The fundamental challenge for refining theories of communication and uncertainty is to abandon the assumption that uncertainty will produce anxiety. To better explain processes of communication and uncertainty management, we must answer questions about (a) the experience and meaning of uncertainty, (b) the role of appraisal and emotion in uncertainty management, and (c) the range of behavioral and psychological responses to uncertainty. This paper outlines and extends a theory of uncertainty management and reviews current theory and research in this area. In addition to the theoretical advances promised by this perspective, the paper describes applications to health communication practice. The drive in disease prevention to reduce uncertainty about the state of health and illness has led to a "culture of chronic illness." Constant surveillance of people's health, combined with improved methods for screening and monitoring, virtually guarantee finding something wrong with every person, creating a society divided into the chronically ill and the worried well (i.e., those waiting to be diagnosed).When making decisions, planning events, and interacting with others, people experience uncertainty. Decision alternatives may appear equally attractive (or equally unattractive) if people lack the information needed to distinguish them. Important event contingencies frequently are probabilistic ("Is it likely to rain if we have the reception outdoors?") and differently valued ("Would it be good or bad if it rained?"; see Babrow, 1992, for a discussion of probability and value in determining human action). The behavior of interactional partners may be unpredictable, perhaps because people communicating with new acquaintances lack information on which to base their judgments or because they witnessed inconsistencies during prior interactions with others. In many such situations, people encounter the complexity that characterizes everyday life.Communication researchers have turned their attention to questions about the forms of uncertainty experienced in different contexts and the varied behavioral Dale E. Brashers is associate professor of speech communication at the University

The fundamental challenge for refining theories of communication and uncertainty is to abandon the assumption that uncertainty will produce anxiety. To better explain processes of communication and uncertainty management, we must answer questions about (a) the experience and meaning of uncertainty, (b) the role of appraisal and emotion in uncertainty management, and (c) the range of behavioral and psychological responses to uncertainty. This paper outlines and extends a theory of uncertainty management and reviews current theory and research in this area. In addition to the theoretical advances promised by this perspective, the paper describes applications to health communication practice. The drive in disease prevention to reduce uncertainty about the state of health and illness has led to a "culture of chronic illness." Constant surveillance of people's health, combined with improved methods for screening and monitoring, virtually guarantee finding something wrong with every person, creating a society divided into the chronically ill and the worried well (i.e., those waiting to be diagnosed).When making decisions, planning events, and interacting with others, people experience uncertainty. Decision alternatives may appear equally attractive (or equally unattractive) if people lack the information needed to distinguish them. Important event contingencies frequently are probabilistic ("Is it likely to rain if we have the reception outdoors?") and differently valued ("Would it be good or bad if it rained?"; see Babrow, 1992, for a discussion of probability and value in determining human action). The behavior of interactional partners may be unpredictable, perhaps because people communicating with new acquaintances lack information on which to base their judgments or because they witnessed inconsistencies during prior interactions with others. In many such situations, people encounter the complexity that characterizes everyday life.Communication researchers have turned their attention to questions about the forms of uncertainty experienced in different contexts and the varied behavioral Dale E. Brashers is associate professor of speech communication at the University

Communication is a means of managing uncertainty. In a state of uncertainty: (a) information seeking can reduce uncertainty by allowing for better discrimination between or among alternatives; (b) information seeking can increase uncertainty by increasing the number of alternatives, or by blurring the distinction between or among alternatives; and (c) information avoidance can maintain uncertainty. Individuals living with HIV or AIDS, like many other chronically-ill or terminally-ill individuals, must manage high levels of uncertainty about their illness. Participants in a focus group study of persons with HIV or AIDS reported effective uncertainty management, including managing uncertainty that was challenging, managing uncertainty that was essential for maintaining hope, learning to live with chronic uncertainty, and managing information problems. New information can serve uncertainty management even if it fails to reduce the number or ambiguity of alternatives, because new information can invite a reappraisal of uncertainty. A theory of uncertainty management based on these findings is offered.

Information management is an important component of coping with illness and illness-related uncertainty. Normative theory and research on information seeking and avoiding in health contexts can help explain why some information management activities are more adaptive than others. Challenges and dilemmas of information management include relational demands (e.g., the need to coordinate the behaviors and goals of the participants) and contextual features (e.g., cross-cultural considerations or channels available for information seeking and providing). Issues that need to be addressed in a normative approach include (a) how information management goals can be accomplished while still accounting for other goals (e.g., identity management or relational maintenance), (b) what roles interpreters can play to facilitate effective cross-cultural information exchange (e.g., as cultural informants), and (c) how information seekers can best manage conflicting or overwhelming information when confronted with messages from multiple channels.R ecent research and theory highlights information management as one possible response to illness-related uncertainty (Mishel, 1988(Mishel, , 1990. For example, people with acute or chronic illnesses often seek information to understand their diagnosis, to decide on treatments, and to predict their prognosis. People wanting to maintain good health seek information to understand risk factors and to learn preventive measures. For both understanding illness and its prevention, information sources include health care providers, peers (e.g., others with the illness), Dale E. Brashers (Ph.D., University of Arizona, 1994) and Daena J. Goldsmith

People with chronic and acute illnesses experience uncertainty about their prognoses, potential treatments, social relationships, and identity concerns. In a focus group study of people living with HIV or AIDS, we examined how social support may facilitate or interfere with the management of uncertainty about health, identity, and relationships. We found that support from others helps people with HIV or AIDS to manage uncertainty by (a) assisting with information seeking and avoiding, (b) providing instrumental support, (c) facilitating skill development, (d) giving acceptance or validation, (e) allowing ventilation, and (f) encouraging perspective shifts. Respondents also reported a variety of ways in which supportive others interfered with uncertainty management or in which seeking support imposed costs. Problems associated with social support and uncertainty management included a lack of coordination in uncertainty management assistance, the addition of relational uncertainty to illness uncertainty, and the burden of others' uncertainty management. Our study reveals strategies respondents used to manage costs and complications of receiving support, including developing an active or self-advocating orientation, reframing supportive interactions, withdrawing from nonproductive social situations, selectively allowing others to be support persons, and maintaining boundaries.

This study investigated why and how individuals avoid health information to support the development of models of uncertainty and information management and offer insights for those dealing with the information and uncertainty inherent to health and illness. Participants from student (n = 507) and community (n = 418) samples reported that they avoided health information to (a) maintain hope or deniability, (b) resist overexposure, (c) accept limits of action, (d) manage flawed information, (e) maintain boundaries, and (f) continue with life/activities. They also reported strategies for avoiding information, including removing or ignoring stimuli (e.g., avoiding people who might provide health advice) and controlling conversations (e.g., withholding information, changing the subject). Results suggest a link between previous experience with serious illness and health information avoidance. Building on uncertainty management theory, this study demonstrated that health information avoidance is situational, relatively common, not necessarily unhealthy, and may be used to accomplish multiple communication goals.

Aerobic exercise training may help prevent or reduce depressive symptoms experienced by persons living with HIV infection. However, the psychological effects of aerobic exercise have not been studied extensively. This study evaluated the effects of an aerobic exercise training program on self-reported symptoms of depression in HIV-infected adults and examined the convergent validity of two widely used depressive symptom scales. Sixty HIV-infected adults participated in a randomized, controlled trial of a supervised 12-week aerobic exercise training program. As compared to study controls, exercise participants showed reductions in depressive symptoms on all indices, and total depressive symptoms scores were highly correlated. Additional study of the psychological effects of aerobic exercise programs in the target population is recommended.

Uncertainty is an important part of the illness experience. Mishel elaborated a theory of uncertainty in acute illness and later expanded the framework to account for uncertainty in chronic illness. Researchers subsequently have investigated the causes and outcomes associated with the uncertainty in illness experience across a variety of medical conditions. The current study applies and extends Mishel's model within the context of HIV illness-related uncertainty. In this qualitative study, focus group methods were used to examine the nature of illness uncertainty experienced by persons living with HIV or AIDS. Findings confirm Mishel's contention that the causes of uncertainty extend beyond those of medical diagnosis, treatment, and recovery to personal and social aspects of daily life. Identified sources of uncertainty may have important mental health and quality of life implications.