Managing Patient-centered Communication across the Type 2 Diabetes Illness Trajectory: A Grounded Practical Theory of Interactional Sensitivity

This article uses the theoretical and methodological framework of Grounded Practical Theory (GPT) to provide a lens for analyzing and interpreting discourse as a situated form of social action in routine Type 2 diabetes visits. Drawing on a total data-set of 400 audio-recorded routine visits, we randomly selected 55 visits for qualitative analysis. In this article, we use Conversation Analysis to document communication techniques, which we in turn use as evidence to ground our claims within the GPT framework. We use two single cases of interaction to analyze communication techniques physicians use when recommending a change from oral medication to insulin. We argue treatment intensification is a key moment in health communication to reflect about patient centeredness because physicians can find themselves in an interactional dilemma: while insulin may effectively help control unstable disease, an insulin recommendation may simultaneously counter patient values and treatment preferences. Our analysis suggests that physicians use what we call interactional sensitivity to balance medical need and patient preferences when making medical decisions by tailoring their communication according to the local situation and the patient's larger illness trajectory. We propose that interactional sensitivity is a type of communication work and a quality of patient-centered communication characterized by the theoretical relationship between tailoring communication to the contingencies of the local interaction and the global illness trajectory. Overall, this article contributes to health communication scholarship by proposing a normative model for reflecting on how physicians negotiate challenging interactions with patients during routine chronic illness visits.     

The persuasiveness of persuasive discourse

This investigation explored why and how persuasion occurs. Toward this end, we examined the processing of two articles under conditions called for in the persuasion and conceptual change literatures. One unique aspect of the current study was the use of topic-specific measures of beliefs, knowledge (i.e., perceived and demonstrated), and interest. The performance of members of three educational communities (i.e., undergraduates, graduate students, and faculty) was compared, as was the knowledge and interest of more or less persuaded readers. One article argued that there are prenatal similarities among humans and other mammals, while the second presented a favorable view of same-sex marriages. Although both articles produced significant changes in readers’ beliefs, knowledge, and interest, there were performance differences by text, educational community, and persuasion group. Results showed that readers’ perceptions of their knowledge played a more significant role in persuasion outcomes than the knowledge they actually demonstrated. Outcomes suggest the need to look more closely at the relationship between knowledge and interest in subsequent studies of persuasion.     

Endurance training adherence in elite junior netball athletes: a test of the theory of planned behaviour and a revised theory of planned behaviour

This study examined the utility of Ajzen's (1985) theory of planned behaviour and Maddux's (1993) revised theory of planned behaviour to predict endurance training intentions and adherence of elite junior netball athletes. One hundred and fifteen athletes from the England Netball World Class Start Programme were assessed on constructs central to the predictions of the two theories. Adherence to a recommended endurance training programme was recorded in self-report diaries across a 9-week period. Validity for the diaries was supported by significant correlations (P < 0.001) with recalls across 7 days and 9 weeks. Adherence was moderate and variable between athletes (mean = 66.05, s = 25.75%). Two separate path analyses were conducted to examine the predictions of the theories. Goodness-of-fit indices suggested acceptable fit of the data to the models. Analyses showed that attitude towards the new behaviour, subjective norms and perceived behavioural control predicted training intentions. The relationship between intention and adherence was weak. The present results suggest that the constructs of the theory of planned behaviour offer some insight into the explanation of intentions to follow an endurance training programme. Constructs unique to the revised theory of planned behaviour did not significantly predict training intentions or behaviour. Implications for practitioners working with team sport performers are provided.     

Effects of competition, exercise, and mental stress on secretory immunity

It has been suggested that the psychological stress associated with competitive sports events may help to explain the increased susceptibility to respiratory infections due to reductions in secretory immunity. In the current study, we investigated the influence of competitive exercise and psychological stress on secretory immunoglobulin A (s-IgA). Salivary s-IgA and heart rate were measured in 62 healthy young recreationally active men at rest and, in a between-subjects design, following one of four 8-min tasks: mental arithmetic, cycling at workloads of 60 to 180 W (mean = 146 W), mental arithmetic while cycling, or competitive cycling. Mental arithmetic was associated with significant increases in s-IgA concentration (mean = 49 microg.min(-1)) and s-IgA secretion rate (mean = 25 microg.ml(-1)) compared with rest, while mental arithmetic combined with exercise was associated with a significant increase in s-IgA concentration only (mean = 124 microg.min(-1)). In contrast, competitive exercise and exercise alone did not influence s-IgA concentration or secretion rate. Heart rate increased modestly to mental arithmetic (mean = 7 beats.min(-1)) and substantially, and similarly, to the three exercise tasks (mean = 56(62 beats.min(-1)). The hypothesis that the psychological stress of competitive exercise contributes to increased susceptibility to infection via reductions in s-IgA requires further investigation.