Graduation Year

2021

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Communication

Major Professor

Steven R. Wilson, Ph.D.

Committee Member

Patrice M. Buzzanell, Ph.D.

Committee Member

Marleah Dean Kruzel, Ph.D.

Committee Member

Maria Koskan Venetis, Ph.D.

Keywords

communication theory, critical interpersonal and family communication, health communication, normative rhetorical theory, scale development

Abstract

This dissertation builds upon the extant literature in fields such as medicine, psychology, sociology, women and gender studies, and communication studies to theoretically explicate and develop a measure of the process of communicative disenfranchisement (CD). This dissertation refers to CD in two capacities: (a) as the phenomenon of CD (i.e., a communication construct and process unfolding over time), and (b) as a theoretical framework (i.e., that builds on CIFC tenets and elucidates the phenomenon of CD) which is abbreviated TCD (i.e., theory of communicative disenfranchisement). TCD enables scholars to assess how talk may disempower and empower again individuals and communities over time. This dissertation explores how CD unfolds for female patients who experience one or more chronic overlapping pain conditions (COPCs) and experience the communicated denial or contestation of symptoms or illness effects by important others. Such interactions inhere notions of power, are affected by material public sphere actants (such as discourses about women in pain and health policies) and require grappling with the relational and identity implications of talk. Existing measures of tangential constructs do not account for these dimensions. Hence, a mid-range theoretical explication of TCD, developed in the context of COPCs, is produced to enable future researchers to examine CD across diverse communication contexts.

Guided by assumptions derived from the critical interpersonal and family communication (CIFC) framework and multiple goals frameworks, two studies comprise this dissertation project. Study one consisted of a systematic qualitative meta-synthesis of publications (e.g., interview studies) about the interactions and experiences of COPC patients as well as patient accounts of these interactions posted to Reddit. Study one accomplished three aims: (a) explicating the dimensions and conceptual boundaries of CD by exploring how women with COPCs themselves talk about CD, (b) facilitating initial item generation for a measure of CD, and (c) suggesting possible outcomes of CD (after which specific hypotheses were proposed).

Study two facilitated the development and validation of a measure of CD. Following guidance by DeVellis (2017) and foregrounded by the theoretical explication completed in the first study, study two consisted of the initial development and validation of a multidimensional measure of CD in the context of COPCs with 400 patients who have spoken to a medical provider at least once about at least one of the 10 COPCs. Participants for study two were recruited through: (a) my personal social network, (b) participants with COPCs from past studies who indicated a continued interest in study participation, (c) snowball sampling from these participants via email, and (d) online/social media advertisements.This dissertation produced measures of three CD constructs as well as a mid-range theoretical explication of the dimensions and effects of TCD in the context of COPCs. These findings may enable researchers to assess the features, prevalence, and outcomes of CD across diverse contexts and populations, and may affect positive social changes in the relations which constitute CD. The theoretical and practical implications of these findings are discussed as well as limitations and directions for future research (e.g., conducting a second validation study).

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