The current study examined verbal and non-verbal problem skills in twenty-seven male children 10-16 years of age, twelve with autism and fifteen children who were neurotypical. The goal of this study was to assess problem solving abilities of children with autism when compared to gender and age matched peers. The twenty-seven participants completed two assessments of the Rapid Assessment of Problem Solving and one online assessment of Raven’s Standard Progressive Matrices. Results of this study showed a .92 reliability of the RAPS for all twenty-seven participants. Correlation between the RAPS and RPM was .419 for all participants. The results of this study indicate a decreased ability to problem solve in children with autism when compared to their neurotypical age and gender matched peers. This study also indicated an increase from verbal problem solving to non-verbal problem solving in children with autism, indicating difficulty with the cognitive load required to solve problems verbally.

Antiretroviral treatment pre-exposure prophylaxis (PrEP) is an effective daily prevention medicine to reduce risks of HIV infections in high-risk populations. The current study examined PrEP uptake among gay men using the integrative model of behavioral prediction (IMBP) as the theoretical framework. Briefly, the IMBP states that attitude, norms, and behavioral control predict intention, which then predicts behavior. The intention-behavior relationship is moderated by actual control variables: skills and environmental constraints. To examine how IMBP variables affect PrEP uptake among gay men, I first conducted formative elicitation interviews with gay men; then I used the results from the interviews to construct the main survey. Then, the project recruited 500 gay men to participate in the survey, half of whom were PrEP takers and half of whom were not. The results of path modeling showed that attitudes and norms predicted behavioral intention, and intention predicted PrEP uptake among gay men. Results of moderation analyses testing the influence of skills and environmental constraints showed that HIV knowledge, lack of access to a doctor(s), and lack of health care system knowledge were significant moderators between intention and PrEP uptake. The practical implications, theoretical contributions, and empirical advancements were discussed.

The study of metaphor has moved from abstraction and poetics into the realms of cognitive science and cultural studies. Rather than being seen as purely figurative and secondary to literal meaning, investigation of metaphors reveals a close relationship to our processes of reasoning, a capacity to both reveal and cover, and a plasticity that forms within surrounding cultural values. I reviewed current metaphor theory, including its concerns and justifications, and designed a simple survey experiment through the Qualtrix webpage. The survey was distributed via the Amazon Mechanical TURK system. The experiment, in two different versions, briefly described obesity and then asked participants to describe their attitudes toward, and preferred solutions for, this emerging public health issue. The paragraphs differed only in the metaphor used to describe obesity. Based upon a metaphorical framing hypothesis, it was predicted that obesity as an "infectious epidemic" would bias readers towards societal causes and a preference for public policy changes, while obesity as "simple calorie math" would bias readers towards individualized causes, and less support for public policy changes. The hypotheses of the study were not supported; there was no significant difference in participant responses between frame conditions. Possible reasons for non-significant results include the survey format, unique aspects of obesity as a public health problem, and participants' level of media exposure to obesity. However, this study could be easily altered into various iterations to confirm or deny many aspects of brief metaphorical framing.

This thesis examines the relationship between physician communication style and patient satisfaction in the diagnostic medical interview. Patient satisfaction is a critical issue for health care organizations today. Health care organizations are coping with the recruitment and maintenance of patient consumers in a competitive and costly market. The literature indicates that effective communication between the physician and the patient is important to patient satisfaction. The physician needs to structure the medical visit in order to acquire medical information and, at the same time, invite communication with patients to determine their concerns and needs. Patient satisfaction may ensue if the patient perceives the physician as possessing a positive communication style.

This dissertation examines end-of-life experiences at a small Zen hospice in the Pacific Northwest region of the United States. Through an exploration of how end-of-life communication, sense-making, decision-making, and care in this setting differ from that of typical clinical settings, this project highlights and interrogates the experiences of dying as spiritually, rhetorically, narratively, relationally, and communally bound events. Keywords: Zen hospice, end of life, narrative sensemaking, medical-ethical decision making, spirituality, healing rhetoric, communities of practice

The main objective of this thesis is to illustrate the benefits of using a cultural studies approach in the field of health communication research in Thailand. In this thesis I apply a cultural studies approach to examine the construction of meanings involving drug use and abuse in Thai television advertisements and dramas. The thesis has as its focus analyses of television texts and audience responses. The major arguments advanced in this thesis are that: (a) the causes of drug use and abuse are complex; (b) drug use and abuse, particularly given the 'risk culture' and 'risk society' of the post-modern world, are products of individual social and cultural contexts; (c) cultural studies assist us to better understand the cultural dimension of human behaviour, including the causes of drug use and abuse; and so (d) by adopting a cultural studies approach to the design and production of health promotion campaigns, such campaigns may be made more effective. The thesis argues that in designing health promotion campaigns, health professionals should be concerned to better understand the complexity of their audiences and the manner in which members of those audiences construct meanings and make sense of texts. Should they do so, the designers of health promotion campaigns may, thereby, develop a more sophisticated understanding of what is necessary to contribute to changing audience behaviour. This, in turn, may assist them to improve the design and effectiveness of future health promotion campaigns. The principal tool drawn from cultural studies used in this thesis is textual analysis. This research method involves making an educated guess at some of the most likely interpretations that might be made of a text. In addition, it demonstrates the complexity of the process of making media texts. The texts analysed in this study are selected from two genres of television: television advertisements and television dramas. I analyse television advertisements used in health promotion / drug prevention campaigns broadcast in Thailand in the period from 1990 to 2004 and two well known Thai television dramas entitled Kam See Than Don: KSTD (1999) and Num Poo: NP (2002).

The current patient-centred healthcare approach encourages individuals to assume greater roles in decisions about their health. The premise is that patients who are well informed about healthcare options are more likely to adhere to prescribed treatments and achieve better health outcomes. This approach assumes that patients have an adequate level of health literacy. While a range of definitions exist, health literacy is commonly defined as an individual’s ability to seek, understand and utilise health information to make appropriate health decisions. / Health literacy is increasingly recognised as a complex multi-dimensional concept which involves interactions between individual abilities and broader environmental factors. However across definitions, there has been little consultation with patients to understand what is important to effectively seek, understand and utilise health information. The lack of a consensual understanding has led to debate as to what health literacy represents and how it should be measured. A range of measures exist with the predominant approach being the testing of individual literacy abilities. However measures do not assess the range of attributes described in definitions. Thus a considerable gap exists between how health literacy is defined and how it is measured. This thesis focused on addressing this gap. The objectives were to: (i) critically appraise existing health literacy measures (ii) develop a conceptual framework from the patient perspective and (iii) use this framework to develop a comprehensive measure of health literacy. / A multi-method qualitative and quantitative approach was used: / (1) Systematic review and appraisal of the content, development and psychometric properties of health literacy measures. / (2) In-depth consultations with patients across healthcare and disease continuums to develop a conceptual framework. / (3) Development of a new health literacy measure based on the conceptual framework using a classical test theory approach. / A critical appraisal of the literature revealed that the majority of health literacy measures are not based on a conceptual framework and none appeared to adequately measure a person’s ability to seek, understand and utilise health information. Content focussed primarily on reading, comprehension and numeracy skills and scoring was poorly defined. Only five of the 19 measures had evidence of acceptable reliability. / The conceptual framework of health literacy from the patient perspective identified 17 key elements: six individual abilities and 11 broader contextual factors that are important to seek, understand and utilise health information and expanded previous conceptualisations of health literacy. This informed the development of the Health Literacy Management Scale (HeLMS) which measures six generic and potentially modifiable abilities and three specific broader social factors. Overall the HeLMS measures an individual’s ability to seek, understand and utilise health information within the healthcare setting. The HeLMS consists of 29 items across eight domains. Rigorous psychometric testing demonstrates that it possesses strong construct validity and high reliability (coefficient α >0.80 for all eight domains). / This research provides unique contributions to the conceptualisation and measurement of health literacy. Limitations in the content and psychometric properties of previously developed measures have been identified through a systematic process. A conceptual framework derived from the patient perspective identifies a range of components that provide new insight into: (i) constructs that should be incorporated to measure health literacy and (ii) areas that need to be addressed to improve health literacy. The development of the HeLMS now allows for a more comprehensive assessment of health literacy. Information from the conceptual framework and the HeLMS are likely to be useful tools to inform the development of public health initiatives to enhance patient participation in the management of their health.

Due to high frequency and occurrence of chronic kidney diseases in Taiwan, as well as the low public awareness, this research aims to explore the knowledge construction process of Hemodialysis in health broadcasting programs from a health communication point of view. This research intended to answer the following questions: 1) What are health radio program audience types? 2) How does the knowledge on hemodialysis differ among audiences? 3) What is the knowledge construction process among audience in regards to hemodialysis? Data were collected by ten episodes of the Kaohsiung Police Ration Station¡¦s ¡§Medical Network¡¨ program for a six month period (January ~ June 2011). This research has utilized content analysis method on the audience type, quantitative description on questions identified by the audience and qualitative methods to summarize and interpret the audience¡¦s knowledge construction process on hemodialysis. The results showed that the main audiences for health broadcast programs are mostly male, age 31 to 50 years, holding profession as drivers, service personnel and potential patients. Among them, the potential patients and their family members most often times ask diagnostic questions, falling into the compelled group in seek of knowledge. Those who have not been diagnosed with the disease often times bring up knowledge confirmation questions, belonging to the proactive knowledge chaser group. These two groups also demonstrated different hemodialysis knowledge construction processes. While the radio program host plays the role of knowledge enhancer to the diagnostic-need group (potential patients), the role transfers to a knowledge transformation model for the knowledge confirmation group (non-patients). Participating physicians follow the treatment process of ¡V examination, diagnosis and treatment to deliver information. The research process shall provide broadcasters or other media professionals a best practice on how the audience absorbs information - to study the distribution and motives of the audience and to deliver the knowledge of health and illnesses.

This dissertation is a narrative inquiry of the ways in which cultural values, norms, and expectations shape the aging experience of elderly adults living independently in Kasson, a small rural town in southeastern Minnesota, and within Prairie Meadows, Kasson's residential assisted living facility. Despite significant evidence of the reciprocal relationship between community connectedness, successful aging, and healthy communities, we know relatively little about the ways in which contextual meanings of old age influence long-term care and perceptions of well-being in late life. I therefore utilized a variety of interpretive methods, including participant observation, textual analysis, in-depth interviews, and photovoice, to complement and enlarge existing research. Ultimately, I engaged crystallization methodology to co-construct with my participants a multivocal, multigenre text of layered accounts, photographs, stories, and personal reflections. My research design and presentation highlight the inherent possibilities of participatory methods, aesthetic ways of knowing, and asset-based community development for influencing policy and practice at individual, community, and societal levels with typically disenfranchised populations in future communication scholarship. My narrative analysis uncovered three overarching narratives - the "small town" narrative, the "aging in place" narrative, and the "old age" narrative - that guide communicative practices within and between Kasson and Prairie Meadows. Overall, elderly adults in these communities negotiate community connectedness in late life by drawing from or re-storying each of the three narratives. First, they co-construct personal and relational identities through social interactions and shared understandings (e.g., civic engagement, church membership, neighborliness, collective history) of what it means to live in a small town. Second, they face uncertainty (e.g., health and dependency issues) by turning to the past to make sense of the present and future. Third, they embrace old age through membership in age-specific contexts (e.g., Red Hats, senior center, Prairie Meadows) while resisting it in others (e.g., tensions between independence, isolation, and communal life). In total, their stories illuminate the ways in which personal meanings and cultural ideologies support and constrain interactions and decisions in late life as individuals strive for long-term living and a meaningful, supportive place in which to grow old.

Throughout history, men have played a significant role in the field of nursing. However, they currently represent only 12% of nursing students and 9.6% of Registered Nurses. As a minority in their occupation, male nurses experience gender-based barriers and negative stereotypes that female nurses do not. Research has addressed these barriers and stereotypes, but has lagged in identifying the consequences of exposure to them other than men's reluctance to enter or stay in the field. With the nurse-patient relationship at the core of quality healthcare, it is important to further clarify the consequences of stereotype exposure for male nurses in the clinical setting. The purpose of this dissertation was to investigate the communicative consequences of exposure to gender-based stereotypes among male nurses through the theoretical lens of stereotype threat (Steele & Aronson, 1995). Stereotype threat describes the apprehension individuals experience from the prospect of confirming a negative self-relevant stereotype. In the reported experiment, the salience of gender-based stereotypes (women are more empathic than men; men are better managers than women) was controlled for while male and female nursing students completed a simulated nurse-patient interaction task. Findings from this study highlight the influence of subtle stereotyping in simulated nurse-patient interactions. Specifically, men were less grammatically accurate when participating under conditions of threat than when not under conditions of threat. This finding provides a need for caution as healthcare is experiencing a shift towards e-health, which will rely heavily on both the spoken and written word. Additionally, findings suggest that the disruptive potential of making salient stereotyped attributes (e.g., empathy) may be offset by patient gender. For example, male participants were less tentative under conditions of threat with a female patient than a male patient. The influence of patient gender provides optimism that a shift in gender-based stereotyping is occurring. Therefore, it is an optimal time to increase recruitment and retention efforts of men in the field of nursing. Recommendations for such efforts are offered as well as future directions for stereotype threat research in interpersonal communication and healthcare. / text