Introduction: Colon cancer incidence and mortality rates in Canada are among the highest worldwide. If detected early colon cancer is highly curable and regular screening can significantly decrease risk of colon cancer mortality. Despite this, screening rates in Canada are consistently low and immigrant and senior populations are particularly vulnerable due to low health literacy and language barriers. This research consists of three studies that were designed to explore the cancer prevention experiences of older English-as-a-Second Language (ESL) Chinese immigrant women in Canada. This includes an investigation of colon and breast cancer screening utilization, health literacy skills and comprehension of colon cancer prevention information, and experiences and preferences when seeking cancer information by these immigrant women. Methods: A convenience sample of 110 Mandarin and Cantonese-speaking ESL immigrant women were recruited from two Southern Ontario communities. For study inclusion participants were required to: (1) be 50 years of age or older, (2) have immigrated to Canada, (3) have Cantonese or Mandarin as their first language and English as their second language, and (4) be able to read in English. Participants were excluded if they or their spouse had been previously diagnosed with any type of cancer. Participants completed a battery of questionnaires assessing demographic characteristics, use of breast and colon cancer screening, acculturation, self-efficacy, health beliefs and health literacy. Health literacy was assessed using the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and comprehension of a colon cancer prevention information sheet from Cancer Care Ontario was assessed using the cloze procedure. Participants participated in a semi-structured interview to explore cancer information seeking preferences and experiences, and their understanding of cancer prevention information. Multivariate logistic regression was used to identify predictors of colon and breast cancer screening. To identify variables significantly associated with performance on the S-TOFHLA and cloze test regression analyses were performed. Directed content analysis was used to identify themes associated with barriers to cancer information seeking and understanding that emerged from the interviews. Results: Study #1: There was high self-reported screening for breast and colon cancer. Eighty-five percent of the women were current mammography screeners and 75% were current colon cancer screeners. Recommendation from a physician (OR=.140; 95% CI= .044, -.448), having a female physician (OR=.141; 95% CI= .033, .591), and high or moderate proficiency in English (OR=.283; 95% CI= .089, .902) significantly predicted mammography screening. Physician recommendation (OR=.103; 95% CI= .031, .349), first language (OR= 1.85; 95% CI= .055, .628) and higher self-efficacy (OR= 3.613; 95% CI= 1.179, 11.070) predicted use of colon cancer screening. Other important predictors included greater health literacy and longer residency in Canada. Study #2: Only 38.7% of the women had adequate health literacy on S-TOFHLA and 54.3% had adequate comprehension of the colon cancer information. Comprehension of the colon cancer information was significantly lower among women who received the information in English, compared to those who received the information in Chinese (p<0.01). Age, acculturation, self-reported proficiency reading English, and education were significant predictors of health literacy but varied depending on the measure (S-TOFHLA, cloze) and language of information (English, Chinese). Study #3: There were unique health information seeking preferences among the older Chinese immigrant women including a strong preference for interpersonal and interactive cancer information from their physician and trusted others, such as friends and family. Barriers to cancer information seeking included language difficulties and limited time with physicians. Differences in health literacy did not distinguish the women on any of the major themes. Conclusion: Language, culture, health literacy and the role of the physician emerged across all three studies examining the cancer prevention experiences of older Chinese immigrant women. While language concordant educational materials may improve understanding of cancer information, the results from this study suggest that it is important to consider factors other than language alone and to address important cultural issues that play a role in the access, use, and understanding of cancer information.

Introduction: The mass print media are a widely-distributed, and often primary, source of health information for the public. Health information in newspapers can amplify or attenuate readers’ perceptions of risk depending on how it is presented. This thesis examines how health information related to wind energy was communicated in Ontario newspapers and includes separate analyses for the presence of fright factors, readability, emergent themes, and emotional tone and sensationalism. As an emerging technology, public understanding of and response to associated health risks and uncertainties towards wind energy can be influenced by media coverage. Methods: Five geographically discontinuous wind energy installations in Ontario and their surrounding communities were selected based on 2006 Canadian Census data. Newspapers serving each community were identified and searched for articles from May 2007-April 2011 on the topic of health effects from wind energy developments. A total of 421 articles from 13 community and 4 national/provincial newspapers were retrieved. In Study #1, a directed content analysis was used to develop a coding instrument based on fright factors known to affect the public’s perception of risk. In Study #2, each newspaper article was analyzed for text readability using the Simple Measure of Gobbledygook (SMOG) readability formula. In Study #3, and as a qualitative component, a semi-directed content analysis was used to find emerging themes and subthemes. Finally, in Study #4, a list of loaded and positive words, informed from previous studies on sensationalism in media reporting and a random sample of newspaper articles included in this study, and the frequency of their appearance was used as a quantitative measure of sensationalism. Results: Study #1: The most commonly reported fright factors were ‘dread’, ‘poorly understood by science’, ‘involuntary exposure’, and ‘inequitable distribution’, occurring in 94% (n=394), 58% (n=242), 45% (n=188), and 42% (n=177) of articles, respectively. The fright factors of ‘dread’, ‘poorly understood by science’, ‘inequitable distribution’, and ‘inescapable exposure’ occurred more frequently in community newspaper articles than in national/provincial ones (p<0.001). Although the total number of occurrences of each fright factor increased following the Green Energy Act, only ‘dread’ (p<0.05) and ‘poorly understood by science’ (p<0.01) increased significantly. Study #2: The mean reading grade level (RGL) of 421 articles on wind turbines and health was at the post-secondary education level (X±SEM; 13.3±0.1). Articles from community and provincial newspapers were written at almost a full RGL lower (13.2±0.2 and 13.1±0.2) than those from national newspapers (13.9±0.2) (p<0.05). Additionally, opinion pieces such as editorial columns were written at a lower RGL than fact-based news articles (13.0±0.2 and 13.5±0.1, respectively; p<0.01). Study #3: The majority of newspaper articles described health effects of wind turbines in general, rather than specific, terms. The most commonly cited causes of health complaints were inadequate setbacks (27%, n=114), noise (21%, n=90), shadow flicker and vibrations (12%, n=49), and electrical exposure (6%, n=27). Other, non-health concerns such as environmental damage (28%, n=117), property values (20%, n=86), aesthetic concerns (18%, n=77), financial burden (18%, n=74), were prevalent and juxtaposed with health issues in 28% of articles (n=118). Concerns with the quality and availability of scientific evidence were frequent in the newspaper articles (34%, n=143), with many articles promoting a moratorium on wind energy developments until further research is conducted (25%, n=103). Study #4: Newspaper articles emphasized negative rather than positive/neutral tone, with community newspapers publishing a higher proportion of negative articles than provincial or national newspapers (X2=6.11, df=1, p<0.05). Conclusion: These findings suggest that the health information related to wind turbines in Ontario newspapers contains a large quantity of fright factors that may produce fear and anxiety in readers, is written at a reading grade level that is too complex for the majority of the Ontario population to fully understand, contains inconsistent information on health effects that often links health concerns with non-health concerns, and is often negative in tone. The influence of the Ontario newspaper media on reader’s risk perceptions of wind energy in Ontario will be important to determine empirically.

Sverige har under många decennier sett en minskning av tuberkulos (TBC), men infektionen har kontinuerligt ökat från 2003. Majoriteten av TBC-fallen är personer som är födda utanför Sverige. Hälsotillståndet har förbättrats i Sverige men det finns fortfarande problem. Kommunikationen mellan flyktingar och sjukvårdsspecialister är bristande idag, vilket resulterar att endast ett fåtal genomgår hälsokontroller. Detta kan leda till en ökning av infektioner och sjukdomar i Sverige. Denna studie undersöker hur hälsokommunikationen idag fungerar mellan den svenska sjukvården, nyanlända immigranter, asylsökande och flyktingar, samt vilken typ av vård som finns tillgänglig för flyktingar med hög risk för att utveckla TBC. Specifikt syftar studien till att förstå på vilket sätt kommunikation brister på samt analysera vilka sätt det finns för att en reducering av TBC i Sverige ska kunna ske och hur kommunikationen kan förbättras. Studien har genomförts med hjälp av både primära källor i form av intervjuer och sekundära källor. Baserat på de intervjuer och sekundära källor som genomförts i studien dras slutsatsen att trots att den svenska sjukvården utvecklas positivt så finns det en hel del brister - hälsokommunikation är bristande idag mellan nyanlända flyktingar, sjukvårdspersonal och myndigheter. En av huvudorsakerna som informanterna i studien nämnt är språket, mycket av det som skrivs och sägs är på svenska. Det är viktigt att en mer välfungerad hälsokommunikation utvecklas mellan de nyanlända flyktingarna, sjukvårdspersonal och myndigheterna för att det ska kunna underlättas för flyktingar att söka vård och samarbeta med sjukvårdspersonal med deras arbete för att kunna förhindra spridning av TBC och andra sjukdomar och infektioner i Sverige. / Sweden has for many decades witnessed a decrease of the spread of tuberculosis (TB), but between the years of 2003-2012 a new pattern has emerged with refugees carrying TB entering the country and contributing to a situation where the infection has slowly begun to spread again. The communication between the refugees and the health professionals has been inefficient, which inevitably results in fewer refugees undergoing health examinations. This in turn can lead to an increase of infections and diseases. The purpose of this study is to examine the current health communication between Swedish health professionals and immigrants, asylum seekers and refugees, and to give an overview of what type of health care currently exist for refugees with a high risk of TB. This is done to understand what is missing in the communication process, what has been done in order to improve the situation, and how it can be further improved in order to prevent TB. In order to fulfill the purpose of this study, a qualitative method has been used combining text analysis of interviews and secondary sources. This study has shown based on the interviews and secondary sources that the Swedish prevention work regarding TB is developing positively in general, but the communication between newly arrived refugees, health professionals and authorities in Sweden is lacking due to the fact that most of what is written and said in this communication process is in Swedish. This makes it difficult for the refugees to understand what is communicated and is stated as one of the main reasons why many refugees do not undergo health examinations, combined with the lack of awareness. Therefore a better functioning health communication between refugees, authorities and health professionals is required to support refugees seeking health care, as well as co-operating with health professionals to prevent the spread of not only TB but other infections and diseases in Sweden.

This study explores the phenomenon of the informal medical consultation, a communication event in which an individual asks for medical information, advice, or care from an off-duty health professional with whom the individual has no formal patient-provider relationship. Using surveys and interviews, the study describes these consultations from the perspective of the health care professional and the informal patient. The study explores foundational theories that offer explanations for the phenomenon. The theories considered include social support, decision-making, social exchange, perceived partner responsiveness to needs, and uncertainty management. This study suggests health care providers perceive informal medical consultations to be more problematic than do the informal patients who consult them. The problematic nature of informal consultations increases as the type of request moves from purely informational to a request for treatment. Informal patients do not perceive this distinction. The informal patient’s motivation to pursue an informal consultation instead of a formal consult is affected by the relationship with, trust in, and access to the informal consultant. The willingness of the informal consultant to engage in an informal consultation is affected by the relationship with the informal patient, the type of request made, and perception of risk/benefit for both the provider and the patient. The study supports the idea that informal medical consultations are potentially problematic within the current medico-legal-ethical environment. Alternately, these consultations may be viewed as offering positive contributions to the health and well-being of informal patients. The study suggests translational research is needed to guide health professionals in considering requests for informal medical consultations.

Over the past few years, the rate of elective interventions in pregnancy in the United States, including elective inductions of labor and elective cesarean deliveries, has increased dramatically. While scholars attribute some of the increase in elective interventions to the female patients who request elective procedures from obstetricians, some literature contradicts that notion and suggests physicians are actually the primary perpetuators of the growth in elective procedures. Although pregnant women may seek elective interventions because of desired convenience, physicians can also claim the benefit of convenience in scheduling deliveries. In addition, elective procedures provide physicians greater monetary compensation than labor and deliveries which evolve without intervention. The current dissertation investigates the communicative role of obstetricians in women’s delivery decisions through in-depth interviews with obstetricians practicing in the state of Kentucky (N=28). Guided by the framework of Message Convergence, the study assesses how obstetricians manage uncertainty surrounding patient care and make clinical decisions in the midst of either unclear evidence or competing messages. The study also reveals the ways that physicians utilize their medical expertise to engage in decision-making with patients. In addition, specific scenarios of decision-making regarding delivery are discussed, including patients’ requests and physicians’ provisions of requests; patients’ requests and physicians’ refusals of requests; and physicians’ recommendations for treatment and patients’ refusals of recommendations for treatment. Finally, the internal tensions and conflicts experienced by physicians in the decision-making process with patients are also examined.

The experience of a pelvic exam or Pap smear is something that, while necessary to maintain reproductive health, can be fraught with difficulty for women. Ouj, Igberase, Exe, and Ejikeme (2011) note that “[m]ost women feel a level of discomfort or pain and for some it is embarrassing, dehumanizing, degrading and associated with fear, anxiety and apprehension” (p. 637). However, little recent research has focused on the specific communication surrounding reproductive care for young women. The Internet is a common place for young people to seek health information, understand their own health risks, and seek social support from others. The current study utilizes information gleaned from the archives of an internet message board and sexual education website to examine the way that young women communicate about reproductive health care, risk, and social support with experts and peers in the online community. Results indicate that young women request, seek, and receive several different types of social support in the online community. Further, themes illuminate the complex nature of women’s concerns about potential risk and reproductive care.

Communication processes can be affected by stigma – a negative evaluation of an individual’s attributes that discredits or identifies the individual as not normal (Goffman, 1963). One such communicative process that is affected by stigma is disclosure. Disclosure is when individuals share personal information that reveals something not previously known (Charmaz, 1991). One such group of individuals who may be forced to choose between disclosing (to get accommodations or social support) and avoiding stigma (by not disclosing) is individuals with disabilities (Braithwaite, 1991; Charmaz, 1991). This study focuses on one particular population of individuals with disabilities – those with a hearing loss. Through the use of interactive interviewing and Communication Privacy Management (CPM) theory, this study examines hard of hearing and deaf individuals’ perceptions of both the disclosure process and stigma. CPM examines how and why people conceal or reveal private information, such as hearing loss (Petronio, 1991, 2002). Using CPM, this study poses research questions surrounding how hard of hearing individuals disclose and manage turbulence surrounding their hearing loss. Further, participants’ perceptions and responses to stigma surrounding hearing loss are also examined. Based on the participants’ responses, managing the boundaries surrounding their hearing loss includes considerations of identity, the other person/people in the interaction, risks of not disclosing, timing, and how much to disclose. Further, participants viewed boundary turbulence as positive only when it was helpful; otherwise, they reported a feeling of a loss of control. In examining stigma and other consequences of disclosure, participants talked about being labeled, not being worth others’ time, and being seen as incapable. Finally, participants reported a wide variety of responses to stigma surrounding their hearing loss. In this study, I also discuss the implications of these findings, both theoretical and practical implications, and how they reflect the lives of the deaf and hard of hearing. Finally, I address the directions for future research on this topic as well as the limitations to this study.

Individuals with chronic illnesses must manage long-term uncertainty and decision making as they cope with the ways the illness influences almost every aspect of their lives. In the context of pediatric illnesses, parents assume the burden of uncertainty management and decision making during the diagnosis and treatment of their child’s illness. It is common for children with complex chronic illnesses to see multiple specialists for the treatment of their condition. The first visit to a specialist is often more elaborate than a routine primary care visit. While previous research has explored parents’ decision making and uncertainty management during a child’s diagnosis and during end-of-life care, less is known about these experiences during the long-term management of a chronic illness through the care of multiple specialists. The aim of the current study was to explore uncertainty and decision making during parents’ first visit to a multidisciplinary clinic for the care of their child’s complex chronic illness. Data were collected through survey measures and semi-structured interviews with 30 parents after their first visit to a vascular anomaly clinic at a large Midwestern children’s hospital. The results suggest parents’ communication with the team of specialists helps them reappraise uncertainty, engage in effective uncertainty management, and feel validated in their decision making. However, the findings also indicate that parents face multiple uncertainty management dilemmas, including not wanting certain types of information, feeling overwhelmed by the amount of information they receive, and having different information preferences than their spouses. Ultimately, the results also have important implications for existing uncertainty theories and their application to parents’ uncertainty experiences.

A cancer diagnosis often causes biographical disruption in the lives of young adult (i.e., 18-39; YA) survivors and their close social network members (i.e., familial, plutonic, or romantic relational partners with whom the survivor has a salient relationship; SNM). In order to integrate their illness into their lives, normatively regain balance and equilibrium, and achieve a “new normal” following a cancer diagnosis, YA survivors and their close SNMs must work to reconstruct their biographies by engaging in tangible interpersonal communication processes often used to initiate and maintain relationships. However, YA cancer survivors report facing social struggles due to the biographical disruption of their illness across the trajectory of diagnosis, treatment, and survivorship. To learn more about their unique social experience of cancer, I conducted private, open-ended narrative interviews with 20 YA survivor-close SNM dyads, 1 YA survivor-SNM close triad, and 10 individual YA survivors (N = 51). I used thematic narrative analysis to determine how and why YA cancer survivors and their close SNMs communicate social support messages with romantic partners, family, friends, peers, and one another. By examining the narratives of YA survivors, their close SNMs, and the dyad itself, this dissertation explores the interpersonal communication processes used to initiate and maintain relationships across the illness trajectory by focusing on the barriers and facilitators these individuals experience in the communication of social support. Through their individual narrative accounts, YA survivors explained why and how they perceived various support attempts from others to be positive or negative, and their close SNMs detailed their attempts to navigate the YA’s larger support network and assume the duties inherent in their newly-adopted “top supporter” role. In addition, reports from YAs and their SNMs revealed that they often engaged in mutual pretense, a unique and often unsustainable form of support that occurred between YA survivors and their close SNMs involving topic avoidance and emotional management. Implications for the advancement of interpersonal communication theory and for practical intervention targeting YA patients and survivors, their close SNMs, and medical practitioners are also discussed.

The goal of risk and crisis communication is to reduce and contain the harm inherent in a threat. In order to achieve this goal, risk and crisis scholars call for continued testing of messages surrounding these events; specifically, messages that address the needs of the at-risk message receiver. Previous scholarship suggests that these messages should include adapting and instructing information (Coombs, 2012), and should be designed using pedagogically sound instructional approaches (Frisby, Sellnow, Sellnow, Lane, & Veil, 2011; Sellnow & Sellnow, 2010). In order to meet this call, this dissertation tested an instructionally sound message that includes both adapting and instructing information related to a foodborne illness event including a hypothetical E. coli contamination in ground beef affecting the state of Kentucky. Foodborne illness outbreaks are unique in that they must address those at risk of contamination while simultaneously addressing the needs of those experiencing the crisis (i.e. those already contaminated). The research tested the ability of participants to make positive sense of risk message related to the E. coli outbreak; specifically exploring the effect of augmenting traditional video warning messages with converging Twitter messages and positive sensemaking on behavioral intentions and self-efficacy. Results indicate that individuals who are able to make positive sense of the message, report greater self-efficacy and behavioral intentions in line with message recommendations. Further, individuals who receive an IDEA model message and converging Twitter messages report greater attitudes and beliefs related to the message than individuals who receive a traditional video warning message. These findings indicate a need for continued research on the role of positive sensemaking and the type of message received as they directly affect perceptions of messages and intentions to comply with recommendations.