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Cross-Cultural Adaptation and Psychometric Validation of the Interview Satisfaction Questionnaire (ISQ) to Assess Unmet Health Communication Needs of Iranian Breast Cancer Patients. 访谈满意度问卷 (ISQ) 的跨文化适应性和心理测量验证,用于评估伊朗乳腺癌患者未得到满足的健康交流需求。
IF 3 3区 医学 Q1 COMMUNICATION Pub Date : 2024-11-01 Epub Date: 2023-12-05 DOI: 10.1080/10410236.2023.2288712
Razieh Keikhaee, Zohreh Sanaat, Saeid Mousavi, Abdolreza Shaghaghi

Autonomous and patient-centered health communication (PCHC) between a healthcare provider (HCP) and a client (HCC) is a critical fundament for successful healthcare outcomes. A standard and validated data collection tool for studying the satisfaction of Iranian breast cancer patients (BCPs) with various aspects of their health communication with HCPs does not exist. The current study assessed the application, feasibility, and cultural appropriateness of the Persian-translated version of the interview satisfaction questionnaire (ISQ) in the Iranian context. A standard translation/back-translation procedure was used to prepare a preliminary Persian version of the ISQ (ISQ-P) which was then evaluated for content and face validity by a panel of experts. The study data were collected from 200 breast cancer patients and used to estimate the internal consistency measure of Cronbach's alpha and intra-class correlation coefficient. Confirmatory factor analysis (CFA) was performed to verify the compatibility of the instrument's identified dimensions with the original ISQ's factor structure. The calculated content validity index (CVI = 0.89), content validity ratio (CVR = 0.49), and Cronbach's alpha coefficient (0.79) indicated the appropriateness of the ISQ-P for its intended purpose. The CFA's outputs (root mean square error of approximation (RMSEA) = 0.09, comparative fit index (CFI) = 0.954, Tucker-Lewis index (TLI) = 0.931, standardized root mean square residual (SRMR) = 0.04) affirmed the fitness of the study data to the original 4-factor conceptual model. The study findings supported the suitability of ISQ-P for assessing health communication episodes by Persian-speaking BCPs. However, due to cultural variation, cross-border diversity of health systems, and organizational circumstances, further validity and reliability appraisal of the ISQ-P in distinct sub-samples is recommended.

医疗服务提供者(HCP)与客户(HCC)之间自主的、以患者为中心的健康交流(PCHC)是医疗服务取得成功的关键基础。目前还没有一种标准的、经过验证的数据收集工具,用于研究伊朗乳腺癌患者(BCPs)对其与医护人员进行健康交流的各个方面的满意度。本研究评估了波斯语翻译版访谈满意度问卷 (ISQ) 在伊朗的应用、可行性和文化适宜性。研究采用了标准的翻译/回译程序,编制了初步的波斯语版 ISQ (ISQ-P),然后由专家小组对其内容和表面效度进行了评估。研究数据收集自 200 名乳腺癌患者,用于估算 Cronbach's alpha 和类内相关系数的内部一致性。研究还进行了确认性因子分析(CFA),以验证该工具所确定的维度与原 ISQ 的因子结构是否一致。计算得出的内容效度指数(CVI = 0.89)、内容效度比(CVR = 0.49)和克朗巴赫α系数(0.79)表明,ISQ-P 符合其预期目的。CFA 的输出结果(均方根近似误差 (RMSEA) = 0.09、比较拟合指数 (CFI) = 0.954、塔克-刘易斯指数 (TLI) = 0.931、标准化均方根残差 (SRMR) = 0.04)证实了研究数据与最初的 4 因子概念模型相匹配。研究结果支持 ISQ-P 适用于评估波斯语 BCP 的健康传播事件。然而,由于文化差异、卫生系统的跨境多样性和组织环境,建议在不同的子样本中对 ISQ-P 进行进一步的有效性和可靠性评估。
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引用次数: 0
Can Stereotype Threat and Lift Visual Messages Affect Subsequent Physical Activity? Evidence from a Controlled Experiment Using Accelerometers. 刻板印象的威胁和提升视觉信息会影响后续的身体活动吗?来自使用加速度计的受控实验的证据。
IF 3 3区 医学 Q1 COMMUNICATION Pub Date : 2024-11-01 Epub Date: 2023-11-08 DOI: 10.1080/10410236.2023.2277573
Camren L Allen, Enoch Montes, Troy Hoang, Therek Romo, Jorge Peña, Jessica Navarro

This study investigated how visual messages conveying stereotype threat or lift influenced physical activity performance. Participants (N = 380) were exposed to a stereotype threat, lift, or control condition image and then engaged in a running task. Accelerometers recorded forward-backward movement, upward-downward movement, and sideways balance. Stereotype threat exposure increased state anxiety relative to the control condition. In addition, forward-backward movement was linked to state anxiety and participants' sex. Moreover, women exposed to stereotype threat who experienced increased state anxiety showed reduced forward-backward movement. Men exposed to stereotype lift displayed higher forward-backward movement. Additionally, stereotype threat visual message exposure increased sideways balance activity for women but not for men. Upward-downward movement was unaffected by stereotype threat or lift. We discuss theoretical and practical implications of how exposure to visual stereotypes can influence physical activity performance.

本研究调查了传达刻板印象威胁或提升的视觉信息如何影响体育活动表现。参与者(N = 380)暴露于刻板印象中的威胁、提升或控制条件图像,然后从事跑步任务。加速度计记录了前后运动、上下运动和侧向平衡。与对照条件相比,刻板印象威胁暴露增加了状态焦虑。此外,前后运动与状态焦虑和参与者的性别有关。此外,受到刻板印象威胁的女性,如果状态焦虑加剧,则前后运动减少。受刻板印象影响的男性表现出更高的前后运动。此外,刻板印象威胁视觉信息的暴露增加了女性的横向平衡活动,但男性没有。上下运动不受刻板印象威胁或提升的影响。我们讨论了暴露于视觉刻板印象如何影响体育活动表现的理论和实践意义。
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引用次数: 0
Emotional Appeals and Norms: How Normative Perceptions Moderate the Persuasive Impacts of Discrete Emotional Appeals within Tobacco Pictorial Warnings in China. 情感诉求与规范:规范感知如何调节中国烟草图片警告中离散情感诉求的说服影响。
IF 3 3区 医学 Q1 COMMUNICATION Pub Date : 2024-11-01 Epub Date: 2023-11-10 DOI: 10.1080/10410236.2023.2277036
Ran Tao, Xinyi Wang, Yidi Wang, Heyu Yao, Shiwen Wu, Jiaying Liu, Sijia Yang

Tobacco pictorial warnings could employ a variety of emotional appeals to enhance effectiveness; however, little research exists to guide the selection of discrete emotional appeals. Further, it remains unclear how contextual pro-smoking norms might influence the persuasive impacts of discrete emotional appeals within pictorial warnings, especially in China, where the overall smoking rate and social acceptance remain high. To fill these gaps, this study leveraged the largest set of pictorial warnings (K = 510) tested to date. Using a randomized large-K multiple-message design, we evaluated the impacts of disgust, fear, self-anger, contempt, shame, and hope appeals among Chinese adult male smokers (N = 2,306) on perceived message effectiveness (PME). Results showed that fear, self-anger, shame, and hope appeals significantly increased PME, while disgust and contempt appeals appeared less effective. Importantly, the PME of nearly all emotional appeals - except hope appeals - was weakened for Chinese adult male smokers with higher pro-smoking normative perceptions, highlighting the importance of considering local contextual influences when implementing pictorial warnings.

烟草图片警告可以采用各种情感诉求来提高效果;然而,很少有研究来指导离散情感诉求的选择。此外,尚不清楚背景支持吸烟的规范如何影响图片警告中离散情感诉求的说服力,尤其是在中国,那里的总体吸烟率和社会接受度仍然很高。为了填补这些空白,本研究利用了最大的一组图片警告(K = 510)。采用随机大K多重信息设计,我们评估了中国成年男性吸烟者厌恶、恐惧、自愤、蔑视、羞耻和希望诉求的影响(N = 2306)关于感知消息有效性(PME)。结果显示,恐惧、自愤、羞耻和希望诉求显著增加了PME,而厌恶和蔑视诉求的效果较差。重要的是,对于支持吸烟的规范认知较高的中国成年男性吸烟者来说,除了希望诉求之外,几乎所有情感诉求的PME都被削弱了,这突出了在实施图片警告时考虑当地背景影响的重要性。
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引用次数: 0
Communicative Practices Clinicians Use to Correct Patient Misconceptions in Primary Care Visits. 临床医生在初级保健就诊时纠正患者误解的沟通方法。
IF 3 3区 医学 Q1 COMMUNICATION Pub Date : 2024-11-01 Epub Date: 2023-12-18 DOI: 10.1080/10410236.2023.2283658
Jennifer Gerwing, Anne E C White, Stephen G Henry

To investigate how clinicians correct patient misconceptions, we analyzed 23 video recordings of primary care visits. Analysis focused on operationalizing, identifying, and characterizing clinician corrections, integrating two inductive approaches: microanalysis of clinical interaction and conversation analysis. According to our definition, patient misconception-clinician correction episodes met three essential criteria: (1) the clinician refuted something the patient had said, (2) which the patient had presented without uncertainty, and (3) which contained a proposition that was factually incorrect. We identified 59 such episodes; the patient misconceptions most commonly related to medication issues; fewer than half had foreseeable implications for patients' future actions. We identified seven clinician correction practices: Three direct practices (displaying surprise, marking disagreement, contradicting the patient) and four indirect practices (presenting the correct proposition, providing explanations, invoking an outside authority, demonstrating with evidence). We found an almost equal distribution of these direct and indirect practices.

为了研究临床医生如何纠正患者的错误观念,我们分析了 23 份初级保健就诊录像。分析的重点是操作、识别和描述临床医生的纠正行为,并整合了两种归纳方法:临床互动微观分析和对话分析。根据我们的定义,患者的误解-临床医生的纠正符合三个基本标准:(1)临床医生反驳了患者所说的话,(2)患者在没有不确定性的情况下表达了自己的观点,(3)其中包含一个与事实不符的命题。我们发现了 59 次此类事件;患者的误解最常见的是与用药问题有关;只有不到一半的误解会对患者未来的行动产生可预见的影响。我们发现了七种临床医生纠正错误的做法:三种直接做法(表示惊讶、标明不同意见、反驳患者)和四种间接做法(提出正确主张、提供解释、援引外部权威、用证据证明)。我们发现这些直接和间接做法的分布几乎相等。
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引用次数: 0
Examining Theoretical Frameworks and Antecedents of Health Apps and Wearables Use: A Scoping Review. 检查健康应用程序和可穿戴设备使用的理论框架和前提:范围审查。
IF 3 3区 医学 Q1 COMMUNICATION Pub Date : 2024-11-01 Epub Date: 2023-11-15 DOI: 10.1080/10410236.2023.2283655
Huanyu Bao, Edmund W J Lee

The advancement of health apps and wearables has garnered substantial academic attention, particularly in examining why individuals decide to use or not use them. In response to the extensive body of research on this topic, we conducted a scoping review of 61 articles published from 2007 to 2022, aiming to examine the dominant theoretical frameworks and antecedents of health apps and wearables use. The findings demonstrated that the dominant theoretical frameworks within this domain were rooted in the human-computer interaction theories, notably the Technology Acceptance Model and the Unified Theory of Acceptance and Use of Technology. Next, our review identified four levels of antecedents: technological, individual, societal, and policy. At the technological level, emphasis was placed on functionality, reliability, and technological infrastructure. Individual antecedents encompassed socio-demographics, personality traits, cognitive responses to benefits and risks, emotional and affective responses, self-efficacy, and digital literacy. Societal antecedents highlighted the role of social networks and social norms, while policy antecedents elaborated on laws, regulations, and guidelines that encouraged health technology adoption. Our discussion illuminated that the evolving trend of theoretical frameworks in health apps and wearables use research, initially rooted in human-computer interaction, is progressively moving toward more comprehensive perspectives. We further underscored the importance of delving into societal and policy antecedents, which often are overshadowed by the more commonly discussed technological and individual factors. In conclusion, we advocated for a multi-stakeholder collaborative network approach, as this would enable communication researchers to understand the use of health apps and wearables more comprehensively.

健康应用程序和可穿戴设备的进步引起了学术界的广泛关注,特别是在研究人们决定使用或不使用它们的原因方面。针对这一主题的广泛研究,我们对2007年至2022年发表的61篇文章进行了范围审查,旨在研究健康应用程序和可穿戴设备使用的主要理论框架和前提。研究结果表明,该领域的主导理论框架植根于人机交互理论,特别是技术接受模型和技术接受与使用统一理论。接下来,我们的回顾确定了四个层面的前因:技术、个人、社会和政策。在技术层面,重点放在功能、可靠性和技术基础设施上。个体前因包括社会人口统计学、人格特征、对利益和风险的认知反应、情绪和情感反应、自我效能感和数字素养。社会前因强调了社会网络和社会规范的作用,而政策前因则详细阐述了鼓励采用卫生技术的法律、法规和指导方针。我们的讨论表明,健康应用程序和可穿戴设备使用研究的理论框架的发展趋势,最初植根于人机交互,正在逐步向更全面的角度发展。我们进一步强调了深入研究社会和政策因素的重要性,这些因素往往被更普遍讨论的技术和个人因素所掩盖。总之,我们提倡多方利益相关者合作网络方法,因为这将使通信研究人员能够更全面地了解健康应用程序和可穿戴设备的使用情况。
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引用次数: 0
Strategies for Assessing Health Information Credibility Among Older Social Media Users in China: A Qualitative Study. 中国老年社交媒体用户健康信息可信度评估策略:一项定性研究
IF 3 3区 医学 Q1 COMMUNICATION Pub Date : 2024-11-01 Epub Date: 2023-11-28 DOI: 10.1080/10410236.2023.2288372
Leanne Chang, Wenshu Li, Xin Xin, Jingyuan Wang

The fact that social media gives users easy access to online health information raises the question of what information evaluation strategies older adults use to distinguish trustworthy from unreliable health information. Identifying how older adults assess the credibility of health information that they acquire on social media is an important step toward understanding and reducing their susceptibility to health misinformation. In this study, we investigated the credibility assessment strategies used by older WeChat users in China. Following a qualitative approach, we conducted in-depth interviews with 40 WeChat users 65-85 years old (M = 71.75, SD = 6.65) in China who had acquired health information on WeChat. Results of theoretical thematic analysis revealed five source-based and content-based evaluative strategies: (1) determining the communicative orientation of the source, (2) assessing source reputation, (3) confirming content based on life experiences, (4) checking for exaggeration in claimed effects, and (5) assessing the consistency of content across sources. Older WeChat users' reliance on certain heuristic cues and their self-reliant approach to assessing information credibility provide contextual explanations for the link between heuristic processing and susceptibility to health misinformation. The findings have implications for anti-misinformation interventions targeting the older population in China and potentially beyond.

社交媒体使用户可以方便地访问在线健康信息,这一事实提出了一个问题,即老年人使用什么信息评估策略来区分值得信赖的健康信息和不可靠的健康信息。确定老年人如何评估他们在社交媒体上获得的健康信息的可信度,是理解和减少他们对健康错误信息易感性的重要一步。在这项研究中,我们调查了中国老年微信用户使用的可信度评估策略。采用定性方法,我们对40名在中国通过微信获取健康信息的65-85岁微信用户(M = 71.75, SD = 6.65)进行了深度访谈。理论主题分析的结果揭示了五种基于来源和基于内容的评估策略:(1)确定来源的交际取向,(2)评估来源的声誉,(3)根据生活经验确认内容,(4)检查声称的效果是否夸大,(5)评估跨来源内容的一致性。老年微信用户对某些启发式线索的依赖以及他们评估信息可信度的自力更生方法为启发式处理与对健康错误信息的易感性之间的联系提供了上下文解释。这一发现对针对中国及其他地区的老年人群的反错误信息干预具有启示意义。
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引用次数: 0
Reflections on Dementia-Related Stigma and Direct Support Seeking by Family Caregivers as Mediating Associations Between Caregiver Stress, Burden, and Well-Being. 对痴呆症相关的耻辱感和家庭照顾者寻求直接支持作为照顾者压力、负担和幸福感之间中介关系的反思。
IF 3 3区 医学 Q1 COMMUNICATION Pub Date : 2024-11-01 Epub Date: 2023-10-24 DOI: 10.1080/10410236.2023.2270248
Karen E Schlag, Anita L Vangelisti

The demanding nature of caring for relatives with Alzheimer's disease and related dementias (ADRD) can lead to family caregiver burden and poor health. The stigmatization of people with ADRD can also impact caregivers' stress, while their support-seeking strategies may mitigate negative impacts of burden on their health. To examine hypothesized relationships, the present study considered whether different dimensions of ADRD family stigma influenced the association between a care recipient's behavioral symptoms and their family caregiver's perceived burden and if direct support seeking explained a connection between caregiver burden and well-being. Family caregivers (n = 375) completed a Qualtrics survey. Path analysis revealed ADRD behavioral symptoms predicted both caregiver and layperson forms of stigma. Layperson stigma also intervened between behavioral symptoms and caregiver burden. Direct support seeking mediated the association between caregiver burden and well-being. Findings underscore the utility of including stigma within ADRD caregiver stress models and studying caregiver health from network and communication perspectives.

照顾患有阿尔茨海默病和相关痴呆症(ADRD)的亲属的要求很高,这可能会导致家庭护理负担和健康状况不佳。对ADRD患者的污名化也会影响照顾者的压力,而他们寻求支持的策略可能会减轻负担对他们健康的负面影响。为了检验假设的关系,本研究考虑了ADRD家庭污名的不同维度是否影响了受照顾者的行为症状与其家庭照顾者感知负担之间的联系,以及直接寻求支持是否解释了照顾者负担与幸福感之间的联系。家庭照顾者(n = 375)完成了Qualtrics调查。路径分析显示,ADRD行为症状可预测照顾者和非专业人员的污名形式。外行的耻辱感也介入了行为症状和照顾者负担之间。寻求直接支持在照顾者负担和幸福感之间起中介作用。研究结果强调了将污名纳入ADRD护理人员压力模型以及从网络和沟通角度研究护理人员健康的效用。
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引用次数: 0
"I Remember Feeling Pretty Darn Lucky": Crafting Family Resilience in Response to a Medical Emergency. "我记得自己感觉非常幸运":打造家庭应对医疗紧急情况的复原力。
IF 3 3区 医学 Q1 COMMUNICATION Pub Date : 2024-11-01 Epub Date: 2023-12-19 DOI: 10.1080/10410236.2023.2296187
Sophie S Downing

Through a combination of autoethnographic reflections and oral history interviews with my parents, I explore the ways in which we enacted resilience throughout my father's unexpected hospitalization, rehabilitation, and his subsequent years of recovery, both individually and communally. Using communication theory of resilience (CTR) as a framework, I identify the ways in which we engaged in the five processes outlined by the theory: crafting normalcy, emphasizing action while backgrounding negative feelings, affirming identity anchors, relying on communication networks, and employing alternative logics. I then propose three additional processes of enacting resilience that emerged from my family's insights: enacting performative resilience, connecting to broader experience, and emphasizing perspective-taking. To conclude, I reflect on the value of these communicative processes and the combination of research practices I engaged in the paper, as well as the practical benefits of CTR and my additions to the theory.

通过自我民族志反思和对我父母的口述历史访谈,我探讨了在我父亲意外住院、康复以及随后几年的恢复过程中,我们个人和社会如何发挥抗逆力。以抗逆力沟通理论(CTR)为框架,我确定了我们参与该理论概述的五个过程的方式:营造正常状态、强调行动同时淡化负面情绪、确认身份锚点、依赖沟通网络以及采用替代逻辑。然后,我从我的家人的见解中提出了另外三个实施抗逆力的过程:实施表演性抗逆力、与更广泛的经验相联系以及强调透视。最后,我反思了这些交流过程的价值和我在论文中参与的研究实践组合,以及 CTR 的实际益处和我对该理论的补充。
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引用次数: 0
The Effectiveness of Social Norm Appeals on Promoting COVID-19 Prevention Behaviors: A Multistudy Examination. 社会规范呼吁对促进COVID-19预防行为的有效性:一项多研究检验。
IF 3 3区 医学 Q1 COMMUNICATION Pub Date : 2024-11-01 Epub Date: 2023-11-19 DOI: 10.1080/10410236.2023.2284493
Rain Wuyu Liu, Ying Cheng, Juliana L Barbati, Stephen A Rains, Tracy E Crane, Kacey C Ernst

Recent research shows social norm perceptions predict people's adherence to COVID-19 preventative health practices. Nonetheless, additional empirical studies are necessary to evaluate the effectiveness of different types of social norm messages on behavioral outcomes with experimental designs. Guided by the social norm literature and frameworks, the current research addresses this need by examining the effects of descriptive and injunctive norm appeals promoting the practice of social distancing and mask-wearing with both a controlled experiment and social media campaigns. Results from this multistudy investigation showed the effectiveness of descriptive and injunctive norm messages (v. no message exposure) in promoting focal behaviors and highlighted the superiority of injunctive norm appeals in promoting behavioral intentions and increasing social media engagement. Theoretical implications and recommendations for practice are discussed.

最近的研究表明,社会规范观念可以预测人们对COVID-19预防卫生措施的依从性。然而,需要更多的实证研究来评估不同类型的社会规范信息对行为结果的影响。在社会规范文献和框架的指导下,目前的研究通过检查描述性和禁令性规范呼吁的影响,通过对照实验和社交媒体活动促进社会距离和戴口罩的实践,解决了这一需求。这项多研究的调查结果显示了描述性和禁令性规范信息(与无信息暴露相比)在促进焦点行为方面的有效性,并强调了禁令性规范呼吁在促进行为意图和增加社交媒体参与度方面的优势。讨论了理论意义和实践建议。
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引用次数: 0
"We Are All in This Together": Which Memorable Moral Messages Guided Student Responses to the COVID-19 Pandemic? “我们在一起”:哪些令人难忘的道德信息指导学生应对COVID-19大流行?
IF 3 3区 医学 Q1 COMMUNICATION Pub Date : 2024-11-01 Epub Date: 2023-11-23 DOI: 10.1080/10410236.2023.2286695
Vincent R Waldron, Corey Reutlinger, Julie Martin, Erica O'Neil, Lucy C Niess

The COVID-19 pandemic has revealed lessons about the moral bases of student compliance with pandemic health messaging, which is a vital concern for educational institutions where students learn and live in close proximity. Existing theoretical and empirical work suggests that audiences may be receptive when prescribed behavior aligns with memorable moral messages (MMM) received from family members or other valued sources. We report the results of two studies that examined the nature of MMM that students found relevant in the fall of 2020 and the moral values they appeared to invoke. In the first, focus group interviews and qualitative thematic analysis were used to identify underlying moral themes. Findings indicated that students were influencegd by MMM focused on empathy/caring, those that addressed communal versus individual responsibilities, and messages that prioritized virtues that were needed (e.g., patience) during the pandemic. During this first phase of the research, we also collected a verbatim list of MMM that students reported recalling and using. To determine if quantitative evidence supported the three-part categorization scheme, a second study asked a sample of 327 students to rate the influence of the MMM reported in Study One. Exploratory factor analysis largely confirmed Study One, with consideration for others, self-determination, and communal responsibility emerging as primary moral considerations. Findings of the two studies are interpreted as partial support for moral foundations theory and consistent with the expectations of negotiated morality theory. Recommendations for health educators and experts are offered, including framing compliance guidelines in a manner consistent with MMM received from family members and helping students navigate the moral tension between self and communal interests.

2019冠状病毒病大流行揭示了学生遵守大流行卫生信息的道德基础,这是学生近距离学习和生活的教育机构的一个至关重要的问题。现有的理论和实证研究表明,当规定的行为与从家庭成员或其他有价值的来源获得的令人难忘的道德信息(MMM)一致时,受众可能会接受。我们报告了两项研究的结果,这两项研究调查了学生们认为与2020年秋季相关的MMM的性质,以及它们似乎援引的道德价值观。首先,使用焦点小组访谈和定性主题分析来确定潜在的道德主题。研究结果表明,学生们受到MMM的影响,关注同理心/关怀,关注公共责任与个人责任,以及在大流行期间优先考虑所需美德(例如耐心)的信息。在研究的第一阶段,我们还收集了一份学生报告回忆和使用的MMM的逐字列表。为了确定定量证据是否支持三部分分类方案,第二项研究要求327名学生对研究一中报告的MMM的影响进行评分。探索性因素分析在很大程度上证实了研究一,考虑他人、自决和公共责任成为主要的道德考虑因素。这两项研究的结果被解释为对道德基础理论的部分支持,与协商道德理论的预期一致。向健康教育工作者和专家提出了建议,包括以与从家庭成员那里收到的MMM一致的方式制定遵守准则,并帮助学生在个人利益和社区利益之间的道德紧张关系中找到方向。
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引用次数: 0
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Health Communication
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