Communication, Control, and Time: The Lived Experience of Uncertainty in Adolescent Pregnancy

193 Pages·2016·0.88 MB·English

University of Tennessee, Knoxville
Trace: Tennessee Research and Creative
Exchange
Doctoral Dissertations Graduate School
8-2014
Communication, Control, and Time: Te Lived
Experience of Uncertainty in Adolescent
Pregnancy
Elizabeth Dortch Dalton
University of Tennessee - Knoxville,
To the Graduate Council:
I am submiting herewith a dissertation writen by Elizabeth Dortch Dalton entitled "Communication,
Control, and Time: Te Lived Experience of Uncertainty in Adolescent Pregnancy." I have examined the
fnal electronic copy of this dissertation for form and content and recommend that it be accepted in
partial fulfllment of the requirements for the degree of Doctor of Philosophy, with a major in
Communication and Information.
Michelle T. Violanti, Major Professor
We have read this dissertation and recommend its acceptance:
Laura E. Miller, Michael J. Palenchar, Gregory C. Pety
Accepted for the Council:
Dixie L. Tompson
Vice Provost and Dean of the Graduate School
(Original signatures are on fle with ofcial student records.)
Communication, Control, and Time: The Lived Experience of Uncertainty in
Adolescent Pregnancy

A Dissertation Presented for the
Doctor of Philosophy
Degree
The University of Tennessee, Knoxville

Elizabeth Dortch Dalton
August 2014
Copyright © 2014 by Elizabeth Dortch Dalton
All rights reserved
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DEDICATION

This dissertation is dedicated to my husband Rob, whose patience, encouragement, and
love have supported me from the first day of class to the day of my defense. It is also dedicated
to our son Will, who has opened my eyes to the wonder of pregnancy and parenting. I hope he
will someday understand that everything I do, including this dissertation, is for him.

iii
ACKNOWLEDGMENTS

I must first acknowledge and thank the brave and generous young women who shared
their stories with me, a stranger, and were so forthcoming in doing so. I hope that they will
someday see the impact of their voices on our understanding of health communication. In
addition, I could not have completed this study without the community contacts who connected
me with these participants. Thanks especially to Stephanie Rollins, Emily Nantz, Bob Blackburn,
Angie Douglass, and everyone who took the time to pass out flyers and spread the word.
I also want to acknowledge my tireless committee members, and especially my chair, Dr.
Michelle Violanti. Her experience and breadth of knowledge have guided me steadily on every
step of this journey. Dr. Michael Palenchar gave me the confidence to pursue this difficult
population and topic, and Dr. Laura Miller has been a topical expert and steadfast friend. From
Public Health, Dr. June Gorksi has continually provided support and enthusiasm, even in
retirement, and Dr. Greg Petty has graciously stepped in as her replacement on the committee.
Drs. Gorski and Petty have been tremendously helpful in aiming this study toward solving real-
world health problems.
I must also acknowledge my family, especially my parents, who remain an important
source of support and have never questioned my decision to pursue a Ph.D. They are always
curious about my research, and have truly fostered my love of learning.
Finally, I want to thank my fellow Ph.D. students for creating an atmosphere of support
and perseverance in our program. Through thick and thin, they have pushed me to do better work
and keep my eye on the prize. They are incredible people who have a world of opportunity
before them.
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ABSTRACT

This study qualitatively examined the lived experience of uncertainty among pregnant
adolescents. Utilizing a phenomenological approach, long interviews were conducted with 10
pregnant adolescent women between the ages of 15 and 18. Interviews were transcribed and
analyzed using the process of phenomenological explication. Data, emergent themes, memos,
and a detailed audit trail were maintained using the qualitative data analysis package Nvivo 10
for Mac (beta version). Findings can be summarized with eight themes that underlie the essence
of uncertainty in adolescent pregnancy: suspicion and denial, disclosure and reactions,
controlling the flow of information, relational renegotiation, the emerging reality of pregnancy,
information behavior, encounters with doctors and other professionals, and the future. From
these themes, it is evident that the lived experience of uncertainty is about loss of control. Also
of importance is the lack of uncertainty about life after the birth and how this may contribute to
cultural and socioeconomic disparities in adolescent pregnancy. In addition, participants’ sense
of control is both threatened by and surrendered to time; time, therefore, both enhances and
mitigates uncertainty. Knowing this allows for recognition of where control can be reestablished
to promote better self-efficacy among pregnant adolescents.
This study has implications for uncertainty in health communication and makes the
argument for further incorporating pregnancy into the health communication research agenda. In
addition, this study compels the extension of research on uncertainty into areas such as mental
health, nutrition, exercise, and hygiene, where time may also play an important role. Implications
for communication theory, particularly related to privacy management and relational turbulence,
as well as home-visitation interventions in the public health sector are discussed.
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TABLE OF CONTENTS

CHAPTER 1: INTRODUCTION AND BACKGROUND ........................................................ 1
Rationale ............................................................................................................................................................. 4
Statement of Problem ...................................................................................................................................................... 6
Review of Related Concepts, Theories, and Literature ............................................................................ 7
Uncertainty and Adolescents ......................................................................................................................................... 8
Uncertainty and Health ................................................................................................................................................... 9
Uncertainty and Pregnancy ......................................................................................................................................... 14

CHAPTER 2: METHODOLOGY .......................................................................................... .17
Meta-theoretical Framework: Phenomenology ....................................................................................... 17
Participants ....................................................................................................................................................................... 18
Data Collection ............................................................................................................................................................... 20
Interviewing and Health ............................................................................................................................................... 20
Procedures ....................................................................................................................................................... 25
Explication of the Data .................................................................................................................................. 28

CHAPTER 3: FINDINGS .......................................................................................................... 31
Description of Participants ........................................................................................................................... 31
Themes .............................................................................................................................................................. 33
Suspicion and Denial .................................................................................................................................................... 34
Disclosure and Reactions ............................................................................................................................................ 43
Controlling the Flow of Information ....................................................................................................................... 54
Renegotiating Relationships ....................................................................................................................................... 60
Emerging Reality of Pregnancy ................................................................................................................................ 74
Information Behavior .................................................................................................................................................... 88
Encounters with Doctors and other Professionals ............................................................................................... 95
The Future ...................................................................................................................................................................... 101

CHAPTER 4: DISCUSSION ................................................................................................ 121
Uncertainty and Control ............................................................................................................................. 122
The Certainty of Childbearing .................................................................................................................. 126
Theoretical Implications ............................................................................................................................. 130
Uncertainty, Time, and Health Behavior ............................................................................................................. 130
Communication, Relationships, and Adolescent Pregnancy ......................................................................... 135
Applied Implications ................................................................................................................................... 138
Home Visitation Services .......................................................................................................................................... 139
Promoting Social Support ......................................................................................................................................... 144
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Possible Selves .............................................................................................................................................................. 146
Limitations ..................................................................................................................................................... 147
Future Research ........................................................................................................................................... 151

References .............................................................................................................................. 157
Appendices ................................................................................................................................. 158
Vita ............................................................................................................................................. 184
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CHAPTER 1: INTRODUCTION AND BACKGROUND

A girl, probably about 14 or 15 years old, sits in an upholstered chair in a quiet, tidy
room. There is a muted television playing, the station set to an HGTV show where people are
searching for beachfront real estate deals. The girl is not watching the television, but is being
very still, staring into the distance and occasionally looking down and picking at her nails. She is
thin with short blond hair, and is wearing jeans, tennis shoes, and a pink hooded sweatshirt. Next
to her sits a woman who looks to be in her 40s, probably the girl’s mother. She looks tired and
concerned, clutching her purse and resting her chin on her hand. Across from them, a boy who
appears to be about 16 or 17 sits slouched in his chair. He has a shaved head, baggy jeans, and a
tattoo is visible where his wrist emerges from the sleeve of his sweatshirt. His eyes stay glued to
his phone as he either texts, scans Facebook, or plays a game to keep himself occupied until they
are called through a nearby door. He begins to rise from his seat, but hesitates, unsure as to
whether he should accompany the two women. Neither of them seems to notice his hesitation,
and he shuffles in behind them just before the door shuts.
When the trio reemerges from the same door about 20 minutes later, the girl’s expression
has not changed. While the mother walks over to a nearby counter, the girl, emotionless, sits
down and begins to examine a long vertical strip of photo paper. The guy peeks over her
shoulder and points to something in one of the photos.
Among this threesome, is hard to determine who the patient is at this doctor’s office. It is
probably not the guy, because this is an obstetrics and gynecology clinic. Neither the girl nor her
mother appears to be pregnant, and surely the girl is too young to be carrying a baby. But
doctors’ offices do not pass out ultrasound photos to just anyone. As the girl and the boy
continue to examine the images, which contain just a tiny speck of a fetus, a nearby patient
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