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.
Nathan A. Crick
Poststructuralism represents a set of attitudes and a style of critique that developed in critical response to the growth and identification of the logic of structural relations that underlie social institutions—whether they exist in terms of politics, economics, education, medicine, literature, or the sciences. Poststructuralism should therefore not be thought of as a distinct philosophy that exists separately as its own “structure”—a proposition that would undermine its most fundamental attitudes. Rather, poststructuralism should be thought of as developing or arising only in response to pre-existing structures and, as a set of attitudes, helping us better understand, interpret, and alter our social environment by calling established meanings into question, revealing the points of ambiguity and indeterminacy inherent in any system, rejecting the rationalistic piety that all systems are internally coherent and circle around an unchanging center, showing how discourses are carriers of power capable of turning us into subjects, and placing upon us the burden of ethical responsibility that accompanies the acceptance of freedom.
Although poststructuralism by its very nature as a set of attitudes denies any attempt at comprehensive definition, this essay examines three of the major postructuralist thinkers in order to relate their thought to the study of communication. First, following Derrida, poststructuralist thought invites a critical deconstruction of any discourse that presents itself as completely coherent, centered, and rational. Poststructuralist approaches thus do not argue against a position by harnessing counterarguments drawing on a different set of principles. Rather, it deconstructs a discourse by occupying it and exposing the gaps, contradictions, paradoxes, and deferments, thus revealing its established hierarchies, binaries, logical conclusions, and principles to be far more loosely structured and poly-vocal than its advocates wish to present them. Second, following Barthes, poststructuralism refuses to locate any single point of origin of any text that can ground its meaning—particularly by pointing to some ground of the author. Although not denying that writers exist, Barthes refuses to identify the meaning of a text with the author’s biography and intentions, instead inviting multiple interpretations from the perspective of individual readers who encounter the text as a unique event. Therefore, just as discourses do not have a unified structure, neither do individual texts or the authors that produce them. Lastly, following Fouacult, poststructuralism invites an inquiry into how discourses, texts, and acts of communication are always implicated in relations of power that act upon possible actions. Following the first two propositions, poststructuralism does not analyze these relations of power as completely structured and determinate, however. Power relations are always within a dynamic relationship with acts of resistance, thereby constantly leaving space for freedom and possibility.
Nathan A. Crick
When John Dewey announced that communication was the most wonderful of all affairs, he recognized the centrality of communication within the tradition of American pragmatism. In other traditions of philosophy, such as idealism or empiricism, communication certainly played a role, but usually it was a secondary function of transmitting ideas from one mind to another. In idealism, ideas were discovered through intuitive revelation of the whole and only later expressed through transcendent eloquence, whereas in empiricism, particular data was attained purely by the senses and communication served a kind of documentary function of fact gathering. Pragmatism, however, inverted this traditional hierarchy. By arguing that the meaning of our ideas was only found in their effects and consequences in experience, particularly those consequences brought about through shared experience, pragmatists made communication both the origin and consummation of knowledge—regardless if that knowledge was practical, scientific, aesthetic, or social. Consequently, pragmatists believed that improving the quality of communication practices was central to improving not only the state of knowledge but the quality of our experience living together in a common world.
Conversation analytic research on “preference organization” investigates recorded episodes of naturally occurring social interaction to elucidate how people systematically design their actions to either promote or undermine social solidarity. This line of work examines public forms of conduct that are highly generalized and institutionalized, not the private desires or preferences of individuals.
For each action a person does in interaction—be it sequence-initiating or sequence-responding—there are alternative ways of doing it. These alternatives are not, however, symmetrical or equally valued. Rather, each alternative has different implications for “face,” “affiliation,” and the relationship of the participants involved.
As an example of a sequence-initiating action, in accomplishing the transfer of something of value (e.g., a loan of money, a ride, information about fellow participants) from one person to another, a participant may do the action of offering, or requesting, that valued item. But the interactants do not treat these offering or requesting alternatives as equivalent. Several studies demonstrate that the social action of offering is “preferred” over the action of requesting. Participants display their orientation to actions as “preferred” by producing them straightforwardly—without delay, qualification, or account. Correlatively, participants treat actions as “dispreferred” by withholding, delaying, qualifying, and/or accounting for them. More specifically, when opening face-to-face encounters, participants treat offers of information as valued and thus “preferred” over requests for that information, because such offers engender solidarity by enabling people to feel included (rather than excluded): Offers of information identifying unfamiliar persons are preferred during introduction sequences; and when a newcomer arrives to an already-in-progress interaction, an already-present speaker’s offer of information about the previous activity/topic of that interaction is preferred.
As an example of a sequence-responding action, after a participant issues a request, the addressed-recipient can grant, or refuse, that request. Again, participants do not treat these alternative response types as equally valued. Whereas participants recurrently do the action of granting in the preferred format—as this response is usually affiliative and supportive of social solidarity, they tend to do the action of refusing in the dispreferred format, as this response is most often disaffiliative and destructive of social solidarity.
Preference organization research illuminates how interaction works in both casual and institutional settings. For an example of the latter, during parent-teacher conferences, there is a marked contrast between how parents and teachers do the actions of praising and criticizing students: Whereas teachers design their student-praising utterances in the preferred format, parents treat their articulation of student praise as dispreferred. Correspondingly, whereas teachers treat their student-criticizing utterances as dispreferred, parents routinely produce their student criticisms as preferred. This regular pattern of parent-teacher interaction constitutes an endogenous method for circumventing conflict. Research on preference organization thus empirically demonstrates that human interaction is organized to promote social affiliation at the expense of conflict.
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.
Bradley A. Serber and Rosa A. Eberly
Mass public shootings in the United States have generated increasingly urgent efforts to understand and prevent active shooter scenarios. After the Columbine High School shooting in 1999, government officials tried to no avail to identify a demographic profile of those who might become active shooters. Confronted with the limitations of identifying potential shooters in advance, government officials, mental health professionals, criminologists, and others interested in preventing active shootings have shifted their focus to guns, mental health, and location security. However, the terrain of each of these topics is murky and exposes additional uncertainties. The sheer number of readily available guns, the prohibition of gun violence research by federal public health and justice institutions, and the variance in attitudes toward and laws about guns in the United States inhibit clear and consistent gun policy. Further, linking active shooters with mental illness risks stigmatizing the vast majority of mentally ill individuals who are more likely to be victims than perpetrators of violence. Because different locations vary in design, function, funding, resources, and vulnerabilities, no organization or institution can guarantee total security despite extensive and costly efforts. While political and social changes can lead to incremental and important improvements in each of these areas, the problem of active shootings is large, multifaceted, and evolving. Adding to the urgency is the increasing number of U.S. states voting to allow concealed and/or open carry of firearms on public college and university campuses.
In the absence of certainty and in recognition of contextual differences, government agencies and educational institutions recently have promoted variants of a “run, hide, fight” approach to active shooter situations, and many schools, workplaces, and other sites have subsequently adopted these tactics in their active shooter training messages. From a rhetorical perspective, pentadic analysis (Burke, 1969) of “run, hide, fight” and its variants reveals the complexities of trying to prevent active shootings. “Run” and “hide” demonstrate both the possibilities and challenges associated with the scene, or when and where an active shooting might occur. “Fight” implies the ambiguities of agent and agency, that is, who gets to fight and how, in debates about gun-free zones, concealed and open carry, and on-site and off-site law enforcement. Meanwhile, the multimodal nature and often disturbing content of active shooter training messages sensationalize the act of active shootings, making them seem more real and present despite the low probability of such an event occurring in any particular place at any particular time. Given these complexities, active shooter training messages as a whole illustrate a tension of purpose in that they presumably attempt to alleviate fear while simultaneously producing it. By looking at a variety of government documents and workplace active shooter training messages, this analysis will explore uncertainties, controversies, and lingering questions about the content and consequences of active shooter training messages and how the producers of these messages frame active shooter scenarios as well as efforts to prevent and respond to such occurrences. No previous studies of the rhetorical or communication dimensions of active shooter training have been conducted, and no archives yet exist that cull such training materials for purposes of comparison, contrast, and analysis in the aggregate.
Chase Wesley Raymond
The adjacency pair is the most basic and normatively accountable sequential structure in interaction. This structure can be expanded through pre-sequences, insert-sequences, and post-expansions, which can be seen to be relevantly oriented to by interactants themselves. Various forces drive this normative organization, including issues related to epistemics, intersubjectivity, progressivity, and affiliation. Larger structures—for example, sequences of sequences, overall structural organization, and storytelling—also exist in interaction but are nonetheless composed of smaller units of talk. While potentially open to a certain amount of cultural variation, sequence organization exists cross-linguistically and cross-culturally as a general structural feature of human social interaction.
Andrea Kloss and Anne Bartsch
Emotions are an important part of how audiences connect with health and risk messages. Feelings such as fear, anger, joy, or empathy are not just byproducts of information processing, but they can interact with an individual’s perception and processing of the message. For example, emotions can attract attention to the message, they can motivate careful processing of the message, and they can foster changes in attitudes and behavior. Sometimes emotions can also have counterproductive effects, such as when message recipients feel pressured and react with anger, counterarguments, or defiance. Thus, emotion and cognition are closely intertwined in individuals’ responses to health messages. Recent research has begun to explore the flow and interaction of different types of emotions in health communication. In particular, positive feelings such as joy and hope have been found to counteract avoidant and defensive responses associated with negative emotions such as fear and anger. In this context, research on health communication has begun to explore complex emotions, such as a combination of fear and hope, which can highlight both the severity of the threat, and individuals’ self-efficacy in addressing it. Empathy, which is characterized by a combination of affection and sadness for the suffering of others, is another example of a complex emotion that can mitigate defensive responses, such as anger and reactance, and can encourage insight and prosocial responses.
As the use of online technologies has grown in recent years, so has the study of computer-mediated communication.
Online communication began in universities through the use of e-mail. Soon, spaces such as multi-user dungeons (MUDs), Listserv, and bulletin boards were developed, which not only allowed people who knew each other offline to interact but also enabled individuals who were not previously acquainted to communicate via the Internet. The development of Web 2.0, which allowed for more user-generated content, led to new and innovative ways of interacting online, most notably thorough social media sites. Social media sites, such as Facebook and Twitter, allow not only for text-based interaction to occur but also for image- and video-based interaction.
Through all these developments, interactional norms and practices have developed. A key factor in these norms is what the medium enables, or affords, participants to do. Features such as whether an interactional platform is synchronous or asynchronous can impact the nature of the interaction. Similarly, the lack of visual or verbal contact when interacting may impact upon the interaction, through the potential for misunderstandings. Participants do, though, develop practices to suit the medium. If we examine these practices in detail, it is possible to also analyze the role which technology plays in the interaction. One method that has been used to do this is conversation analysis, which was developed for and using spoken interaction. Conversation analysis examines conversation in forensic detail to illuminate the norms and practices through which we conduct our everyday lives. In using this method for analyzing online interaction, we can not only understand the practices but also examine the affordances of particular interactional platforms.
Various interactional features of computer-mediated communication (CMC) have been examined from a conversation analytic perspective, including sequential organization, openings, turn-taking, and repair. A common focus of these studies it to explore the interactional patterns but also to understand how these might be impacted by the technology itself. The development of norms for a variety of forms of technologized interaction demonstrates how individuals are capable of adapting their interactional practices for new contexts.
Jessica Gasiorek and R. Kelly Aune
A majority of the extant literature in health and risk message processing focuses—for obvious reasons—on social influence and compliance-gaining. Interpersonal and relational issues with doctors and patients are a secondary focus. In contrast, research that specifically addresses comprehension of health and risk messaging is somewhat scant. However, other domains (e.g., cognitive psychology, reading studies) offer models and studies of comprehension that address message processing more generally. This material can usefully inform research in a health and risk context.
An important aspect of any communicative event is the degree to which that event allows interactivity. This can be described in terms of a continuum from static messaging to dynamic messaging. Message features may affect simple comprehension (in the former case) and active understanding (in the latter case) of messaging along this continuum. For static messaging, text features are the dominant focus; for dynamic messaging, how communicators cooperate, collaborate, and adjust their behavior relative to each other’s knowledge states is the focus. Moderators of these effects, which include sources’ dual goals informing and influencing targets, are also important to consider. Examples of this include direct-to-consumer-advertising (DTCA) of pharmaceutical medicines and pharmaceutical companies, which must meet the demands of the government regulatory bodies (e.g., fair and balanced presentation of benefits and risks) while simultaneously influencing the message processing experience of the target to minimize negative perceptions of their products. Impediments to creating understanding can arise in both the highly interactive setting of the face-to-face doctor-patient context as well as more static messaging situations such as PSAs, pamphlets, and pharmaceutical package inserts.
Making sense of message comprehension in health and risk communication is complex, and it is complex because it is broad in scope. Health and risk communication runs the gamut of static to dynamic messaging, employing everything from widely distributed patient information leaflets and public service announcements, to interactive web pages and massively connected social networking sites, to the highly interactive and personalized face-to-face meeting between doctor and patient. An equally comprehensive theoretical and methodological tool box must be employed to develop a thorough understanding of health and risk communication.