At risk individuals tend to avoid information that might perturb their sense of security. I propose certainty appraisal as an important emotional dimension that affects health message processing and persuasion. Specifically, I suggest that emotions high on certainty appraisal can provide confidence to cope with the insecurity instigated by threatening health communications. Five studies are proposed to demonstrate the interaction of certainty appraisal with two health message characteristics: vulnerability to threat and response efficacy. Studies 1-3 provide evidence that when a health threat is highly self-relevant uncertainty related emotions impede processing whereas certainty related emotions facilitate it. Studies 4-5 show that individuals who are feeling uncertain prefer to attend a high efficacy message as it offers reassurance via useful recommendations. The findings extend affect regulation theories to involve emotional uncertainty as a state to be "repaired" by avoiding further deterioration or striving for restoration. / Ph. D.

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Increasing physical activity and adopting a healthy diet have the goal to enhance consumer welfare. The goal of this set of studies is to contribute to a research agenda that tries to support and enhance the life of consumers, through the exploration of emotional intelligence as a new possible avenue of research related to consumer behavior and health. Four studies are proposed that look at the possibility to introduce emotional intelligence in decision making and performance related to health (i.e. adoption and maintenance of a healthy diet/weight). The findings suggest the salient role of emotional reasoning (i.e. understanding and regulation of emotions) on decision making and performance related to health. Training on emotional intelligence and health seems to activate mechanisms that help people to use their knowledge in the right direction in order to make better decisions and improve performance related to health (i.e. adoption/maintenance of healthy diet/weight). / Ph. D.

Social media use related to chronic disease has become pervasive, yet few researchers have examined the influence of social media on health care message dissemination and health care outcomes. In this study, the use of Instagram, an image-rich social media platform, for sharing health information was examined. Nurses, as key providers of patient information, need to understand the relative effectiveness of different types of social media for health information, how social media is currently used by health care consumers, and how to best use various social media platforms to improve patient outcomes. The purpose of this study was to gain an understanding of the meaning of Instagram use for visual image sharing related to #rheumatoidarthritis. Guided by Rogers's diffusion of innovation theory, a visual ethnography approach using content analysis was completed. Images for analysis (n = 106) were randomly selected, using the Instagram public search feature, during 7 distinct periods. Content analysis, conducted by 2 coders, was used to identify categories and provide a sentiment analysis of the images. Approximately 75% of the images were determined to be positive by both coders. Social interaction and self-expression were the most frequently identified categories, suggesting that individuals use Instagram primarily for sharing awareness, sharing encouragement, and self-expression regarding rheumatoid arthritis (RA). This finding is consistent with use of Instagram for social networking and self-promotion. The potential for positive social change may ultimately be the ability for Instagram to serve as a social, personal, and health-related information sharing platform for diverse audiences, particularly those who may be socially isolated due to RA.

Prior research has indicated that laypeople construct mental representations of physical symptoms in order to attempt to understand illness (e.g., Leventhal, Safer, Panagis, 1983; Leventhal & Contrada, 1987; Lau, Bernard, & Hartman, 1989). These "illness representations" are influenced by prior experience with and prior knowledge about illness as well as efforts to seek additional information through social channels or media. More and more, the internet is a prominent source of health information, especially for older adults (aged 50 year and up). Yet, few studies have systematically examined how older adults search for health information online. Similarly, recent trends in healthcare such as health consumerism assume that patients will be more empowered if they have access to more information. However, little has been done to investigate whether patients, in fact, feel more empowered after acquiring online health information. The current study examined the online health information seeking of older adults (N = 79) in order to determine the cognitive and diagnostic processes that older adults use to acquire information. Older adults read a vignette which depicted one of two common illnesses and then were asked to "think-aloud" while they attempted to diagnose the illness. Older adults then diagnosed the illness using either a traditional search engine (Google) or popular self-diagnosis tool (WebMD Symptom Checker), and answered questions about illness representations, cognitive effort, web interactivity, and feelings of empowerment after the search. Quantitative results showed inconsistent change in illness representations. Plausible reasons for a lack of findings are discussed. Participants who used WebMD perceived greater cognitive effort while using the computer program than those who used Google, and participants who were inaccurate in their diagnosis perceived greater cognitive effort of diagnosing than those who were accurate. Accuracy was unrelated to perceived interactivity, age, or search method. Participants 50-64 years old found a new version of WebMD to be less interactive than Google. In contrast, participants 65 years or older perceived no difference in interactivity depending upon search method. In terms of empowerment, participants who used Google perceived greater choice than WebMD. There were no differences in feelings of competence depending upon search method. Qualitative results showed that participants spent the majority of time navigating the computer and processing health information. Most participants diagnosed the illness by eliminating diseases whose symptoms did not match the symptoms of the illness vignette. Participants tended to visit commercial health websites such as Everyday Health and begin their information search by typing a vignette symptom into the search bar. Participants who were 65 years or older were less confident about their diagnosis than 50-64 year old participants. Finally, participants who used Google to diagnose were more likely to comment about the credibility of the information found when compared to those who used WebMD. The current study found no change in illness representations after an online information search. However, this produces questions as to the amount of time in which the layperson constructs his/her illness representation. In addition, few differences in interactivity, accuracy, or empowerment were found between an online health information search conducted with a search engine as compared to a self-diagnosis tool. However, individual differences suggest that different age cohorts may prefer information to be presented in different ways which could influence web design. Further studies in human-computer interaction and health cognition may be able to answer the questions that arose.

The purpose of this study was to evaluate the psy- chometric properties of a Swedish version of The Krantz Health Opinion Survey (KHOS). A conven- ience sample of 79 persons (47 men and 32 women) was recruited from The Heart and Lung Patients’ National Association at ten local meeting places in different areas in Sweden. The questionnaire was examined for face and content validity, internal con-sistency and test-retest reliability. The findings showed that the Swedish version of KHOS is accept- able in terms of face and content validity, internal consistency and test-retest reliability over time among 79 individuals >65 years of age and with a cardiac disease. In conclusion, wider evaluations of the psy- chometric use of KHOS for other populations and settings are recommended. / SAMMI

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