Disclosure Decision-making Process Research Articles

Navigating the Decision to Disclose Mental Illness in the Workplace: The Role of Leader Motivating Language and Perceived Organizational Support

ABSTRACT Mental health disclosure in the workplace has drawn much attention as it comes with multiple benefits such as reducing financial burden, facilitating relationships, and counteracting related stress. Drawing on insights from the disclosure decision-making model, motivating language theory, and organizational support theory, the study presents a model that pictures the underlying mechanisms of the disclosure decision-making process. The findings from a survey of 416 participants suggested that the direction-giving and empathic language strategy can lead to employees’ perceived organizational support. Such perception can help them reduce anticipated negative outcomes when considering disclosure and increase their disclosure efficacy, which in turn increases their disclosure intention.

Using the Disclosure Decision-Making Model to Examine Patient Confusion Disclosure

ABSTRACT The disclosure decision-making model (DD-MM) has been heavily explored within its initially proposed scope. Fewer known studies have tested the DD-MM’s boundaries by assessing the model’s application beyond close personal relationships, and none have explored it in a context outside of long-term health conditions. The current study investigates the disclosure decision-making process of patients to their healthcare providers when they experience situational confusion. A primarily quantitative online survey analyzed data from 251 U.S. adults who felt confusion during a recent appointment with their healthcare provider. Findings indicate that, although stigma and perceived disclosure efficacy impacted patient confusion disclosure as anticipated, anticipated response and relational quality (i.e., receiver assessments) did not play a significant role in disclosure. Stigma, anticipated response, and perceived disclosure efficacy were all related to remaining patient confusion as expected. This study contributes to our understanding of the scope of disclosure decision-making model as well as the to-date overlooked nuances of situational patient confusion: what impacts confusion disclosure and its likelihood to remain beyond the appointment’s end. Limitations, implications, and future directions are discussed.

Graduate students’ perspectives on the role of faculty advisors in helping students with mental health problems

Objective: Graduate students are more likely to experience mental illness than their peers in the general population. One potential source of support for personal issues and/or mental illness is a graduate student’s faculty advisor. Although the relationship between faculty advisors and graduate students can positively influence the success and overall well-being of graduate students, graduate students may be reluctant to disclose mental health issues to their advisors. This study explores graduate students’ perspectives on factors that influence their decision to disclose, or not to disclose, personal mental health information to their faculty advisor. Participants: The participants for this study were 28 graduate students from three universities in the southern United States. Methods: Four semi-structured focus groups were conducted over Zoom. Results: Thematic analysis of a series of focus groups with graduate students identified several consistent themes related to this disclosure decision-making process. Conclusions: Results have implications for mental health literacy and interpersonal communication interventions for those charged with mentoring graduate students.

Unravelling the Complexities Of Disclosure For Employees With Non-Visible Disabilities / Illnesses At Work: A Qualitative Meta-Synthesis

Objective(s) To understand the experiences of persons with non-visible disabilities / illnesses pertaining to disclosure decision-making and navigating disclosure and concealment at work while comparing across disability / illness types, gender, age, and geographic location. Data Sources We conducted a qualitative meta-synthesis using Noblit and Hare's seven steps of meta-ethnography. Comprehensive searches were conducted via MEDLINE, CINAHL, EMBASE, APA PsychInfo, Scopus, and Sociological Abstracts (date limit: 2000 to July 2020). Study Selection Primary, peer-reviewed, qualitative or mixed methods studies (including only qualitative components), written in English, that explored disclosure decision-making and/or navigation of disclosure/concealment with participants who had non-visible disabilities/illnesses in competitive employment settings were included. Three reviewers were involved in screening. Data Extraction Data were extracted using a standardized charting form that aligned with the research question and objectives developed by the primary author (VT). VT independently extracted the data and a lab research assistant double-checked and extracted the data from 53% (10 articles) of randomly selected articles. Data Synthesis Studies were analyzed to develop conceptual categories, third-order constructs (i.e., themes), and a line-of-argument with reflections and comparisons drawn from the Disclosure Decision Making Model and Disclosure Process Model and consideration of disability/illness type, gender, age, and geographic location. Twenty-four studies were included involving 489 participants, aged 16 to 81, from nine countries, including non-visible disabilities/illnesses such as Human Immunodeficiency Virus, Multiple Sclerosis, fibromyalgia, epilepsy, learning disabilities, Juvenile Idiopathic Arthritis, and mental illnesses. We developed four themes for the disclosure decision-making process (self- and other-focused, experiential, and environmental/workplace factors) and two themes for the disclosure/concealment event (disclosure/concealment logistics and timing) and noted emerging trends across ages, genders, disability and illness types, and geographic locations. Conclusions : Knowledge obtained could be used among professionals who support persons with non-visible disabilities or illnesses to help them navigate disclosure at work, and to consider the role of age, genders, disability and illness types, and geographic locations on disclosure. Author(s) Disclosures No conflicts of interest to report. To understand the experiences of persons with non-visible disabilities / illnesses pertaining to disclosure decision-making and navigating disclosure and concealment at work while comparing across disability / illness types, gender, age, and geographic location. We conducted a qualitative meta-synthesis using Noblit and Hare's seven steps of meta-ethnography. Comprehensive searches were conducted via MEDLINE, CINAHL, EMBASE, APA PsychInfo, Scopus, and Sociological Abstracts (date limit: 2000 to July 2020). Primary, peer-reviewed, qualitative or mixed methods studies (including only qualitative components), written in English, that explored disclosure decision-making and/or navigation of disclosure/concealment with participants who had non-visible disabilities/illnesses in competitive employment settings were included. Three reviewers were involved in screening. Data were extracted using a standardized charting form that aligned with the research question and objectives developed by the primary author (VT). VT independently extracted the data and a lab research assistant double-checked and extracted the data from 53% (10 articles) of randomly selected articles. Studies were analyzed to develop conceptual categories, third-order constructs (i.e., themes), and a line-of-argument with reflections and comparisons drawn from the Disclosure Decision Making Model and Disclosure Process Model and consideration of disability/illness type, gender, age, and geographic location. Twenty-four studies were included involving 489 participants, aged 16 to 81, from nine countries, including non-visible disabilities/illnesses such as Human Immunodeficiency Virus, Multiple Sclerosis, fibromyalgia, epilepsy, learning disabilities, Juvenile Idiopathic Arthritis, and mental illnesses. We developed four themes for the disclosure decision-making process (self- and other-focused, experiential, and environmental/workplace factors) and two themes for the disclosure/concealment event (disclosure/concealment logistics and timing) and noted emerging trends across ages, genders, disability and illness types, and geographic locations. : Knowledge obtained could be used among professionals who support persons with non-visible disabilities or illnesses to help them navigate disclosure at work, and to consider the role of age, genders, disability and illness types, and geographic locations on disclosure.

Unravelling the Complexities of Workplace Disclosure Among Persons with Non-Visible Disabilities and Illnesses: A Qualitative Meta-Ethnography.

Deciding whether and how to disclose a disability at work for persons with non-visible disabilities and illnesses involve complex processes. Research has focused on antecedents and outcomes of disclosure. More research is needed to understand the lived experiences related to disclosure decision-making and actual navigation of disclosure and concealment at work. To understand the experiences of persons with non-visible disabilities and illnesses regarding workplace disclosure decision-making, navigating disclosure and/or concealment, and experiential differences across disability and illness types, ages, geographic locations, and genders. We conducted a qualitative meta-synthesis using Noblit and Hare's seven steps of meta-ethnography. Searches were conducted via six databases. Studies were analyzed to develop conceptual categories, third-order constructs (themes), and a line-of-argument with comparisons drawn from the disclosure decision making model, disclosure process model, and consideration of disability and illness types, genders, ages, and geographic locations. Twenty-four studies were included involving 489 participants, aged 16 to 81, from nine countries, focusing on one non-visible disability or illness, or multiple. We developed four themes for the disclosure decision-making process (self- and other-focused, experiential, and environmental/workplace factors) and two themes for the disclosure/concealment event (disclosure/concealment logistics and timing) and noted emerging trends across ages, genders, disability and illness types, and geographic locations. Knowledge obtained could be used among professionals who support persons with non-visible disabilities and illnesses to help them navigate disclosure at work, and to consider the role of age, genders, disability and illness types, and geographic locations on disclosure.

Disclosure dilemmas: how people with a mental health condition perceive and manage disclosure at work

Purpose Little research has explored the process of disclosure decision-making from antecedents to outcomes. This paper presents a model of decision-making about disclosure of a mental health condition to the immediate supervisor in the workplace shortly after starting a new job. Methods A qualitative descriptive design was employed to explore participants’ experiences of the disclosure decision-making process, the disclosure event itself (if applicable), and their perceptions of the impact of the decision on personal, interpersonal, and organizational outcomes. The transcripts were coded and analyzed using directed content analysis. Results Twenty-eight participants were purposively selected to represent different disclosure decisions, sex, diagnoses, and maintenance of employment. Analysis identified goals and conditions/context were important antecedents for the disclosure decision. All participants discussed concerns about prejudice and discrimination if they disclosed, and, for those who chose to disclose, high stress and anxiety were described during the disclosure event; however, supervisor reactions were generally described as positive. Conclusions Regardless of the disclosure strategy adopted, participants reported that their disclosure decision helped to support their self-acceptance and recovery. For those who disclosed, most perceived a positive response by their supervisor. However, the pervasive concerns of prejudice indicate there is still much work to be done. IMPLICATIONS FOR REHABILITATION Decision-making about disclosure of a mental health condition to the immediate supervisor in the workplace is a complex process. Disclosure goals, the relationship with the supervisor and the workplace context are important antecedents to the disclosure decision. Careful consideration should be given to the planning of disclosure, particularly related to what information will be shared, how it will be shared, and an appropriate level of emotional content to enhance the likelihood of a positive response from the supervisor. Disclosure planning should take the supervisor’s style and organizational norms into account.

Revisiting the privacy calculus: Why are consumers (really) willing to disclose personal data online?

With the digital age, businesses are increasingly collecting consumers’ data, which is raising privacy issues. Existing research has been dominated by the rational-based privacy calculus theory, which overlooks the role of irrationality and contextual factors. This study accounts for the influence of both rational (benefits and costs) and irrational (habits) factors in the disclosure decision-making process, while considering the moderating role of context sensitivity. Data gathered from 956 consumers who disclosed personal data with self-selected companies partially supports the context-dependence of data disclosure and reveals that, although consumers do face a trade-off between perceived benefits and privacy loss, habit plays a dominant role. The study extends the privacy calculus theory and provides insights for businesses aiming to collect consumers’ data across industries.

Information-seeking strategy and likelihood of workplace health disclosure

PurposeThis study seeks to address the question on the role of information-seeking behavior in dealing with uncertainty on workplace health disclosure from the perspectives of internal communication.Design/methodology/approachAn online survey was conducted with 409 full-time employees in large-sized companies in the United States.FindingsThe results showed that employees engage in proactive and passive information-seeking strategies when they are uncertain about their supervisors' reactions toward their health problems. Positive EOR and organizational climate would increase their intention to adopt inquiry strategy, whereas negative EOR and the climate would increase their intention to adopt monitoring strategy. Employees who adopt inquiry strategy tend to perceive the benefits of health disclosure, whereas those who adopt monitoring strategy tend to perceive the risks of health disclosure. If employees perceived increased benefits in terms of health disclosure, then they tend to disclose their health problems to their supervisors, and vice versa.Originality/valueThis study is among first to investigate workplace health disclosure decision-making from the perspectives of internal communication. These findings highlight the importance of excellent internal communications in employees' health disclosure decision-making process and support the proposition that proactive information-seeking is a strategy that contributes to uncertainty management in the workplace. This study also provides significant practical guidelines for corporate communication practitioners and leaders by establishing a safe and friendly environment where employees feel comfortable to disclose their health problems to supervisors.

Adolescents’ Disclosure of Mental Illness to Parents: Preferences and Barriers

ABSTRACT Adolescents with a diagnosable mental health disorder must often first disclose their mental health problems to a parent in order to obtain professional mental health treatment. The decision to disclose private, personal health information is the result of successful progression through disclosure decision-making processes fraught with barriers that can discourage disclosure; therefore, the current study explored adolescents’ perceptions of factors that facilitate or discourage disclosure of mental health information to parents. Thematic analysis of a series of focus groups with adolescents with and without a mental health disorder discovered several themes that describe factors adolescents consider in the disclosure decision-making process. Several identified themes are consistent with past research related to health-related disclosure decisions, but some themes suggest that the mental health disclosure decision-making processes of adolescents may be different than the decision-making processes of adults in other health contexts. Results of the study have implications for interventions associated with adolescents’ and parents’ mental health literacy, mental health stigma and communication about mental health issues.

Effects of a Decision-Making Intervention to Help Decide Whether to Disclose HIV-Positive Status to Family Members on Well-Being and Sexual Behavior.

An HIV diagnosis is often followed by uncertainty, questions over next steps, and concerns over how to share the diagnosis with others. The goal of the current study was to investigate the effects of an intervention designed to help people living with HIV decide whether or not they want to disclose their status to family members (i.e., decision-making process rather than actual disclosure) and the subsequent decision on their well-being and sexual behavior. Additionally, differences in outcomes among men who have sex with men (MSM), heterosexual men (HSM), and women were examined. A total of 346 women and men living in the Southeastern part of the United States. Participated in the study, which consisted of a baseline assessment, followed by randomization into either the disclosure intervention or attention control case management group. Both treatments consisted of seven sessions over a 12-month period. Results from repeated measures ANOVA indicated that although there was no significant intervention effect, participants in both groups reported some improvements in well-being and decreases in risky sexual behavior. However, no consistent differences in outcomes emerged among MSM, HSM, and women. Assisting with the disclosure decision-making process and reducing HIV transmission risk should continue to be an essential focus in future research endeavors and for frontline professionals dedicated to HIV-related care and prevention.

To Disclose or Not? Understanding Employees’ Uncertainty and Behavior Regarding Health Disclosure in the Workplace: A Modified Socioecological Approach

The health disclosure of employees may facilitate effective workplace health programs and policy design and implementation of an organization. Given the complexity of the decision-making process of health disclosure, the present study seeks to understand the health disclosure behavior of employees from an interdisciplinary perspective. We incorporated the socioecological model of disclosure from the public health field, uncertainty reduction theory from the interpersonal communication discipline, and organizational relationship concepts from the public relations area. Guided by the above theoretical frameworks, a survey of 409 full-time employees in the United States found that individual-, interpersonal-, and organizational-level factors were significantly associated with employees’ perceived uncertainty—a perquisite variable that predominates individuals’ decision-making process. Engaging in different communication behaviors also helped employees reduce uncertainty about health disclosure in the workplace. The findings implore organizations to implement interventions targeting multiple levels of the socioecological framework to reduce employees’ perceived uncertainty, which in turn facilitate their disclosure decision-making process.

Disclosure, Stigma, and Social Support among Young People Receiving Treatment for Substance Use Disorders and their Caregivers: A Qualitative Analysis.

Relational processes (i.e., disclosure, stigma, social support) experienced by youth with substance use disorders (SUDs) and their caregivers may act as barriers to, or facilitators of, recovery but are understudied. Single-session qualitative semi-structured interviews were conducted with 19 patients and 15 caregivers recruited by clinicians from a SUD program. There was variability in disclosure experiences, including how many people knew about patients' SUD diagnosis and treatment, whether patients or caregivers primarily disclosed to others, and feelings about others knowing about one's or one's child's SUD treatment. After disclosing, patients and caregivers experienced stigmatizing (e.g., social rejection) and supportive (e.g., understanding, advice) reactions from others. Disclosures may have important implications for relationship and recovery-related outcomes. Moreover, some child-caregiver pairs have significant disagreements regarding disclosure of SUD treatment. Addressing relational processes within treatment by encouraging patients and caregivers to share the disclosure decision-making process may support the recovery of youth with SUDs.

Disclosing Mental Illness Information to a Friend: Exploring How the Disclosure Decision-Making Model Informs Strategy Selection

ABSTRACTWithin the context of mental illness disclosure between friends, this study tested the disclosure decision-making model (DD-MM; Greene, 2009) to comprehensively investigate factors that predict disclosure enactment strategies. The DD-MM describes how individuals determine whether they will reveal or conceal non-visible health information. Processes of revealing, called disclosures, take various forms including preparation and rehearsal, directness, third-party disclosure, incremental disclosures, entrapment, and indirect mediums (Afifi & Steuber, 2009). We explore the disclosure decision-making process to understand how college students select to disclose their mental illness information with a friend. Participants were 144 students at a Midwestern university who had disclosed their mental illness information to a friend. Structural equation modeling analyses revealed that college students choose strategies based on their evaluation of information assessment and closeness, and that for some strategies, efficacy mediates the relationship between information assessment and strategy. This manuscript discusses implications of findings and suggests direction for future research.

Parent perspectives of the challenging aspects of disclosing a child's epilepsy diagnosis to others: Why don't they tell?

Objectives This study aimed to explore the challenges parents of children with epilepsy (CWE) experienced when deciding to disclose their child's epilepsy diagnosis to others. Methods Using a qualitative exploratory design, interviews were conducted with 34 parents (27 mothers and 7 fathers) of 29 CWE (aged 6-16 years). Parents were recruited from a neurology clinic of a specialist children's hospital and from a national epilepsy association. Interviews were directed by a semi-structured guide informed by a review of the literature. Data were transcribed verbatim, imported into NVivo, coded and thematically analysed. Results Findings revealed five themes representative of the core disclosure challenges parents encountered, many of which promoted concealment and/or selective disclosure, namely: seeking normalcy for the child, the invisibility of epilepsy, negative reactions to disclosure, contending with poor public perceptions of epilepsy and coming to terms with the diagnosis. Discussion This study presents crucial information for healthcare professionals (HCPs) who help families to navigate the disclosure decision-making process. Providing HCPs working with families living with epilepsy with insight into diagnosis disclosure challenges will enable them to recognise the support needs of parents and work collaboratively with families to tackle such difficulties, ultimately improving their psychosocial wellbeing.

Age and life course location as interpretive resources for decisions regarding disclosure of HIV to parents and children: Findings from the HIV and later life study

Studies of disclosure amongst older people living with HIV (PLWH) are uninformed by critical social-gerontological approaches that can help us to appreciate how older PLWH see and treat age as relevant to disclosure of their HIV status. These approaches include an ethnomethodologically-informed social constructionism that explores how ‘the’ life course (a cultural framework depicting individuals' movement through predictable developmental stages from birth to death) is used as an interpretive resource for determining self and others' characteristics, capacities, and social circumstances: a process Rosenfeld and Gallagher (2002) termed ‘lifecoursing’. Applying this approach to our analysis of 74 life-history interviews and three focus groups with older (aged 50+) people living with HIV in the United Kingdom, we uncover the central role that lifecoursing plays in participants' decision-making surrounding disclosure of their HIV to their children and/or older parents. Analysis of participants' accounts uncovered four criteria for disclosure: the relevance of their HIV to the other, the other's knowledge about HIV, the likelihood of the disclosure causing the other emotional distress, and the other's ability to keep the disclosed confidential. To determine if these criteria were met in relation to specific children and/or elders, participants engaged in lifecoursing, evaluating the other's knowledge of HIV, and capacity to appropriately manage the disclosure, by reference to their age. The use of assumptions about age and life-course location in decision-making regarding disclosure of HIV reflects a more nuanced engagement with age in the disclosure decision-making process than has been captured by previous research into HIV disclosure, including on the part of people aging with HIV.

To tell or not to tell: A systematic review of the disclosure practices of children living with epilepsy and their parents.

Disclosing an epilepsy diagnosis to others is complex due to the condition's largely invisible nature and associated stigma. Despite this, little has been documented in terms of what this process involves for children living with epilepsy (CWE) and their parents. A systematic review was conducted to examine and synthesize evidence pertaining to: (i) the disclosure practices of CWE and their parents, (ii) enablers and barriers for disclosure, (iii) the impact of disclosure practices, and (iv) the relationship between disclosure management and other variables. The electronic databases PsycINFO, PubMed, MEDLINE, CINAHL, Scopus, and Web of Science were searched systematically. Any empirical, peer-reviewed journal articles with findings reported regarding the self- or proxy-reported disclosure practices of children aged 0-18years with any type of epilepsy and/or their parents were deemed eligible for inclusion. Two review authors completed all stages of screening, data extraction, and quality assessment independently with two additional review authors resolving any discrepancies. A total of 32 articles were included in the review. Only one dated study examined disclosure as a primary focus; in the remaining studies, disclosure was a subfocus of larger studies or pertinent qualitative themes/subthemes incidentally emerged. The limited evidence suggests that: 1) CWE and parents adopt varying disclosure management strategies - from concealment to voluntary disclosure; 2) disclosure decisions are challenging for CWE and parents; 3) many barriers to disclosure exist (e.g., fear of stigmatization and rejection); 4) only a limited number of factors that enable disclosure are known (e.g., openness by others to engage with and learn about epilepsy); 5) disclosure management is significantly related to a number of variables (e.g., child/maternal perceived stigma and seizure control); and 6) there are varying outcomes for CWE and/or their parents in accordance with the adoption of specific disclosure management strategies (e.g., disclosure resulting in greater acceptance and the receipt of support or evoking anxiety/fear in others; and concealment resulting in misunderstandings, embarrassment, and stigma-coaching), but the evidence remains inconclusive in terms of which disclosure management strategy is optimal. While some preliminary work has been conducted, disclosure of epilepsy is a topic that has been largely neglected to date. This is despite the fact that disclosure is a significant source of concern for CWE and parent populations. Future studies should focus on elucidating the unique contextual factors that inform disclosure decisions in order to develop a theoretical framework that can explain the epilepsy disclosure decision-making process.

Employee Decision-Making About Disclosure of a Mental Disorder at Work

Fear of stigma may lead employees to choose not to disclose a mental disorder in the workplace, thereby limiting help-seeking through workplace accommodation. Research suggests that various factors are considered in making decisions related to disclosure of concealable stigmatizing attributes, yet limited literature explores such decision-making in the context of mental disorder and work. The purpose of this grounded theory study was to develop a model of disclosure specific to mental health issues in a work context. In-depth interviews were conducted with 13 employees of a post-secondary educational institution in Canada. Data were analyzed according to grounded theory methods through processes of open, selective, and theoretical coding. Findings indicated that employees begin from a default position of nondisclosure that is attributable to fear of being stigmatized in the workplace as a result of the mental disorder. In order to move from the default position, employees need a reason to disclose. The decision-making process itself is a risk-benefit analysis, during which employees weigh risks and benefits within the existing context as they assess it. The model identifies that fear of stigmatization is one of the problems with disclosure at work and describes the disclosure decision-making process. Understanding of how employees make decisions about disclosure in the workplace may inform organizational policies, practices, and programs to improve the experiences of individuals diagnosed with a mental disorder at work. The findings suggest possible intervention strategies in education, policy, and culture for reducing stigma of mental disorders in the workplace.

Factors contributing to parental decision-making in disclosing donor conception: a systematic review

BACKGROUND In recent years, changes in attitudes towards (non-)disclosure of donor conception to offspring and/or others have been observed. Studies have started to identify possible factors that contribute to these changes that are relevant for clinics, counsellors and policy-makers in their approach to the disclosure process. The aim of this systematic review was to integrate the existing knowledge on factors that influence the disclosure decision-making process of donor conception to offspring and/or others in heterosexual couples, and to discuss future trends and concerns. METHODS A bibliographic search of English, French, German and Dutch language publications of five computerized databases was undertaken from January 1980 to March 2012. A Cochrane Database systematic review approach was applied. RESULTS A total of 43 studies met the inclusion criteria, and these represented 36 study populations. The review shows that the parents' disclosure decision-making process is influenced by a myriad of intrapersonal, interpersonal, social and family life cycle features. These influences were not necessarily independent but rather were interwoven and overlapping. Theoretical frameworks have not yet been used to explain how the different factors influenced disclosure. Methodological limitations of the original publications (lack of information, several factors included in one study, descriptive character of studies) and this review (multiple factors that may interact) which hindered integration of the findings are outlined. CONCLUSIONS Intrapersonal, interpersonal, social and family life cycle factors influence the parents' disclosure decision-making process. The review has demonstrated the need for the development of a theoretical model to enable integration of the identified influencing factors. Further research is needed on the role of stigma, confrontation efficacy, extended family, donor siblings' characteristics, cross-border treatment, culture, gender and socio-educational factors.

How parents whose children have been conceived with donor gametes make their disclosure decision: contexts, influences, and couple dynamics

To describe parents' disclosure decision-making process. In-depth ethnographic interviews. Participants were recruited from 11 medical infertility practices and 1 sperm bank in Northern California. One hundred forty-one married couples who had conceived a child using donor gametes (62 with donor sperm, 79 with donor oocytes). Husbands and wives were interviewed together and separately. Thematic analysis of interview transcripts. Ninety-five percent of couples came to a united disclosure decision, some "intuitively," but most after discussions influenced by the couples' local sociopolitical environment, professional opinion, counseling, religious and cultural background, family relationships, and individual personal, psychological, and ethical beliefs. Couples who were not initially in agreement ultimately came to a decision after one partner deferred to the wishes or opinions of the other. Deferral could reflect the result of a prior agreement, one partner's recognition of the other's experiential or emotional expertise, or direct persuasion. In disclosing couples, men frequently deferred to their wives, whereas, in nondisclosing couples, women always deferred to their husbands. Although the majority of couples were in initial agreement about disclosure, for many the disclosure decision was a complex, negotiated process reflecting a wide range of influences and contexts.