Karyn Ogata Jones
Since McCombs and Shaw first introduced the theory in 1972, agenda setting has emerged as one of the most influential perspectives in the study of the effects of mass media. Broadly defined, “agenda setting” refers to the ability of mass media sources to identify the most salient topics, thereby “setting the agendas” for audiences. In telling us what to think about, then, mass media sources are perceived to play an influential role in determining priorities related to policies, values, and knowledge on a given topic or issue.
Scholars have studied this phenomenon according to both object (issue) salience and attribute salience and along aggregate and individual audience responses. The audience characteristics of need for orientation, uncertainty, relevance, and involvement are advanced as moderating and predicting agenda-setting effects. When agenda-setting theory is applied to the study of messaging related to health and risk communication, scholars have reviewed and identified common themes and topics that generally include media’s role in educating and informing the public about specific health conditions as well as public health priorities and administrative policies.
Agenda setting is often examined in terms of measuring mass media effects on audiences. Looking at interpersonal communication, such as that coming from medical providers, opinion leaders, or peer networks, in studies will allow research to examine the combined effects of interpersonal and mass communication. Testing possible interactions among differing sources of information along with assessment of issue and attribute salience among audiences according to an agenda-setting framework serves to document audience trends and lived experiences with regard to mass media, health, and risk communication.
Claude H. Miller and Reinaldo Cortes Quantip
Within a range of health communication contexts, anger can be either a detriment to the receptivity of health promotion messages when poorly controlled, or a benefit to information processing when appropriately directed. In the former case, anger can disrupt cognitive processing, leading to a range of negative outcomes, including emotional turbulence and a preoccupation with anger-eliciting events that can severely limit the receptivity of health promotion and risk prevention messages. However, when properly directed and elicited in moderation, anger can motivate greater purpose and resolve in response to health threats, stimulate more active processing of health warnings, sharpen focus on argument quality, and direct greater attention to coping-relevant information concerning harmful health risks.
Rachel A. Smith
A premise in health promotion and disease prevention is that exposure to and consequences of illness and injury can be minimized through people’s actions. Health campaigns, broadly defined as communication strategies intentionally designed to encourage people to engage in the actions that prevent illness and injury and promote wellbeing, typically try to inspire more than one person to change. No two people are exactly alike with respect to their risk for illness and injury or their reactions to a campaign attempting to lower their risk. These variations between people are important for health messaging. Effective campaigns provide a target audience with the right persuasive strategy to inspire change based on their initial state and psychosocial predictors for change. It is often financially and logistically unreasonable to create campaigns for each individual within a population; it is even unnecessary to the extent to which people exist in similar states and share psychosocial predictors for change. A challenging problem for health campaigns is to define those who need to be reached, and then intelligently group people based on a complex set of variables in order to identify groups with similar needs who will respond similarly to a particular persuasive strategy. The premise of this chapter is that segmentation at its best is a systematic and explicit process of research to make informed decisions about how many audiences to consider, why the audience is doing what they are doing, and how to reach that audience effectively.
Bradford William Hesse
The presence of large-scale data systems can be felt, consciously or not, in almost every facet of modern life, whether through the simple act of selecting travel options online, purchasing products from online retailers, or navigating through the streets of an unfamiliar neighborhood using global positioning system (GPS) mapping. These systems operate through the momentum of big data, a term introduced by data scientists to describe a data-rich environment enabled by a superconvergence of advanced computer-processing speeds and storage capacities; advanced connectivity between people and devices through the Internet; the ubiquity of smart, mobile devices and wireless sensors; and the creation of accelerated data flows among systems in the global economy. Some researchers have suggested that big data represents the so-called fourth paradigm in science, wherein the first paradigm was marked by the evolution of the experimental method, the second was brought about by the maturation of theory, the third was marked by an evolution of statistical methodology as enabled by computational technology, while the fourth extended the benefits of the first three, but also enabled the application of novel machine-learning approaches to an evidence stream that exists in high volume, high velocity, high variety, and differing levels of veracity.
In public health and medicine, the emergence of big data capabilities has followed naturally from the expansion of data streams from genome sequencing, protein identification, environmental surveillance, and passive patient sensing. In 2001, the National Committee on Vital and Health Statistics published a road map for connecting these evidence streams to each other through a national health information infrastructure. Since then, the road map has spurred national investments in electronic health records (EHRs) and motivated the integration of public surveillance data into analytic platforms for health situational awareness. More recently, the boom in consumer-oriented mobile applications and wireless medical sensing devices has opened up the possibility for mining new data flows directly from altruistic patients. In the broader public communication sphere, the ability to mine the digital traces of conversation on social media presents an opportunity to apply advanced machine learning algorithms as a way of tracking the diffusion of risk communication messages. In addition to utilizing big data for improving the scientific knowledge base in risk communication, there will be a need for health communication scientists and practitioners to work as part of interdisciplinary teams to improve the interfaces to these data for professionals and the public. Too much data, presented in disorganized ways, can lead to what some have referred to as “data smog.” Much work will be needed for understanding how to turn big data into knowledge, and just as important, how to turn data-informed knowledge into action.
Kory Floyd and Colter D. Ray
Affectionate communication comprises the verbal and nonverbal behaviors people use to express messages of love, appreciation, fondness, and commitment to others in close relationships. Like all interpersonal behaviors, affectionate communication has biological and physiological antecedents, consequences, and correlates, many of which have implications for physical health and wellness. Investigating these factors within a biological framework allows for the adjudication of influences beyond those attributable to the environment. In particular, there are observable genetic and neurological differences between individuals with a highly affectionate disposition and those less prone to communicating affection, suggesting that variance in the tendency to engage in affectionate behavior is not entirely the result of environmental influences such as enculturation, parenting, and media exposure. In addition, the expression of affection is associated with markers of immune system competence and appears to help the body to relax and remain calm. The biological effects of affectionate communication are perhaps most pronounced in situations involving either acute or chronic stress. Specifically, highly affectionate individuals are less likely than others to overreact physiologically to stress-inducing events. Whatever stress reaction they do mount is better regulated than among their less affectionate counterparts. Moreover, highly affectionate individuals—or simply those who receive expressions of affection prior to or immediately following a stressful situation—exhibit faster physiological recovery from their elevated stress. Perhaps unsurprisingly, therefore, being deprived of adequate affectionate communication is predictive of multiple physical and psychological detriments, including elevated stress and exacerbated depression, social and relational problems, insecure attachment, susceptibility to diagnosed anxiety and mood disorders, susceptibility to diagnosed secondary immune disorders, chronic pain, and sleep disturbances.
Janice L. Krieger and Jordan M. Neil
Strategic communication is an essential component in the science and practice of recruiting participants to clinical research studies. Unfortunately, many clinical research studies do not consider the role of communication in the recruitment process until efforts to enroll patients in a timely manner have failed. The field of communication is rich with theory and research that can inform the development of an effective recruitment plan from the inception of a clinical research study through informed consent. The recruitment context is distinct from many other health contexts in that there is often not a behavioral response that can be universally promoted to patients. The appropriateness of a clinical research study for an individual is based on a number of medical, psychological, and contextual factors, making it impossible to recommend that everyone who is eligible for a clinical research study enroll. Instead, clinical research study recruitment efforts must utilize strategic communication principles to ensure that messages promote awareness of clinical research, maximize personal relevance, minimize information overload, and facilitate informed choice. This can be accomplished through careful consideration of various aspects of the communication context described in this chapter, including audience segmentation, message content, message channels, and formative, process, and outcome evaluation, as well as the enrollment encounter.
Sandra Petronio and Maria K. Venetis
Communication privacy management theory (CPM) argues that disclosure is the process by which we give or receive private information. Private information is what people reveal. Generally, CPM theory argues that individuals believe they own their private information and have the right to control said information. Management of private information is not necessary until others are involved. CPM does not limit an understanding of disclosure by framing it as only about the self. Instead, CPM theory points out that when management is needed, others are given co-ownership status, thereby expanding the notion of disclosing information; the theory uses the metaphor of privacy boundary to illustrate where private information is located and how the boundary expands to accommodate multiple owners of private information. Thus, individuals can disclose not only their own information but also information that belongs to others or is owned by collectives such as families.
Making decisions to disclose or protect private information often creates a tension in which individuals vacillate between sharing and concealing their private information. Within the purview of health issues, these decisions have a potential to increase or decrease risk. The choice of disclosing health matters to a friend, for example, can garner social support to cope with health problems. At the same time, the individual may have concerns that his or her friend might tell someone else about the health problem, thus causing more difficulties.
Understanding the tension between disclosing and protecting private health information by the owner is only one side of the coin. Because disclosure creates authorized co-owners, these co-owners (e.g., families, friends, and partners) often feel they have right to know about the owner’s health conditions. The privacy boundaries are used metaphorically to indicate where private information is located. Individuals have both personal privacy boundaries around health information that expands to include others referred to as “authorized co-owners.” Once given this status, withholding to protect some part of the private information can risk relationships and interfere with health needs. Within the scheme of health, disclosure risks and privacy predicaments are not experienced exclusively by the individual with an illness. Rather, these risks prevail for a number of individuals connected to a patient such as providers, the patient’s family, and supportive friends. Everyone involved has a dual role. For example, the clinician is both the co-owner of a patient’s private health information and holds information within his or her own privacy boundary, such as worrying whether he or she diagnosed the symptoms correctly. Thus, there are a number of circumstances that can lead to health risks where privacy management and decisions to reveal or conceal health information are concerned.
CPM theory has been applied in eleven countries and in numerous contexts where privacy management occurs, such as health, families, organizations, interpersonal relationships, and social media. This theory is unique in offering a comprehensive way to understand the relationship between the notion of disclosure and that of privacy. The landscape of health-related risks where privacy management plays a significant role is both large and complex. The situations of HIV/AIDS, cancer care, and managing patient and provider disclosure of private information help to elucidate the ways decisions of privacy potentially lead to health risks.
Andrew M. Ledbetter
Owing to advances in communication technology, the human race now possesses more opportunities to interact with interpersonal partners than ever before. Particularly in recent decades, such technology has become increasingly faster, mobile, and powerful. Although tablets, smartphones, and social media are relatively new, the impetus behind their development is old, as throughout history humans have developed mechanisms for communicating ideas that transcend inherent temporal and spatial limitations of face-to-face communication. In the ancient past, humans developed writing and the alphabet to preserve knowledge across time, with the later development of the printing press further facilitating the mass distribution of written ideas. Later, the telegraph was arguably the first technology to separate communication from transportation, and the telephone enabled people at a distance to hear the warmth and intimacy of the human voice. The development of the Internet consolidates and advances these technologies by facilitating pictorial and video interactions, and the mobility provided by cell phones and other technologies makes the potential for communication with interpersonal partners nearly ubiquitous. As such, these technologies reconfigure perception of time and space, creating the sense of a smaller world where people can begin and manage interpersonal relationships across geographic distance.
These developments in communication technology influence interpersonal processes in at least four ways. First, they introduce media choice as a salient question in interpersonal relationships. As recently as the late 20th century, people faced relatively few options for communicating with interpersonal partners; by the early years of the 21st century, people possessed a sometimes bewildering array of channel choices. Moreover, these choices matter because of the relational messages they send; for example, choosing to end a romantic relationship over the phone may communicate more sensitivity than choosing to do so via text messaging, or publicly on social media. Second, communication technology affords new opportunities to begin relationships and, through structural features of the media, shape how those meetings occur. The online dating industry generates over $1 billion in profit, with most Americans agreeing it is a good way to meet romantic partners; friendships also form online around shared interests and through connections on social media. Third, communication technology alters the practices people use to maintain interpersonal relationships. In addition to placing traditional forms of relational maintenance in more public spaces, social media facilitates passive browsing as a strategy for keeping up with interpersonal partners. Moreover, mobile technology affords partners increased geographic and temporal flexibility when keeping contact with partners, yet simultaneously, it may produce feelings of over-connectedness that hamper the desire for personal autonomy. Fourth, communication technology makes interpersonal networks more visibly manifest and preserves their continuity over time. This may provide an ongoing convoy of social support and, through increased efficiency, augment the size and diversity of social networks.
A community of practice (CoP) situated in a health and risk context is an approach to collaboration among members that promotes learning and development. In a CoP, individuals come together virtually or physically and coalesce around a common purpose. CoPs are defined by knowledge, rather than task, and encourage novices and experienced practitioners to work together to co-create and embed sustainable outputs that impact on theory and practice development. As a result, CoPs provide an innovative approach to incorporating evidence-based research associated with health and risk into systems and organizations aligned with public well-being.
CoPs provide a framework for constructing authentic and collaborative learning. Jeanne Lave and Etienne Wenger are credited with the original description of a CoP as an approach to learning that encompasses elements of identity, situation, and active participation. CoPs blend a constructivist view of learning, where meaningful experience is set in the context of “self” and the relationship of “self” with the wider professional community. The result is an integrated approach to learning and development achieved through a combination of social engagement and collaborative working in an authentic practice environment. CoPs therefore provide a strategic approach to acknowledging cultural differences related to translating health and risk theory into practice.
In health and risk settings, CoPs situate and blend theory and practice to create a portal for practitioners to generate, shape, test, and evaluate new ideas and innovations. Membership of a CoP supports the development of professional identity within a wider professional sphere and may support community members to attain long range goals.
Creating Authentic and Lasting Community Relationships to Enhance Awareness and Understanding of Cancer Research
Linda Fleisher, Evelyn González, and Armenta Washington
Building and sustaining relationships fundamentally requires mutual trust based on authentic and reciprocal communication. Successful academic and community partnerships require a deep understanding of the needs of all stakeholders facilitated through dialogue and ongoing communication strategies. This dialogue is especially crucial to address health disparities and bridge the divide between academics and other professionals and the communities they serve. Innovative and sound health communications and community engagement approaches can help to address this divide. For those working with communities to improve health, Community Based Participatory Research (CBPR) principles can serve as a compass to guide those efforts of building on the strengths and resources within the community and ensuring co-learning to address social inequities. Moreover, using innovative and interactive health communication strategies, such as community forums, photovoice projects, and the development of culturally sensitive and relevant messaging, can empower and engage the community, facilitating long-lasting relationships between the academic institutions and communities that ultimately address the unique concerns and values of those most in need.