April 4-6, 2024 • Hyatt Regency • Lexington, KY
Innovations in Health Communication
Innovations in Health Communication
Abstract: Forms of Problematic Integration in the Context of Pregnancy Termination for Medical Reasons
Scientific advancements in prenatal screening and diagnostic tools offer pregnant people an unprecedented amount of information about the fetus, including the presence of any abnormalities (Lord et al., 2022). Those whose prenatal tests point to life-limiting fetal abnormalities are forced to consider the unimaginable—a termination for medical reasons (TFMR). Although TFMR prevalence rates are unknown, research on the outcomes of prenatally diagnosed fetal anomalies indicates that the majority of affected pregnancies end in TFMRs (Hendrix et al., 2023). This incredibly difficult decision to interrupt a wanted pregnancy is made more complicated by the stigma of abortion, legislative restrictions on pregnancy termination, and the uncertainties involved in prenatal diagnostics and parental decision-making. How parents manage these uncertainties has important implications for their emotional well-being, yet little is known about the types of uncertainties associated with TFMRs (Lord et al., 2022).
Multiple health communication theories address the communicative management of uncertainty, but only one, problematic integration theory (PIT), focuses on the sources of uncertainty (Babrow, 1992). As such, PIT offers a useful theoretical lens through which to view the types of uncertainty associated with TFMRs. PIT argues that we are constantly making predictions and evaluating them. When our predictions (i.e., our probabilistic orientations) and evaluations are incongruent, we experience problematic integration (PI). PIT describes four sources or forms of PI: (a) divergence, which occurs with discrepant desires and expectations; (b) uncertainty, or difficulties forming probabilistic orientations regarding something we evaluate positively or negatively; (c) ambiguity, which refers to having mixed feelings about a prediction; and, (d) impossibility, or wanting the unattainable. In a recent systematic review of the literature on PIT, Kuang and Babrow (2021) encouraged researchers to delve further into these four forms and to consider additional ones. Due to the potential theoretical contributions of a study on PI in the context of TFMR and the pressing need for further research on uncertainty in this context, we designed a study to address the following RQ: What forms of problematic integration characterize the TFMR experience?
To answer this question, we gathered 78 online narratives posted by TFMR parents on three of the most popular TFMR support websites. Through a thematic analysis, we found that TMFR parents experienced divergence with respect to the diagnosis, the prognosis, and the implications of TFMRs for future pregnancies. In addition, parents described ontological uncertainties, questioning if they’d survive the loss, why they were affected, and how they could make such a difficult decision. Narratives also touched on epistemological uncertainties associated with unclear or contradictory information. TFMR parents described the choice between keeping and ending the pregnancy as well as the decision between termination options in terms of ambivalence, and parents’ efforts to maintain hope when all hope was lost was evidence of impossibility. Finally, we identified one additional source of PI, which we labelled indeterminacy. Parents frequently mentioned having difficulty forming both probabilistic and evaluative orientations, which is not currently considered in PIT. The discussion offers possible explanations for these findings and considers their implications.
Multiple health communication theories address the communicative management of uncertainty, but only one, problematic integration theory (PIT), focuses on the sources of uncertainty (Babrow, 1992). As such, PIT offers a useful theoretical lens through which to view the types of uncertainty associated with TFMRs. PIT argues that we are constantly making predictions and evaluating them. When our predictions (i.e., our probabilistic orientations) and evaluations are incongruent, we experience problematic integration (PI). PIT describes four sources or forms of PI: (a) divergence, which occurs with discrepant desires and expectations; (b) uncertainty, or difficulties forming probabilistic orientations regarding something we evaluate positively or negatively; (c) ambiguity, which refers to having mixed feelings about a prediction; and, (d) impossibility, or wanting the unattainable. In a recent systematic review of the literature on PIT, Kuang and Babrow (2021) encouraged researchers to delve further into these four forms and to consider additional ones. Due to the potential theoretical contributions of a study on PI in the context of TFMR and the pressing need for further research on uncertainty in this context, we designed a study to address the following RQ: What forms of problematic integration characterize the TFMR experience?
To answer this question, we gathered 78 online narratives posted by TFMR parents on three of the most popular TFMR support websites. Through a thematic analysis, we found that TMFR parents experienced divergence with respect to the diagnosis, the prognosis, and the implications of TFMRs for future pregnancies. In addition, parents described ontological uncertainties, questioning if they’d survive the loss, why they were affected, and how they could make such a difficult decision. Narratives also touched on epistemological uncertainties associated with unclear or contradictory information. TFMR parents described the choice between keeping and ending the pregnancy as well as the decision between termination options in terms of ambivalence, and parents’ efforts to maintain hope when all hope was lost was evidence of impossibility. Finally, we identified one additional source of PI, which we labelled indeterminacy. Parents frequently mentioned having difficulty forming both probabilistic and evaluative orientations, which is not currently considered in PIT. The discussion offers possible explanations for these findings and considers their implications.