The Impact of Health Communication Research on Medical and Health Professional Education and Training.

In this essay, we review how health communication scholarship has been translated into various communication skills trainings (CSTs), we present four case studies of how health communication research informed the development and implementation of specific CSTs, and we reflect on how we can productively define "impact" in looking back as well as looking forward within this line of research.

A Reasoned Action Approach to Social Connection and Mental Health: Racial Group Differences and Similarities in Attitudes, Norms, and Intentions.

This study employed a Reasoned Action Approach to investigate two communication behaviors that were being built into a statewide behavioral health campaign: initiating a conversation about one's own mental health struggles, and starting a conversation to discuss someone else's mental health difficulties. We examined whether the extent of attitudes, perceived norms, and perceived behavioral control regarding intent to perform these behaviors varied by racial identity. Using original survey data from Texans (N = 2,033), we conducted regression analyses for the two communication behaviors and found that intention to seek help was primarily explained by instrumental attitude, injunctive norm, descriptive norm, and perceived capacity; and intention to start a conversation to help someone else was primarily explained by instrumental attitude, injunctive norm, and perceived capacity. Additionally, we identified important common and distinct determinants of the two behaviors across different racial groups. Implications for health communication campaign message development and audience segmentation are discussed.

Doula Support Challenges and Coping Strategies during the COVID-19 Pandemic: Implications for Maternal Health Inequities.

The COVID-19 pandemic has made birthing more stressful and isolating, which has raised particular concern for populations of birthing people affected by maternal health inequities. Doulas have been proposed as one means of improving health outcomes by providing emotional, physical, and informational support to patients and their families before, during, or after labor. However, the social and economic conditions of the COVID-19 pandemic have posed new challenges for doula care. We conducted thematic analysis on 25 semi-structured interviews with practicing doulas in the United States to explore changes to doula care during the pandemic. Although doulas have faced many challenges in providing virtual and socially-distanced support during the pandemic, the rising use of telehealth among doulas has revealed new coping strategies and opportunities for virtual communication with the doula community. Our findings indicate that doula experiences during the pandemic can inform future doula care practices, particularly for birthing people of color and low-income birthing people.

Examining the Effectiveness of Genetic Counselors' Communication of Variant of Uncertain Significance Results of Breast Cancer Genes.

Receiving a variant of uncertain significance (VUS) result is quite common for individuals who undergo genetic testing. Because VUS results are often unexpected and necessarily complex, they are challenging for genetic counselors to deliver. The current research sought to examine how three specific message features (risk estimate formats, establishment of a future plan, and linguistic agency), and message receivers' intolerance of uncertainty, influenced the effectiveness of genetic counselors' communication of a VUS result. A series of MANCOVAs and multiple regressions suggested that these message features affected message receivers' perception of a genetic counselor's credibility and receivers' uncertainty appraisal and information-seeking intentions. Specifically, establishing a future plan and assigning agency to a VUS result enhanced perceived counselor credibility. When results were presented in a numeric format, assigning agency to counselors resulted in heightened danger appraisal and greater information-seeking intentions. Individuals' intolerance of uncertainty moderated the association between risk formats and uncertainty appraisal. These results have both theoretical and practical implications for communication of uncertainty in the context of genetic counseling.

What Motivates Health Communication's Peer Reviewers to Review? A Survey of Our Scholarly Community.

The peer review process is a necessary, labor-intensive, and imperfect element of scientific research. Among the many issues identified by its critics, finding willing reviewers can be an arduous task for journal editors and is acknowledged as one of the primary factors holding up the publication process. In an attempt to better understand and serve Health Communication reviewers, we surveyed them and inquired about their motivations for reviewing a manuscript, including why they agree, decline, or disregard invitations to review submissions. According to responses from 380 reviewers, the most compelling reasons for agreeing to review reflected a dedication to performing scholarly service and loyalty to the journal. The primary reasons selected for declining to review included lack of time and insufficient expertise to evaluate the submission. The main reasons for failing to respond to requests to review were e-mail overload and indecision about whether to take on the review. Recognition for service was the most recommended suggestion offered to motivate reviewers to agree to take on more manuscripts. On the whole, reviewers feel a strong sense of duty to review manuscripts. However, time constraints, poor fit, and lack of recognition are roadblocks to agreeing.

Parenting Practices, Autonomous Motivation, and Adolescent Diet Habits.

Guided by self-determination theory, the aim of this study was to examine whether adolescents' autonomous motivation for making healthy diet choices mediates the association between parenting practices regarding diet and adolescent food choices. We analyzed data from the NCI FLASHE study, a survey of demographically diverse parents and their adolescent children (N = 1,646 dyads). Path models supported self-determination theory's assertion that indirect, encouraging parenting practices fostered internal motivation; in contrast, regulation was both positively and negatively linked to motivation depending on the model. Models also yielded direct paths between parenting practices and healthy and unhealthy diet choices. Overall, regardless of what predicted motivation, adolescents' autonomous motivation was linked with their consumption of healthier foods and drinks. As such, cultivating a sense of internal motivation during these formative years may put young people on a path toward healthy patterns of self-regulation later in life.

Health Literacy and Perceptions of Stigma.

Calls for progress in health literacy argue that efforts across society are promising for increasing capacities at a broader level. However, it is unknown how the general public perceives people who struggle with health information. While it may be ideal to establish interventions beyond the individual, stigma held by others could limit this work. This study explores whether one's personal health literacy skills are associated with stigma enacted toward others who struggle with health literacy. Adults (N = 5,151) responded to a survey consisting of health literacy assessments and a vignette in which a patient made a health-related mistake. Differences were observed regarding the number of participants who self-reported (n = 251) versus objectively scored as having low health literacy (n = 794). Participants who self-reported (MlowHL = 5.67, MhighHL = 5.99, p < .01) or had low objective health literacy (MlowHL = 5.75, MhighHL = 6.01, p < .001) exhibited less pity for the person in the vignette than health literate participants. Participants were more demanding of a young person featured in the vignette (33-year old), indicating greater personal responsibility (M72 = 5.12, M33 = 5.67), anger (M72 = 4.54, M33 = 5.57), and less pity (M72 = 6.18, M33 = 5.75) compared to an older person (72-year old). Results from the present study suggest contradictory perceptions among patients who are likely to feel stigma themselves.

Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons.

BACKGROUND: In the midst of rapid expansion of medical knowledge and decision-support tools intended to benefit diverse patients, patients with limited health literacy (the ability to obtain, process, and understand information and services to make health decisions) will benefit from asking questions and engaging actively in their own care. But little is known regarding the relationship between health literacy and question-asking behavior during outpatient office visits. QUESTIONS/PURPOSES: (1) Do patients with lower levels of health literacy ask fewer questions in general, and as stratified by types of questions? (2) What other patient characteristics are associated with the number of questions asked? (3) How often do surgeons prompt patients to ask questions during an office visit? METHODS: We audio-recorded office visits of 84 patients visiting one of three orthopaedic hand surgeons for the first time. Patient questions were counted and coded using an adaptation of the Roter Interaction Analysis System in 11 categories: (1) therapeutic regimen; (2) medical condition; (3) lifestyle; (4) requests for services or medications; (5) psychosocial/feelings; (6) nonmedical/procedural; (7) asks for understanding; (8) asks for reassurance; (9) paraphrase/checks for understanding; (10) bid for repetition; and (11) personal remarks/social conversation. Directly after the visit, patients completed the Newest Vital Sign (NVS) health literacy test, a sociodemographic survey (including age, sex, race, work status, marital status, insurance status), and three Patient-Reported Outcomes Measurement Information System-based questionnaires: Upper-Extremity Function, Pain Interference, and Depression. The NVS scores were divided into limited (0-3) and adequate (4-6) health literacy as done by the tool's creators. We also assessed whether the surgeons prompted patients to ask questions during the encounter. RESULTS: Patients with limited health literacy asked fewer questions than patients with adequate health literacy (5 ± 4 versus 9 ± 7; mean difference, -4; 95% CI, -7 to -1; p = 0.002). More specifically, patients with limited health literacy asked fewer questions regarding medical-care issues such as their therapeutic regimen (1 ± 2 versus 3 ± 4; mean difference, -2; 95% CI, -4 to -1]; p < 0.001) and condition (2 ± 2 versus 3 ± 3; mean difference, -1; 95% CI, -3 to 0; p = 0.022). Nonwhite patients asked fewer questions than did white patients (5 ± 4 versus 9 ± 7; mean difference, -4; 95% CI, -7 to 0; p = 0.032). No other patient characteristics were associated with the number of questions asked. Surgeons only occasionally (29%; 24/84) asked patients if they had questions during the encounter, but when they did, most patients (79%; 19/24) asked questions. CONCLUSIONS: Limited health literacy is a barrier to effective patient engagement in hand surgery care. In the increasingly tangled health-information environment, it is important to actively involve patients with limited health literacy in the decision-making process by encouraging question-asking, particularly in practice settings where most decisions are preference-sensitive. Instead of assuming that patients understand what they are told, orthopaedic surgeons may take "universal precautions" by assuming that patients do not understand unless proved otherwise. LEVEL OF EVIDENCE: Level II, therapeutic study.

Applied Grant Writing Training for Future Health Communication Researchers: The Health Communication Scholars Program.

Health communication faculty face increasing expectations regarding their academic productivity, including the expectation to seek and secure external funding. Doctoral training in health communication that does not fully prepare students for the challenges of securing external funding is doing them a disservice that will make them less competitive for academic positions and less likely to succeed in the academic positions they assume. The purpose of this study is to share the evaluation of a program, the Health Communication Scholars Program (HCSP), designed to train future health communication researchers in the pursuit of external funding. The HCSP includes a grant-writing workshop, requires interdisciplinary graduate student teams to submit applications, and awards funding to top proposals. HCSP participants responding to an evaluation survey (N = 25) had overwhelmingly positive experiences; respondents felt the program provided great value, improved their writing skills, gave them skills to pursue funding in the future, and helped them secure tenure-track faculty positions. The results of this formal evaluation suggest the HCSP is an experience that builds crucial skills and prepares graduate students for the demands they will face as faculty. It is a relatively low-cost, replicable model that merits consideration and adoption at other institutions that hope to provide professional development for doctoral students interested in health communication.

Cyberframing Cancer: An Exploratory Investigation of Valenced Cybercoping on Cancer Blogs.

Although scholarship on coping with cancer implies many ways that coping is communicative, the discursive features of coping have been understudied. The purpose of the present investigation was to theorize the content of cancer blogs, a form of cybercoping, by examining valenced coping-relevant frames that bloggers use to describe their experiences with cancer. This research is both theoretically and methodologically innovative. Theoretically, we advance the concept of cyberframing by connecting the rather disconnected literatures on coping and framing and by studying this topic from a communication perspective. Methodologically, this is one of the few studies of coping with cancer that has used naturally occurring communication data to its advantage. A content analysis of cancer blog entries (N = 194) indicated that more than 90% of cancer blog posts were embedded in a valenced frame. The frames were either negative, positive, or balanced; balanced frames varied in the intensity of the valence. The most common frames were positive and balanced with low affect.

Toward a Better Understanding of Patient Health Literacy: A Focus on the Skills Patients Need to Find Health Information.

While many health literacy assessments exist, this area of research lacks an instrument that isolates and reflects the four components driving this concept (abilities to find, understand, use, and communicate about health information). The purpose of this study was to determine what abilities comprise the first component, how a patient finds health information. Low ( n = 13) and adequate ( n = 14) health literacy patients, and health professionals ( n = 10) described their experiences when looking for health information and the skills they employed to complete these tasks. Major skills/themes elicited included knowing when to search, credibility assessments, finding text and numerical information, interpersonal seeking, technology and online search, and spatial navigation. Findings from this study suggest that each of the dimensions included in the definition of health literacy warrants specific attention and assessment. Given identification of the skills comprising each dimension, interventions targeting deficits across health literacy dimensions could be developed to improve patient health.

Lysophosphatidic acid receptor 5 inhibits B cell antigen receptor signaling and antibody response.

Lysophospholipids have emerged as biologically important chemoattractants capable of directing lymphocyte development, trafficking, and localization. Lysophosphatidic acid (LPA) is a major lysophospholipid found systemically, and its levels are elevated in certain pathological settings, such as cancer and infections. In this study, we demonstrate that BCR signal transduction by mature murine B cells is inhibited upon LPA engagement of the LPA5 (GPR92) receptor via a Gα12/13-Arhgef1 pathway. The inhibition of BCR signaling by LPA5 manifests by impaired intracellular calcium store release and most likely by interfering with inositol 1,4,5-triphosphate receptor activity. We further show that LPA5 also limits Ag-specific induction of CD69 and CD86 expression and that LPA5-deficient B cells display enhanced Ab responses. Thus, these data show that LPA5 negatively regulates BCR signaling, B cell activation, and immune response. Our findings extend the influence of lysophospholipids on immune function and suggest that alterations in LPA levels likely influence adaptive humoral immunity.

Sharing Health Information and Influencing Behavioral Intentions: The Role of Health Literacy, Information Overload, and the Internet in the Diffusion of Healthy Heart Information.

Low health literacy remains an extremely common and problematic issue, given that individuals with lower health literacy are more likely to experience health challenges and negative health outcomes. In this study, we use the first three stages of the innovation-decision process found in the theory of diffusion of innovations (Rogers, 2003). We incorporate health literacy into a model explaining how perceived health knowledge, information sharing, attitudes, and behavior are related. Results show that health information sharing explains 33% of the variance in behavioral intentions, indicating that the communicative practice of sharing information can positively impact health outcomes. Further, individuals with high health literacy tend to share less information about heart health than those with lower health literacy. Findings also reveal that perceived heart-health knowledge operates differently than health literacy to predict health outcomes.

Health Literacy and Health Information Technology Adoption: The Potential for a New Digital Divide.

BACKGROUND: Approximately one-half of American adults exhibit low health literacy and thus struggle to find and use health information. Low health literacy is associated with negative outcomes including overall poorer health. Health information technology (HIT) makes health information available directly to patients through electronic tools including patient portals, wearable technology, and mobile apps. The direct availability of this information to patients, however, may be complicated by misunderstanding of HIT privacy and information sharing. OBJECTIVE: The purpose of this study was to determine whether health literacy is associated with patients' use of four types of HIT tools: fitness and nutrition apps, activity trackers, and patient portals. Additionally, we sought to explore whether health literacy is associated with patients' perceived ease of use and usefulness of these HIT tools, as well as patients' perceptions of privacy offered by HIT tools and trust in government, media, technology companies, and health care. This study is the first wide-scale investigation of these interrelated concepts. METHODS: Participants were 4974 American adults (n=2102, 42.26% male, n=3146, 63.25% white, average age 43.5, SD 16.7 years). Participants completed the Newest Vital Sign measure of health literacy and indicated their actual use of HIT tools, as well as the perceived ease of use and usefulness of these applications. Participants also answered questions regarding information privacy and institutional trust, as well as demographic items. RESULTS: Cross-tabulation analysis indicated that adequate versus less than adequate health literacy was significantly associated with use of fitness apps (P=.02), nutrition apps (P<.001), activity trackers (P<.001), and patient portals (P<.001). Additionally, greater health literacy was significantly associated with greater perceived ease of use and perceived usefulness across all HIT tools after controlling for demographics. Regarding privacy perceptions of HIT and institutional trust, patients with greater health literacy often demonstrated decreased privacy perceptions for HIT tools including fitness apps (P<.001) and nutrition apps (P<.001). Health literacy was negatively associated with trust in government (P<.001), media (P<.001), and technology companies (P<.001). Interestingly, health literacy score was positively associated with trust in health care (P=.03). CONCLUSIONS: Patients with low health literacy were less likely to use HIT tools or perceive them as easy or useful, but they perceived information on HIT as private. Given the fast-paced evolution of technology, there is a pressing need to further the understanding of how health literacy is related to HIT app adoption and usage. This will ensure that all users receive the full health benefits from these technological advances, in a manner that protects health information privacy, and that users engage with organizations and providers they trust.

"The uncertainty is what is driving me crazy": the tripartite model of uncertainty in the adolescent and young adult cancer context.

Building on scholarship indicating that uncertainty is a fundamental component of the cancer experience, this study focuses on an understudied population: adolescents and young adults (AYAs) with cancer. Because AYAs' health outcomes lag behind those of older and younger people with cancer, scholars have recommended that the subjective experiences of AYAs be better understood. Using the tripartite model of uncertainty sources as a guiding framework, we analyzed naturally occurring messages from an online discussion forum for AYA cancer survivors. The majority of messages communicating uncertainty expressed medical uncertainty regarding the complexities of understanding treatment options and sequelae. Results indicated that several overarching areas of AYA uncertainty correspond to themes reported by other cancer populations, but that some distinctive concerns arise amid the normative complexities of late adolescence and young adulthood.

Boosting healthy heart employer-sponsored health dissemination efforts: identification and information-sharing intentions.

Health information dissemination options have expanded to include workplaces and employer-sponsored efforts. This study focuses on a core relational concept found in workplaces, organizational identification-the feeling of belongingness-and the impact of partnering with employers and health clinics in health information dissemination. We use social-identity theory and multiple identification to test our predictions from a sample of working adults representing more than 100 different employers. We found that when people strongly identify with their employer, they have increased health behavioral intentions and they intend to talk about the health information with coworkers. The significant models explain more than 50% and 30% of the variance in these two outcomes. The experimental results examining single and multiple organizational sources revealed no differences on any outcomes. These findings offer a contribution to health information dissemination research by articulating how identification with an employer functions to affect behavioral intentions.

Online friends, offline loved ones, and full-time media: young adult "mass personal" use of communication resources for informational and emotional support.

As Web 2.0 technologies proliferate, patient education is changing dramatically. Information about prevention and survivorship arrives from a mix of sources. The present manuscript describes a study to shed light on how young adults (YAs) affected by cancer manage the digital world. Our investigation was guided by a research question asking how young adults affected by cancer engage in communication work in an environment of mass personal communication. The sample for this research consisted of 500 posts comprising 50 complete threads from an online support community for young adults affected by cancer. Threads were purposively sampled in a multi-stage process. Researchers used constant comparison to define themes, examining text in increments. Individuals harnessed assets of various communication tools for the purposes of message preparation and credibility checking. YAs demonstrated the multi-channel way they move between channels for different purposes, driven by preparation for future interactions. The result is a process that allows co-creation of knowledge in a trusted community. Findings indicate that completing communication work through multiple channels in a deliberate and savvy way is normal for YAs, particularly for message preparation and credibility checking. The multidirectional nature of digital tools plays an important role for YAs, as interactive resources appear to be the first or second stop for information after key events in the cancer trajectory. Results from this study are important as guidance to help manage the volume and depth of information common to the cancer experience in the Web 2.0 world.

Missed opportunities for prenatal family-centered care during the COVID-19 pandemic: a qualitative study.

BACKGROUND: The purpose of this study was to describe the impact of COVID-19 on fatherhood experiences during pregnancy. METHODS: A semi-structured interview guide was developed to collect qualitative data from fathers about their experiences in pregnancy and prenatal care, how they communicated with providers, strategies for information seeking, and social support they received during the pregnancy. One-time, virtual interviews were conducted via Zoom with fathers that were either expecting a baby or fathers who had a baby after March 2020 and were 18 years or older. Thematic analysis was used to identify themes that highlighted the fatherhood experience. RESULTS: In total, 34 interviews with new or expectant fathers were completed. Two central themes that highlight the experiences of fathers: missed opportunities to shift toward family-centered care and inequity in the parent dyad during pregnancy. Additional supporting themes included: limited patient-provider relationship, lack of telemedicine use, inadequate uncertainty management for parents, unidirectional information sharing between parents, and limited opportunities for achieving role attainment during pregnancy. CONCLUSION: The COVID-19 pandemic created a decision point for prenatal care. Instead of focusing on family-centered practices, prenatal care exclusively centered on the mother and fetus, resulting in problematic experiences for fathers including limited access to information about the pregnancy and health of the mother and fetus, heightened stress related to COVID-19 safety requirements, and few opportunities to attain their role as a father. Prenatal care should actively seek robust strategies to improve family-centered care practices that will withstand the next public health emergency.

'That gave me a lot of comfort, that he would ask my opinion about how we wanted to talk about this': A qualitative analysis of clinical communication experiences of ostomy patients.

OBJECTIVES: The purpose of this study was to investigate the communication challenges and successes that people with ostomies experienced during their healthcare encounters. DESIGN: We conducted semistructured interviews of people with ostomies. Interviews focused on important social situations and health communication strategies for managing these situations. We transcribed interviews and coded them to create themes. PARTICIPANTS: Participants were eligible to participate if they were above the age of 18 and have had an ostomy for at least a year. 27 people participated in the study. SETTING: The study was conducted in a university setting. RESULTS: Interviews with ostomates surfaced several themes related to ostomate needs. Participants benefited from communication that was open, thorough and had a positive outlook on ostomies. Participants found patient-clinician communication to be challenging when there was a lack of knowledge surrounding ostomy care, communication was unclear or inadequate, and when clinicians had a negative outlook on ostomies. CONCLUSIONS: Findings from this project are intended to amplify existing patient and clinician education materials and to inform the creation of a communication guide specifically for the ostomy context.

Development and refinement of a communication guide to help young adults in Texas reconnect and reduce loneliness.

Objective: Loneliness among young people is a contemporary public health crisis exacerbated by the COVID-19 pandemic. The present research examined the development of a modest yet meaningful health communication intervention resource that would become an asset in a larger health campaign: a communication guide aimed at helping young people reach out and reconnect with others. Methods: Study One established the need for a loneliness intervention in Texas with survey data (N = 795). A communication guide was developed based on research and theory. Study Two employed focus group interviews with potential audience members (N = 31) to critically assess and inform revisions to the communication guide. Results: Study One results indicated that a substantial proportion of young adult Texans felt as though their social connection had decreased and their loneliness had increased since the onset of the pandemic. Themes in focus group responses from Study Two suggested several strengths of the communication guide and some opportunities for revision. Conclusion: A communication guide with tips for reconnecting could be a valuable tool to empower young people and promote social connection. Innovation: This study involved the development and refinement of a new communication resource that was informed by a priority audience of a major health communication campaign.