Miscarriage is one of the most common pregnancy complications health care providers discuss with patients. Previous research suggests that women’s distress is compounded by ineffective communication with providers, who are usually not trained to deliver bad news using patient-centered dialogue. The purpose of this study was to use a patient-centered approach to examine women’s experiences with and perspectives of communication during a miscarriage to assist in the development of communication training tools for health care providers. During focus groups, 22 women who had experienced miscarriage discussed video-recorded standardized patient-provider interactions and recalled communication during their own miscarriages. Results of a pragmatic iterative analysis of the transcripts suggest training techniques and communication behaviors that should guide education for providers to deliver the diagnosis of and treatment options for early pregnancy loss, such as demonstrating empathy, creating space for processing, checking for understanding, and avoiding medical jargon and emotionally charged language.
This manuscript uses the theory of message design logics to investigate the relative sophistication of responses to disclosure of HIV status. In Study 1, 548 college students imagined a sibling revealing an HIV-positive diagnosis. Their responses to the HIV-disclosures were coded as expressive (n = 174), conventional (n = 298), or rhetorical (n = 66). Type of message produced was associated with gender and HIV aversion. In Study 2, 459 individuals living with HIV rated response messages that were taken verbatim from Study 1. Expressive messages were rated lowest in quality, and rhetorical messages were rated highest. The discussion focuses on the utility of message design logics for understanding responses to HIV disclosures and the implications for message design logics. This is the accepted version of the following article: Caughlin, J. P., Brashers, D. E., Ramey, M. E., Kosenko, K. A., Greene, Derlega, Yep, & Petronio, 2003). People often fail to disclose that they are living with HIV because of the stigma associated with the illness and concerns about how others will react (e.g., Alonzo & Reynolds, 1995;Herek, Capitanio, & Widaman, 2002), but keeping the diagnosis a secret can lead to a lack of social support, unsafe sexual behavior, and failure to seek treatment or to take medications as needed (e.g., Chesney & Smith, 1999). Stigma and lack of disclosure of HIV status are such important health concerns that they warrant counseling programs to help these individuals manage the psychological, social, and health aspects of their illness (Rintamaki, Davis, Skripkauskas, Bennett, & Wolf, 2006).Much HIV disclosure research has examined how people living with the disease decide whether to divulge their status (e.g., Derlega, Winstead, & Folk-Barron, 2000;Derlega, Winstead, Greene, Serovich, & Elwood, 2004;Sullivan, 2005). Some research also has examined disclosers' perceptions of the responses they receive when telling others about their HIV-positive diagnosis (Greene & Faulkner, 2002;Serovich, Kimberly, & Greene, 1998). Greene and Faulkner, for example, interviewed 10 female African American adolescents, who described how people responded when told about their HIV diagnosis. The responses varied considerably and included treating the participants unfavorably, having negative emotional reactions, telling others, and providing support.Understanding how people respond to disclosures about HIV-positive status is important for numerous reasons. For instance, people living with HIV often experience uncertainty about how others will react (Brashers et al., 2003). If this uncertainty contributes to anxiety about revealing the information, research describing reactions to HIV disclosures can be useful by illuminating "the issues and dilemmas that may be encountered when disclosing" (Serovich et al., 1998, p. 15). Research on responses to HIV disclosures from the perspective of the responder is also important.People who disclose an HIV-positive test result may hope for various sorts of responses from the recipien...
Pregnancy loss due to miscarriage is a pervasive health issue. Although talking about the miscarriage experience with friends and family members has been linked to better adjustment, revealing this loss can be difficult because discussing a miscarriage often makes people uncomfortable. Moreover, couples often manage this information jointly as they decide whether to share the miscarriage with people outside the dyad. We conducted in-depth interviews with couples to explore the nature of co-ownership in the miscarriage context and to identify the privacy rules that couples develop to manage this information. We found that couples frame miscarriage as a shared but distinct experience and that both members exert rights of ownership over the information. Couples' privacy rules centered on issues of social support and others' need to know about the loss. Even though couples described their privacy rules as implicitly understood, they also recalled having explicit conversations to develop rules. We discuss how the management of co-owned information can improve communication and maintain relationships.
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