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Articles 601 - 630 of 1597

Full-Text Articles in Health Communication

“No Justice, No Peace”: Yard Signs As Public Pedagogy And Community Engagement At The Intersection Of Public Health Crises, Brigitte Mussack Oct 2021

“No Justice, No Peace”: Yard Signs As Public Pedagogy And Community Engagement At The Intersection Of Public Health Crises, Brigitte Mussack

Journal of Communication Pedagogy

This paper examines yard signs as a site for public pedagogy that engages two concurrent, and comorbid, public health crises: the COVID-19 pandemic and racism. Specifically, I reflect on how yard signs responding to the George Floyd murder in my own Minneapolis neighborhood exist during a kairotic moment; as myself and my students are increasingly confined to our own homes, and as the boundaries between school and home are blurred, the public health crisis of racism and the specific community response of yard signs present opportunities for examining how these signs can act as entry points into difficult conversations among …


Romantic Partner Interference And Psychological Reactance In The Context Of Caregiving For An Aging Family Member, Hannah Ball, Jennifer L. Bevan, Tessa Urbanovich, Erin S. Craw Oct 2021

Romantic Partner Interference And Psychological Reactance In The Context Of Caregiving For An Aging Family Member, Hannah Ball, Jennifer L. Bevan, Tessa Urbanovich, Erin S. Craw

Communication Faculty Articles and Research

Negotiating romantic relational dynamics is inherent to family caregiving situations, which continue to be on the rise in the United States. However, despite evidence that family caregiving duties are linked to a variety of negative relational outcomes, limited research examines communication processes that contribute to or alleviate the burden of caregiver duties on romantic relationships. Guided by psychological reactance theory (PRT), this study examined the link between romantic partner interference with family caregiving duties and the reactance process, as well as directness of communication about irritation as a type of freedom restoration behavior associated with reactance. Adults caring for aging …


Burnout In The Nursing Profession: Extant Knowledge And Future Directions For Research And Practice, Sara Labelle Oct 2021

Burnout In The Nursing Profession: Extant Knowledge And Future Directions For Research And Practice, Sara Labelle

Communication Faculty Articles and Research

Burnout is a psychological state resulting from prolonged psychological or emotional job stress, and is a culmination of three factors: emotional exhaustion, depersonalization, and reduced personal accomplishment. Due to the nature of the “people-work” they must constantly perform, along with a highly stressful and unpredictable work environment, nurses have alarmingly high rates of burnout among members of their profession. Given the importance of research on burnout to understanding the context-specific stressors and challenges of nursing, this review offers a synthesis of research published in the last decade in both nursing and communication journals, with an emphasis on discussing opportunities for …


The Role Of Photography In Increasing Efficiency Of Dermatologic Inpatient Consulting Service, Ritu Swali, Tyler D. Evans, Dillon Clarey, Corey Georgesen, Ashley Wysong Oct 2021

The Role Of Photography In Increasing Efficiency Of Dermatologic Inpatient Consulting Service, Ritu Swali, Tyler D. Evans, Dillon Clarey, Corey Georgesen, Ashley Wysong

Graduate Medical Education Research Journal

Abstract

Introduction:

Inpatient dermatology consultations can bring a mixed bag of pathologies. Due to the highly specialized nature of dermatology and the lack of dermatologic training in medical school, the dermatologic team is consulted for matters that range from non-urgent to pressing. Pictures are a critical component of dermatology and greatly aid in the diagnosis of cutaneous diseases. In the inpatient setting, pictures can help streamline diagnosis and prevent unnecessary tests or procedures. The purpose of this study was to evaluate for the presence of pictures in patients’ chart after a dermatology consult had been placed through EPIC at the …


The Multi-Step Approach To Covid Prevention In The Casamance Region, Saraí Hernandez Salguero Oct 2021

The Multi-Step Approach To Covid Prevention In The Casamance Region, Saraí Hernandez Salguero

Independent Study Project (ISP) Collection

Located in the Oussouye Department approximately 43 kilometers away from the city of Ziguinchor in the Basse Casamance region of southern Senegal is the Oussouye commune where I had the pleasure of staying for three weeks. I had learned that the inhabitants of this village were not significantly impacted by the Covid-19 virus since it became global knowledge at the start of 2020. As of March 2020, the village had only reported 69 active cases and the department saw only 8 deaths in total. I sought to figure out what could be the cause of this and through a series …


Reports And Commands: Deciphering A Health Exhibition Using The Speaking Mnemonic, David H. Lee Oct 2021

Reports And Commands: Deciphering A Health Exhibition Using The Speaking Mnemonic, David H. Lee

Publications and Research

The Amazing You exhibition at the Tampa Museum of Science and Industry had over 400 different multimedia health exhibits. Visitors walked through life stages, from conception through death, the exhibits at first showcasing developmental milestones, then diseases and chronic conditions associated with ageing. Museum executives described the exhibition as a public health intervention that stressed disease prevention, screening and behaviour change. This piece considers the question: What makes an exhibition be a health intervention? To describe complexities of the communication environment I use a mnemonic device called SPEAKING, an acronym for ‘Scene/Setting, Participants, Ends, Act Sequence, Key, Instrumentalites, Norms and …


Journal Of Communication Pedagogy, Complete Volume 4, 2021 Sep 2021

Journal Of Communication Pedagogy, Complete Volume 4, 2021

Journal of Communication Pedagogy

This is the complete volume 4 of the Journal of Communication Pedagogy.


The 12 Fundamentals Of Highly Effective Communicators: Teaching Theory-Based Professional Communication To Pharmacy Students, Erin Donovan, Laura Brown, Calandra Lindstadt, Billy Table, Elham Heidari, Andrew Coolidge, Suheib Omran, Sharon Rush Sep 2021

The 12 Fundamentals Of Highly Effective Communicators: Teaching Theory-Based Professional Communication To Pharmacy Students, Erin Donovan, Laura Brown, Calandra Lindstadt, Billy Table, Elham Heidari, Andrew Coolidge, Suheib Omran, Sharon Rush

Journal of Communication Pedagogy

Pharmacists are increasingly expected to communicate skillfully, yet few Doctor of Pharmacy (PharmD) curricula include theoretically-derived or evidence-based communication training. The 12 Fundamentals of Highly Effective Communicators is a pedagogical tool that we developed to teach principles of communication to two consecutive cohorts of PharmD students in their second year (P2). Students were asked to reflect on which of the 12 Fundamentals they found most helpful in their pharmacy training and practice. The most frequently selected Fundamental was “There is no ‘one size fits all’ message that will work in EVERY situation.” Students provided specific examples of how they perceived …


Toward Improving Physician/Patient Communication Regarding Invisible Chronic Illness (Ici): The Potential Of Mhealth Technology In Instructional Communication, Jami Leigh Warren, Karen Clancy, Christy Brady, Kendall Rump, Tayla New-Oglesby Sep 2021

Toward Improving Physician/Patient Communication Regarding Invisible Chronic Illness (Ici): The Potential Of Mhealth Technology In Instructional Communication, Jami Leigh Warren, Karen Clancy, Christy Brady, Kendall Rump, Tayla New-Oglesby

Journal of Communication Pedagogy

Patients that suffer from invisible chronic illness (ICI) such as autoimmune conditions, neurological conditions, and gastrointestinal problems often struggle to obtain a proper medical diagnosis due to a lack of objective indicators to help health-care providers diagnose patients with ICIs. Thus, researchers conducted interviews with 21 participants with Postural Orthostatic Tachycardia Syndrome (POTS) to determine what messages they received from health-care providers as they pursued a diagnosis, how they interpreted those messages, and what role mHealth technology may play in improving patient/provider communication and effective diagnosis/treatment of ICIs. Several themes regarding potential instructional communication intervention content emerged from the interview …


Human-Machine Communication: Complete Volume. Volume 3. Diffusion Of Human-Machine Communication During And After The Covid-19 Pandemic Sep 2021

Human-Machine Communication: Complete Volume. Volume 3. Diffusion Of Human-Machine Communication During And After The Covid-19 Pandemic

Human-Machine Communication

This is the complete volume of HMC Volume 3. Diffusion of Human-Machine Communication During and After the COVID-19 Pandemic


What Will Affect The Diffusion Of Ai Agents?, James W. Dearing Sep 2021

What Will Affect The Diffusion Of Ai Agents?, James W. Dearing

Human-Machine Communication

For billions of people, the threat of the Novel Coronavirus SARS-CoV-2 and its variants has precipitated the adoption of new behaviors. Pandemics are radical events that disrupt the gradual course of societal change, offering the possibility that some rapidly adopted innovations will persist in use past the time period of the event and, thus, diffuse more rapidly than in the absence of such an event. Human-machine communication includes a range of technologies with which many of us have quickly become more familiar due to stay-athome orders, distancing, workplace closures, remote instruction, home-bound entertainment, fear of contracting COVID-19, and boredom. In …


The Role Of Vidura Chatbot In The Diffusion Of Knowcovid-19 Gateway, Kerk F. Kee, Prasad P. Calyam, Hariharan Regunath Sep 2021

The Role Of Vidura Chatbot In The Diffusion Of Knowcovid-19 Gateway, Kerk F. Kee, Prasad P. Calyam, Hariharan Regunath

Human-Machine Communication

The COVID-19 pandemic is an unprecedented global emergency. Clinicians and medical researchers are suddenly thrown into a situation where they need to keep up with the latest and best evidence for decision-making at work in order to save lives and develop solutions for COVID-19 treatments and preventions. However, a challenge is the overwhelming numbers of online publications with a wide range of quality. We explain a science gateway platform designed to help users to filter the overwhelming amount of literature efficiently (with speed) and effectively (with quality), to find answers to their scientific questions. It is equipped with a chatbot …


Communicative Development And Diffusion Of Humanoid Ai Robots For The Post-Pandemic Health Care System, Do Kyun David Kim, Gary Kreps, Rukhsana Ahmed Sep 2021

Communicative Development And Diffusion Of Humanoid Ai Robots For The Post-Pandemic Health Care System, Do Kyun David Kim, Gary Kreps, Rukhsana Ahmed

Human-Machine Communication

As humanoid robot technology, anthropomorphized by artificial intelligence (AI), has rapidly advanced to introduce more human-resembling automated robots that can communicate, interact, and work like humans, we have begun to expect active interactions with Humanoid AI Robots (HAIRs) in the near future. Coupled with the HAIR technology development, the COVID-19 pandemic triggered our interest in using health care robots with many substantial advantages that overcome critical human vulnerabilities against the strong infectious COVID-19 virus. Recognizing the tremendous potential for the active application of HAIRs, this article explores feasible ways to implement HAIRs in health care and patient services and suggests …


The Effects Of Situational And Individual Factors On Algorithm Acceptance In Covid-19-Related Decision-Making: A Preregistered Online Experiment, Sonja Utz, Lara N. Wolfers, Anja S. Göritz Sep 2021

The Effects Of Situational And Individual Factors On Algorithm Acceptance In Covid-19-Related Decision-Making: A Preregistered Online Experiment, Sonja Utz, Lara N. Wolfers, Anja S. Göritz

Human-Machine Communication

In times of the COVID-19 pandemic, difficult decisions such as the distribution of ventilators must be made. For many of these decisions, humans could team up with algorithms; however, people often prefer human decision-makers. We examined the role of situational (morality of the scenario; perspective) and individual factors (need for leadership; conventionalism) for algorithm preference in a preregistered online experiment with German adults (n = 1,127). As expected, algorithm preference was lowest in the most moral-laden scenario. The effect of perspective (i.e., decision-makers vs. decision targets) was only significant in the most moral scenario. Need for leadership predicted a stronger …


Our Future Arrived: Diffusion Of Human-Machine Communication And Transformation Of The World For The Post-Pandemic Era, Do Kyun David Kim, Gary Kreps, Rukhsana Ahmed Sep 2021

Our Future Arrived: Diffusion Of Human-Machine Communication And Transformation Of The World For The Post-Pandemic Era, Do Kyun David Kim, Gary Kreps, Rukhsana Ahmed

Human-Machine Communication

The world is getting into a new phase in history. For the first time, humans are verbally communicating and developing meaningful relationships with non-living objects. AI is a wormhole to open a gateway to the new world, and the COVID-19 pandemic prepared the world to transform its system to be an open system that responds to, communicates with, and utilizes the remnants coming out of the wormhole of the new world. Now, we urgently need to create a holistic discourse on how we can recognize, develop, or shape the identities of communicable machines as people develop a partnership with them. …


Leveraging The Rhetorical Energies Of Machines: Covid-19, Misinformation, And Persuasive Labor, Miles C. Coleman Sep 2021

Leveraging The Rhetorical Energies Of Machines: Covid-19, Misinformation, And Persuasive Labor, Miles C. Coleman

Human-Machine Communication

The rampant misinformation amid the COVID-19 pandemic demonstrates an obvious need for persuasion. This article draws on the fields of digital rhetoric and rhetoric of science, technology, and medicine to explore the persuasive threats and opportunities machine communicators pose to public health. As a specific case, Alexa and the machine’s performative similarities to the Oracle at Delphi are tracked alongside the voice-based assistant’s further resonances with the discourses of expert systems to develop an account of the machine’s rhetorical energies. From here, machine communicators are discussed as optimal deliverers of inoculations against misinformation in light of the fact that their …


Stress And Coping In Journalists: Findings Of A Three-Year Counselling Service, Asha Bedar Sep 2021

Stress And Coping In Journalists: Findings Of A Three-Year Counselling Service, Asha Bedar

CEJ Research and Publications

A profession whose practitioners kill stories, make deadlines, and run towards burning buildings can only be one that operates on a steady diet of stress. But gone are the days of valorising newsroom suffering, as journalists the world over have begun to understand the toll their work takes. Burnout, anxiety, depression are just some of the ways they routinely describe their mental state. Support for media workers is, however, scant in Pakistan. It was, thus, the good fortune of IBA’s Centre for Excellence in Journalism in Karachi to receive funding and support from DW Akademie to start a one-of-its-kind free …


Cost-Effectiveness Analysis Comparing Integrated And Malaria-Only Social And Behavior Change Programming In Nigeria: Initial Costing Data, Avenir Health Sep 2021

Cost-Effectiveness Analysis Comparing Integrated And Malaria-Only Social And Behavior Change Programming In Nigeria: Initial Costing Data, Avenir Health

Sexual and Reproductive Health, Rights, and Choices

Breakthrough RESEARCH is conducting an effectiveness evaluation of social and behavior change (SBC) programming implemented by Breakthrough ACTION in Nigeria, comparing an integrated SBC program in Kebbi and Sokoto states with a malaria-only SBC program in Zamfara state. Using these results on impact, a cost-effectiveness analysis will determine which approach is more cost-effective in achieving improvements in health. This report presents estimated costs for the initial stage of the project, from April 2018 through December 2019, in the three northern states where the study is being conducted.


Breakthrough Research—Social And Behavior Change Costing Community Of Practice Series Brief #3: Capturing The Start-Up Costs Associated With Social And Behavior Change Interventions, Breakthrough Research Sep 2021

Breakthrough Research—Social And Behavior Change Costing Community Of Practice Series Brief #3: Capturing The Start-Up Costs Associated With Social And Behavior Change Interventions, Breakthrough Research

Sexual and Reproductive Health, Rights, and Choices

A successful social and behavior change (SBC) intervention requires the investment of time and resources in the intervention’s start-up phase, which is defined as the time from the project initiation until the project begins broad implementation. When conducting a costing study of an SBC intervention, it is useful to capture these initial costs separately and allocate them appropriately over the life of the intervention. By examining start-up costs separately, the post-start-up implementation costs can be forecasted more accurately for future budgeting purposes and for determining the appropriate costs for scaling-up interventions. This is the third in a series of briefs …


Examining The Relationship Between African-Americans And Their Physicians, Genesis Weever Aug 2021

Examining The Relationship Between African-Americans And Their Physicians, Genesis Weever

Symposium of Student Scholars

For years, there has been a bad history amongst the relationship between African-Americans and their fellow medical institutions. Many African-Americans do not believe that medical professionals have their best interest at heart. Oftentimes, their white counterparts may receive better care, even when they have the same condition. Many African-Americans may even face barriers that their white counterparts will not experience, and will be denied access to healthcare. This results in more deaths and critical illnesses of African-Americans. In order to discover the underlying problem and a possible solution, a review of the literature was initiated. Using a literature matrix and …


Great (Soft) Power Competition: Us And Chinese Efforts In Global Health Engagement, Michael W. Wissemann Aug 2021

Great (Soft) Power Competition: Us And Chinese Efforts In Global Health Engagement, Michael W. Wissemann

The US Army War College Quarterly: Parameters

Global health engagement, an underutilized strategy rooted in the strengths of soft power persuasion, can lead to more military-to-military cooperation training, help establish relationships that can be relied on when crises develop, stabilize fragile states, and deny violent extremist organizations space for recruiting and operations. Examining Chinese efforts worldwide to curry favor and influence and the challenges posed by the COVID-19 pandemic, this article shows health as a medium is a very compelling and advantageous whole-of-government approach to national security policy concerns.


Why Do Graphic Health Warnings Fail: An Explanatory Case Study On The Persistence Of Smoking Behavior Among Male Adult Smokers In A Rural And Low-Income Setting In The Philippines, John Rafael Arda, Ashley Gabrielle Jeanjaquet, Navin John Pasia, John Dominic Mari Rafael, Danyz Samantha Rita, Kaye Bernice Siao, Jecelyn Grace Yparraguirre, Genejane Adarlo Aug 2021

Why Do Graphic Health Warnings Fail: An Explanatory Case Study On The Persistence Of Smoking Behavior Among Male Adult Smokers In A Rural And Low-Income Setting In The Philippines, John Rafael Arda, Ashley Gabrielle Jeanjaquet, Navin John Pasia, John Dominic Mari Rafael, Danyz Samantha Rita, Kaye Bernice Siao, Jecelyn Grace Yparraguirre, Genejane Adarlo

Health Sciences Faculty Publications

Background: The Philippines enacted in 2014 Republic Act No. 10643 that mandated the printing of Graphic Health Warnings on tobacco packages. However, smoking behavior among male smokers in the country, particularly in rural and low-income areas, persists even if the Graphic Health Warnings are according to the guidelines set by the World Health Organization. Hence, this explanatory case study aims to examine why and how most male adult smokers in a rural and low-income setting in the Philippines fail to quit smoking despite the presence of Graphic Health Warnings on tobacco packages.

Methods: Forty-four male adult smokers from Barangay Urdaneta …


Investir Dans Le Changement Social Et Comportemental Est Rentable Pour Améliorer Les Comportements Antipaludiques En Côte D’Ivoire, Breakthrough Research Aug 2021

Investir Dans Le Changement Social Et Comportemental Est Rentable Pour Améliorer Les Comportements Antipaludiques En Côte D’Ivoire, Breakthrough Research

Sexual and Reproductive Health, Rights, and Choices

Social and behavior change (SBC) interventions are considered an essential part of malaria prevention and treatment interventions, yet gaps in information on the cost and impact of SBC mean decisionmakers have underappreciated the value of SBC for contributing to improved health outcomes. To address this issue, Breakthrough RESEARCH has leveraged evidence from 112 studies on the impact of SBC interventions on malaria health behaviors and 70 studies on general SBC intervention costs to model the cost-effectiveness of SBC programming for malaria in the Business Case for Investing in Social and Behavior Change for Malaria.


Investing In Social And Behavior Change Is Cost-Effective For Improving Malaria Behaviors In Côte D’Ivoire, Breakthrough Research Aug 2021

Investing In Social And Behavior Change Is Cost-Effective For Improving Malaria Behaviors In Côte D’Ivoire, Breakthrough Research

Sexual and Reproductive Health, Rights, and Choices

Social and behavior change (SBC) interventions are considered an essential part of malaria prevention and treatment interventions, yet gaps in information on the cost and impact of SBC mean decisionmakers have underappreciated the value of SBC for contributing to improved health outcomes. To address this issue, Breakthrough RESEARCH has leveraged evidence from 112 studies on the impact of SBC interventions on malaria health behaviors and 70 studies on general SBC intervention costs to model the cost-effectiveness of SBC programming for malaria in the Business Case for Investing in Social and Behavior Change for Malaria.


Mental Health Awareness Training Manual: For Faculty To Help Students, Ricardo Vega Aug 2021

Mental Health Awareness Training Manual: For Faculty To Help Students, Ricardo Vega

Electronic Theses, Projects, and Dissertations

Mental health issues and stigma can affect students in many ways. The teacher-student relationship can be affected by the fear and inconsistent thoughts to be successful in college settings caused by mental health issues. First-generation college students face mental health issues due to support, education degree expectations, inhibition of uncertainty, and resources (Pascarella et al., 2004). This project is about providing communication strategies for faculty to help reduce stigma and provide students with resources to support their mental health.


Designing Educational Newsletter Interventions: An Example That Supported Grandfamilies’ Physical Wellness Needs, Priscilla Brenes, Mary Meck Higgins Jul 2021

Designing Educational Newsletter Interventions: An Example That Supported Grandfamilies’ Physical Wellness Needs, Priscilla Brenes, Mary Meck Higgins

Journal of Extension

Effective newsletters have theory-based content and designs tailored to their readers and offer limited-cost community-level approaches to providing helpful, relevant, and engaging information. In accordance with this, we offer an example of a newsletter intervention that supported grandfamilies’ physical wellness needs. Six issues of a brief mail-delivered newsletter were sent yearly for up to 5 years to low-income custodial grandparents. In evaluating the newsletter, most respondents reported reading it, discussing its information, and having greater awareness, knowledge, and motivation or confidence regarding wellness recommendations. Furthermore, 91% described improving 1 or more of their grandfamilies’ cooking, eating, or physical activity practices.


Encouraging Community Ownership During The Isolating Days Of A Pandemic, Cora Scott Jul 2021

Encouraging Community Ownership During The Isolating Days Of A Pandemic, Cora Scott

eJournal of Public Affairs

Because of the pandemic, the future feels difficult and uncertain, and few of us have much control over it, beyond doing our best to keep ourselves informed and those around us safe. The result is a lot of unhappy people. Gallup survey data show that pessimism about the future of the pandemic in the U.S. is rising. This is infecting our general outlook. This article explains on how one local government and health department successfully communicated during the pandemic and even increased community engagement. This was done through encouraging a sense of community ownership.


Telling A New Story Of Obsessive-Compulsive Disorder: Narrative Versus Argument Communication Effects On Ocd Stigma And Recognition, Ashlyn Blaire Soileau Jul 2021

Telling A New Story Of Obsessive-Compulsive Disorder: Narrative Versus Argument Communication Effects On Ocd Stigma And Recognition, Ashlyn Blaire Soileau

LSU Master's Theses

This study utilizes narrative persuasion theory to investigate the effect of narrative and argument appeals when communicating about Obsessive-Compulsive Disorder (OCD) to the public. This study tested stigma and recognition of OCD with a 2x2 factorial between-subject design using advertisement types and gender as the independent variables. Findings showed that communication type and gender do not affect OCD recognition. However, a univariate ANCOVA analysis, when controlling for empathy and OCD experience. The results revealed that gender and ad type did affect OCD stigma. Also, women showed lower stigma scores for social restrictiveness when seeing the narrative appeal when contrasted with …


Pattern Of Use Of Electronic Health Record (Ehr) Among The Chronically Ill: A Health Information National Trend Survey (Hints) Analysis, Rose Calixte, Sumaiya Islam, Zainab Toteh Osakwe, Argelis Rivera, Marlene Camacho-Rivera Jul 2021

Pattern Of Use Of Electronic Health Record (Ehr) Among The Chronically Ill: A Health Information National Trend Survey (Hints) Analysis, Rose Calixte, Sumaiya Islam, Zainab Toteh Osakwe, Argelis Rivera, Marlene Camacho-Rivera

Publications and Research

Effective patient–provider communication is a cornerstone of patient-centered care. Patient portals provide an effective method for secure communication between patients or their proxies and their health care providers. With greater acceptability of patient portals in private practices, patients have a unique opportunity to manage their health care needs. However, studies have shown that less than 50% of patients reported accessing the electronic health record (EHR) in a 12-month period. We used HINTS 5 cycle 1 and cycle 2 to assess disparities among US residents 18 and older with any chronic condition regarding the use of EHR for secure direct messaging …


The Nurse-Family Connection: Exploring Verbal And Nonverbal Immediacy, Kristen P. Treinen Jul 2021

The Nurse-Family Connection: Exploring Verbal And Nonverbal Immediacy, Kristen P. Treinen

Communication and Theater Association of Minnesota Journal

Immediacy is the key to developing and maintaining interpersonal relationships. Furthermore, each relationship has a unique set of rules and patterns of communication that help maintain the trust and continue the process of relational development. What is not unique about interpersonal relationships is the foundation of trust, a bond, that can be established through the use of immediacy. This study examines not only if nurses believe effective communication with family members is necessary, but how and in what ways nurses have forged a care connection with family members using verbal and nonverbal immediacy.