Roxanne L. Parrott, Amber K. Worthington, Rachel A. Smith, and Amy E. Chadwick
The public, including lay members who have no personal or familial experience with genetic testing or diagnosis, as well as individuals who have had such experiences, face many intrinsic decisions relating to understanding genetics. With the sequencing of the human genome and genetic science discoveries relating genes to cancer, heart disease, and diabetes, the scope of such decisions broadened from prenatal genetic testing related to reproductive choices to genetic testing for contributors to common causes of morbidity and mortality. The decision about whether to seek genetic testing encompasses concerns about stigma and discrimination. These issues lead some who can afford the cost to seek screening through online direct-to-consumer sites rather than in clinical settings. Many who may benefit from genetic testing lack awareness of family health history that could guide physicians to recommend these diagnostic tests. Families may not discuss health history due to genetic illiteracy, with the public’s genetic illiteracy increasing their illness uncertainty and decreasing the likelihood that physicians will engage in conversations about personalized medicine with their patients. Physicians may nonetheless order genetic tests based on patients’ symptoms, during preoperative workups, or as part of opportunistic screening and assessment associated with a specific genetic workup. Family members who receive positive genetic test results may not disclose them to life partners, other family members, or insurance companies based on worries and anxiety related to their own identity, as well as a lack of understanding about their family members’ risk probability. For many, misguided beliefs that genes absolutely determine health and disease status arise from media translations of genetic science. These essentialist beliefs negatively relate to personal actions to limit genetic expression, including failure to seek medical care, while contributing to stereotypes and stigma communication. As medical science continues to reveal roles for genes in health across a broad spectrum, communicating about the relationships that genes have for health will be increasingly complex. Policy associated with registering, monitoring, and controlling the activities of those with genetic mutations may be coercive and target individuals unable to access health care or technology. Communicating about genes, health, and risk will thus challenge health communicators throughout the 21st century.
Irina Iles and Xiaoli Nan
Counterfactual thinking is the process of mentally undoing the outcome of an event by imagining alternate antecedent states. For example, one might think that if they had given up smoking earlier, their health would be better. Counterfactuals are more frequent following negative events than positive events. Counterfactuals have both aversive and beneficial consequences for the individual. On the one hand, individuals who engage in counterfactual thinking experience negative affect and are prone to biased judgment and decision making. On the other hand, counterfactuals serve a preparative function, and they help people reach their goals in the future by suggesting effective behavioral alternatives.
Counterfactual thoughts have been found to influence an array of cognitive processes. Engaging in counterfactual thinking motivates careful, in-depth information processing, increases perceptions of self-efficacy and control, influences attitudes toward social matters, with consequences for behavioral intentions and subsequent behaviors. Although it is a heavily studied matter in some domains of the social sciences (e.g., psychology, political sciences, decision making), counterfactual thinking has received less attention in the communication discipline. Findings from the few studies conducted in communication suggest that counterfactual thinking is a promising message design strategy in risk and health contexts. Still, research in this area is critically needed, and it represents an opportunity to expand our knowledge.
Mohan Jyoti Dutta
This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Communication. Please check back later for the full article.
Health and risk are constituted globally amid structures of unequal flow of labor, capital, commodities, and communication, shaped by the material inequalities in the distribution of resources. Globalization—the accelerated flow of goods, people, services, and capital across spaces—has been accompanied by large inequalities in economic access to resources; inequalities in access to health opportunities, health resources, and health care services; and inequalities in health outcomes (reflected in mortality and morbidity rates). Disparities in health outcomes observed within and across nation states are shaped by economic inequalities, noting the structural determinants of health, the inequities in access to health services, as well as the local-national-global policies that constitute health. Drawing upon the foundations in postcolonial and Subaltern Studies theories, the culture-centered approach (CCA) examines the communicative processes by which marginalization takes place in global contexts and the ways in which health risks and vulnerabilities are constituted amid material inequalities in distributions of resources.
With an emphasis on the processes of erasure of diverse voices, the CCA asks the question: What are the processes, strategies, and tactics through which the voices of subaltern communities are erased? The access to communicative spaces, platforms, strategies, and tools is shaped within material structures, thus shaping messages, processes, and discourses within the agendas of powerful political, social, and economic actors with economic access to resources. The disenfranchised, with limited access to the communicative spaces and to the spheres of voicing, are often absent from the discursive spaces where health policies and programs are discussed, the sites where interventions are planned, and the processes where communicative strategies targeting them are carried out. The agency of the subaltern is erased from the sites of recognition and representation where policies are debated, decided upon, implemented, and evaluated.
Connecting communication to materiality, the CCA suggests that erasure of the subaltern sectors of the globe is tied to their material disenfranchisement. Materially disenfranchised communities are missing from the policy platforms that target them through a wide variety of interventions. To understand the unequal distribution of health resources and opportunities, we need to closely examine the inequality in opportunities for having a voice and for participating in decision-making structures and processes. Putting forth the argument that inequalities in health outcomes need to be situated amid economic structures that determine how health resources will be distributed and the ways in which these mechanisms will be discussed and determined, the CCA foregrounds strategies for listening to voices that have hitherto been erased. Through strategies of listening, locally grounded understandings are placed within the discursive spaces of policy formulation and program development. In understanding the health experiences of communities that experience poor health outcomes, the emphasis is on creating spaces for listening that foreground local experiences, interpretations, and understanding. Alternative imaginations of the political economy of health are rooted in the voices of local communities at the margins, foregrounding contextually embedded interpretive frames for organizing health, healing, and curing.
Communication is understood in relationship to materiality, acknowledging the interplays between the symbolic and the material in generating health risks and vulnerabilities, and further suggesting strategies of resistance and participation that seek to invert these inequities by foregrounding subaltern rationalities of health and wellbeing. The presence of subaltern voices brings forth alternative imaginations of health, offering new theoretical frameworks that point toward alternative ways of structuring health, economics, and politics. Attending to differentials in distributions of material and communicative infrastructures, the CCA resists the marginalization of the subaltern sectors through the foregrounding of opportunities for local grassroots participation, in the definition of problem configurations and in the corresponding articulations of locally meaningful solutions. The presence of subaltern voices in discursive spaces offers alternative logics of political and economic organizing that challenge the commoditization of health as private property and suggests ideas of health rooted in community life, sustainable practices, and cooperative economies. Local interpretations of health are foregrounded, situated in relationship to the structures within which these meanings are constituted and fostering openings for imagining new structures of health grounded in local understandings. These local understandings offer entry points of solidarity for re-envisioning global practices that challenge the hegemony of neoliberalism as a universal solution to health and development.
Jon F. Nussbaum and Amber K. Worthington
Health and risk message design theories do not currently incorporate a lifespan view of communication. The lifespan communication perspective can therefore advance theorizing in this area by considering how the fundamental developmental differences that exist within and around individuals of different ages impact the effectiveness of persuasive message strategies. Designing health messages for older adults therefore requires an examination of how theoretical frameworks used in health and risk message design can be adapted to be age sensitive and to effectively target older adults. Additionally, older adults often make health decisions in conjunction with informal caregivers, including their adult children or spouses, and/or formal caregivers. Message design scholars should thus also consider this interdependent influence on health behaviors in older adults. Strategic messages targeting these caregivers can appeal to, for example, a caregiver’s perception of responsibility to care for the older adult. These messages can also be designed to not only promote the older adults’ health but also to alleviate caregiver stress and burden. Importantly, there is an unfounded stereotype that all older adults are alike, and message designers should consider the most beneficial segments of the older adult audience to target.
In health and risk communication, evidence is a message feature that can add credibility, realism, and legitimacy to health and risk messages. Evidence is usually defined into two types: statistical or narrative. Statistical evidence employs quantifications of events, places, phenomena, or other facts, while narrative evidence involves stories, anecdotes, cases, or testimonials. While many health and risk messages employ statistical or factual information, narrative evidence holds appeal for health and risk communication for its utility in helping individuals learn their risks and illnesses through stories and personal experiences. In particular, narratives employed as evidence in a health or risk message especially hold value for their ability to communicate experiences and share knowledge, attitudes, beliefs, and ideas about complex health issues, propose behavior change, and assist individuals coping with disease. As a result, the personal experiences shared, whether they are from first-hand knowledge, or recounting another’s experience, can focus attention, enhance comprehension for risks, and recall of health and risk information. Furthermore, readers engage with the story and develop their own emotional responses which may align with the purpose of the health and risk message. Narratives, or stories, can occur in many ways or through various points of view, but the stories that “ring true” to readers often have a sense of temporality, coherence, and fidelity. As a result, formative research and pre-testing of health and risk messages with narratives becomes important to understand individual perceptions related to the health issue and the characters (or points of view). Constructs of perceived similarity, interest, identification, transportation, and engagement are helpful to assess in order to maximize the usefulness and persuasiveness of narratives as evidence within a health and risk message. Additionally, understanding the emotional responses to narratives can also contribute to perceptions of imagery and vividness that can make the narrative appealing to readers. Examining what is a narrative as evidence in health and risk messages, how they are conceptualized and operationalized and used in health and risk messages is needed to understand their effectiveness.
Jennifer A. Malkowski, J. Blake Scott, and Lisa Keränen
Rhetoric, commonly understood as the art, practice, and analysis of persuasion, has longstanding connections to medicine and health. Rhetorical scholars, or rhetoricians, have increasingly applied rhetorical theories, concepts, and methods to the texts, contexts, discourses, practices, materials, and digital and visual artifacts related to health and medicine. As an emerging interdisciplinary subfield, the rhetoric of health and medicine seeks to uncover how symbolic patterns shape thought and action in health and medical texts, discourses, settings, and materials.
In practice, rhetoricians who study health and medicine draw from the standard modes of rhetorical analysis, such as rhetorical criticism and rhetorical historiography, as well as from social science methods—including participant observation, interviewing, content analysis, and visual mapping—in order to deepen understanding of how language functions across health and medical objects, issues, and discussions. The objects of analysis for rhetorical studies of health and medicine span medical research, education, and clinical practice from laboratory notes to provider–patient interaction; health policymaking and practice from draft policies through standards of care; public health texts and artifacts; consumer health practices and patient advocacy on- and offline; public discourses about disease, death, bodies, illness, wellness, and health; online and digital health information; popular entertainments and medical dramas; and alternative and complementary medicine. Despite its methodological breadth, rhetorical approaches to science and medicine consistently involve the systematic examination and production of symbolic exchanges occurring across interactional, institutional, and public contexts to determine how individuals and groups create knowledge, meanings, identities, understandings, and courses of action about health and illness.
M. Jeffrey Farrar, Yao Guan, and Kaitlyn Erhardt
Humans live not only in a physical world but also in a mental world. Theory of mind reflects the understanding that the mind is comprised of different mental states, such as intentions, desires, and beliefs. This conception of the mind is a critical achievement in human development because it directly impacts effective communication and social interaction. It allows for the understanding of others’ behaviors by inferring their mental states. The formation of a theory of mind has been a central topic in psychology, neuroscience, cognitive science, and philosophy. It impacts related processes, such as communication skills, perspective-taking ability, and social cognition.
Across the life span, the understanding of the mind becomes increasingly complex. Early in development, infants and toddlers can discern the intentions of others. Later, more sophisticated reasoning about the mental states of others becomes possible. For instance, the ability to follow and understand the recursive thought that “Sam believes, that Mary said, that Jose wanted . . .” develops. Additionally, within distinctive developmental time periods, people differ in their ability to take into account mental states. Once people’s beliefs, including their misconceptions, are identified, it is possible to generate effective communication strategies designed to teach, learn, and even reduce risk-taking behaviors.