Research on post-cesarean recovery predominantly addresses physical healing, while less attention has been given to how women communicate pain, seek support, and manage family expectations during recovery, particularly in rural Bangladesh. Guided by the communication theory of resilience (CTR), this qualitative study examined how 20 women navigated recovery six to twelve months after cesarean birth. Semi-structured interviews conducted in Bengali were analyzed using applied thematic analysis. Findings were organized into two main themes: enduring fear, suffering, and silence; and enabling and constraining networks during postpartum recovery. Our study extends previous CTR research by showing how Bangladeshi women perform resilience during adverse and prolonged circumstances, in embodied ways that usurp-reinforce the gendered and patriarchal status quo on multiple levels, and by navigating profound social, material, and cultural constraints. Bangladeshi women coped with their circumstances through their mothers' support and online networking. Like others who have experienced trauma, Bangladeshi mothers focused on ongoing productive adaptation to be able to survive. They felt encouraged by their digital networking through which they engaged in anticipatory resilience for more agentic possible futures and relational changes.
Mental health, like physical health, is essential to overall well-being. However, the symptoms of mental health disorders, coupled with societal understandings of mental health, often lead individuals to keep their struggles private, hindering help-seeking behaviors. This study, guided by communication privacy management theory (CPM), examined how Ghanaian celebrities navigate the decision to disclose or withhold information about their mental illnesses. Data were collected through individual semi-structured interviews with 20 Ghanaian celebrities and analyzed using the phronetic iterative approach. Participants engaged in masked, sequential, and partial disclosure patterns. The findings reveal that disclosure is not a binary decision, but a continuum shaped by cultural, relational, and professional dynamics. These findings extend CPM by introducing new disclosure patterns unique to mental illness and celebrity contexts. The reasons why participants engage in these disclosure patterns include lack of trust, public image and reaction concerns, and fear of their mental struggles being downplayed. These reasons illustrate how concerns about reputational harm and past confidentiality shape the regulation of privacy boundaries among Ghanaian celebrities. The findings challenge assumptions about collectivist cultures, such as Ghana, by showing that individuals still maintain strong privacy boundaries around stigmatized health topics. It also expands CPM's applicability to celebrity and artistic contexts. Practically, the findings suggest that mental health professionals should develop culturally sensitive, trust-centered approaches that support gradual disclosure.
Loneliness among older adults is a growing public health concern, given its close association with their overall well-being. Drawing on the social surrogacy hypothesis, which suggests that parasocial relationship (PSR) can provide a sense of belonging and social connection, this study examined whether PSR is indirectly associated with subjective well-being through different dimensions of loneliness among older adults. Specifically, we adopted a multidimensional perspective on loneliness by distinguishing among family, romantic, and social loneliness. We also investigated whether these indirect associations would be moderated by gender. Using cross-sectional survey data from 934 adults aged 60 and over in South Korea, we found that PSR was indirectly associated with positive affect and life satisfaction through romantic and social loneliness. Notably, the indirect effects of PSR on positive affect and life satisfaction through social loneliness varied by gender, such that these effects were significant for older men but not for older women. These findings extend the social surrogacy hypothesis to understanding PSR's role in older adults' loneliness and well-being.
The pervasive use of digital media before sleep is increasingly recognized as a critical factor affecting sleep and psychological well-being. However, the impact of bedtime media at different stages-specifically, before bedtime and before shuteye-remains unclear. Using data from the United Kingdom Time Use Survey collected between 2016 and 2021, this study analyzes 3,044 diary entries from 1,577 adults aged 18-45, aiming to investigate the relationship between bedtime media use, sleep delay, and anxiety. Results indicate that pre-shuteye media use significantly delays sleep and increases anxiety, while pre-bedtime media use does not delay sleep but is directly associated with reduced anxiety. Notably, as a key mechanism through which digital media use impacts anxiety, both bedtime and shuteye time reflect delayed sleep, with shuteye time playing the primary role. This study contributes to our understanding of shuteye time as a mechanism in media effects, shedding light on the source of anxiety among adults.
Health journalists provide essential, verified information on a range of topics including wellness, medical research, health policy, and health business. We conducted a national online survey of US health journalists (N = 629) to investigate how occupational practices and perceptions vary for health journalists who specialize in different health topics. Latent class analysis identified four distinct health beats: personal health and wellness, health sciences and research, health business, and health systems. The four beats are associated with variations in how journalists frame stories, the reach of the outlets they work for, whether they are staff or freelancers, how much of their reporting work is about health, as well as their job satisfaction and autonomy to choose topics and frame stories. Comparing health beats highlights distinctions in how health journalists consider health beyond the individual level, including public health, social determinants of health, and health policy, and how local journalists differ from national health journalists in their emphasis on health systems, health policy, and other issues of immediate relevance for communities.
Framing research in health persuasion, predominantly grounded in Western individualist cultures, has largely examined gain-loss messages that target benefits to the self or close others. Whether this individual-centric paradigm fully captures the persuasive logic of smoking cessation messages in the collectivist cultural contexts remains an open question. This study introduces and tests a nation-benefit gain-loss framing in China. We conducted a 2 (gain-loss framing: gain vs. loss) × 3 (beneficiary focus: self, other, nation) between-subjects experiment with adult smokers in China (N = 727). Results showed that nation-benefit messages produced significantly higher intentions to quit than self- or other-benefit messages. Perceived national benefit mediated the relationship between nation-benefit framing and quit intentions. Furthermore, this relationship was moderated by nationalism, such that the positive influence of perceived national benefit on quit intentions was stronger among individuals with higher levels of nationalism. This research contributes to health communication theory by demonstrating that in collectivist contexts, appealing to a higher-order collective good can be a potent persuasive strategy. Our findings extend framing research beyond predominantly self- and other-benefit approaches and offer evidence-based implications for anti-tobacco communication in China, and potentially in other settings where nation-benefit appeals are culturally resonant.
Although Black women represent 13% of the population of women, nearly 50% of HIV acquisitions among women occur in Black women. Pre-exposure prophylaxis (PrEP) is a highly effective and widely available biomedical HIV prevention option. Despite the medication's efficacy and availability, most women who could benefit are not using it. Although PrEP can be used autonomously and discretely, many women who wish to use it may feel obligated to disclose PrEP use to male sex partners and may experience partner resistance to their utilization of PrEP, undermining PrEP's potential for autonomous use and its efficacy. This study examines the process of disclosing the intention to use PrEP to sexual partners among women in a high-prevalence community. We analyzed interviews from (N = 23) adult, sexually active Black cisgender women. We conducted reflexive thematic analysis, followed by co-occurrence analysis, to identify (a) reasons for disclosure, (b) anticipated partner responses to disclosures, and (c) the strategies women anticipate using to disclose. Results demonstrate that many women would disclose PrEP use to their partners. Respondents commonly cited relationship- and partner-motivated reasons and anticipated using direct strategies to disclose. Others described entrapment and incremental strategies for disclosure. Although some participants anticipated supportive responses to their disclosure, others reported uncertainty about their partner's response as well as anticipated negative emotional reactions and/or conflict/accusation. Results demonstrate that programs to cultivate women's skills for negotiation of safer sex via PrEP are needed to support women's uptake of this important innovation.
Social media is a key source of health messages. Advancing theory of memorable messages (ToMM), we examine the manifest content of memorable health messages received by college students (N = 271) from social media platforms (RQ1) and identify ways in which they perceive those memorable health messages have shaped their health beliefs and behaviors (RQ2). We employ thematic co-occurrence analysis to examine co-occurrences among types of memorable messages and health beliefs and behaviors (RQ3). We denoted two co-occurrence relationships, one relationship ("A") between universalized health prescriptions and verifying the information and/or making lifestyle changes, and one relationship ("B") between individualized health encouragement and enhancing health autonomy. An overwhelming majority of memorable messages reported were from creators or influencers that participants did not follow or interact with beforehand, complicating the longstanding assumption that memorable messages emerge primarily from interpersonal relationships. We extend ToMM by conceptualizing memorable messages as platform-mediated communicative artifacts, complicating implicit understandings of message memorability, proposing a normativity-autonomy continuum, and centering health information management practices as mechanisms that might explain how memorable messages shape health beliefs and behaviors.
This study examines older adults' psychological reactance to child-to-parent health misinformation interventions by attending to relational concerns regarding parental authority, as well as how such reactance is linked to problematic health information and family communication practices. We surveyed 428 Chinese older adults aged 60 and above. Structural equation modeling indicates that threat to behavioral freedom and threat to parental authority function as factors of reactance, with threat to parental authority conceptualized as a role-based social value threat. Psychological reactance is associated with orientations toward older adults' practices often discussed as problematic in health and family communication contexts, including tendencies toward unverified health information sharing and avoidance of health-related communication with adult children. Perceived communication style was central: autonomy-supportive prevention was negatively associated with both threats, whereas controlling prevention was positively associated with both. Correction was mainly associated with threat to behavioral freedom, although autonomy-supportive correction was directly associated with lower health communication avoidance. These results advance theoretical understanding of psychological reactance as a relationally embedded phenomenon and offer insights into factors associated with problematic health information practices and intergenerational communication among older adults.
This study examined whether social media use for health purposes is associated with support for tobacco control policies among individuals with a family history of cancer. We employed a moderated mediation framework and analyzed the Health Information National Trends Survey (HINTS 5, Cycle 4; N = 2,671) data, a nationally representative sample collected from the United States. We found that cancer worry mediated 4.6% of the total effect, with smoking status positively moderating this pathway. While nonsmokers showed higher baseline support, smokers exhibited steeper increases in policy backing as cancer worry intensified. Results aligned with the stimulus-organism-response (S-O-R) model, suggesting targeted social media messaging could enhance tobacco policy advocacy, particularly for smokers with familial cancer risks. The study offers theoretical contributions to public health and health communication, as well as practical implications for policymakers and the general public.
Routine enquiries about violence in antenatal care are recommended in many countries, yet little is known about how such questions are designed in practice and how different ways of asking may shape pregnant women's opportunities to respond. This study examines how midwives ask about violence in Norwegian antenatal care consultations. These data comprise 35 video- and audio-recorded first and second antenatal consultations with eight midwives, of which 20 included routine enquiries about violence. Using conversation analysis, we identified four recurring question formats: bare category questions, post-answer specifications, within-question specifications and concrete-act questions. Bare category questions treated violence as a self-evident gloss and commonly occasioned minimal, sequence-closing denials. Post-answer specifications introduced clarification only after an initial denial, thereby reinforcing the answer rather than reopening the enquiry. Within-question specifications progressively unpacked the category of violence before a response was required, making narrative or transformative responses relevant next actions. Concrete-act questions avoided category labels altogether and instead invited responses to specific behaviors, supporting uptake based on lived experiences. Taken together, the findings show that routine violence enquiry cannot be understood as a uniform yes/no screening item: rather, whether, how, and when "violence" is specified or described through word selection may influence what types of responses become relevant. The study contributes to health-communication research by demonstrating how guideline-recommended questioning is accomplished turn by turn and discusses implications for communication training and policy implementation in antenatal care.
The COVID-19 pandemic revealed stark racial and ethnic disparities in illness and death, exposing decades of neglect and discrimination. While the news media has played a crucial role in calling attention to these disparities, it is important to examine how this information has been conveyed. Drawing on structural violence and news framing analytical frameworks, we qualitatively analyzed early COVID-19 coverage of racial health disparities in two major US regional newspapers: Los Angeles Times (California) and Dallas Morning News (Texas), representing states led by different political parties. An inductive thematic analysis of 75 news articles revealed three key themes: (1) the urgency and demands for comprehensive COVID-19 data disaggregated by race to make visible the disproportionate impact on marginalized communities enabling timely interventions; (2) the pervasive web of structural inequities and systemic racism that functioned as underlying structural drivers of these disparities; and (3) the influence of state-level pandemic policies and the varied public responses shaped by differential access to privilege and race/ethnic identity. Overall, our analysis shows that, despite limited coverage of the COVID-19's impact on racial minorities, both newspapers prioritized community concerns and lived experiences, departing from typical color-blind framing. These findings emphasize the potential of local journalism to amplify marginalized voices and address health crises in their communities (and beyond), while highlighting the persistent need to challenge the ideological foundations of structural racism.
This study explores the perceptions, understanding, and behaviors regarding health-related risk issues reported in interviews with 21 Hispanic female agricultural workers living and working in central Florida. Results reveal that these farmworkers are aware of many health risk issues facing women in their communities, and realize the relevance and impact of them on their health, safety, and well-being (affective learning). They also actively seek information about these risks and pursue support to both treat and prevent them (behavioral learning). However, results also reveal learning gaps in terms of unintelligible health information (cognitive learning) and pursuing expert medical support regarding physical and mental illnesses, as well as abuse (behavioral learning). Finally, this study extends the IDEA model theoretical framework in two important ways. First, it employs the model as both theory and method. In doing so, it confirms the utility of the IDEA model for both collecting and examining interview data provided by underrepresented populations regarding health risk issues. Second, it employs the model effectively as a pre-assessment tool to identify internal and external learning gaps in affective learning perceptions, cognitive learning comprehension, and behavioral learning actions regarding health-related risk issues. As such, it provides a foundation upon which future research may construct and implement authentic learner- and learning-centered strategic instructional health risk communication interventions directly targeting identified gaps in what female agricultural workers currently believe, know, and do. Finally, the study also identifies recommendations for future research focused on health-risk communication as it may inform strategic instructional interventions.
Communication during cancer often constitutes significant "communication work," demanding time, energy, and cognitive resources, as conceptualized by the integrative theory of communication work (ITCW). This burden is exacerbated for vulnerable populations, such as female migrant domestic workers (MDWs), who face additional challenges, including dependency on employers for healthcare access, precarious employment, language barriers, and limited social support. This qualitative study, drawing on focus group discussions with Filipino MDWs diagnosed with cancer in Hong Kong, explores factors that affect their communication work. Our analysis reveals that several personal, social, structural, and informational factors complicate MDWs' communication work during the diagnosis and treatment of cancer. These findings extend the ITCW framework to MDWs with cancer, offering insights into the unique burdens they face and informing strategies to reduce communication work, conserve resources, and improve health and well-being.
Based on regulatory focus theory and framing theory, this study employed a 2 (message framing: gain vs. loss) × 2 (regulatory focus: promotion vs. prevention) between-subjects experiment to examine American parents' willingness to vaccinate their 5- to 11-year-old children against COVID-19. Our findings indicate that the direct effect of message framing was minimal. Messages were more persuasive when framing valence was matched with participants' chronic regulatory focus. Loss-framed messages when matched with a prevention focus-and gain-framed messages matched with a promotion focus-were more effective in increasing risk perception, vaccination attitude, and intention than mismatched conditions. Furthermore, processing fluency mediated the relationship between regulatory fit and persuasive outcomes. This study contributed to the existing literature on health behavioral change and offers important practical implications for health communication practitioners and policymakers. Limitations were acknowledged, and directions for future research were proposed.
With the growing use of artificial intelligence (AI) chatbots and online medical consultation, individuals seeking health information increasingly face not only the question of whether to seek information, but also which source to consult. Integrating the risk information seeking and processing (RISP) framework with the concept of source credibility, this study examines how risk-related motivations and credibility-related evaluations shape preferences for AI chatbots versus online human doctors. In an online experimental survey (N = 248), participants were randomly assigned to a higher-sensitivity topic (sexually transmitted diseases) or a lower-sensitivity topic (seasonal allergies). Regression analyses revealed an overall preference for online human doctors. Informational subjective norms emerged as the strongest predictor of source choice, increasing the likelihood of preferring online human doctors, while positive channel beliefs in AI significantly predicted preference for AI agents across conditions. Importantly, higher perceived information-gathering capacity was associated with greater preference for AI in low sensitive context. Topic sensitivity influenced source preference indirectly through subjective norms, whereas affective responses and knowledge-related factors showed limited effects. These findings suggest that RISP-related motivations explain when health information seeking becomes salient, whereas source credibility considerations help explain how individuals translate those motivations into source preferences. The study contributes to research on digital health communication by clarifying how human and AI sources are evaluated in contemporary health information environments.
There has been growing concern about the potential negative consequences of misinformation on behavioral choices. The reasoned action approach, a theory of behavior, suggests that only the misinformation beliefs that are explicitly about the consequences of a given behavior will directly affect behavioral outcomes. Our prior research supports this claim. Still, this theory accepts that other misinformation beliefs-those that are not directly about the consequences of a behavior-might still affect behavior by shaping the behavioral, normative and/or control beliefs that directly affect the behavior. This study asks whether this effect is supported empirically. Using nationally representative longitudinal survey data, the present study provides evidence that general misinformation beliefs about the coronavirus at baseline (although previously shown to not have direct effects on behavior) were negatively associated with subsequent behavioral beliefs about the benefits of two recommended COVID-19 protective behaviors: social distancing (B = -0.21, SE = 0.04) and facemask-wearing (B = -0.26, SE = 0.04). Prior work has shown that these same behavioral beliefs were longitudinally associated with future engagement in the protective behaviors. Based on these findings, we consider whether misinformation beliefs are worthwhile targets for campaign messages.
Patient portal use has been linked to increased patient engagement, improved relationships with healthcare providers, and higher patient satisfaction. The current study aimed to contribute to patient portal research by proposing the breadth of functions utilized and the breadth of healthcare entities connected as two novel ways to conceptualize and operationalize patient portal use, updating the research on the disparities in patient portal access, and examining differentiated use of patient portals beyond the dichotomy of access vs no access. We analyzed Health Information National Trends Survey (HINTS) 7 data with the full-sample person weights and replicate weights. More than two-thirds of the U.S. adult population had patient portal access, but the vast majority of them accessed patient portals less than once every two months on average. Making appointments, messaging providers, looking up test results, and viewing clinical notes were used by more than half of the U.S. adult population. Primary care providers were the most widely connected entities, with other providers, insurers, clinical labs, pharmacies, and hospitals showing a low level of connection to patients via portals. In the United States, both unequal access and differentiated use exist between sociodemographic groups, highlighting the need for continued monitoring and concerted efforts to address them. At the same time, a close examination of the factors that led to the higher access rates and beneficial uses by traditionally disadvantaged groups-women and people with poorer health-could offer effective strategies to close the gaps.
Despite evidence that there is a link between exposure to alcohol-related content on social media and alcohol use, there has been less focus on testing the underlying mechanisms that explain the link. Findings from the primary studies that test the mechanisms are fragmented and inconsistent, with no systematic synthesis to date. We aimed to identify what mediators had been tested that may explain the link between exposure to alcohol-related content on social media with alcohol use. We conducted a systematic search of five major databases (MEDLINE, PsycINFO, CINAHL, Web of Science, and ProQuest). Article selection and data extraction were performed independently by at least two reviewers. The pooled indirect effect of social media alcohol exposure via the selected mediators was estimated using a two-stage meta-analytic structural equation modeling approach. Of the 397 articles screened, 10 studies met the inclusion criteria. Overall, social norms were the most common mediator examined. Our meta-analysis found significant indirect associations between social media alcohol exposure and alcohol use via descriptive norms (B = 0.07; 95% CI: 0.05-0.10) and injunctive norms (B = 0.05; 95% CI: 0.02-0.07). Other mediators identified included drinking motives, alcohol-related beliefs (e.g., "drinking makes socialising easier"), drinking identity, and poster prototypes (i.e., perceptions of the typical people who post alcohol-related content). Exposure to alcohol-related content on social media was indirectly associated with alcohol use through psychosocial factors, mainly perceived social norms. Norms-focused strategies (e.g., personalized normative feedback) may be a useful component of multi-component interventions, alongside approaches targeting other pathways.
Despite the routine use of a variety of message evaluation (ME) measures (e.g., perceived message effectiveness) in formative research for tobacco education campaigns, studies assessing the validity of these measures for predicting actual message effectiveness (AME) (e.g., intention to use e-cigarettes) are needed. A within-subjects experiment with adolescents (N = 2,120) was conducted with youth-focused e-cigarette prevention ads to examine and compare the validity of 10 ME measures often used in message pretesting studies. Aggregate message-level ME scores were created and their relationship with outcomes commonly targeted by tobacco prevention campaigns was assessed, while controlling for individual characteristics and baseline measures of the outcomes. More ME measures predicted intention to use e-cigarettes than other e-cigarette-related outcomes. Perceived message effectiveness (PME), assessed as message perceptions and as effects perceptions, psychological reactance, and perceived argument strength were the strongest predictors of intention to use e-cigarettes. Other ME measures, such as information seeking and positive emotional reactions, predicted outcomes that PME measures did not. However, due to the use of aggregate message-level ME scores, none of the ME measures were particularly strong predictors of AME. The lack of variation in the association between ME measures and intention to use e-cigarettes by e-cigarette use status suggests these ME measures are broadly applicable. These findings support the validity of ME measures and suggest that to better anticipate potential message effects on multiple tobacco education campaign outcomes, it may be worthwhile to include other ME measures in addition to message or effects perceptions in message pretesting.
