Grieving "The Death of Possibility": Memorable Messages of (Dis)Enfranchised Loss in Invisible, Physical Illness

A Longitudinal Interview Study of People with Long COVID: Uncertainties, Liminality, and Processes of Becoming

Current estimates indicate around 6% of US adults have experienced long COVID symptoms. Given the novelty of both COVID and long COVID, those who continue to be ill after an initial SARS-CoV-2 infection have little precedence on which to rely when navigating the medical (e.g. diagnoses, treatment options), social (e.g. others' reactions, isolation), and personal (e.g. roles, identities) sources of uncertainty that accompany the illness. In this study, we explore uncertainty as a process of liminality, a heuristically useful lens for demonstrating how uncertainties intertwine, compound, contradict, and change across time, and how people are continually in a process of "becoming." We interviewed 19 people with long COVID five times during the middle stages of the pandemic (Summer 2021 to Summer 2022; 89 total interviews). Findings illustrate how liminality is a body-self dialectic characterized by physical changes that bear upon valued identities and how this dialectic is shaped by a sociocultural and historical context comprising medical, social, political, and mediated spheres of life. We discuss the contributions of this research for theorizing about uncertainty, conducting longitudinal qualitative research, and living with chronic illness.

Disseminating Premenstrual Dysphoric Disorder Information on TikTok: A Content Analysis

Premenstrual dysphoric disorder (PMDD) is characterized as an extreme form of premenstrual syndrome (PMS) in which a combination of severe mood, somatic, and cognitive symptoms present one to two weeks prior to the onset of menstruation. As people increasingly turn to social media, specifically TikTok, to gain information about health-related topics and information, discourse about this taboo chronic condition has increased. Sensitized by concepts from the theory of communicative disenfranchisement (TCD), our two-pronged methodological approach includes a content analysis of TikTok videos (N = 97) that discuss PMDD symptomology, treatment, and a thematic analysis of disenfranchising talk associated with PMDD. We identify TikTok as a meaningful communicative mechanism for health information-exchange, particularly for communication about contested illness. Practical and theoretical implications for applying TCD in mediated contexts, as well as engaging with social media as a means for health communication are discussed.

Making end-of-life health disparities in the U.S. visible through family bereavement narratives

Objective

End-of-life experiences can have important implications for the meaning-making and communication of bereaved family members, particularly due to (in)access to formal healthcare services (i.e., palliative care and hospice). Grounded in Communicated Narrative Sense-Making theory, this study extends knowledge about how the stories told about end-of-life by bereaved family members affect and reflect their sense-making, well-being and importantly, potential disparities in end-of-life care.

Methods

Semi-structured interviews with 25 bereaved individuals were conducted regarding their experiences with the terminal illness and death of an immediate family member. Using a framework of family bereavement narratives, a cross-case data analysis demonstrated qualitative patterns between (in)access to end-of-life care and how participants framed bereavement stories.

Results

Four themes illustrated the continuum of communication that families engaged in when making sense of end-of-life experiences, including reflections on silence, tempered frustrations, comfort with care, and support from beyond.

Innovation

This innovative qualitative connection between family members' bereavement stories and end-of-life care emphasizes the importance of employing a health equity lens within hospice and palliative care, especially in addressing the important aim of comprehensively supporting families even when illness ends. This study demonstrates that access to, quality of, and imagining beyond current structures for EOL may be vital factors for facilitating effective sense-making for the dying and their family systems.

Conclusion

These findings illustrate the potential interconnections between (in)access to end-of-life care, sense-making, and communication for individuals and families experiencing terminal illness and bereavement.

Framing Chronic Pain in U.S. News Coverage of the Opioid Epidemic (2012-2022)

Chronic pain, pain persisting longer than six months, afflicts 20% of the U.S. population and is the leading cause of disability. To manage pain, many chronic pain patients (CPPs) and healthcare providers turn to opioids, prescription medications that block pain signals and offer relief. However, in light of the U.S.' ongoing opioid epidemic, CPPs without a history of opioid use disorder (OUD) are facing increased stigma when seeking opioid medication. Further, many have been forced to taper their therapeutic dose due to updated Centers for Disease Control and Prevention prescribing guidelines in 2016 and 2022, with a range of (adverse) outcomes. Though research has explored experiences of chronic pain and OUD independently, few studies have explored how media coverage of the opioid epidemic has shaped representations, and resulting stereotypes, of CPPs. Guided by framing theory, this content analysis examines sources' characterization of CPPs amidst a decade of U.S. news coverage of the opioid epidemic (N = 492). Findings identify four dominant news frames, including two novel frames termed culpability and strategy, and elements (i.e., characters, significant events) that comprise these frames. When discussed, CPPs were ascribed the identity of a drug-seeking addict 82% of the time. Collectively, this study provides insight as to how news media coverage of the opioid epidemic influence(d) public perceptions of chronic pain (patients). Findings offer theoretical and practical implications for media outlets, policymakers, CPPs and healthcare providers, as well as highlighting how use of opioids for pain management does not equate to abuse of opioids.

"There's Going to be a Tipping Point Where I'm Not Gonna Be Able to Work": Communicative Resilience Amidst Precarity in the Careers of Individuals with Autoimmune Diseases

Throughout their career, people living with autoimmune diseases must navigate workplace precarity amidst ongoing disruptions to health and wellbeing. Informed by the communication theory of resilience (CTR), we conduct semi-structured, narrative interviews with 25 individuals living with autoimmune diseases to examine their career-related disruptions and communicative resilience enactments. Data analysis reveals two major themes: (1) disability as a discursive-material disruption and (2) career-triggering illness complications. Theoretically, our findings extend anticipatory and adaptive-transformative CTR tensions through the moment-to-moment disruptions that intersect this community's careers and health journeys. Practically, we seek to re-imagine workplace accommodations and disability to better meet both the health and work needs of stigmatized and chronically ill individuals, such as individuals with autoimmune diseases.

The Autoimmune Library: An Arts-Based Approach to Women of Color's (Counter)Narratives of Chronic Illness

Guided by critical race theorizing (CRT) and arts-based methodologies (i.e., metaphor and pictorial narrative mapping [PNM]), the present study analyzed the healthcare (counter)narratives of 150 United States (U.S.) women of color (i.e., Black/African American, Hispanic/Latina, Native American/Alaska Native, and Multiracial) who have autoimmune disease. Sensitized by the metaphor of a library book, participants were asked to story their healthcare journey through identification of a title, chapters, genre, and book cover description (i.e., [Illness] Storybook Survey). Using critical thematic analysis, we first identified dominant and counter-narratives present in participant storybooks, categorized by literary supra-themes of characters (i.e., dominant narrative of me versus my body, counter-narratives of me versus the system and illness as lineal), plot (i.e., dominant narrative of a hero's journey, counter-narrative of chaos), and tone (i.e., dominant narrative of inspiration, counter-narratives of tangible self-help and humor). Next, guided by PNM, a data visualization technique, each author illustrated one counter-narrative within each literary supra-theme. Our analysis interrogates how participants' stories both reify and resist ideological and structural power at the intersections of their racial, gender, and illness identities. Collectively, this study offers unique contributions to critical, intersectional, and arts-based approaches to communication research, and forwards new methods for studying health narratives historically located in the margins.

(Re)making Scales: Communicative enfranchisement in Women's Narrative Discourses About Health Dismissal

Dismissal of women's health concerns is a discursive phenomenon with social and material consequences. A burgeoning literature documents how women experience dismissal through various forms of disenfranchising talk. Yet, women are not only subjected to disenfranchising talk; they are called to respond to it. Meaning, analyses of disenfranchisement should also examine efforts toward enfranchisement. One process by which scholars can study communicative (dis)enfranchisement is through people's scalar activity, or how they contextualize experiences at different levels of social reality. Studies of scale demonstrate that the language people use to narrate their personal experiences has meaning for how they position themselves in relation to other social actors, as well as how they make statements about what matters, how much, and to whom. Drawing on 36 interviews with women whose health issues have been dismissed, we apply scale as a theoretical lens and methodological tool to study how women use language in particular, meaningful, and patterned ways in narratives about health dismissal. Our findings suggest that women's narrative discourse is enfranchising in so much as women critique, resist, and transform the contexts of their dismissal. We document how they and others scale "realness" and "normality" across narrated and narrating events. We also note how women scale up from their own experiences to women's experiences writ large, asserting truth claims about issues borne of the broader U.S. healthcare system. Findings have implications for how critical health communication researchers study how women's health issues are constructed in talk.

Memorable Messages about Pregnancy and Abortion from the Perspective of College-Enrolled Emerging Adults

Emerging adults are the age group in the U.S. most likely to become pregnant, have a child, receive abortions, and be most supportive of legal abortion. To gain insight into these seemingly contradictory facts and attitudes, this study examines emerging adults' memorable messages about abortion and pregnancy to understand the beliefs, norms, values, and expectations circulating for younger adults. Ninety-two emerging adult college students provided memorable messages about both abortion and pregnancy. Utilizing thematic co-occurrence analysis, messages about pregnancy and abortion were characterized by three themes: political ideologies of sex, healthcare experience, and life-changing. Emerging adults described the messages as making them feel knowledgeable, empowered, and scared. Two theoretical relationships were identified: (1) pregnancy is connected to the political ideologies of sex with reactions of feeling empowered and scared and (2) abortion is connected to the politics of sex and the reactions of feeling knowledgeable and scared. Theoretical implications for the theory of memorable messages and practical applications for emerging adults are discussed.

"Saving us to Death": Ideology and Communicative (Dis)enfranchisement in Misapplications of the 2016 CDC Opioid Prescribing Guidelines

Guided by the theory of communicative (dis)enfranchisement (TCD), this study interrogates how interactions in which chronic pain patients are force tapered from their prescribed opioids are constrained and afforded by the hegemonic ideologies. To interrogate the harms caused for chronic pain patients by ideological policies enacted by the Centers for Disease Control and Prevention and assess what communicative mechanisms reify and resist such ideologies, this research analyzes 238 posts authored by chronic pain patient Reddit users. Reflexive thematic analysis illuminated a hegemonic ideology of opiophobia, (im)material ramifications of (a) discrimination by doctors, and (b) political and legal interference; mechanisms of reification: (a) positioning suicide as a rational option, (b) advocating for the use of illicit substances, and (c) stopping opioids voluntarily; and mechanisms of resistance: (a) counter-organizing and (b) counter-generating knowledge. We offer theoretical implications for the TCD and practical implications for patients, providers, patient advocacy organizations, and policymakers.

"I have to fight for them to investigate things": a qualitative exploration of physical and mental healthcare for women diagnosed with mental illness

Introduction

Women play a significant role in the management of their own healthcare and that of others, however women diagnosed with mental illness and physical health concerns experience significant health inequalities as compared to people living without mental health concerns.

Methods

In this paper, we reflect on the experiences of 20 cis women diagnosed with mental and physical health concerns who agreed to be a part of this research. This qualitative study is part of the larger Healthtalk Australia research project which was not gender specific. Female participants shared many experiences of mental and physical healthcare in interviews with researchers that pointed to the need for a gendered approach to addressing health inequalities. Consequently, we iteratively consolidated transcripts of interviews with participants into thematic categories facilitated by NVIVO 12.

Results

We identified two broad themes and a set of subthemes: in the doctor's office - experience of labelling; negotiating medications; and interactions with physical and mental health, and outside the doctor's office - responses to trauma, financial concerns, and reliance on participant's internal resources to get healthcare needs met.

Discussion

We conclude that participants in this study undertook significant work to manage their own healthcare needs, despite being challenged by clinicians and systems that failed to see them as whole people with expertise regarding their own health.