The HPV vaccine represents an important step in the primary prevention of cervical cancer, yet uptake rates for the vaccine remain below what is needed to establish "herd immunity" from the virus. While many studies have examined both psychosocial and communication factors affecting HPV vaccination decisions, this study adopts a unique approach to understand the communication environment within which this health decision happens, such as the many and sometimes conflicting messages about vaccine efficacy and safety guiding young women's decisions. Using the message convergence framework, this project identifies how further study of converging and diverging messages in the communication environment in which young women make their vaccination decision can extend research in considering optimal communication strategies to enhance demand for HPV vaccination. In Study 1, 39 unvaccinated women participated in qualitative interviews and were asked questions in order to understand the important elements of the HPV vaccination communication environment that affected their decision (i.e., common sources and content of messages, how they discussed these messages "interacting" and influencing their decision). Study 2 builds on the findings of Study 1 by employing an experimental design to test different message convergence conditions on women's intent to vaccinate (e.g., what happens when a doctor and a family member give conflicting information and recommendations about HPV vaccination?). Three hundred and nine unvaccinated women were randomly assigned to one of nine experimental message conditions and then assessed on behavioral intentions. Support was found for the message convergence framework. This project represents the first formal testing of the message convergence framework and the first time it has been used in the health context. The findings from these studies are discussed in terms of the implications for future cervical cancer research and prevention campaigns, as well as the utility of the message convergence framework for other health communication research topics in which researchers are seeking to better understand and consider the communication environment when designing health behavior interventions.

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.