Health-related Uncertainty Research Articles

Development of Theory of Uncertainty on COVID-19: Theory Derivation Based on Uncertainty in Illness Theory

Purpose: The purpose of this study is to develop the Theory of Uncertainty on COVID-19 using the strategy of theory derivation. Methods: Theory derivation was carried out in the following steps: review the literature to explore the phenomena related to uncertainty on COVID-19; select a parent theory that provides valuable concepts and a useful structure for derivation, and identify the concepts and structure of the parent theory to use in derivation; modify and redefine the concepts and structure of the parent theory to create a derived theory. In the literature review process, relevant findings were synthesized to support the propositions of the derived theory. Results: The Theory of Uncertainty on COVID-19 was derived from the Uncertainty in Illness Theory to make it relevant and applicable to a specific aspect of uncertainty on COVID-19, health-related uncertainty perceived by a person who has not contracted COVID-19. It is a middle-range theory targeting the general population and consists of a linear and unidirectional model centered on three themes: antecedents of uncertainty, appraisal of uncertainty, and coping with uncertainty. Conclusion: The Theory of Uncertainty on COVID-19 will be able to contribute to efforts to manage perceived uncertainty on pandemic diseases and improve individual biopsychosocial health in the future.

Green bond market boom: did environmental, social and governance criteria play a role in reducing health-related uncertainty?

<abstract><p>Recent years have been characterized by considerable growth of the green bond market in Europe, particularly in the domain of social bond issuance. Considering the recent pandemic, it is also a stylized fact that this growth is positively correlated with the concept of health-related uncertainty, as the green bond market aims to acquire financing in order to allow the development of projects that comply with the so-called environmental (E), social (S) and governance (G) criteria. This study then applies a dynamic spatial econometric analysis and several robustness checks to assess the extent to which each E, S and G criterion contributes to the societal dynamics of health-related uncertainty. The analysis takes advantage of available data on the number of confirmed cases of COVID-19 to measure health-related uncertainty at the municipal level, so that a higher (lower) number of confirmed cases constitutes a proxy for a greater (smaller) degree of uncertainty, respectively. To reinforce the need to evaluate impacts in a context characterized by health-related uncertainty, the time span covers the first wave of COVID-19, which is the period when uncertainty reached its highest peak. Additionally, the geographical scope is mainland Portugal since this country has become a breeding ground for startups and new ideas, being currently one of the world leaders in hosting businesses that reached Unicorn status. The main result of this research is that only the social dimension has a significant, positive and permanent impact on health-related uncertainty. Therefore, this study empirically confirms that the European green bond market has been and can be further leveraged by the need to finance projects with a social scope.</p></abstract>

Uncertainty in healthcare and health decision making: Five methodological and conceptual research recommendations from an interdisciplinary team.

Uncertainty is prevalent in various health contexts. It is imperative to understand how health-related uncertainty can impact individuals' healthcare experiences and health decision making. The purpose of the present paper is to provide five overarching recommendations from an interdisciplinary team of experts to address gaps in the literature on health-related uncertainty. We present a case study of health-related uncertainty within the specific context of alcohol use to demonstrate these gaps and provide context for the recommendations. The five recommendations concerning health-related uncertainty include: (1) use common, consistent terminology to discuss uncertainty, (2) clarify measures of individual differences in response to uncertainty, (3) increase research on uncertainty and affect, (4) investigate the impact of the channel through which uncertainty is communicated, and (5) develop theory-driven interventions to improve uncertainty management. We conclude by reviewing health contexts in which health-related uncertainty exists and note how our recommendations complement existing reviews and data.

Food literacy as a resilience factor in response to health-related uncertainty

PurposeDuring the Covid-19 pandemic, people were deprived of their freedom, unable to engage in physical and social activities, and worried about their health. Uncertainty, insecurity, and confinement are all factors that may induce stress, uneasiness, fear, and depression. In this context, this study aims to identify possible relationships of emotions caused by health risks and restrictions to outdoor activities with well-informed decisions about food consumption.Design/methodology/approachThe theoretical framework of this research draws on the stimulus-organism-response paradigm yielding six research hypotheses. An online survey was designated to test these hypotheses. A total of 1,298 responses were gathered from Italy, Greece, and the United Kingdom. Data analyses include demographic group comparisons, moderation, and multiple regression tests.FindingsThe results showed that when people miss their usual activities (including freedom of movement, social contact, travelling, personal care services, leisure activities, and eating at restaurants) and worry about their health and the health of their families, they turn to safer food choices of higher quality, dedicating more of their time and resources to cooking and eating.Research limitations/implicationsThe findings showcase how risk-based thinking is critical for management and marketing strategies. Academics and practitioners may rely on these findings to include extreme conditions within their scope, understanding food literacy as a resilience factor to cope with health risks and stimulated emotions.Originality/valueThis study identified food behavioural patterns under risk-laden conditions. A health risk acted as an opportunity to look at food consumption as a means of resilience.

Contradictory and complex health messages: an experimental test of different sources of uncertainty

ABSTRACT Contradictory and complex health messages are prevalent in the media and can lead to uncertainty in decision-making. We explore if the theoretical distinction between message contradiction and complexity is manifested in laypersons’ perceptions. U.S. adults (N = 584) were randomly assigned to one of three conditions: contradictory messages, complex messages, or no-message control. Participants in the message conditions read contradictory or complex messages and completed measures of perceived contradiction and complexity. All participants completed measures of issue uncertainty and decision uncertainty. The theoretical distinction between contradiction and complexity was not reflected in participants’ perceptions. Although participants rated contradictory messages as more inconsistent than complex messages, the complex messages were not rated as more complex than contradictory messages. Results supported a model in which perceptions of contradiction and complexity give rise to issue uncertainty, leading to decision uncertainty. The unique perceptions and effects of distinct sources of health-related uncertainty need further investigation.

Existential uncertainty in the patient cancer experience: Delimiting the concept.

To delimit the concept of existential uncertainty in the patient cancer experience from other, related aspects of uncertainty in the context of an existing framework of health-related uncertainty. In-depth interviews were carried out with six people living with cancer and analyzed using theory-driven, concept-focused thematic analysis. Our analysis suggests that existential uncertainty is concerned with meaning rather than information; with the person rather than the disease; and with the fundamental nature of our human being-in-the-world rather than the more practical aspects of our relationships with others. Patient expressions of existential uncertainty may involve a nonscientific discourse of metaphor, analogy, and imagination. It is important for professionals working in supportive oncology to have a conceptual understanding of uncertainty in order to choose how best to respond to patients' needs, as different interventions may be more or less appropriate to different aspects of patient uncertainty.

Assessing the hedging potential of gold and other precious metals against uncertainty due to epidemics and pandemics.

We assess the hedging capabilities of four prominent precious metals namely gold, palladium, platinum and silver against market risks due to epidemics and pandemics. The research objective is informed by the COVID-19 pandemic which amplifies health risks with attendant concerns for financial markets. We utilize the health-related uncertainty index developed by Baker et al. (Equity market volatility: infectious disease tracker [INFECTDISEMVTRACK], 2020) which measures uncertainty in the financial markets due to infectious diseases including the COVID-19 pandemic and construct a predictive model that accommodates the salient features of both the predictand and predictor series. Our results support the safe haven property only for gold before and during the COVID-19 pandemic. We push the analysis further for in-sample and out-of-sample forecast evaluation and find that accounting for uncertainty due to infectious diseases improves the forecast of the four precious metals relative to the benchmark model (historical average). We highlight for investors that the gold market remains the safest market among the precious metals particularly during the COVID-19 pandemic.

Vague Language in Online Medical Consultation

Online medical consultation has become increasingly popular, while little is known about what features of such service can impact users’ emotions and behaviours. This study looked into the language features of online text-based medical consultation. Specifically, the aim of this paper was to examine the effects of vague language (i.e., non-specific, imprecise language) on health-related uncertainty, and its affective and behavioural consequences, while considering individual differences in regulatory focus. A between-subject (vague language vs. precise language vs. control condition) web-based experiment was conducted (N = 249), where participants in the experimental groups read virtual doctor-patient conversations where the doctor used either vague or precise language. Results showed that vague language induced more uncertainty than precise language (p = .010); such uncertainty was appraised as a danger (r = .18, p = .004) but not an opportunity (r = .01, p = .932), and subsequently led to negative emotions (r = .45, p < .001). No effects were found on behavioural outcomes, and there was no moderation from regulatory focus. The results suggest that online healthcare providers should refrain from using vague language in communication with patients to avoid eliciting uncertainty and subsequent negative feelings. Future research is needed to further examine the behavioural effects of uncertainty and explore factors that could foster the appraisal of opportunity.

Effect of Health-Related Uncertainty and Natural Variability on Health Impacts and Cobenefits of Climate Policy.

Climate policy can mitigate health risks attributed to intensifying air pollution under climate change. However, few studies quantify risks of illness and death, examine their contribution to climate policy benefits, or assess their robustness in light of natural climate variability. We employ an integrated modeling framework of the economy, climate, air quality, and human health to quantify the effect of natural variability on U.S. air pollution impacts under future climate and two global policies (2 and 2.5 °C stabilization scenarios) using 150 year ensemble simulations for each scenario in 2050 and 2100. Climate change yields annual premature deaths related to fine particulate matter and ozone (95CI: 25 000-120 000), heart attacks (900-9400), and lost work days (3.6M-4.9M) in 2100. It raises air pollution health risks by 20%, while policies avert these outcomes by 40-50% in 2050 and 70-88% in 2100. Natural variability introduces "climate noise", yielding some annual estimates with negative cobenefits, and others that reach 100% of annual policy costs. This "noise" is three times the magnitude of uncertainty (95CI) in health and economic responses in 2050. Averaging five annual simulations reduces this factor to two, which is still substantially larger than health-related uncertainty. This study quantifies the potential for inaccuracy in climate impacts projected using too few annual simulations.

Factors Affecting Adolescents' Willingness to Communicate Symptoms During Cancer Treatment: A Systematic Review from the Children's Oncology Group.

The purpose of this systematic review is to (1) synthesize evidence facilitators and barriers affecting adolescent willingness to communicate symptoms to health care providers (HCPs) and (2) create practice recommendations. The PICOT (Population, Intervention, Comparison, Outcome, Time) question guiding the review was, among adolescents with cancer, what factors affect their willingness to communicate symptoms to HCPs? Three databases, PubMed, CINAHL, and PsychINFO, were searched using keywords from the PICOT question. Inclusion criteria included original research studies with samples of at least 51% adolescents aged 10-18 years who were receiving or had received cancer treatment. Studies were included that evaluated outcomes related to willingness to communicate in general as well as communication of specific treatment symptoms. Exclusion criteria included systematic reviews and publications emphasizing cancer screening, cancer prevention, survivorship, or decision making. A total of 11 studies were included in the systematic review. Two of the studies focused on symptom communication; the remaining nine studies focused on general communication or the overlap between general and symptom communication. Barriers to symptom and/or general communication included negative expectations, health-related uncertainty, ambiguousness with assessments, unfamiliarity, restriction of information, perceived negative provider characteristics/behaviors, adolescent circumstance, worry about others' perceptions, and provider approach. Facilitators to symptom and/or general communication included open communication, perceived favorable provider characteristics/behaviors, seasoned adolescent, and patient-provider rapport. Five practice recommendations were developed from the evidence that supports general and symptom communication between adolescents who are receiving or have completed cancer treatment and their HCPs.

Perpetuating the cycle of silence: the intersection of uncertainty and sexual health communication among couples after breast cancer treatment.

The aims of this study are (1) to identify sources of uncertainty breast cancer survivors and partners of breast cancer survivors (BCS) report as a result of sexual health changes after primary treatment and (2) to investigate the challenges they experience when attempting to communicate about sexual health-related uncertainty. Forty BCS and 13 partners completed written reflections and participated in semi-structured interviews. Analyses revealed five predominant sources of uncertainty for BCS and partners: perceptions of post-treatment body, worry about effects on relational partners, ethical concerns about dissatisfaction with sexual relationship (partners only), fears about future of the relationship, and apprehension about SH treatment futility. These concerns are linked to communication challenges for couples: supporting survivors' body esteem, navigating potentially hurtful disclosures, responding to partners' "obstructive behavior," and believing communication is futile. Findings suggest women and partners find themselves caught in a destructive cycle that reinforces uncertainty and inadvertently perpetuates silence and relational distress. To disrupt the cycle of silence, BCS and partners need to know that their interpretation of the other person's behaviors/needs is not always accurate. Strategies are required to help women and their partners express uncomfortable thoughts and feelings in safe and supportive environments. Practitioners should be conscious of potential SH issues, be familiar with existing support resources for survivors, and be prepared to disseminate information that will empower women and their partners.

Experiences of liver health related uncertainty and self-reported stress among people who inject drugs living with hepatitis C virus: a qualitative study

BackgroundPeople who inject drugs (PWID) are most at risk of hepatitis C virus infection in Australia. The introduction of transient elastography (TE) (measuring hepatitis fibrosis) and direct acting antiviral medications will likely alter the experience of living with hepatitis C. We aimed to explore positive and negative influences on wellbeing and stress among PWID with hepatitis C.MethodsThe Treatment and Prevention (TAP) study examines the feasibility of treating hepatitis C mono-infected PWID in community settings. Semi-structured interviews were conducted with 16 purposively recruited TAP participants. Participants were aware of their hepatitis C seropositive status and had received fibrosis assessment (measured by TE) prior to interview. Questions were open-ended, focusing on the impact of health status on wellbeing and self-reported stress. Interviews were voice recorded, transcribed verbatim and thematically analysed, guided by Mishel’s (1988) theory of Uncertainty in Illness.ResultsIn line with Mishel’s theory of Uncertainty in Illness all participants reported hepatitis C-related uncertainty, particularly mis-information or a lack of knowledge surrounding liver health and the meaning of TE results. Those with greater fibrosis experienced an extra layer of prognostic uncertainty. Experiences of uncertainty were a key motivation to seek treatment, which was seen as a way to regain some stability in life. Treatment completion alleviated hepatitis C-related stress, and promoted feelings of empowerment and confidence in addressing other life challenges.ConclusionTE scores seemingly provide some certainty. However, when paired with limited knowledge, particularly among people with severe fibrosis, TE may be a source of uncertainty and increased personal stress. This suggests the need for simple education programs and resources on liver health to minimise stress.

P.7.a.006 - Executive functions in children with neurodevelopment disorders

For those living with Kawasaki disease and coronary artery aneurysms, little is known about the psychosocial burden faced by parents and their children.Exploratory, descriptive, mixed-methods design examining survey and interview data about health-related uncertainty, intrusiveness, and self-efficacy.Parents' uncertainty was associated with missed diagnosis, higher income, and maternal education. Higher uncertainty scores among children were associated with absence of chest pain and lower number of echocardiograms. High intrusiveness scores among parents were associated with previous cardiac catheterization, use of anticoagulants, lower parent education and income, and missed diagnosis. High intrusiveness scores among children were associated with high paternal education. Children's total self-efficacy scores increased with chest pain and larger aneurysm size. Qualitative analysis showed two central themes: Psychosocial Struggle and Cautious Optimism.Negative illness impact is associated with a more intense medical experience and psychosocial limitations. Timely assessment and support are warranted to meet parents' and children's needs.

Psychosocial Response to Uncertain Newborn Screening Results for Cystic Fibrosis

To explore the psychosocial implications of diagnostic uncertainty that result from inconclusive results generated by newborn bloodspot screening (NBS) for cystic fibrosis (CF). Using a mixed methods prospective cohort study of children who received NBS for CF, we compared psychosocial outcomes of parents whose children who received persistently inconclusive results with those whose children received true positive or screen-negative results. Mothers of infants who received inconclusive results (n = 17), diagnoses of CF (n = 15), and screen-negative results (n = 411) were surveyed; 23 parent interviews were completed. Compared with mothers of infants with true positive/screen-negative results, mothers of infants with inconclusive results reported greater perceived uncertainty (P < .006) but no differences in anxiety or vulnerability (P > .05). Qualitatively, parents valued being connected to experts but struggled with the meaning of an uncertain diagnosis, worried about their infant's health-related vulnerability, and had mixed views about surveillance. Inconclusive CF NBS results were not associated with anxiety or vulnerability but led to health-related uncertainty and qualitative concerns. Findings should be considered alongside efforts to optimize protocols for CF screening and surveillance. Educational and psychosocial supports are warranted for these families.

Kawasaki Disease With Coronary Artery Aneurysms: Psychosocial Impact on Parents and Children

IntroductionFor those living with Kawasaki disease and coronary artery aneurysms, little is known about the psychosocial burden faced by parents and their children. MethodsExploratory, descriptive, mixed-methods design examining survey and interview data about health-related uncertainty, intrusiveness, and self-efficacy. ResultsParents' uncertainty was associated with missed diagnosis, higher income, and maternal education. Higher uncertainty scores among children were associated with absence of chest pain and lower number of echocardiograms. High intrusiveness scores among parents were associated with previous cardiac catheterization, use of anticoagulants, lower parent education and income, and missed diagnosis. High intrusiveness scores among children were associated with high paternal education. Children's total self-efficacy scores increased with chest pain and larger aneurysm size. Qualitative analysis showed two central themes: Psychosocial Struggle and Cautious Optimism. DiscussionNegative illness impact is associated with a more intense medical experience and psychosocial limitations. Timely assessment and support are warranted to meet parents' and children's needs.

Health Blogging and Social Support: A 3-Year Panel Study

The reported study explored the implications of informal computer-mediated social support for the well-being of individuals coping with illness over the course of 3 years. A panel study was conducted in which respondents—bloggers writing about their experiences living with a health condition—reported on their perceptions of social support and well-being during 2010 and again during 2013. Among respondents who completed both questionnaires (n = 49), increases in support availability from family and friends were related to improvements in bloggers' health self-efficacy as well as improvements in bloggers' loneliness, particularly among those who also experienced increased support availability from blog readers. Increased blog reader support availability was associated with improvements in bloggers' health-related uncertainty. Among respondents who completed the initial questionnaire (N = 121), a survival analysis showed that neither support available from family and friends nor support from blog readers predicted continued health blogging over the 3-year period.

Information Seeking in Uncertainty Management Theory: Exposure to Information About Medical Uncertainty and Information-Processing Orientation as Predictors of Uncertainty Management Success

Uncertainty management theory outlines the processes through which individuals cope with health-related uncertainty. Information seeking has been frequently documented as an important uncertainty management strategy. The reported study investigates exposure to specific types of medical information during a search, and one's information-processing orientation as predictors of successful uncertainty management (i.e., a reduction in the discrepancy between the level of uncertainty one feels and the level one desires). A lab study was conducted in which participants were primed to feel more or less certain about skin cancer and then were allowed to search the World Wide Web for skin cancer information. Participants’ search behavior was recorded and content analyzed. The results indicate that exposure to two health communication constructs that pervade medical forms of uncertainty (i.e., severity and susceptibility) and information-processing orientation predicted uncertainty management success.

An Examination of the Relationships Among Uncertainty, Appraisal, and Information-Seeking Behavior Proposed in Uncertainty Management Theory

Uncertainty management theory (UMT; Brashers, 2001, 2007) is rooted in the assumption that, as opposed to being inherently negative, health-related uncertainty is appraised for its meaning. Appraisals influence subsequent behaviors intended to manage uncertainty, such as information seeking. This study explores the connections among uncertainty, appraisal, and information-seeking behavior proposed in UMT. A laboratory study was conducted in which participants (N = 157) were primed to feel and desire more or less uncertainty about skin cancer and were given the opportunity to search for skin cancer information using the World Wide Web. The results show that desired uncertainty level predicted appraisal intensity, and appraisal intensity predicted information-seeking depth—although the latter relationship was in the opposite direction of what was expected.

Reflections on living with HIV over time: exploring the perspective of HIV-infected women over 50

Objectives: Approximately 32.7% of people living with HIV/AIDS (PLWHA) in the USA are now over the age of 50. Women comprise a significant percentage of the US HIV epidemic and the percentage of women diagnosed with HIV continues to grow; however, little is known about women's experiences living and coping with HIV over time. The goal of this study was to explore the experiences of US women over 50 living with HIV to better understand how they make sense of their diagnosis and cope with their illness over time and during the aging process.Method: Nineteen women (mean age = 56.79, SD = 4.63) referred from Boston-area organizations and hospitals completed one-time, in-depth individual interviews, out of which 47% of the participants were identified as Black/African Americans, and 37% as White. The average time since diagnosis was 16.32 years (SD = 5.70). Inclusion criteria included: (1) female sex, (2) aged 50 or older, (3) HIV diagnosis, and (4) English speaking. Transcribed interviews were analyzed using a grounded theory approach and NVivo 9 software.Results: Findings are described across the following themes: (1) experiences at diagnosis, (2) uncertainty of disease course, (3) acceptance, and (4) living ‘well’ with HIV. Participants appeared to be well adjusted to their HIV diagnosis and described a progression to acceptance and survivorship; they identified strategies to ‘live well’ in the context of HIV. For some, health-related uncertainty about the future remained. These findings were organized into a model of coping with HIV.Conclusion: Themes and issues identified by this study may help guide interventions across the lifespan for women with HIV.

Health Blogging

The reported study explored the implications of making public, written disclosures about illness-related experiences in the context of health blogging. The outcomes associated with specific forms of expression used by bloggers and their readers were investigated. A panel study was conducted among 72 individuals who live with and blog about their experiences with a specific health condition. The results, although modest, show that elements of health blogging are associated with improvements in bloggers’ well-being. Bloggers’ use of insight words was associated with decreased health-related uncertainty and, among bloggers who posted relatively more frequently, increased purpose in life. Additionally, for those bloggers whose readers commented more frequently, readers’ use of negative emotion words was associated with increased perceptions of personal growth among bloggers.