The concept of ambiguity tolerance (TA), variously called Uncertainty Avoidance, Ambiguity Avoidance, or Intolerance, can be traced back nearly 70 years. It has been investigated by many different types of researchers from clinical and differential, to neuro- and work psychologists. Each sub-discipline has tended to focus on how their variable relates to beliefs and behaviors in their area of expertise, from religious beliefs to reactions to novel products and situations.
The basic concept is that people may be understood on a dimension that refers to their discomfort with, and hence attempts to avoid, ambiguity or uncertainty in many aspects of their lives. There have been many attempts to devise robust and valid measures of this dimension, most of which are highly inter-correlated and require self-reporting. There remains a debate as to whether it is useful having just one or more dimensions/facets of the concept.
Using these tests, there have been many correlational studies that have sought to validate the measure by looking at how those high and low on this dimension react to different situations. There have also been some, but many fewer, experimental studies, which have tested very specific hypotheses about how TA is related to information processing and reactions to specific stimuli. There is now a welcomed interest by neuroscientists to explore the concept from their perspective and using their methodologies.
These studies have been piecemeal, though most have supported the tested hypotheses. There has been less theoretical development, however, of the concept attempting to explain how these beliefs arise, what sustains them, and how, why, and when they may change. However, the concept has continued to interest researchers from many backgrounds, which attests to its applicability, fecundity, and novelty.
In understanding crowd psychology and its explanation of conflict and violence, there are different theoretical approaches that turn on different understandings of communication processes. There are three models of communication in the crowd worth reviewing: classic, normative, and dynamic. Classic models suggest that crowd members are influenced by an idea of emotion presented to them. Normative models suggest that influence is constrained by what is seen as consonant with group norms. And, finally, dynamic models examine how that which becomes normative in the group depends upon intergroup relations. The last of these approaches can explain the patterned, socially meaningful and yet changing nature of crowd action. Crowd action, itself, is a form of communication because it serves to shape the social understandings of participants as well as the social understandings of those beyond the crowd. It is argued that the nature and centrality of crowds contribute to the understanding and creating of social relations in society.
Wayne A. Beach, Kyle Gutzmer, and Chelsea Chapman
Beginning with phone calls to an emergency psychiatric hospital and suicide prevention center, the roots of Conversation Analysis (CA) are embedded in systematic analyses of routine problems occurring between ordinary persons facing troubling health challenges, care providers, and the institutions they represent. After more than 50 years of research, CA is now a vibrant and robust mode of scientific investigation that includes close examination of a wide array of medical encounters between patients and their providers. Considerable efforts have been made to overview CA and medicine as a rapidly expanding mode of inquiry and field of research. Across a span of 18 years, we sample from 10 of these efforts to synthesize important priorities and findings emanating from CA investigations of diverse interactional practices and health care institutions. Key topics and issues are raised that provide a unique opportunity to identify and track the development and maturity of CA approaches to medical encounters. Attention is also given to promising new modes of research, and to the potential and challenges of improving medical practices by translating basic and rigorous empirical findings into innovative interventions for medical education. A case is made that increasing reliance on CA research can positively impact training and policies shaping the delivery of humane and quality medical care.
Laura Loeb and Steven E. Clayman
The news interview is a prominent interactional arena for broadcast news production, and its investigation provides a window into journalistic norms, press-state relations, and sociopolitical culture. It is a relatively formal type of interaction, with a restrictive turn-taking system normatively organized around questions and answers exchanged for the benefit of an audience. Questions to politicians are sensitive to the journalistic norms of neutralism and adversarialness. The neutralism norm is relatively robust, implemented by interviewers adhering to the activity of questioning, and avoiding declarative assertions except as prefaces to a question or as attributed to a third party. The adversarialism norm is more contextually variable, implemented through agenda setting, presupposition, and response preference, each of which can be enhanced through question prefaces. Adversarial questioning has increased significantly in the United States over time, and in some other national contexts. Adversarial questioning creates an incentive for resistant responses from politicians, which are managed with overt forms of damage control and covert forms of concealment. News interviews with nonpartisan experts and ordinary people are generally less adversarial and more cooperative. Various hybrid interview genres have emerged in recent years, which incorporate practices from other forms of broadcast talk (e.g., celebrity talk shows, confrontational debates) within a more loosely organized interview framework. These hybrid forms have become increasingly prominent in contemporary political campaigns and current affairs discussions.
Michael Mackert, Sara Champlin, and Jisoo Ahn
Health literacy—defined as the ability of an individual to obtain, process, understand, and communicate about health information—contributes significantly to health outcomes and costs to the U.S. health-care system. Approximately one-quarter to one-half of U.S. adults struggle with health information, which includes understanding patient education materials, reading medication labels, and communicating with health-care providers. Low health literacy is more common among the elderly, those who speak English as a second language, and those of lower socioeconomic status. In addition to conceptualizing health literacy as an individual-level skill, it can also be considered an organizational or community-level ability.
Increased attention to the field of health literacy has resulted in debates about the definition and the best ways to assess health literacy; there is also a strong and growing movement within the field of health literacy research and practice to frame health literacy less as a deficit to overcome and more as an approach to empowering patients and improving outcomes. As health-care providers have recognized the importance of health literacy, workshops, and training programs have been developed and evaluated to improve the care of low-health-literate patients. Similarly, health promotion professionals have developed best practices for reaching low-health-literate audiences with traditional and new digital media, which can also increase access for patients with hearing or visual impairments. Additionally, recent policy changes in the United States, including those related to the Affordable Care Act, contribute to a greater focus and regulation of factors that impact health literacy. Researchers and practitioners together are advancing understanding of health literacy, its relationship to health outcomes and health-care costs, and improved strategies for improving the health of lower health literate patients. Development and review of health literacy pieces can aid in shared decision making and provide insights for patients on various health-care services.
Ee Lin Lee
Language is an arbitrary and conventional symbolic resource situated within a cultural system. While it marks speakers’ different assumptions and worldviews, it also creates much tension in communication. Therefore, scholars have long sought to understand the role of language in human communication. Communication researchers, as well as those from other disciplines (e.g., linguistics, anthropology, psychology, and sociology), draw on each other’s works to study language and culture. The interdisciplinary nature of the works results in the use of various research methods and theoretical frameworks. Therefore, the main goal of this essay is to sketch the history and evolution of the study of language and culture in the communication discipline in the United States.
Due to space constraints only select works, particularly those that are considered landmarks in the field, are highlighted here. The fundamentals of language and the development of the Sapir–Whorf hypothesis in leading to the formation of the language and social interaction (LSI) discipline are briefly described. The main areas of LSI study—namely language pragmatics, conversation analysis, discourse analysis, and the ethnography of communication—are summarized. Particular attention is paid to several influential theories and analytical frameworks: the speech act theory, Grice’s maxims of implicatures, politeness theory, discursive psychology, critical discourse analysis, the ethnography of speaking, speech codes theory, and cultural discourse analysis. Criticisms and debates about the trends and directions of the scholarship are also examined.
Language attitudes are evaluative reactions to different language varieties. They reflect, at least in part, two sequential cognitive processes: social categorization and stereotyping. First, listeners use linguistic cues (e.g., accent) to infer speakers’ social group membership(s). Second, based on that categorization, they attribute to speakers stereotypic traits associated with those inferred group membership(s). Language attitudes are organized along two evaluative dimensions: status (e.g., intelligent, educated) and solidarity (e.g., friendly, pleasant). Past research has primarily focused on documenting attitudes toward standard and nonstandard language varieties. Standard varieties are those that adhere to codified norms defining correct usage in terms of grammar, pronunciation, and vocabulary, whereas nonstandard varieties are those that depart from such norms in some manner (e.g., pronunciation). Standard and nonstandard varieties elicit different evaluative reactions along the status and solidarity dimensions. Status attributions are based primarily on perceptions of socioeconomic status. Because standard varieties tend to be associated with dominant socioeconomic groups within a given society, standard speakers are typically attributed more status than nonstandard speakers. Solidarity attributions tend to be based on in-group loyalty. Language is an important symbol of social identity, and people tend to attribute more solidarity to members of their own linguistic community, especially when that community is characterized by high or increasing vitality (i.e., status, demographics, institutional support). As a result, nonstandard language varieties can sometimes possess covert prestige in the speech community in which they are the speech norms. Language attitudes are socialized early in life. At a very young age, children tend to prefer their own language variety. However, most (if not all) children gradually acquire the attitudes of the dominant group, showing a clear status preference for standard over nonstandard varieties around the first years of formal education and sometimes much earlier. Language attitudes can be socialized through various agents, including educators, peers, family, and the media. Because language attitudes are learned, they are inherently prone to change. Language attitudes may change in response to shifts in intergroup relations and government language policies, as well as more dynamically as a function of the social comparative context in which they are evoked. Once evoked, language attitudes can have myriad behavioral consequences, with negative attitudes typically promoting prejudice, discrimination, and problematic social interactions.
Maricel G. Santos, Holly E. Jacobson, and Suzanne Manneh
For many decades, the field of risk messaging design, situated within a broader sphere of public health communication efforts, has endeavored to improve its response to the needs of U.S. immigrant and refugee populations who are not proficient speakers of English, often referred to as limited English proficient (LEP) populations. Research and intervention work in this area has sought to align risk messaging design models and strategies with the needs of linguistically diverse patient populations, in an effort to improve patient comprehension of health messages, promote informed decision-making, and ensure patient safety. As the public health field has shifted from person-centered approaches to systems-centered thinking in public health outreach and communication, the focus in risk messaging design, in turn, has moved from a focus on the effects of individual patient misunderstanding and individual patient error on health outcomes, to structural and institutional barriers that contribute to breakdown in communication between patients and healthcare providers.
While the impact of limited proficiency in English has been widely documented in multiple spheres of risk messaging communication research, the processes by which members of immigrant and refugee communities actually come to understand sources of risk and act on risk messaging information remain poorly researched and understood. Advances in risk messaging efforts are constrained by outdated views of language and communication in healthcare contexts: well-established lines of thinking in sociolinguistics and language education provide the basis for critical reflection on enduring biases in public health about languages other than English and the people who speak them. By drawing on important findings about language ideologies and language learning, an alternative approach would be to cultivate a deeper appreciation for the linguistic diversity already shaping our everyday lives and the competing views on this diversity that constrain our risk messaging efforts.
The discourse surrounding the relationship between LEP and risk messaging often omits a critical examination of the deficit-based narrative that tends to infuse many risk messaging design efforts in the United States. Sociolinguists and language education specialists have documented the enduring struggle against a monolingual bias in U.S. education and healthcare policy that often privileges proficiency in English, and systematically impedes and discriminates against emerging bilingualism and multilingualism. The English-only bias tends to preclude the possibility that risk messaging comprehension for many immigrant and refugee communities may represent a multilingual capacity, as patients make use of multiple linguistic and cultural resources to make sense of healthcare messages. Research in sociolinguistics and immigration studies have established that movement across languages and cultures—a translingual, transcultural competence—is a normative component of the immigrant acculturation process, but these research findings have yet to be fully integrated into risk messaging theory and design efforts. Ultimately, critical examination of the role of language and linguistic identity (not merely a focus on proficiency in English) in risk messaging design should provide a richer, more nuanced picture of the ways that patients engage with health promotion initiatives, at diverse levels of English competence.
Soyoon Kim and Brian G. Southwell
Typical discussion about the success of mediated health communication campaigns focuses on the direct and indirect links between remembered campaign exposure and outcomes; yet, what constitutes information exposure and how it is remembered remain unclearly defined in much health communication research. This problem mainly stems from the complexity of understanding the concept of memory. Prolific discussions about memory have occurred in cognitive psychology in recent decades, particularly owing to advances in neuroimaging technologies. The evolution of memory research—from unitary or dichotomous perspectives to multisystem perspectives—has produced substantial implications for the topics and methods of studying memory. Among the various conceptualizations and types of memory studied, what has been of particular interest to health-communication researchers and practitioners is the notion of “encoded exposure.” Encoded exposure is a form of memory at least retrievable by a potential audience member through a conscious effort to recollect his or her past engagement with any particular unit of campaign content. While other aspects of memory (e.g., non-declarative or implicit memory) are certainly important for communication research, the encoded exposure assessed under a retrieval condition offers a critical point at which to establish the exposure-outcome link for the purpose of campaign design and evaluation. The typical methods to assess encoded exposure include recall and recognition tasks, which can be exercised in various ways depending on retrieval cues provided by a researcher to assess different types and levels of cognitive engagement with exposed information. Given that encoded exposure theoretically relies on minimal memory trace, communication scholars have suggested that recognition-based tasks are more appropriate and efficient indicators of encoded exposure compared to recall-based tasks that require a relatively high degree of current-information salience and accessibility. Understanding the complex nature of memory also has direct implications for the prediction of memory as one of the initial stages of communication effects. Some prominent message-level characteristics (e.g., variability in the structural and content features of a health message) or message recipient-level characteristics (e.g., individual differences in cognitive abilities) might be more or less predictive of different memory systems or information-processing mechanisms. In addition, the environments (e.g., bodily and social contexts) in which people are exposed to and interact with campaign messages affect individual memory. While the effort has already begun, directions for future memory research in health communication call for more attention to sharpening the concept of memory and understanding memory as a unique or combined function of multilevel factors.
Message Recipient Psychological Characteristics: Incurious and Curious Motives to Learn about Health Risks
Successfully conveying information about the risk of potential threats to an individual’s physical and mental health is a serious challenge for healthcare practitioners. Adding to the challenge is the role of individual differences in people’s tendencies to want to learn (or in their choice to passively avoid) new information. These characteristic motives can be both curious and incurious in nature and interact with the perceived locus of the relevant health threat, which must be taken into account first. Some health threats are relatively “external,” and involve addressing the potential risk of an undesired event (e.g., developing illness, encountering relationship troubles). Research indicates that individuals who view external threats as “controllable” are more likely to respond positively to relevant information, but perception of control alone does not determine whether health-relevant information is likely to be sought or acted on. Besides perceived controllability, individual differences in incurious worry reduction motives (IWRM) play an important role as well. Two different kinds of IWRM have been identified: focus on distress (IWRM-FD) and focus on relief (IWRM-FR). Dispositional tendencies toward IWRM-FD are associated with greater willingness to seek out information when risk is perceived as low (i.e., information about the potential external threat is expected to make one feel better), but a tendency to passively avoid any information when risk is considered high (i.e., information is expected to intensify distress). In contrast, tendencies toward IWRM-FR reflect wanting more information about potential threats when risk is believed to be high, while passively avoiding news when perceived risk is low. In regard to coping with perceived risk, IWRM-FD scores predict avoidant coping, whereas IWRM-FR levels are associated with proactive coping and seeking others’ advice.
Other risks are more “internal,” and involve threats to an individual’s certainty about his or her self-concept, purpose in life, or the wisdom of past behavior; in short, an “identity crisis.” Such threats underlie wondering things like “Who am I, really?” and are associated with less self-awareness, lower self-esteem, and greater overall distress. In response to internal threats, intrapersonal curiosity (InC) motivates individuals to engage in introspective self-exploration that may help them to clarify, to elaborate on, and to improve their understanding of their self-concept. Recent research has found that individual differences in InC are positively associated with IWRM, suggesting that dealing with identity crises involves the desire to better know oneself, as well as wishing to mitigate worries about experiencing self-doubt.
Bearing the above in mind, research on individual differences in tendencies to avail oneself of different coping strategies indicates that proactive coping (e.g., positive reframing, seeking advice) tends to result in beneficial outcomes, such as personal growth and improved health, but some proactive strategies are “double-edged” and may lead to some negative outcomes as well. In particular, proactive strategies like acceptance of one’s limitations or discussing them with others when seeking social support were helpful, but they also had the potential to leave individuals feeling less sure of themselves. These findings suggest that practitioners who wish to more effectively communicate information about risk of potential health threats should consider whether the nature of the threat is internal or external, the role of individual differences in IWRM and InC, and how to help their patients to focus on the positive benefits of acceptance (i.e., identify solvable problems) and seeking social support (i.e., acquiring useful advice) over the negative aspects (i.e., admitting limitations).