common ground’ within patient-centered communication. These factors underlying readiness to learn have been reported by patients with diabetes and require further consideration for tailoring communication and education to support person-centred care and self-management. / October 2016

The Academy of Nutrition and Dietetics and the Cooperative Extension System are organizations that serve the public and agricultural communities, respectively. Within these broad organizations are two groups of food systems professionals, registered dietitian nutritionists (RDNs) and Extension agents, who are utilizing communication as a critical point of access for health-related issues. Both groups of professionals negotiate organizational structure in order to construct their own health knowledge and, subsequently, communicate accurate information to their constituents. Understanding the ways that these professionals navigate their roles as health communicators are important for contributing to public discourse about how health knowledge is created and disseminated. Specifically, for the first article, I conducted semi-structured interviews with RDNs to analyze the ways in which they navigate both commercial and health messaging from industry groups at their largest organizational meeting. Industry affiliations have historically been a controversial aspect of Academy operations, yet little research has explored RDNs unique experiences with industry. Findings revealed RDNs have varied interpretations of industry messages and are utilizing strategies to negotiate interactions with industry. The spectrum of RDN interpretation suggests that formal dietetic training should address media literacy strategies in order to help RDNs navigate a complex message landscape. For the second article, through national focus groups with Extension professionals, I sought to understand how Extension is responding to healthcare reform changes and how this has translated into programming for their constituents. Extension participants reported a lack of available resources to improve their own health insurance knowledge, which has impacted their abilities to serve their constituents effectively. Findings emphasized a need for both collaborations both within Extension and across other agencies in order to improve health insurance access for agricultural communities. By researching these two organizations, I hope to contribute to new understandings about how professionals navigate and communicate knowledge related to public health. Both articles have practical implications for each group, and they also offer examples of opportunities to utilize leverage points for structural change within the food system.

Master of Science / Journalism and Mass Communications / Nancy W. Muturi / Kenyan society has seen problems with alcohol abuse and has seen many deaths related to illicitly brewed alcohol. A Kenyan government body, The National Authority for the Campaign Against Alcohol and Drug Abuse (NACADA), has done research about the problem, but very few outsiders have performed research in this area. This research seeks to study the problem from outside of the standard government framework while using a cultural approach. The purpose of this project is to document the alcohol abuse problem in Kenya, and what methods of mass communication, if any, could be used to help convey a solution to the problem. It is to provide a firsthand account of the alcohol abuse problem that plagues the East African nation in an effort to bring more and awareness to the situation. To document the situation, I interviewed several key cultural figures chosen based on their affiliation with the academic, religious, medial or cultural framework of Kenyan society. Each person was asked a serious of questions regarding the alcohol problem in Kenya, what could be done from their particular perspective, and how the media have and could influence the situation. The information gathered indicated that the alcohol problem is widespread in Kenya, that the people with alcohol problems tend to be men, and that the problem is multifaceted and very complex. Many factors contribute to the problem, such as idleness, poverty, unemployment, and more, and the problem affects many more people than just the people drinking the alcohol. The information gathered is meant to help provide suggestions to helping solve this problem in Kenya. Recommendations from this research will provide guidance for those who are trying to create media campaigns to combat alcohol abuse in Kenya.

Introdução: A comunicação é o processo pelo qual ocorrem compreensão e compartilhamento de mensagens enviadas e recebidas, sendo que o conteúdo destas mensagens exerce influência no comportamento das pessoas envolvidas. Atualmente, a área da saúde tem utilizado ferramentas de cuidado à distância para prestar assistência aos pacientes em diversos contextos - a chamada Telessaúde. A influência desta modalidade de cuidado sobre a natureza e o conteúdo da comunicação deve ser muito bem compreendida, visto que o processo de comunicação humana adequado é essencial na assistência à saúde com qualidade. Objetivos: avaliar a percepção do profissional da saúde referente a elementos de Comunicação Humana no cuidado por Telessaúde. Os objetivos específicos foram: verificar que elementos de Comunicação Humana o enfermeiro e o médico identificam no cuidado por Telessaúde, e discutir, por meio dos achados, em que aspectos essa modalidade de cuidado pode impactar na comunicação interpessoal entre os profissionais de saúde e, consequentemente, na assistência aos pacientes. Método: pesquisa descritiva, com abordagem qualitativa, realizada com 20 profissionais que atuam em telessaúde no Brasil. Os dados foram coletados com médicos e enfermeiros por meio de sistema de vídeo ou áudio, no período de junho a outubro de 2014. O número de participantes foi determinado pela saturação de dados, conforme metodologia adotada. Os dados foram analisados pela proposta de análise de conteúdo de Bardin. Resultados: Dos discursos emergiram quatro categorias principais, sendo a maioria composta de subcategorias: Entendendo a importância da comunicação (Comunicação adequada é fundamental, pois interfere na conduta; Identificando as barreiras de comunicação); O relacionamento interpessoal interferindo na comunicação; Comunicando-se por meio da tecnologia (Tecnologia facilita a prática; Entendendo os fatores que dificultam a comunicação à distância; Identificar o não verbal por telessaúde é mais difícil) e Aprendendo o processo de comunicação (Não há dificuldades em comunicar-se; Importância do aprendizado da comunicação verbal e não verbal; Importância do aprendizado da telessaúde). Conclusão: Concluímos com este estudo que a comunicação interpessoal adequada na área da saúde é considerada primordial por médicos e enfermeiros que atuam em Telessaúde no Brasil porque acreditam interferir em sua conduta profissional. O relacionamento interpessoal é o principal fator de interferência nesse processo. A tecnologia tem facilitado a prática profissional, porém, do ponto de vista comunicacional, o cuidado à distância apresenta nuances que dificultam o processo de comunicação, principalmente devido à dificuldade de percepção do não verbal na assistência por telessaúde. Para superar estas dificuldades, médicos e enfermeiros concordam que a comunicação é uma competência que deve ser lecionada aos profissionais durante sua formação e, especificamente para atuação à distância, esta habilidade deve ser ensinada considerando as nuances que a distância pode trazer no processo comunicacional entre as pessoas. / Introduction: Communication is the process through which understanding and sharing of sent and received messages occur, considering that the content of these messages influences the behaviour of people involved. Nowadays, the health care segment has used distance care tools to serve patients in different contexts - the so-called Telehealth. The influence of this type of care on the nature and content of communication must be well understood, since the adequate process of human communication is essential in quality health assistance. Objectives: evaluate the perception of the health care professional regarding Human Communication elements in Telehealth care. The specific objectives were: verifying which elements of Human Communication the nurse and the doctor identify in Telehealth care, and dissussing, through findings, in which aspects this type of care can impact the interpersonal communication among health care professionals and, consequently, patients care. Method: descriptive research, with qualitative approach, performed with 20 professionals who work in Telehealth in Brazil. Data were collected from doctors and nurses through audio or video system, from June to October 2014. The number of participants was determined by saturation of data, according to adopted methodology. Data were analyzed by the content analysis proposal of Bardin. Results: From the discourses, four main categories emerged, and most are composed of subcategories: understanding the importance of communication (dequate communication is fundamental, because it interferes in behaviour; Identifying the limitations of communication); The interpersonal relationship interfering in the communication; Communicating through technology (Technologies facilitates practice; Understanding the factors that make distance communication difficult; Identifying the non-verbal through Telehealth is more difficult) and Learning the process of communication (There are no difficulties in communicating; The Importance of learnig verbal and non-verbal communication; The importance of Telehealth learning). Conclusion: We have concluded in this study that adequate interpersonal communication in health care is considered fundamental by doctors and nurses that work in Telehealth in Brazil because it is believed that it interferes with their professional behaviour. Interpersonal relationship is the main factor of interference in this process. Technology has facilitated professional practice, however, from a communicational perspective, distance health care presents nuances that make the process of communication difficult , maily due to the difficulty of perception of non-verbal aspects in Telehealth care. To overcome these difficulties, doctors and nurses agree that communication is a competence that must be taught to professionals during their professional education and, especifically to work at distance, this ability must be taught taking into consideration the nuances that distance may bring in the communication process among people.

Master of Science / Department of Journalism and Mass Communications / Nancy W. Muturi / Stigma towards mental illness is a problem that runs deep in most societies, causing difficulties for the people who are ill, the people related to them, and the community (Papadopoulos, Leavey, & Vincent, 2002). Stigma is one of the most crucial reasons for depressed people to avoid seeking help. Numerous interventions and campaigns for reducing public stigma have been implemented with limited effect on mental health stigma. Previous studies have focused on effectiveness of anti-stigma messages, how they are communicated and on the use of contact strategies to strengthen campaign influence (Jensen, 2017). This study examined how the key elements of the attribution theory— locus of causality, stability, and controllability – contribute to public emotional reaction and discrimination towards people with depression. Other vital variables included the level of perceived stigma, level of contact with stigmatized persons, six dimensions of stigma, communication channels, the access to depression-related resources and demographic factors. Data were gathered through an online survey that was distributed to a random sample recruited from M-Turk (N=533). Results showed negative associations between locus of causality and negative emotions (β = -.38, t = -9.47, p =.000), and discrimination (β = -.10, t = -2.41, p =.02), which means that the more participants believe the situation are responsible for the cause of depression, the more negative emotion and intention of discrimination they held. Among all information channels, Interpersonal Channel was the only significant predictor of discrimination (β = .21, t = 4.29, p =.000). Overall, this study shows that more empathy and more familiarity with depression do not lead to less discrimination. On the contrary, participants believed people with depression were easily controlled by the situation and did not put effort to change it.

Choices are often difficult to make by patients with Alzheimer Dementia. They often become acutely confused when faced with too many options because they are not able to retain in their working memory enough information about the various individual choices available. In this case study, we describe how an essentially simple benign task (choosing a dress to wear) can rapidly escalate and result in a catastrophic outcome. We examine what went wrong in the patient/caregiver interaction and how that potentially catastrophic situation could have been avoided or defused.

In this case study, we present a patient with preexistent posttraumatic stress disorder and psychosis who has been recently diagnosed with Dementia with Lewy Bodies. He is experiencing vivid hallucinations. What went wrong between him and his wife as a result of these hallucinations is presented. Alternative actions that could have been used are suggested.