Katherine Miller

Hispanic Cultural Norms for Health-Seeking Behaviors in the Face of Symptoms

This study examines factors that contribute to the delayed use of medical care among Hispanics when chronic disease–related symptoms (warning signs) occur. As an adjunct to a larger project funded by the National Cancer Institute, this study accessed a population of primarily Hispanic, mostly male employees at public work sites in two Arizona counties. Through focus groups and a survey of employees, a model describing the factors underlying health care use was tested. Seriousness of symptoms has the most effect on visits to doctor, with more serious symptoms leading to prompter visits. Faith in God and seriousness of symptoms both are related to the search for a doctor one can trust. Also, a cluster of variables describing past bad experiences, practical barriers, and emotional avoidance are related to the desire to get advice or medical help from someone who is close; these influence the search for a trusted doctor, which in turn leads to prompter visits to doctor.

Compassionate Communication in the Workplace: Exploring Processes of Noticing, Connecting, and Responding

This research contributes to the growing body of literature exploring emotion and communication in the workplace by considering the workers in a variety of jobs that require “compassionate communication.” Compassion is conceptualized as one form of emotional work and is theoretically developed through a model that highlights the subprocesses of noticing, feeling, and responding. Analyses of interviews with 23 workers in a wide range of human service jobs indicated a number of complexities in the communication of compassion in the workplace. Processes of “noticing” included both noticing the need for compassion and noticing details of clients’ lives in order to communicate more successfully in compassionate ways. Processes of “connecting” included both emotional processes (empathy) and cognitive processes (perspective taking). Processes of “responding” included both nonverbal strategies, such as immediacy behaviors and environmental structuring, and verbal strategies for balancing the informational and emotional content of messages. These results are interpreted in the light of both contemporary and traditional communication theory, and practical implications are presented for human service workers and others involved in compassionate communication in the workplace.

Strategic ambiguity in the role development process

Abstract Todays turbulent business and social environment often compels organizations to adopt internal programs that will help them cope with complexity. One organizational sector in which this is particularly true is the health care industry, as managed care programs and competitive forces have changed the way hospitals and clinics operate. This study looks at a specific organizational program designed to cope with these industry changes and considers the impact of the program on the nurses involved. Drawing on theory and research on role development and strategic ambiguity, this case analysis looks at a hospital system in which the nursing role of “care coordinator”; was defined in a strategically ambiguous way. After analyzing interviews with 19 care coordinators, conclusions are drawn regarding affective reactions to strategic role ambiguity, behavioral adaptation to strategic role ambiguity, and the importance of conceptualizing role ambiguity as a systemic process.

The dialectics of care: communicative choices at the end of life.

Communication at the end of life poses important challenges for patients, families, and caregivers. Previous research on end-of-life communication has concentrated on areas including the provision of bad news and clinical and personal decision making. In this study, we turn our attention to the processes through which caregivers provide comfort in palliative care. Our ethnographic and interview study of spiritual communication among hospice workers and their patients is guided by a dialectical framework. We find a central dialectic in which hospice workers recognize the tension between “leading” and “following” patients and families in discussions of spirituality at the end of life. Our analysis reveals that though some care providers choose one pole of this dialectic, most workers try to manage the dialectic by shifting between leading and following in different situations or different points in time or by transcending the dialectic and addressing the multiple goals of interaction.

Financial Feeling: An Investigation of Emotion and Communication in the Workplace

There is growing interest in the role of emotion when considering communication in the workplace. This work has most often considered workers in front-line service positions in investigations of emotional labor, and human service workers in investigations of empathy and emotional work. In this study, we consider processes of both emotional labor and emotional work in the financial planning profession. Financial planners occupy a role requiring ongoing relationships with clients, conversations about the often emotional topic of money, and a need to manage emotion in a variety of interaction contexts. Thus, from extant theory and literature regarding emotion and communication, we proposed research questions regarding the roles of emotional labor and emotional work in the financial planning profession. These questions were investigated in a web-based survey study of almost 300 professional financial planners and supporting interviews with 14 financial planners. Results indicate support for existing theory on emotional work, extensions to current research regarding emotional labor, and important implications for the role of emotion and communication in a range of professional service roles.

Making Sense of Sibling Responsibility for Family Caregiving

As the population in the United States and around the globe ages, families are faced with decisions about caregiving for elderly parents. Research suggests that daughters often take on these stressful caregiving responsibilities, with varying levels of help from siblings. In this article, we examine these sibling relationships within the caregiving context, considering the ways in which siblings negotiate the division of tasks for elderly parents and make sense of siblings who provide little help in caregiving activities. Our content analysis of interviews with 25 family caregivers indicated that there was little negotiation of caregiving tasks. Furthermore, family caregivers make sense of sibling participation in caregiving in three ways. First, some caregivers account for caregiving as an individual activity for which they are especially suited. Second, some caregivers see caregiving as stemming from values about family life, but excuse nonparticipant siblings by defining them as outside family boundaries. Finally, caregivers with strong family values who could not make sense of siblings through an exclusionary frame engaged in verbal backtracking during the telling of their stories as a way of making sense of personal caregiving responsibilities.

Providing Care for Elderly Parents: A Structurational Approach to Family Caregiver Identity

Because of expanding life spans and the increasingly chronic nature of disease, caregiving is becoming a dominant activity in todays society. Caregiving for elderly parents has been identified as a complex activity involving the balancing of many tasks and roles, and an activity that has the potential for both intense stress and for psychological and relational rewards. In this study, we consider the complexity of caregiving by examining the identity and identification processes of family caregivers. Taking a structurational approach to identity and identification, we examine in-depth interviews with 11 caregivers of elderly parents. The narratives and comments provided by these caregivers led us to the consideration of two major structures influencing the identity of family caregivers: structures of parenting and structures of competence. We explore the nature of these structures in terms of the ways they are adapted and transformed in the identification of caregivers and the way they influence rewards and stresses in the caregiving role. Our analyses point to complex adaptations of these private (family) and public (competence) structures, and to both functional and dysfunctional transformations of these structures in the caregiving role.

Family Communication, Self-Efficacy, and White Female Adolescents' Risk Behavior

This study examines perceived family communication culture, social identity, development of communicative self-efficacy, and reported risk behaviors for adolescent girls. Twenty-five women between the ages of 18 and 20 were interviewed and transcripts were analyzed using grounded theory (Strauss & Corbin, 1990). The results suggest that there are indeed links between family communication culture, social identity, communicative self-efficacy, and risk behavior. Implications for future research and practice are discussed.

Communication, risk behavior, and perceptions of threat and efficacy: A test of a reciprocal model

Abstract Despite empirical and anecdotal evidence of the growing problem of alcohol use and abuse on college campuses, there is a high level of uncertainty regarding factors contributing to this particularly risky behavior. Past research has argued persuasively for the role individuals’ level of self‐efficacy and perceptions of threat or susceptibility play in decisions to engage (or not engage) in a variety of behaviors (Witte, 1992). However, factors contributing to the development of these perceptions of self‐efficacy and threat have yet to be completely understood. The present investigation argues that it is through our interactions with others, as well as our personal experiences with risky behaviors, that we develop perceptions of threat and efficacy. Recognizing, however, the complex and reciprocal nature of the attitude‐behavior relationship, this paper explores the intricacies of the relationships among communication, threat, efficacy, and behavior. 239 undergraduates at a medium‐sized northeaste...

Communication in the Age of Managed Care: Introduction to the Special Issue

T wo decades ago, one would be hard-pressed to find a single scholarly article on managed care, let alone a special issue of a journal devoted to the topic. Hacker and Marmor (1999) claim that the term “managed care” was still being introduced and explained to the public in the New York Times as recently as 1989. Managed care, though, has quickly become the predominant method of providing health care in the United States. In 1996, managed care organizations had enrolled between 80 and 90% of individuals who had health insurance (Brider, 1996). This is remarkable considering that fee-for-service health care was clearly the system most people were familiar with in the 1970s and the start of the 1980s. Traditional fee-for-service, where a patient acts as a bill-payer and is reimbursed through an indemnity insurance plan, is no longer the dominant method of payment—indeed, fee-for-service now accounts for just 2% of private health plans (Hacker & Marmor, 1999). Thus, in just 20 years, the way Americans offer, receive, and discuss medical treatment has radically changed. Managed care, along with its many acronyms (the two most widely used are probably HMOs—health maintenance organizations—and PPOs—preferred provider organizations), has found its way into the lexicon of everyday life. While the roots of managed care can be traced back to just after World War II, this delivery and payment system did not gain in popularity until the mid-1980s when health care costs skyrocketed and companies searched for ways to reduce costs (Lammers & Geist, 1997). The soaring costs were a result of a variety of factors, including the increasing life expectancy of Americans and increasing technological sophistication of medicine. And, when government health care programs like Medicare and Medicaid offered no real incentive to providers for keeping costs down, it is little surprise that health care costs spiraled out of control. As a result, employers supplying health insurance for their employees were struggling to keep up. A survey of 300 companies in New England between