Language and Social Interaction

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.

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.

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.

In the wake of what has been called the “discursive turn” or “linguistic turn” in the social sciences, research at the intersection of language and communication and race and racism shifted from being largely dominated by quantitative and experimental methods to include qualitative and particularly discursive approaches. While the term “discursive” potentially encompasses a wide range of modes of discourse analysis, discursive approaches share a focus on language use as social action, and as a constitutive feature of actions, events, and situations, rather than as merely a passive means of describing or transmitting information about them. When applied to the study of race and racism, such approaches have examined ways in which language functions to construct, maintain, and legitimate as well as subvert or resist racial and/or racist ideologies and social structures.

Research in these areas has made use of a range of empirical materials, including “elite” texts and talk (media texts, parliamentary debates, academic texts, etc.), individual interviews, focus groups and group discussions, “naturally occurring” talk-in-interaction from conversational and institutional settings, and text-based online interactions. Although these different data types should not be seen as strictly mutually exclusive, each of them serves to foreground particular features of racial or racist discourse(s), thus facilitating or constraining particular sorts of discourse analytic findings. Thus, different data sources respectively tend to foreground ideological features of racial discourse(s) and their intersection with power and domination, including examination of “new” racisms and the production and management of accusations and denials of racism; discursive processes involved in the construction and uses of racial subjectivities and identities; interactional processes through which prejudice and racism are constructed and contested; and the everyday interactional reproduction of systems of racial categories, independently of whether the talk in which they occur can or should be considered “racist.”

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.

In everyday life, we are faced with disparate examples of intergroup bias, ranging from a mild tendency to ingroup favoritism to harsh episodes of discrimination, aggression, and even conflicts between groups. Where do they stem from? The origins of intergroup bias can be traced back to two main motivations, that is, attachment to one’s own group (“ingroup love”) and negative feelings toward outgroups (“outgroup hate”). Although lay people, but also some researchers, see the two motivations as intertwined, growing evidence from different fields (e.g., social psychology, evolutionary psychology, and neuroscience) has indicated that intergroup bias is more often driven by needs of ingroup protection and affiliation, which do not imply outgroup hostility or competitive attitudes. Outgroup hate is instead likely to arise in intergroup contexts characterized by a high degree of enmity. It is important that members of the groups involved, but also external observers, recognize ingroup love as the primary motor of intergroup conflict: the attribution of hate to the outgroup’s behavior renders negotiation and conflict resolution harder while at the same time justifying severe aggression or even annihilation of the opposing outgroup.

In the domain of intergroup communication, an intriguing way through which group members express their ingroup love and outgroup hate is represented by variations of linguistic abstraction and valence in depicting behaviors performed by ingroup or outgroup members. This unintended use of language reveals that group members are more prone to express ingroup love also at a linguistic level. However, specific changes in intergroup relations along variables such as group size, group status, or relative deprivation can give rise to linguistic patterns of outgroup hate.

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.

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.