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The Michelle P. Waiver (MPW) is the primary means of health insurance for more than 10,000 people in the state of Kentucky. The waiver is especially popular among families with young children with disabilities because it is robust in its benefit offerings and also one of the few Medicaid resources that does not include parental income as a qualifying factor in eligibility. Through the waiver, children receive a medical card as well as additional coverage for medical expenses that fall beyond the scope of traditional health insurance. For these young children to gain access to the comprehensive offerings of the MPW, their parents must apply for the waiver, negotiate the terms of service, and make critical health care decisions on their behalf, or at least until they reach adulthood—although this responsibility often extends throughout the child’s life. The present study builds upon recent research on parental uncertainty in caregiving for children with complex care needs. By combining two ecological approaches to health communication research, Brashers’s (2001) uncertainty management theory (UMT) and Ball-Rokeach, Kim, and Matai’s (2001) communication infrastructure theory (CIT), my aim in this dissertation was to explain how meso-level (e.g., community organization) interactions influenced parental caregivers’ experiences of uncertainty. I collected data through narrative interviews with 31 parents of children who are currently receiving services through the MPW and analyzed them using narrative thematic analysis. The analysis focused on the community-level communication that contributes to parent caregivers’ ability to successfully access and negotiate care within the MPW system. Findings show that parents experience unique personal, social, and medical uncertainties related to the MPW. In addition, the findings demonstrate that MPW-related uncertainty and decision making are managed with a variety of strategies aimed to decrease, increase, or maintain desired levels of uncertainty. Finally, findings showcase how one’s connectedness to community storytelling at the meso level, particularly within online communities and disability network communities supports their adaptive management of MPW-related uncertainty. This project contributes to the health communication literature theoretically by (a) expanding the conceptualization of the uncertainty in illness framework to include the means of health care (i.e., Medicaid) as a consequential element of an individual’s illness experience, (b) identifying two additional strategies of uncertainty management (i.e. advocacy and vigilance), and by (c) extending existing notions of residency, connectedness, and belongingness within the CIT framework to include membership in online and disability-specific networks. Practically, this project offers important insights that can guide future research exploring the role of meso-level communication in parent caregivers’ management of waiver-based care, such as in identifying the need for a systematic communication process that introduces potentially eligible families to the MPW.

Successful physician-patient communication is increasingly being acknowledged as a vital aspect of healthcare today. Research in the field has not examined all aspects of patient-centered care and the aspects that have been studied have not been grounded in actual patient action. The research done in the field has largely been studied quantitatively. The present thesis research attempts to contribute to the gap in the field of physician-patient communication by qualitatively examining patient assertiveness. This thesis examines conversations between women in Portland, Oregon recently diagnosed with breast cancer talking to their surgeons about their diagnoses and treatment options. Using grounded qualitative theoretical analysis, this thesis uncovered five major themes of patient assertiveness in breast cancer care.

This thesis is a part of a Bachelor’s degree within the field of Media and Communication at the School of Education and Communication at Jönköping University in Sweden. It is based on a Minor Field Study accomplished from the 30th of October to the 17th of December 2006 in Kampala, Uganda, East Africa. The background of the research is that women who are between 15 and 24 years old and live in sub-Saharan Africa are more than tree times as likely to be infected by HIV/AIDS as men in the same age and location. The purpose of the study is to discover indicators of what kind of health communication young women need to protect themselves from HIV/AIDS. The young women in the study are between 15 and 24 years old and live in areas affected by urban poverty in Kampala, Uganda. To be able to gain a deeper understanding for the young women’s situation, the empirical study has been based on eleven conversation interviews made one by one with eleven young women. The procedure of the study has been guided by developed grounded theory and during the analysis of the interviews phenomenology has been used. The result of the study shows that the ABC (Abstinence, Be faithful and Condom use) approach, which is used to fight HIV/AIDS in Uganda, is well known and carries an important message about prevention methods. At the same time it preaches moral in its hierarchical order which seems to judge women harder than men. The ABC approach was turned around by one of the young women in the study, which might create a more realistic message. It is however necessary to complement the approach with communication to young women about for example women’s rights and general sexual knowledge. This can be done through the use of verbal interpersonal communication, combined with easy access to HIV testing. The young women themselves can be effective peer educators and there is a need to let the interpersonal agenda be reflected in the political agenda, as well as in the developing media. To make young women able to act on their knowledge for protection, men and the community also need to be approached with gender sensitive messages.

Hypotheses on the efficiency of evidence-based printed materials can be directed by health communication concepts. These concepts can provide a general framework that goes beyond the traditional vulgarization point of view: instead, it points towards a strategy to obtain health outcomes and provoke behavior change, from a disease prevention, management and health promotion perspective. The present study proposes a comprehensive framework based on concepts from health risk communication, Tarde's theory of social values, usability, readability and plain language. Using the mapping approach, an evaluation grid was applied to printed evidence-based materials with proven effectiveness, in order to reveal the underlying strategy and isolate the characteristics of effective materials. The results allowed us to define two types of printed evidence-based materials, according to the robustness of the evidence they contain and the target audience. It was also possible to identify indicators of notions that are translated into operationalized items, frequent in those materials that might be responsible for their efficiency: clear purpose of the documents, limited scope, learning motivation and correspondence to the logic, experience and language of readers. Effectiveness of printed evidence-based materials could also be correlated to numeracy, objectiveness, standard definitions, constant timeframes and denominators, risks enumerated in order of importance, effective response, and high degree of threat, urgency, novelty and visibility of the disease. It was also possible to identify some missing communication concepts: cultural diversity, narrative, increased easiness of procedures and aesthetic advantage for the patient. In the process of work, the theory of social values emerged as a dynamic component that can bring together and explain many concepts, as well as physician’s acceptance of the guidelines. Value in terms of usefulness and truth plays a major role in cognitive appreciation of the documents. This concept gives a strategic meaning to the whole work and allows us to better understand attitude and behavior change.

<p>This thesis is a part of a Bachelor’s degree within the field of Media and Communication at the School of Education and Communication at Jönköping University in Sweden. It is based on a Minor Field Study accomplished from the 30th of October to the 17th of December 2006 in Kampala, Uganda, East Africa.</p><p>The background of the research is that women who are between 15 and 24 years old and live in sub-Saharan Africa are more than tree times as likely to be infected by HIV/AIDS as men in the same age and location.</p><p>The purpose of the study is to discover indicators of what kind of health communication young women need to protect themselves from HIV/AIDS. The young women in the study are between 15 and 24 years old and live in areas affected by urban poverty in Kampala, Uganda.</p><p>To be able to gain a deeper understanding for the young women’s situation, the empirical study has been based on eleven conversation interviews made one by one with eleven young women. The procedure of the study has been guided by developed grounded theory and during the analysis of the interviews phenomenology has been used.</p><p>The result of the study shows that the ABC (Abstinence, Be faithful and Condom use) approach, which is used to fight HIV/AIDS in Uganda, is well known and carries an important message about prevention methods. At the same time it preaches moral in its hierarchical order which seems to judge women harder than men. The ABC approach was turned around by one of the young women in the study, which might create a more realistic message. It is however necessary to complement the approach with communication to young women about for example women’s rights and general sexual knowledge. This can be done through the use of verbal interpersonal communication, combined with easy access to HIV testing. The young women themselves can be effective peer educators and there is a need to let the interpersonal agenda be reflected in the political agenda, as well as in the developing media. To make young women able to act on their knowledge for protection, men and the community also need to be approached with gender sensitive messages.</p>

Individuals have become more involved in health-related decisions, in part due to an unprecedented access to information that can be used to enhance both physical and mental health. Much of this health-related information is presented in a numerical format; unfortunately, research suggests many Americans may not possess the literacy skills necessary to comprehend numerical health-related information. More research needs to be conducted to examine numeracy and its role in cancer risk perceptions, and how those risk perceptions relate to cancer self-protective behaviors. The purpose of the current study was to: (a) examine socio-demographic variables associated with numeracy, (b) determine which factors are associated with cancer risk perceptions, and (c) apply the Risk Perception Attitude (RPA) Framework to examine associations between risk perception groups and cancer self-protective behaviors. The study used data from the 2007 Health Information National Trends Survey (HINTS), which was developed by the National Cancer Institute to collect nationally representative data on the U.S. public's use of cancer-related information. Logistic regression was used to assess the association between each dependent variable and independent variables associated with each research question. Results indicated age and education were associated with objective numeracy, whereas age, education, and occupational status were associated with subjective numeracy. Among participants with a previous cancer diagnosis, objective numeracy and smoking status were associated with a somewhat high/very high perceived risk of developing cancer in the future. Age, race/ethnicity, family cancer history, smoking status, and self-reported general health were associated with a somewhat high/very high perceived risk of developing cancer in the future among participants without a previous cancer diagnosis. RPA group was not significantly associated with cancer self-protective behaviors. Findings from this study have important implications for public health, including health communication and interventions designed to enhance health behaviors. Future research should focus on using a full objective numeracy scale with a nationally representative population and examining temporal relationships between cancer risk perceptions and health behaviors.

loveLife, the South African national HIV/AIDS prevention programme for youth, is known for its brand-oriented billboards and mass media campaign that ranges over various print-, broadcast- and alternative media. However, the organisation also implements a national grass-roots peer motivation programme where various activities are co-ordinated by youths (GroundBREAKERS and Mpintshis) from the community. The organisation has been criticised for its communication approach, with many researchers primarily focusing on the organisation's mass media and billboards. This study investigates the communicative approach(es) in loveLife's programme implementation in the light of the normative theory of participatory communication. The focus of this study is to identify how loveLife describes its communication approach, what communication approach the organisation employs and how the organisation's communication approach is perceived by a sample of its target audience. The research was conducted by means of a literature review, qualitative content analysis of loveLife's policy documentation and a selection of the organisation's media. Semi-structured interviews were also conducted at head office, which are contrasted with focus groups with the participants at an implementation site. Broadly, it was found that loveLife's programme is more participatory than most critics would expect and that the organisation attempts to put its primary focus on face-to-face communication. But, there is also tension in what loveLife communicates on a national level and how it relates to grass-roots activities as the national / media-driven communication is more modernistic in its approach, whereas the grass-roots communication is more participatory. / Thesis (M.A. (Communication Studies))--North-West University, Potchefstroom Campus, 2010.

loveLife, the South African national HIV/AIDS prevention programme for youth, is known for its brand-oriented billboards and mass media campaign that ranges over various print-, broadcast- and alternative media. However, the organisation also implements a national grass-roots peer motivation programme where various activities are co-ordinated by youths (GroundBREAKERS and Mpintshis) from the community. The organisation has been criticised for its communication approach, with many researchers primarily focusing on the organisation's mass media and billboards. This study investigates the communicative approach(es) in loveLife's programme implementation in the light of the normative theory of participatory communication. The focus of this study is to identify how loveLife describes its communication approach, what communication approach the organisation employs and how the organisation's communication approach is perceived by a sample of its target audience. The research was conducted by means of a literature review, qualitative content analysis of loveLife's policy documentation and a selection of the organisation's media. Semi-structured interviews were also conducted at head office, which are contrasted with focus groups with the participants at an implementation site. Broadly, it was found that loveLife's programme is more participatory than most critics would expect and that the organisation attempts to put its primary focus on face-to-face communication. But, there is also tension in what loveLife communicates on a national level and how it relates to grass-roots activities as the national / media-driven communication is more modernistic in its approach, whereas the grass-roots communication is more participatory. / Thesis (M.A. (Communication Studies))--North-West University, Potchefstroom Campus, 2010.

Made available in DSpace on 2014-12-17T14:47:00Z (GMT). No. of bitstreams: 1 MarianaPS_DISSERT.pdf: 2738410 bytes, checksum: 57acadc5ae898f14de694389f6b696f2 (MD5) Previous issue date: 2013-02-20 / The current study strives to address the interpersonal relationships of the nursing team from the perspective of the communicative action, by contributing to the health work process. It aims to analyze the interpersonal relationships of the nursing team in its work environment. This is a descriptive study with a qualitative approach. Data collection wal held from interviews, guided by a script with open questions. The study was conducted at a state hospital in the city of Natal/RN/Brazil. The research subjects were the workers of the nursing team, including nurses, nursing technicians and nursing assistants, totaling 16 subjects. The capture of information was performed in April 2012. The project was approved by the Ethics Research Committee, under CEP/UFRN protocol n. ? 262/11 and Certificate of Presentation for Ethical Consideration n. ? 0289.0.051.000-11. The analysis was performed from the categories that emerged from the research through a dialogue with the authors studied in the theoretical framework of the Theory of communicative action , by J?rgen Habermas, as well as The changing in the world of work, by Ricardo Antunes, and Characterization of the team , by Marina Peduzzi. The outocomes point out that the interpersonal relationship of the nursing team is very troubled, with no interaction among the individuals involved in this process, among themselves and with other health professionals. We have developed a particular concept about team, which is comprised of three essential elements: multiplicity of individuals, common objective and heterogeneity. In the studied environment, it was realized the existence of grouping teams. The interpersonal relationship of the nursing can be a facilitator or an obstacle in the workplace in such a way that causes positive or negative consequences, both to the health workers, and to the sicks. In this context, the interviewees have intensified their viewpoints with regard to the weaknesses that permeate the nursing relationship, by pointing them more frequently than the strengths. The work conditions have signaled a failing situation, which is evidenced by the constant improvisation process before the lack of human and material resources, low wages, deficit in recognizing the nursing worker, and physical and emotional wear, by creating a professional exhaustion. The devaluation of the worker also became a strong factor for this study, because it was characterized a reason of job dissatisfaction, due to the lack of valuation policies, which should be prepared by the institution or, even, they are unknown by the worker itself. The worker participation in the design of these policies has emerged as a relevant factor. The poor work conditions lead the worker to a process of professional demotivation and dissatisfaction, by causing the feeling of devaluation within its work environment. Hence, it was found in this research that the lack of communication leads to situations of inadequate interpersonal relationships, which are creators of an unsuitable environment for the performance of the nursing team / O presente estudo pretende abordar as rela??es interpessoais da equipe de enfermagem sob a ?tica da a??o comunicativa, contribuindo para o processo de trabalho em sa?de. Tem como objetivo analisar as rela??es interpessoais da equipe de enfermagem em seu ambiente de trabalho. Trata-se de um estudo descritivo com abordagem qualitativa. A coleta das informa??es ocorreu a partir de entrevistas individuais, guiadas por um roteiro com quest?es abertas. O estudo foi realizado em um hospital estadual no munic?pio de Natal/RN. Os sujeitos da pesquisa foram os trabalhadores da equipe de enfermagem, incluindo enfermeiros, t?cnicos e auxiliares de enfermagem, totalizando 16 sujeitos. A capta??o das informa??es ocorreu no m?s de Abril de 2012. O projeto foi aprovado pelo Comit? de ?tica em Pesquisa, sob protocolo CEP/UFRN 262/11 e Certificado de Apresenta??o para Aprecia??o ?tica n? 0289.0.051.000-11. A an?lise foi realizada a partir das categorias que emergiram da pesquisa atrav?s de um di?logo com os autores estudados no referencial te?rico da Teoria da a??o comunicativa , de J?rgen Habermas, como tamb?m as Transforma??es do mundo do trabalho , de Ricardo Antunes, e a Caracteriza??o de equipe , de Marina Peduzzi. Os resultados apontam que o relacionamento interpessoal da equipe de enfermagem ? bastante conflituoso, n?o havendo intera??o entre os sujeitos envolvidos neste processo, entre si e com os demais profissionais da sa?de. Elaborou-se um conceito pr?prio de equipe, composto por tr?s elementos essenciais: multiplicidade de indiv?duos, objetivo comum e heterogeneidade. No ambiente estudado, percebeu-se a forma??o de equipes agrupamentos. O relacionamento interpessoal da enfermagem pode ser um fator facilitador ou conturbador do ambiente laboral, de tal forma que cause consequ?ncias positivas ou negativas, tanto nos trabalhadores da sa?de, quanto nos doentes. Nesse contexto, as entrevistadas intensificaram suas observa??es em rela??o ?s fragilidades que permeiam as rela??es da Enfermagem, por apont?-las de modo mais constante em rela??o ?s fortalezas. As condi??es de trabalho sinalizaram para uma precariza??o evidenciada pelo constante processo de improvisa??o diante da falta de recursos humanos e materiais, baixa remunera??o salarial, d?ficit no reconhecimento do trabalhador de enfermagem e desgaste f?sico e emocional, gerando um esgotamento do profissional. A desvaloriza??o do trabalhador tornou-se tamb?m um fator marcante para esse estudo, por se caracterizar em um motivo de insatisfa??o profissional, devido ? falta de pol?ticas de valoriza??o elaboradas pela institui??o ou, at? mesmo, desconhecidas pelo pr?prio trabalhador. A participa??o do trabalhador na elabora??o dessas pol?ticas despontou como relevante. As condi??es prec?rias de trabalho levam o trabalhador a um processo de insatisfa??o e desmotiva??o profissional, ocasionando o sentimento de desvaloriza??o em seu ambiente de trabalho. Assim, constatou-se na presente pesquisa que a aus?ncia da comunica??o conduz a situa??es de relacionamentos interpessoais inadequados, criadores de um ambiente impr?prio ao trabalho da equipe de enfermagem