Allison M. Scott

Medical, Personal, and Social Forms of Uncertainty Across the Transplantation Trajectory

We designed this study to identify sources of uncertainty across the transplantation trajectory. We interviewed 38 transplant patients, who reported medical, personal, and social forms of uncertainty. Prior to transplantation, they reported uncertainty related to insufficient information about diagnosis, complex decisions about transplantation, unknown/unknowable organ availability, unclear expectations about medical procedures/outcomes, ambiguity in meaning of life, complex role and identity challenges, unclear financial consequences, questioning from others, and unclear relational implications. They reported that uncertainty experienced after transplantation was related to complex medication regimens, unpredictable future health/prognosis, complex role and identity challenges, unclear financial consequences, possible stigmatizing reactions, unclear relational implications, and complex interactions with the deceased donor’s family. These findings lay the groundwork for additional research on uncertainty management for transplant patients, and suggest that health care professionals and supportive others cannot apply a one-size-fits-all solution when aiding in uncertainty management.

Exploring the Presentation of News Information About the HPV Vaccine: A Content Analysis of a Representative Sample of U.S. Newspaper Articles

Approximately 20 million people in the United States have genital human papillomavirus (HPV), a sexually transmitted infection linked to cancer. We examined the news information presented about the HPV vaccine in major U.S. newspapers over the 19 months following its Food and Drug Administration (FDA) approval. To answer the question of how news information is presented in ways that might influence public health, we explored the frequency of cancer prevention and sexually transmitted infection prevention message frames used to describe the HPV vaccine, the extent to which journalists relied on official sources, and the presence of personal examples. A content analysis of 547 newspaper articles revealed that less than half of the articles provided detailed health information. Of the articles that contained a message frame, cancer prevention was most frequently employed. Government/political sources, medical doctors, and the Centers for Disease Control and Prevention (CDC) were the most commonly cited sources. Finally, we found that only 16% of all the articles we sampled featured personal accounts. Together, our findings suggest that U.S. newspaper coverage lacked detailed information about both HPV and the HPV vaccine in spite of federal approval of the vaccine, legal mandates for the vaccine, and a widespread information campaign. Implications for public health are discussed.

A Close Examination of Trait Reactance and Issue Involvement as Moderators of Psychological Reactance Theory

This study used psychological reactance theory (PRT) to investigate (a) the effectiveness of 2 message features (freedom-threatening language and character frame) and (b) the role of trait reactance and issue involvement as moderators of a perceived freedom threat. Within the context of organ donation, the results indicated no differences for character frame among the donor, recipient, or waiting list narratives. However, freedom-threatening language was positively associated with a perceived freedom threat. In turn, a perceived freedom threat was positively associated with state reactance, which was inversely, albeit nonsignificantly, associated with organ donation attitudes. Attitudes predicted intentions to be an organ donor. Results also revealed that trait reactance was positively associated with a perceived freedom threat. Although not associated with a freedom threat, issue involvement was positively associated with organ donation attitudes and intent to be a donor. Additionally, a trait reactance by issue involvement by freedom-threatening language interaction predicted a perceived freedom threat. Results are discussed with an emphasis on these moderators in PRT.

Putative secrets: When information is supposedly a secret

Secrets are common within relationships. Sometimes, unbeknownst to a secret keeper, a relational partner learns a secret but allows the keeper to believe that the secret is still unknown. This article summarizes two investigations of such instances, which we call putative secrets. Study 1 (N = 207) provided a descriptive base of putative secret topics, means by which secrets are kept, and perceived reasons for keeping secrets. Study 2 (N = 383) found that the relational impact of putative secrets depended on the secret topic, individuals’ perceptions of the topic, the ways the secret was kept, and the perceived reasons for keeping the secret. There were also theoretically interesting interactions among the reasons for keeping the secret.

Managing Multiple Goals in Supportive Interactions: Using a Normative Theoretical Approach to Explain Social Support as Uncertainty Management for Organ Transplant Patients

In this study, we used a normative theoretical perspective to examine the relationship between uncertainty management and support in the lives of organ transplant patients. We conducted in-depth interviews with 8 pretransplant and 30 posttransplant patients, including individuals who were waiting for or had received a kidney, liver, heart, or pancreas. Interview transcripts were analyzed using a grounded theory approach, which involved two levels of thematic analysis. Participants reported that others provide assistance in various ways, and that this social support entailed a number of challenges. Participants also described several strategies for handling these support dilemmas. These findings suggest that the effectiveness of support is related to how well multiple goals (including uncertainty-related goals) are managed in the supportive interaction.

Enacted Goal Attention in Family Conversations about End-of-life Health Decisions

Most extant research on end-of-life communication in families has been based on the assumption that more communication is better communication. We used a multiple goals theoretical perspective to demonstrate that the quality of communication about end-of-life decisions matters. Members of 121 older parent/adult child dyads (N = 242) engaged in an elicited conversation about end-of-life health choices and reported their assessments of the conversation. Using multilevel linear modeling, we found that outside ratings of a persons communication quality (i.e., attention to task, identity, and relational goals) as well as outside ratings of the partners communication quality were positively associated with the persons reported conversational satisfaction and hopefulness and negatively associated with the persons hurt feelings and relational distancing.

Managing Multiple Goals in Family Discourse About End-of-Life Health Decisions

Previous research on end-of-life communication in families has largely considered whether family members have talked about end-of-life healthcare (quantity of talk) but not whether certain characteristics of that discourse matter (quality of talk). In the current study, the authors adopted a multiple goals theoretical perspective to examine discursive features that individuals use to manage goal dilemmas in family conversations about end-of-life health choices. Discourse analysis of end-of-life conversations between 121 older adults and their adult children showed that participants attended to relevant task, identity, and relational goals in ways that affirmed or threatened these goals, and the ways in which certain goals were accomplished had implications for how (and whether) other goals were pursued. Findings suggest that end-of-life talk in families is most effective when family members are able to address the task of discussing end-of-life decisions while also attending to the relevant identity and relational implications of such conversations.

Using communication to manage uncertainty about cervical cancer screening guideline adherence among Appalachian women

ABSTRACT Changes to the United States Preventive Services Task Force (USPSTF) recommendations for cervical cancer preventive services have led to patient confusion, especially in medically underserved populations. We investigated how patient uncertainty concerning cervical cancer screening guidelines is appraised and managed through communication with healthcare providers by conducting in-depth, face-to-face interviews with 24 adult women between the ages of 24 and 65 (m = 41, SD = 14) living in Appalachia Kentucky. In general, participants expressed a high degree of uncertainty about the updated cervical cancer screening guidelines and appraised this uncertainty as both a danger and an opportunity. Communication with healthcare providers served both to exacerbate and to mitigate patient uncertainty. The study identifies how healthcare providers may use the change in USPSTF guidelines as a “teachable moment” to productively counsel patients on the importance of timely screening, the typical progression of certain types of high-risk HPV (human papillomavirus) infection to cervical cancer, and the importance of follow-up care.

Perceptions About Organ Donation Among African American, Hispanic, and White High School Students

We applied the Health Belief Model (HBM) to better understand perceptions of organ donation among African American, Hispanic, and White high school students. We conducted 14 focus groups with 18-year-old students to identify strategies to reach this audience when promoting the First-Person Consent Registry (FPCR) for organ donation. We found that African American, Hispanic, and White high school students are largely unaware of the need for organ donors, and are unfamiliar with how to join the FPCR. Participants identified more barriers to joining the FPCR than benefits. Two aspects of self-efficacy emerged related to joining the FPCR: decisional and task efficacy. Overall, few differences were found with respect to organ donation myths across the three ethnic groups. The results are discussed, with an emphasis on how the findings compare and contrast with previous organ donation research. We focus on message design and dissemination strategies for practitioners targeting 18-year-old high school students with organ donation promotional materials.

Do Message Features Influence Responses to Depression Disclosure? A Message Design Logics Perspective

This project uses a multiple goals theoretical perspective to examine the sophistication of responses to depression disclosure. In the first study, 504 college students imagined that a friend revealed a depression diagnosis using one of several messages exhibiting different identity management goals. Their responses were coded for expressive, conventional, or rhetorical message design logic. Variation in how depression was disclosed influenced the sophistication of responses. In the second study, 352 individuals with depression rated messages taken verbatim from the first study. Expressive messages were evaluated less favorably than conventional messages, which in turn were rated less favorably than rhetorical messages. The discussion focuses on the connection between attention to multiple goals and communication sophistication in responding to important disclosures.