Theses and Dissertations from UMD
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Item #ISOLATEDNOTALONE DURING COVID-19: EXTENDING THE SITUATIONAL THEORY OF PROBLEM SOLVING TO ONLINE ABUSE INTERVENTION CAMPAIGNS(2023) Dias, Shawna; Aldoory, Linda; Communication; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Domestic abuse has long been regarded as a significant public health issue, but intimate partner violence cases increased dramatically during the COVID-19 pandemic, leading some reporters to label it as “an opportunistic infection.” The United Nations attributed the increase in domestic abuse to COVID-19 quarantines and shelter-in-place orders, which forced victims to remain trapped in their homes with their abusers. Cosmetics brand, Avon, which has a history of responding to women’s health issues, launched the #IsolatedNotAlone abuse intervention campaign on its social media platforms. The campaign sought to educate the public about the ubiquitousness of domestic abuse and inform victims about available intervention resources. The #IsolatedNotAlone campaign was most active during the spring and summer months of 2020. During that time, the campaign reached an estimated 2.9 million social media users and provided supportive services to nearly 16,000 domestic abuse survivors. Although the campaign was a success, it didn’t reach near as many social media users as other abuse-related initiatives, like the #MeToo movement, which achieved 12 million reposts within its first 24 hours.This dissertation explores the usefulness of the Situational Theory of Problem Solving (STOPS) for understanding how publics organize and react to #IsolatedNotAlone and similar abuse intervention campaigns. STOPS is commonly used to examine public reactions to organizational crises, but this dissertation took an alternative approach and examined its applications for health communication. The research questions ask how situational antecedents, as outlined in STOPS, motivate social media users to learn more about domestic abuse, and how situational motivations and referent criteria influence the communicative actions of social media users. Additionally, the research questions ask how communicative behaviors influence online social support group formation and organization. The sample in this research included ethnically diverse men, women, and non-binary participants who identified as white, Black, Native American, Asian, and Hispanic. I chose to keep the sample demographics wide because I wanted to better understand how diverse groups experience and understand domestic abuse and domestic abuse intervention messages, and their motivations for communicating or not communicating about abuse. Twenty-eight social media users participated in semi-structured qualitative interviews via telephone or Zoom. The data suggests social media users with alike situational antecedents are similarly motivated to communicate about domestic abuse interventions unless they individually recognize significant constraints. Individuals with strong problem recognition and involvement recognition display a wider range of communicative actions than those with low problem recognition and involvement recognition. Based on the findings, this study produces practical implications for abuse intervention message design and distribution. The findings also demonstrate that STOPS has some utility for understanding public response to health intervention messages, though the framework may require adaptation for use in future health communication initiatives. The data suggest that referent criteria, time, and power have a larger role in health communication and influence audience members’ problem recognition, involvement recognition, and communicative actions.Item The Health Literacy Process Older Adult Long-Term Smokers Use to Make an Informed Decision about Lung Cancer Screening: A Grounded Theory Study(2019) Platter, Heather N; Feldman, Robert; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Lung cancer is the leading cause of cancer-related death in the United States with 160,000 annual deaths. Recent advances in screening technologies have proven effective in reducing mortality and increasing early stage detection of lung cancer, yet only 3.9% of the 6.8 million eligible Americans were screened in 2015. Potential barriers to lung cancer screening have been examined; however, there is limited research available on the impact of health literacy and the process of informed decision-making about lung cancer screening. To fill this gap, this study explored how health literacy relates to intentions and behaviors to screening for lung cancer among long-term smokers between 55 to 80 years old who have a 30-pack year smoking history, health insurance, and a provider seen in the past two years. The study was guided by the following research question: “How does health literacy relate to intentions and behaviors to screen for lung cancer?” Twelve participants (N=12) were enrolled in the study. Participants were 58.3% female, 83.3% black, 83.3% had screened for any cancer besides lung cancer, and 75% were current smokers with a 41.8 mean pack-year history. The majority of the sample (91.7%) had adequate health literacy based on the Short Test of Functional Health Literacy in Adults. Data were transcribed verbatim and analyzed using constructivist grounded theory methods, proceeding through four stages of coding (open, focused, axial, and theoretical). Analysis produced a Health Literacy Theoretical Model of Informed Decision-Making about Lung Cancer Screening. The theoretical model is underpinned by a core category: Making an Informed Decision about Lung Cancer Screening. This core category is supported by eight categories characterizing how health literacy relates to lung cancer screening among older adult long-term smokers, including Health Information Seeking Behaviors, Trusted Sources, Knowledge, Trusted Provider, Advocacy, Perceived Risk, Patient-Provider Communication, and Shared Decision-Making. This is one of the only known studies that describes the health literacy process of informed decision-making about lung cancer screening. The results of this grounded theory study have several implications for public health practice, research, and policy and have the ability to increase lung cancer early detection and survival.Item EXAMINING THE GET YOURSELF TESTED CAMPAIGN: HOW ONLINE INFORMATION SEEKING AND SEXUAL HEALTH PERCEPTIONS INFLUENCE EFFICACY AND COMMUNICATIVE ACTION(2013) Briones, Rowena Lyn; Aldoory, Linda; Communication; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The purpose of this study is to explore young adults' meaning construction of sexual health, sexual health campaigns, and online sexual health information through the lens of the GYT: Get Yourself Tested Campaign. A secondary purpose is to develop theory in the area of e-health. Finally, this study will offer practical recommendations to the CDC's Division of STD Prevention, one of the developers of the GYT Campaign, on how to better disseminate sexual health information to young adults via the online space. The theoretical frameworks chosen for this study are the health belief model (HBM) and the situational theory of problem solving (STOPS). Additionally, literature pertaining to campaigns, e-health and sexual health contributed to this study. The integration of these theories within this scholarly body of knowledge demonstrated the potential for merging communication theory and health behavior theory for future scholarship and practice. A qualitative research methodology was used to collect and analyze data. Specifically, 50 in-depth interviews and five focus group sessions with young adults provided insight on how they made meaning of sexual health, online information seeking, and the GYT campaign. Analytical techniques from the grounded theory approach were used to analyze these data. A constructionist/interpretive research perspective was the guiding epistemology to situate this audience-centered study. Themes emerged regarding sexual health perceptions, online information seeking, HBM/STOPS, and campaign development. Findings suggested that young adults were aware of the issue of poor sexual health, but faced a number of constraints that prevented them from reaching their optimal health potential. These were alleviated by the benefits of searching for information online. This study contributes to the scholarly body of knowledge by integrating theories and applying it to an online context. Furthermore, this study demonstrates the utility of an integrated HBM/STOPS framework in campaign planning, which was explicated through the development of the E-Health Information Management Model (E-HIMM). The findings revealed that the integrated constructs from both theories were readily present in the knowledge, attitudes, and behavioral intentions of the participants, which could provide useful evidence for campaign developers when constructing messages for the young adults audience.Item WOMEN'S VOICES: INTEGRATING DIFFUSION OF INNOVATIONS THEORY WITH SOCIAL MARKETING TO UNDERSTAND WOMEN'S HEALTH(2012) Sundstrom, Beth Lee; Aldoory, Linda; Communication; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Women's health serves as a marker for societal health and wellness. Women champion access to health care services for their children and families. The mother-child dyad provides a unique view of the duality of women's reproductive health. Particularly in the time period following the birth of a child, the health of mother and baby remain inextricably linked. This study focused on biological mothers of newborns. The purpose of this study was to explore how biological mothers of newborns made meaning of health. A secondary purpose of this study was to explore how women made meaning of current social marketing campaigns targeting their health. The theoretical goal of this study was to elaborate conceptual opportunities for the integration of diffusion of innovations theory within a social marketing framework. Literature regarding social marketing, diffusion of innovations theory, and women's health contributed to this study. The literature review suggested the potential to apply diffusion of innovations theory to a social marketing framework in order to better understand women's health and the health of their families. A qualitative research methodology was used to collect and analyze data. Specifically, 44 in-depth interviews with mothers of newborns provided insight into how these women made meaning of their health. Analytical techniques from the grounded theory approach were used to analyze these data. A feminist research perspective situated this study as praxis-oriented audience research to uncover new mother's health needs within a social marketing framework. Themes emerged regarding social marketing, diffusion of innovations theory, and women's health. Findings suggested that these mothers of newborns embody and challenge the mother-child dyad in various ways, resist the biomedical paradigm, and envision new ways to interact in their social networks. This study contributes to the social marketing scholarly body of knowledge by developing the application of diffusion of innovations as a particularly relevant and useful theory. Results indicate that diffusion of innovations theory offers an audience segmentation opportunity based on innovativeness and adopter categories. Findings suggest opportunities to apply diffusion of innovations theory within a social marketing framework to better understand women's health and the health of their families.Item Situating Organizational Participation, Discourse, and Development at Two Key Global Maternal Health Conferences: A Critical-Cultural Analysis(2012) Hobler, Mara R.; Aldoory, Linda; Communication; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This dissertation studied discourse produced by development organizations for and about the global maternal health problem (GMH). Discourse analysis was conducted to answer two research questions: How did distinctive organizations engage in the Women Deliver and Global Maternal Health conferences; and how did the organizations represent the problem of GMH at the conferences (Carvalho, 2008)? This analytic inductive study considered distinctions between GMH organizations and examined how organizations exhibited constitutive (reified) understandings. The global development community has sharpened its focus on GMH due to the lack of progress toward the Millennium Development Goals. Goal five (reduction of maternal mortality), is the farthest behind. Estimates suggest that 1,000 women currently die during pregnancy and childbirth daily (WHO, 2011). Correspondingly, organizations have publically expressed renewed commitments. Organizational (Ashcraft & Mumby, 2004), postmodern scholars (Holtzhausen & Voto, 2002), and critical global public relations scholars (Curtin & Gaither, 2007; L'Etang, 2005, 2010) claim that meaning production occurs through hegemonic public relations. The purpose of this dissertation was to extend the field's understanding of manifestations of organizational power and discursive meanings. In total, 72 units of data were analyzed from a purposive sample of six organizations. Codes were assigned 1603 times and reduced using Charmaz's (2006) emergent coding scheme. For validity, member check discussions were conducted with eight individuals. Findings revealed that advocacy was woven into meanings at the conferences; seen through organizational identity, speaker identity, and conceptual identities. Organizations sought recognition and legitimacy, and agreement with other organizations. Power and hierarchy undermined messages of accountability, integrity, and rights. Significantly, development discourse was univocal, as suggested by symbolic representations of organizational roles and identity constructions. Discursive themes of policy, progress, health, and measurement regulated representations. However, divergent meanings did create contradictions between understandings. Consistent with theory, meanings were fluid and unfixed, but had historical and political significance. This dissertation met the need for public relations theorists to embrace the circuit of culture as a means of capturing discrete meanings. The study also offers a three-dimensional model to accommodate interactions by multiple consumers of communication patterns and articulations.Item "BUT I'M JUST A LITTLE VOICE:" EXPLORING FACTORS THAT AFFECT RURAL WOMEN'S MEANING MAKING OF EMPOWERMENT AND HEALTH(2011) Austin, Lucinda; Aldoory, Linda; Communication; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This research study explores how empowerment can be incorporated as an element of health communication campaigns to positively affect rural women's everyday health activities. This study questions how rural women make meaning of empowerment and health, the factors that affect rural women's empowerment, and how health communication campaigns may bolster individual and community empowerment. Building from multiple theoretical--including empowerment theory, the situational theory of publics, the theory of planned behavior, the social cognitive theory, and a socio-ecological perspective--this study explores empowerment as a critical link in health communication and public relations theory. Dimensions of individual empowerment such as self-efficacy and perceived behavioral control were explored in more depth, as were other factors that affected empowerment, including social support, religiosity, and involvement as a construct of the situational theory of publics. This study employed a qualitative research method to explore empowerment through these rural women's lived experiences. Research was conducted through 41 qualitative, in-depth interviews with women residing in a small rural community; 15 of these women also participated in photovoice as a research method. Findings from this research demonstrate the importance of multi-level and multi-faceted socio-ecological approaches to health communication campaigns, involving communication at many levels such as the individual, organizational, and community levels. As findings from this research highlight, rural women's notions of empowerment may be impacted by their community and social interactions, their religious involvement, and their experiences with personal and family health problems. Physical and structural factors in women's lives also left them with feelings of powerlessness in certain health situations, suggesting the need for health communication campaigns to also address larger changes in structure and policy. Based upon the research findings and the prior literature, a model is proposed to aid in understanding of the factors that influence women's feelings of empowerment.Item Factors Related to Listeriosis Prevention in Pregnant Women: A Mixed Methods Exploratory Study(2010) Saperstein, Sandra Lynn; Gold, Robert S; Atkinson, Nancy L; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This research examined factors related to listeriosis prevention in pregnant women, with the aim of improving messages designed for pregnant women. Pregnant women are twenty times more likely than other adults to become infected by Listeria monocytogenes. Listeriosis can lead to miscarriage, stillbirth, or illness in the newborn. Current FDA guidelines for pregnant women advise avoiding foods that pose high risk of L monocytogenes contamination: hot dogs or luncheon meats without reheating, soft cheeses made with unpasteurized milk, refrigerated pâtés, refrigerated smoked seafood, and unpasteurized milk. These were updated in 2003 as our understanding of L. monocytogenes contamination in foods has changed. Previous research found that pregnant women were unaware of the guidelines, defensive when made aware, and consuming high-risk foods. The impact of changing guidelines has not been examined. A sequential explanatory mixed methods study was conducted. First, data collected in the second Infant Feeding Practices Study was analyzed to determine whether demographic and health-related factors were related to awareness of L. monocytogenes and the consumption of high-risk foods. Next, six focus groups with pregnant women were used to triangulate secondary data analysis findings, examine underlying beliefs related to listeriosis, and explore the impact of changing listeriosis prevention messages. The Extended Parallel Process Model was used as a theoretical framework to guide the groups. The results showed that awareness has increased, with 37% of IFPS II participants aware of L. monocytogenes. However, almost 75% reported eating unheated cold cuts. Subgroup differences were identified and fell along income and educational lines. Those with less education and lower incomes were less aware and more likely to consume high-risk foods. Focus group findings suggest that risk and efficacy beliefs affected adoption of the guidelines, consistent with the EPPM. Participants felt that too much emphasis on the potential of advice to change weakens response efficacy. The findings suggest that listeriosis prevention messages should heighten risk perceptions, enhance efficacy perceptions, and suggest, but not belabor, the notion of changing messages.