Explaining essential issues concerning their area of expertise to laypersons is a significant part of medical experts’ daily working routine. Often, laypersons depend on such glimpses of in-depth knowledge in order be able to evaluate their momentary position in a certain situation, for instance giving into or disapproving of a surgery. Unfortunately, providing medical explanations is rather difficult: Experts’ specialized and highly integrated knowledge often proves to be an obstacle to effective communication with laypersons. On experts’ side adaptive behavior is needed that identifies patients’ current understanding and anticipates potential problems in understanding. Hence, adaptive behavior not only includes individualized explanations on a certain medical issue but also sensitive perception of laypersons verbal information. Reacting to errors in a one-to-one tutorial interaction can be seen as an essential adaptive behavior of an expert. Nevertheless research on experts’ behavior indicates at least two problems: Experts do not notice relevant differences between correct content knowledge and the tutee’s current understanding. Furthermore, even if they notice this discrepancy and their tutees’ false beliefs they do not react to this circumstance appropriately, e.g., they present non-adapted (correct) information instead of explaining directly what is wrong with the tutee’s current perspective. I will present two studies on tutors’ reflections and reactions to tutees’ false beliefs in online medical counseling. The results indicate that tutors do not directly refer to the false beliefs tutees communicate though they clearly identify the wrongness of the information. In the discussion I focus on two general questions with regard to adaptivity: First, what is the relation between anticipation of tutees knowledge and adaptive language behavior? Second, what role play politeness and face-threatening behavior in health communication?

In the health promotion literature, risk perception – individuals' beliefs about their vulnerability to diseases and negative health outcomes – is theorized to be an important predictor of behavior change. Risk perception is also a key component of several theories of health behavior change, including the health belief model and protection motivation theory. Empirically, findings are mixed, with some studies showing a positive association between risk perception and behavior change, others showing no association, and still others showing a negative association. Derived from the external parallel process model and social cognitive theory, the risk perception attitude (RPA) framework posits that the ambiguity in the literature can be explained by taking into account people’s efficacy beliefs. According to the RPA framework, the positive association between risk perception and behavior change is strengthened if people feel efficacious in their ability to make the change. If perceptions of efficacy are low, however, high risk perceptions do not translate into behavioral action. The RPA framework classifies people into four groups. Those with high risk perceptions and strong efficacy beliefs constitute the responsive group and those with low risk perceptions and weak efficacy beliefs constitute the indifference group; the proactive group has low risk perceptions and strong efficacy beliefs, and the avoidance group has high risk perceptions and weak efficacy beliefs. Disease prevention behaviors are hypothesized to be highest for the responsive group, lowest for the indifference group, and intermediate for the proactive and avoidance groups. The RPA framework has been applied across a number disease prevention behaviors (diabetes, HIV/AIDS, breast cancer, skin cancer, etc.), populations, and cultures, through both experimental and observational studies. This presentation will summarize that work and propose directions for future research.

Advances in biomedical and communication revolutions have opened up exciting possibilities for improving human health lending health communication science a central role in health promotion and disease prevention. At the same time, there is a shift in patient-provider communication from a paternalistic model to a more consumerist model with the expectation that the patients or consumers make important health-related decisions after carefully weighing different alternatives based on information. The resulting explosion in and demand for health information, available and offered through a variety of information delivery platforms including mass media and the Internet among others, offers great promise as well as pitfalls to those who are incidentally exposed to the information as well as active seekers. Yet, these developments also offer two major challenges. One, the sheer amount of information as well as the way it is packaged and delivered poses a significant challenge to those trying to make sense of it. Equally, if not more critical, are communication inequalities among different social groups that differ in access to information and the ability to act on it, as well as in making sure that it is accurate, readily available and easy to use. The promise of information revolution, in short, could potentially go unfulfilled for certain groups in our societies such as the poor and the minorities who also face disproportionate burden of disease and other disadvantages leading to increasing health disparities between the haves and have-nots. This talk will survey the major challenges in health communications in the era of medical and information revolutions with a particular focus on the underserved and the poor and will end with a review some potential solutions to resolve these challenges.

Objectives. Switzerland’s constitution is unique in Europe having four official languages representing the geographically different regions. Evidence in voting behavior, organ donation rates or attitudes (i.e. risk perception) showed that there are more than just linguistic differences. Health campaigns are usually created in one language and then translated: a procedure not only related to translation but also conceptual understanding problems. The objective of this paper is to see what the international scientific community knows about adapting health messages to particular audiences and in particular cultural contexts and how these strategies could be adapted to the special Swiss setting.
Method. Pubmed, IsI Web of Knowledge and GoogleScholar were searched for key words such as health communication, culture, statistical evidence, narratives, and different combinations and variations of these terms. All relevant articles were chosen according to relevance criteria defined by the researcher.
Findings. Different researchers showed how to design and adapt health messages for different target audiences. (Maibach/Parrot, 1995) Messages can be adapted in different ways: they can be adapted to the stage of behavioral change (Maibach/Cotton, 1995; Cappella, 2006; Lippke et al, 2010) or to a specific audience (Slater; Austin, Siska, 1995; Kreuter, 2003) or to certain psychological features, such as the use of statistical evidence vs. narratives (Kopfman et al., 1998; Greene/Brinn, 2003; Mazor et al. 2007), fear appeals (Hale, 1993; Hale/Dillard, 1995) or positive affect (Cacioppo/Petty, 1989; Monahan, 1995).
Practical implications. Literature shows that messages can be targeted in different ways. Adapting health messages to cultural contexts has been conducted (Huerta and Macario, 1999) and the question is whether also for a multilinguistic country like Switzerland it would be more effective to adapt targeting strategies. Further research in the domain is needed, since there is no scientific evidence, that targeting health campaigns to micro-cultural differences would be effective as well.

Introduction: When exploring the antecedents of individuals’ health behavior and outcomes, the concept of health literacy is deemed to be a factor of major influence (DeWalt et al., 2004; Paasche-Orlow et al., 2005). However, studies on the relationships between these constructs showed mixed results. For example, while Hawthorne (1997) revealed that adolescents with lower literacy were more likely to smoke, Arnold et al. (2001) found a strong relationship between literacy levels and knowledge about the effects of smoking, but no relationship between these two constructs and smoking rates among pregnant women.
Objectives: This paper investigates why health literacy and knowledge alone cannot explain sufficiently health behavior. A look at the large body of theories and models of health behavior (Glanz et al., 2008) reveals that other individual characteristics need to be considered. Self-efficacy, for instance, is a prominent individual characteristic included in Social Cognitive Theory and Health Belief Model. Together with personal relevance, locus of control, and self-determination it forms the concept of psychological empowerment which has been studied not only in health but also in workplace settings (e.g. Menon, 2002; Spreitzer, 1995). Psychological empowerment entails a set of beliefs and attitudes that can, but do not have to be related to health literacy. Therefore, the integration of psychological empowerment in current health literacy concepts promises a better understanding of health behavior and outcomes.
Implications: Using an integrated approach is crucial for health intervention programs, which aim at enhancing promotional activities of lay people or self-management skills of chronic patients. If intervention programs are adapted to both, literacy and psychological empowerment levels, they suggest more success than standardized health education materials only. In how far this can be proved empirically is subject to future research.

Mobile technologies and online Web 2.0 applications are becoming important communication channels and are used by individuals and organizations in all sectors and markets. In the last couple of years, even public health and social marketing professionals and scholars started to use these technologies for the development and promotion of behaviour change interventions, programmes and campaigns (Chou et al., 2009; Evans, Davis, & Zhang, 2008; Evans et al., 2009; Fjeldsoe, Marshall, & Miller, 2009; Gosselin & Poitras, 2008; Lefebvre, 2009 Tufano & Karras, 2005). These new media represent a great potential for designing and developing health marketing and public health interventions (Della et al., 2008), because Web 2.0 and mobile technologies allow to reach and engage large segments of population, and to monitor their health behaviours in an efficient and cost-effective way (Bennett & Glasgow, 2009). Since mobile and Web 2.0 technologies are interactive, customizable and portable, they could also easily be adopted to serve different purposes and different populations (Evans et al., 2009; Timpka et al., 2008). They allow to target, personalize and tailor messages to specific segments of populations or individuals, extending the potential of computer-based and online tailoring interventions.
However, it is not yet known if, how and to what extent mobile and Web 2.0 technologies effectively affect behaviour change. As for online tailored communication, it is not clear what factors or combination of factors impact on individuals health habits and decisions (Suggs & McIntyre, 2007). The aim of this paper is to conceptually identify trends and discuss the use of these technologies, focusing on their limitations and challenges, under the light of an integrated social marketing and communication framework.

Nursing handovers are institutional routines aiming at the transmission of patient information between shifts of caregivers (Perry, 2004). Whereas streamlining of handovers is advocated for efficiency and accuracy reasons (Hughes & Clancy, 2007), there is concern about the appropriateness of standardization: the use of standardized handover procedures has for instance been related to unreliable information transmission (Boucheix & Coiron, 2008). Too much standardization could hence be detrimental to patients’ safety (Patterson, 2008).
Coordination in uncertain environments and tasks requires adaptability. For instance, the use of unprogrammed (adaptable) procedures is more efficient than the use of programmed ones in hospital units facing a high uncertainty (Argote, 1982, Gittell, 2002), because routines are not meant to account for exceptions (uncertainty). Agents hence need to alter them in order to complete their aims efficiently (Feldman, 2000). This reconfiguration of routines allows organizational subunits to rapidly adapt to changes in their environment (Feldman & Pentland, 2003).
Adaptability is also useful in face-to-face task communication: standardized verbal protocols are inefficient in case of unexpected situations. Coordination is hence made through the depiction of the situation and the negotiation of appropriate solutions (Morrow et al.,1994). Narratives are also useful when care situations are non-routine (Bangerter, Mayor et Pekarek Doehler, in press). We hence hypothesize that handover communication is less structured in units high in uncertainty than in units low in uncertainty. We test this using sequential analysis of coded contents of handover.
We will show differences and similarities of sequential communication structure during handovers of nursing units which vary in task uncertainty and that communication in units facing high uncertainty is less standardized than in units facing low uncertainty. This could be an indicator of adaptability of communication, which is a necessity for caregivers dealing with patients in uncertain care situations (Nemeth et al., 2008).

Individual political preferences are the result of both personal characteristics and social contexts. Research has illuminated the impact of personal characteristics on individual political preferences, but the social environment in which people lives and its influence on people's opinion has received little attention in public opinion research since the Katz, Lazarsfeld and Roper's study in the 1940s. This contribution expands our understanding by focusing on the social influences on individual choices and examining the relationship between individual characteristics and interpersonal communication to the voting choices. The analyses are based on a panel survey that was conducted during the public discussion about the smoking ban in Ticino which was voted by the population in March 2006. The focus here is on the two waves that were conducted before the vote. Results show that social environment is significanlty related to individual's opinion. Respondents who perceive their friends being in favour of the smoking ban are more likely to be in favour of it. Respondents who discussed at several occasions with supporters are more likely to be in favour of the smoking ban. In the same vein, respondents who discussed several times with opponents are more likely to be against the smoking ban. In addition, it was found that social context also influence the direction of opinion change when such a change takes place.

Objective: This study tests whether the personality trait of agreeableness in the patients moderates their reactions to the physician’s behavior. We predicted that the more agreeable the patients, the more positive the interaction outcomes when they see a high affiliative physician as compared to a low affiliative physician.
Methods: Participants (60 students) watched videotaped excerpts (2 min each) of 4 physicians exhibiting a high affiliative behavior and of 4 physicians exhibiting a low affiliative behavior, and reported after each physician their satisfaction, trust, and perception of the physician’s competence, and how well they thought that they would adhere to the treatment recommendations of the physician. They also completed the agreeableness scale of the NEO-PI-R personality questionnaire.
Results: The higher the agreeableness scores of the participants, the higher was their trust with the high affiliative physicians as compared to the low affiliative physicians, their perception of the physician’s competence, and their determination to adhere to the treatment.
Conclusion: Results confirmed the moderating effect of the patients’ agreeableness on the link between the physicians’ affiliativeness and the interaction outcomes.
Practice Implications: These results suggest that the more agreeable the patients are, the more important it is that physicians adopt a high affiliative behavior.

In Switzerland, there is evidence of underlying differences in risk perception among Swiss Germans and Swiss Italians. When informing the population about eventual health hazards, such variance in risk perception should be taken into account and risk communication targeted to the cultural context. The present paper aims at identifying which theoretical constructs could explain such differences among language groups. In particular it concentrates on Cultural Cognition, a recent attempt to combine two of the most widely used approaches in risk perception: the Psychometric Paradigm and the Cultural Theory of Risk. The Psychometric Paradigm has been developed by psychologists and assumes that risk does not exist “out there”, but that it is subjectively defined by individuals using multiple qualitative risk characteristics (Slovic, 2000). Studies using this approach have generated a cognitive map of risk perception, identifying “personality profiles” of numerous hazards. Contemporarily, the Cultural Theory of risk has been developed by anthropologists, who argue that reactions to risks are inseparably connected with the ways in which society it self is perceived and experienced (Douglas & Wildavsky, 1982). Those theorists assume that individuals are culturally biased and that they “select” to credit risks that cohere with their world views, and to ignore risks that undermine and threaten them. The Cultural Cognition project unifies the two frameworks, suggesting that the dynamics featured in the psychometric paradigm are the mechanisms through which different cultural worldviews shape risk perception (Kahan, Slovic, Braman, & Gastil, 2006). Until today, most of the studies investigating a link between cultural worldviews and risk perception have been conducted among different nations or ethnic groups. We suggest that the phenomena of Cultural Cognition can also be used to explain variance in risk perception among language groups within a small country like Switzerland. A better understanding of such differences would be fundamental for an effective risk communication strategy adapted to the characteristics of the language regions.

The healthcare domain is a substantive part of an ever-changing environment, where the Net is increasingly becoming a source of information for laypeople and health professionals. The Internet is praised in literature for its potential to enhance users’ abilities to cope with their pathologic conditions (Eysenbach, 2001). Yet, online websites are mainly informative and provide generic advices. There exists an “information gap” between general knowledge about chronic illnesses and the application of this knowledge to ameliorate the individual’s condition. Adaptive communication - intended as a combination of evidence-based medicine material, continuous counselling, and tailoring to the users’ needs - can help improve the process of knowledge translation and, ultimately, patients’ health outcomes. Nevertheless, theoretically sound and verifiable models leading from eHealth usage to health outcomes are still scant (Bennett & Glasgow, 2009). Thus, the objective of this presentation is to review the main postulated models of eHealth effects, and, when possible, their testing and evaluation.
While the large majority of the studies dealing with eHealth interventions are strictly experimental, four models have been developed to explain the pathways of change from website exposure to improved health outcomes (Eysenbach, 2003; Street, 2003; Murray, 2005; Dutta-Bergman, 2006). However, these models are either to broad to be empirically verified or not sufficiently specific in explaining how eHealth exposure should be operationalized. Moving from these considerations, a discussion on a specific eHealth model, developed to test an eHealth intervention for patients affected by chronic conditions, will be put forward. This model is meant to take into account a more precise way of operationalizing the eHealth intervention as a predictor of health outcomes. The challenges and open questions that are still under examination will be put forward for discussion.

With the increasing flow of information in our societies, the traditional basic definition of literacy as the ability to read and write seemed not to be sufficient anymore to capture all the abilities and skills necessary to enable individuals to achieve their goals, to develop their knowledge and potential, and to participate fully in their community and wider society. To acknowledge this complexity UNESCO (2004) has recently redefined literacy as the "ability to identify, understand, interpret, create, communicate, compute and use printed and written materials associated with varying contexts”. In addition, over the past few decades, we have been faced with the emerging of a constellation of context‐specific literacy concepts (e.g. health literacy, media literacy, or cultural literacy) shifting the focus from educational research to other disciplines (Nutbeam 2009).
As a reflection on the adaptivity of the field of health communication, this conceptual paper analyzes and discusses the evolving and multi‐faceted concept of health literacy. In particular we are interested in the adaptation process. We start from the origins of the concept in school health education (Simonds 1974), when it was understood as a set of technical skills, and describe the way it changed to a concept very specific and exhaustive at the same time (Nutbeam 2008; Mancuso 2009).
Comparing the evolution of the concept of health literacy to the one of traditional literacy concept, we are now able to have an idea of how the previous will most likely evolve in the next future. In particular we conclude that, to respond to the increasing complexity of the healthcare sector, partly related to the diffusion of new technologies, it will be necessary to move from one single concept of health literacy to more specific concepts, adapted to the contents and contexts of the different diseases (e.g. cancer) or groups of conditions (e.g. chronic conditions).
We assume that this adaptation will be crucial to gain a deeper understanding of specific health literacy deficiencies and to create and improve new and existing health communication and education interventions.

Being able to adapt one’s communication to the needs of one’e counterpart is particularly important in handovers. The aim of the present study is to identify how perspective taking of physician residents affects the satisfaction of their partner in the handover dyad. Perspective taking is seen as a social skill to consider and understand another person’s psychological point of view. Because of the fact that perspective taking in the context of physician- physician handovers has not been investigated much, this article tries to give an overview about the relation of perspective taking as a social skill and its role in the handover communication. Based on these theoretical aspects, it is predicted that a higher level of perspective taking (and other social skills) is associated with a higher level of satisfaction with handovers for handover partners. To measure perspective taking and other social skills, participants (10 physician residents working on an intensive care unit) filled out some dimensions of the Social Competence Inventory (SCI, Kanning, 2009) at the intake assessment. During an event-sampling phase, they were asked to report their satisfaction with each handover immediately of it took place.
Preliminary analyses indicate that, on an aggregate level, there is a positive association between the perspective taking scores of the actor (outgoing resident) and satisfaction of the partner (incoming resident). Results confirmed that the degree to which one physician is able to adapt to the perspective and needs of another has an impact on the latter’s satisfaction as one outcome of handover episodes. It remains to be investigated whether this effect holds also regarding other outcomes. The results of the study suggest that social skills, especially perspective taking, are important for satisfaction. This emphasizes the importance of physician’s skills to adapt his communication not only with regard to patients but also with regard to other physicians.