The Indirect Effect of Family Communication Patterns on Young Adults’ Health Self-disclosure: Understanding the Role of Descriptive and Injunctive Norms in a Test of the Integrative Model of Behavioral Prediction

Abstract

Family communication patterns (FCP) are relational schema theorized to influence behaviors indirectly via cognitive processes, including perceived norms. However, relatively little is known about the indirect effect of FCP on health self-disclosure via perceived norms. We examine FCP’s associations with young adults’ health self-disclosure to their parents, assessing the theory of normative social behavior and the integrative model of behavioral prediction. Young adults (N = 504) completed a cross-sectional survey. Mediation analysis showed the effect of conversation orientation on health self-disclosure via communication efficacy and descriptive norms. Injunctive norms moderated the indirect effect of descriptive norms on self-disclosure. Results suggest conversation, but not conformity orientation, influenced young adults’ self-disclosure, while norms and efficacy act as predominant drivers of disclosure behavior.

KEYWORDS:

• family communication patterns, theory of normative social behavior
• theory of planned behavior, interpersonal communication
• family communication

Medical decision making during young adulthood is described as a transitional phase where young adults navigate the difficult transition from pediatric to adult care (Castillo & Kitsos, 2017), while often remaining covered by their parents’ health insurance (Antwi et al., 2015) and consulting with their parents on more serious issues (Nicoteri & Arnold, 2005). This unique life phase provides increased independence for young adults while retaining parental support in medical decision making. Critical to the receipt of parental support is young adults’ health self-disclosure, or the divulgence of experiences (e.g., current health issues) and feelings (e.g., worries and concerns; Derlega et al., 1993) regarding their health (Checton & Greene, 2012) to their parents. Health self-disclosure to parents is associated with outcomes such as healthcare-seeking (Nguyen et al., 2016) and diabetes management (Berg et al., 2017); thus, understanding the factors that influence young adult’s health self-disclosure to parents is of critical importance.

We seek to understand how family communication patterns shape young adults’ perceived family communication norms and self-disclosure of health information, as prior studies suggest (Brannon, 2020; Hays et al., 2017; Manning et al., 2017). Building off this research, we test a model (Figure 1) that is informed by the integrative model of behavioral prediction (IMBP; Fishbein & Yzer, 2003), family communication patterns (FCP) theory (Koerner & Fitzpatrick, 2002), and theory of normative social behavior (TNSB; Rimal & Real, 2005). In doing so, we hope to better understand the degree to which FCP influence young adults’ decisions to self-disclose to their parents via attitudes, communication efficacy and descriptive and injunctive norms.

Figure 1 Study conceptual model

Family Communication Patterns

According to FCP theory, family socialization builds schema, or cognitive scripts, that influence cognition and behaviors (Koerner & Fitzpatrick, 2002). Family communication patterns are “central beliefs” determining family communication (Koerner & Fitzpatrick, 2002, p. 85) comprised of two dimensions: conversation and conformity orientation. Conversation orientation is the degree to which family members “are free to interact with one another as they share ideas” (Schrodt et al., 2008, p. 250), while conformity orientation is the degree to which family members are expected to hold the same beliefs or attitudes (Ritchie & Fitzpatrick, 1990). FCP are theoretically (Ritchie & Fitzpatrick, 1990) and empirically (Hays et al., 2017; Rauscher et al., 2015) linked to health self-disclosure.

Conversation orientation is associated with increased communication and desirable communication outcomes, such as positive co-parenting behaviors (Schrodt & Shimkowski, 2017), increased disclosures of genetic risk to family members (Rauscher et al., 2015), and increased intentions to discuss family health history (Hovick et al., 2021). Conformity orientation is typically, but not always (e.g., relational maintenance; Ledbetter & Beck, 2014), associated with decreased communication and undesirable communication outcomes such as children’s suppression of emotions to parents (i.e., surface acting; Schrodt, 2020), antagonistic co-parenting (Schrodt & Shimkowski, 2017) and decreased family health history discussion intentions (Hovick et al., 2021). Thus, we predict that:

H₁: Conversation orientation will be positively associated with young adults’ health self-disclosure to their parents.

H₂: Conformity orientation will be inversely associated with health self-disclosure to their parents.

Predictors of Health Self-Disclosure

In addition to testing the direct relationship between FCP and health self-disclosure, we examine the IMBP’s well supported (e.g., Kim & Niederdeppe, 2013; Mello & Hovick, 2016) hypotheses suggesting that individual characteristics (e.g., FCP) indirectly impact behavior via attitudes, self-efficacy, and perceived norms (Fishbein & Yzer, 2003). In the IMBP, perceived, or subjective, norms are a combination of descriptive norms (i.e., our beliefs about what others have done) and injunctive norms (i.e., our beliefs about what others expect us to do (Fishbein & Yzer, 2003) or would approve of us doing (Park & Smith, 2007)). Although injunctive and descriptive norms are commonly combined into a single subjective norm construct, doing so may obscure their independent or additive effects (Park & Smith, 2007). Subjective norms are often the weakest predictor of behavior and intentions (Armitage & Conner, 2001); thus, examining descriptive and injunctive norms separately may explain additional variance in intentions and behaviors (Rivis & Sheeran, 2003). Furthermore, the TNSB (Rimal & Real, 2005) proposes an interaction such that the relationship between descriptive norms and behavior is moderated by injunctive norms; our perceptions of what others do are more influential when we believe that relevant others will approve of or expect the behavior. Proposed relationships and empirical support from these relationships are detailed below.

Attitudes

Attitudes refer to an individual’s level of approval or disapproval of performing a specific behavior (Fishbein & Yzer, 2003). Relational schema (i.e., scripts or general knowledge about relationships that guide interactions) such as FCP are theorized to influence attitudes toward how to communicate with others (Koerner & Fitzpatrick, 2002). FCP and health outcomes are indirectly associated via attitudes (Baiocchi-Wagner & Talley, 2013; Hesse & Rauscher, 2016), and attitudes are positively associated with health self-disclosure to family members (Hyde & White, 2009; Mo et al., 2019). Therefore, we propose:

H₃: The effects of (a) conversation orientation and (b) conformity orientation on health self-disclosure will be mediated by health self-disclosure attitudes.

Communication Efficacy

Self-efficacy describes an individual’s perceived ability to perform a behavior (Fishbein & Yzer, 2003). Similarly, communication efficacy describes one’s perceived ability to effectively communicate (Afifi, 2015). Indeed, children from families with higher conversation orientation may have greater communication efficacy because they have more freedom to communicate (Koerner & Fitzpatrick, 2002). Communication efficacy is similar to communication competence, which is positively associated with conversation and inversely associated with conformity orientation (Koesten, 2004). Self-efficacy is positively linked to conversation and negatively to conformity orientation (Smith et al., 2016) and mediates the conversation orientation and behavioral intention relationship when conformity orientation is lower (Hesse & Rauscher, 2016). Communication efficacy is linked to disclosure of chronic health conditions (Checton & Greene, 2012). Thus, we propose that:

H₄: Communication efficacy will mediate the effects of (a) conversation orientation and (b) conformity orientation on health self-disclosure.

Descriptive and Injunctive Norms

Both descriptive and injunctive norms are significantly and positively associated with health self-disclosures (Mo et al., 2019). In separating descriptive and injunctive norms and examining the interaction between the two, we incorporate predictions from the TNSB. The TNSB suggests people want to mirror the behavior of those around them (descriptive norms), although differing expectations for or endorsements of the behavior (injunctive norms) can offset the influence of observed behavior (Rimal & Real, 2005). Thus, in the TNSB, injunctive norms are proposed to moderate the effects of descriptive norms on behaviors. Because support for this moderation prediction is mixed in the literature (Rimal, 2008; Rimal & Real, 2005), further testing is needed to better understand these relationships, particularly as it relates to family communication.

Early FCP theorization suggests conversation and conformity orientation may influence perceived family communication norms (i.e., perceived social pressure on how to communicate within the family; Koerner & Fitzpatrick, 2002). Families with higher conversation orientation may engage in more frequent conversations, having a stronger perception of how others around them communicate (e.g., increased perceived descriptive norms), and families with higher conformity orientation may engage in less discussion and have a weaker perception of how others around them communicate (i.e., decreased perceived descriptive norm; Ritchie, 1991; Sheinkopf, 1973; Tims & Masland, 1985). Families with higher conversation orientation also may be more likely to express expectations regarding disclosure (Sheinkopf, 1973), which could strengthen perceived injunctive norms, but families with higher levels of conformity orientation may be less likely to do so. Because FCP are relational schema built upon observed behavior (Koerner & Fitzpatrick, 2002), in alignment with the TNSB, we propose that descriptive norms are the primary driver of behavior (i.e., health self-disclosure), with injunctive norms as a modifier of this relationship (Rimal & Real, 2005).

Existing studies examine the relationship between FCP and perceived descriptive and injunctive norms but not the moderating effects of injunctive on descriptive norms. For example, Brannon (2020) did not examine the moderating effect of descriptive and injunctive norms and found that only conversation orientation had a significant effect on the injunctive norm. Similarly, Manning et al. (2017) found that for families with higher levels of conversation and conformity orientation, injunctive norms were positively associated with behavioral intentions. For families with lower levels of conformity orientation, descriptive norms were positively associated with behavioral intentions (conversation orientation not associated; Manning et al., 2017). In failing to examine the interaction between the two normative perceptions, any moderating effect that injunctive norms may have had on the descriptive norm and behavior relationship was not detected in these prior studies. Therefore, in alignment with past FCP theorization (e.g., Ritchie, 1991; Sheinkopf, 1973; Tims & Masland, 1985) and the TNSB (Rimal & Real, 2005), we propose that:

H₅: Descriptive norms will mediate the effects of (a) conversation orientation and (b) conformity orientation on health self-disclosure.

H₆: The indirect effect of descriptive norms on health self-disclosure will be moderated by the level of injunctive norms for (a) conversation orientation and (b) conformity orientation.

Methods

Undergraduate students between the ages of 18–25 (M = 20.13, SD = 1.64), recruited from a research pool at a large Midwestern university, participated in a cross-sectional, online survey (N = 574) for course or extra credit. The authors’ Institutional Review Board approved the study. Participants who did not meet inclusion criteria (n = 12) or had missing or invalid data (n = 58) were removed from the data set. The final sample size was 504. No variable contained more than 1.6% missing responses, suggesting that listwise deletion was appropriate for dealing with missing data (Pigott, 2001).

Measures

We measured all items on a scale of 1 (strongly disagree) to 5 (strongly agree) and used variable means in analysis (see Table 1), unless otherwise noted. Participants indicated those people who they considered to be their parents. Most participants selected their biological mother (96.9%, n = 487) and biological father (93.4%, n = 471), and 7% (n = 36) selected more than two people as parents.

Table 1 Spearman Correlations for Model Variables of Interest (N = 504)

	1.	2.	3.	4.	5.	6.	7.	M	SD
1. Conversation Orientation	—							3.51	0.83
2. Conformity Orientation	−.42**	—						2.80	0.83
3. Attitudes	.62**	−.32**	—					3.78	0.77
4. Injunctive Norms	.40**	−.21^**	.43**	—				4.10	0.91
5. Descriptive Norms	.46**	−.15**	.50**	.71**	—			3.96	0.93
6. Communication Efficacy	.58**	−.18**	.53**	.44**	.50**	—		3.99	0.88
7. Health Self-Disclosure	.49**	−.19**	.36**	.33**	.37**	.42**	—	15.86	3.87

* p < .05. ** p < .01.

Demographic and Individual Characteristics

Demographic measures included gender (1 = female, 0 = male), age (continuous), race (1 = white, 0 = other race/ethnicity), and health insurance status (i.e., “do you currently have any kind of health care coverage?”; 1 = yes, 0 = no). Participants self-reported their health status (i.e., “in general, would you say that your health is … ”) on a scale from 1 (poor) to 5 (excellent).

Revised Family Communication Patterns

The Revised Family Communication Patterns is a twenty-six-item scale measuring conversation and conformity orientation (Ritchie & Fitzpatrick, 1990). Conversation orientation included fifteen items (e.g., “I can tell my parents almost anything”). Conformity orientation included eleven items (e.g., “in our family, my parents usually have the last word”). Reliability estimates for conversation (α = .91) and conformity (α = .87) orientations were good.

Attitudes

Items adapted from the Planned Behavior Questionnaire (Ajzen, 1991) assessed attitudes with 5-point semantic differential pairs (e.g., unpleasant-pleasant, unenjoyable-enjoyable, boring-interesting, unhealthy-healthy, foolish-wise, harmful-beneficial). The reliability estimate was good (α = .84) and higher scores indicated more positive disclosure attitudes.

Norms

Adapted items from Park and Smith (2007) measured perceived health self-disclosure descriptive (two items, e.g., “most family members, whose opinions I value, have shared information about their health issues,” r = .71) and injunctive norms (three items, e.g., “most family members, whose opinions I value, would approve of me sharing my information about health issues,” α = .94).

Communication Efficacy

Three items adapted from Hovick (2014) measured communication efficacy for health self-disclosure (e.g., “I am confident I can approach my parents to talk about health issues”). The reliability estimate was good (α = .80).

Health Self-Disclosure

The Jourard Self-Disclosure Questionnaire (Jourard, 1971) body subscale measured health self-disclosure with four items. Participants indicated (e.g., 1 = strongly disagree to 5 = strongly agree) if they had disclosed to their parents their current health problems (e.g., “whether or not I now have any health problems, e.g., trouble with sleep, digestion, allergies, heart condition, headaches, etc.”), current efforts to stay healthy (e.g., “whether or not I now make special efforts to keep fit and healthy, e.g., diet and exercise”), past health (e.g., “my past record of illness and treatment”), and health concerns (e.g., “whether or not I have any long-range worries or concerns about my health, e.g., cancer, ulcers, heart trouble”). As recommended (Jourard, 1971), we used the sum of responses in analysis, with higher scores indicating greater self-disclosure (ranging from 4 to 20; M = 15.86, SD = 3.90).

Analysis

We first performed descriptive analysis (M, SD, and ranges). Spearman correlations were used to assess correlations between model variables, accounting for non-normality (Table 1). We then assessed direct relationships between model variables and interaction effects using multiple linear regression analyses in SPSS Version 25. Finally, to assess indirect effects predictions, we tested two models using the SPSS PROCESS (version 3) macro with bootstrapping (5,000 samples, Hayes, 2017). We first used PROCESS model 4, which can assess simple mediation with up to ten parallel mediators (attitudes, communication efficacy, and descriptive norms hypotheses) and controlled for the effect of descriptive and injunctive norms. Then, we used PROCESS model 14 to assess moderated mediation (descriptive and injunctive norm interaction hypotheses) and controlled for the effect of attitudes and communication efficacy.

Results

Direct Relationships

We first tested the direct effects of participant demographics (Table 2) and conversation and conformity orientation on health self-disclosure. Health self-disclosure was positively associated with conversation orientation (H1 supported) but not conformity orientation (H2 not supported). Demographic and FCP variables explained 27% of the variance in self-disclosure. Next, we tested main effects of conversation and conformity orientation on study mediators and moderator. Conversation orientation was positively associated with attitudes, communication efficacy, injunctive and descriptive norms. However, conformity orientation was not significantly associated with any of the proposed mediator or moderator variables (see Table 3).

Table 2 Demographic Characteristics (N = 504)

Characteristic	% (Frequency)
Sex
Male	33.5 (169)
Female	66.1 (333)
Not indicated	0.4 (2)
Age
18	17.3 (87)
19	21.0 (106)
20	27.4 (138)
21	17.5 (88)
22	9.7 (49)
23	2.8 (14)
24	1.6 (8)
25	2.8 (14)
Race
White	71.4 (360)
Hispanic/Latino	3.8 (19)
Black/African American	6.5 (33)
Asian	15.1 (76)
Another group	3.2 (16)
Health Status
Excellent/Very Good/Good	92.8 (468)
Fair/Poor	6.6 (33)
No Response	0.6 (3)
Health Insurance Status
Yes	90.9 (458)
No	3.2 (16)
Don’t know	5.7 (29)
Prefer not to answer	0.2 (1)

Table 3 Multiple Regression Analyses to Test Direct Relationships between Model Variables

	Attitudes (N = 500)		Communication Efficacy (N = 498)		Descriptive Norms (N = 498)		Injunctive Norms (N = 497)		Self-Disclosure Step 1 (N = 491)		Self-Disclosure Step 2 (N = 485)
	β	SE	β	SE	β	SE	β	SE	β	SE	β	SE
White	−0.09	0.06	0.12	0.07	0.10	0.09	0.18*	0.09	1.12*	0.35	1.00*	0.34
Age	0.01	0.02	0.02	0.02	0.03	0.02	−0.01	0.02	−0.03	0.10	<0.01	0.09
Female	0.13*	0.06	0.10	0.07	0.14	0.08	−0.09	0.08	0.75*	0.32	0.46*	0.32
Health Status	0.10*	0.03	0.03	0.06	0.03	0.05	−0.06	0.05	0.10	0.19	0.03	0.19
Conversation	0.51**	0.04	0.53**	0.04	0.53**	0.05	0.40**	0.05	2.21**	0.21	1.40**	0.26
Conformity	−0.06**	0.04	0.08	0.04	0.07	0.05	−0.08	0.05	0.13	0.20	0.10	0.20
Attitudes											0.34	0.28
Communication Efficacy											0.56*	0.23
Descriptive Norms											−1.29	0.70
Injunctive Norms											−1.13	0.60
Descriptive x Injunctive Norm											0.40*	0.16
F	56.58 (4, 694)		45.16 (6, 492)		24.09 (6, 492)		17.64 (6, 491)		29.77 (6, 485)		19.71 (11, 474)
R^2	0.41		0.36		0.23		0.18		0.27		0.31

For consistency with PROCESS, which only reports unstandardized betas values, all reported bootstrap estimates reported are unstandardized beta values. 1 = White, 0 = Nonwhite; * p ≤ .05 ** p ≤ .001

Next, we tested the direct effects of study mediators and moderators on health self-disclosure (Table 3). Only communication efficacy was significantly and positively associated with health self-disclosure. However, an interaction was detected between descriptive and injunctive norms on health self-disclosure, as predicted. The addition of cognitive mediators and moderator explained an additional 4.7% of the variance in health self-disclosure.

Indirect Effects

We also tested the indirect effects of FCP on health self-disclosure. No indirect effect was found for conversation orientation on health self-disclosure via attitudes (bootstrap estimate = .17, bootstrap SE = .15, 95% CI [−.13, .48]; H3a not supported). However, an indirect effect was detected for conversation orientation on self-disclosure via communication efficacy (bootstrap estimate = .36, bootstrap SE = .15, 95% CI [.06, .68], H4a supported) and descriptive norms (bootstrap estimate = .25, bootstrap SE = .12, 95% CI [.02, .48], H5a supported). No indirect effects were detected for conformity orientation on health self-disclosure via attitudes (bootstrap estimate = −.02, bootstrap SE = .03, 95% CI [−.09, .02]), communication efficacy (bootstrap estimate = .05, bootstrap SE = .04, 95% CI [−.01, .13]), or descriptive norms (bootstrap estimate = .03, bootstrap SE = .03, 95% CI [−.03, .10], H3b-H5b not supported).

Finally, we tested whether the indirect effect of descriptive norms on self-disclosure was conditional based on the level of injunctive norms for conversation and conformity. Based on the index of moderated mediation, a conditional indirect effect was found for conversation orientation (bootstrap estimate = .20, bootstrap SE = .09, 95% CI [.03, .41]; H6a supported), but not for conformity orientation (bootstrap estimate = .02, bootstrap SE = .03, 95% CI [−.02, .10]; H6b not supported). We probed the conditional indirect effect of conversation orientation on disclosure through descriptive norms at three values (the 16^th, 50^th, and 84^th percentile) of the injunctive (Figure 2) as suggested by Hayes (2017). The conditional indirect effect of descriptive norms on self-disclosure was significant only at the highest level of injunctive norms (bootstrap estimate = .42, bootstrap SE = .14, 95% CI [.15, .71]).

Figure 2 Interaction between injunctive and descriptive norms

Discussion

This study explored the effects of conversation and conformity orientation on young adults’ health self-disclosure to their parents, including key mediators and moderators of these effects. Our results show that young adults from families with higher conversation orientation are more likely to disclose health topics with their parents, which is due in part to increased communication efficacy and perceived norms. Our findings partially support theoretical predictions that FCP impact behaviors (Schrodt et al., 2008) through cognitive processes (Koerner & Fitzpatrick, 2002). These findings also echo past research suggesting conversation orientation has a stronger effect on outcomes than conformity orientation (Schrodt et al., 2008). One explanation is that the concept of conformity orientation extends beyond Ritchie and Fitzpatrick’s conceptualization (Ritchie & Fitzpatrick, 1990), which emphasizes parental control. Although we were unable to do so here, future studies linking FCP and health self-disclosure should include updated conformity orientation conceptualizations and scales (e.g., Hesse et al., 2017; Horstman et al., 2018), as they may shed light on the relationships tested here. For example, Hesse et al. (2017) propose that conformity may be cold (i.e., the extent to which families emphasize parental control) or warm (i.e., the extent to which family values are emphasized through rules and discipline). Warm conformity (but not cold conformity) was significantly associated with injunctive norms about alcohol use (Brannon, 2020).

Our results show that communication efficacy and descriptive norms mediate the effect of conversation orientation on self-disclosure, further linking FCP to health behaviors. Although attitudes are often associated with behaviors and intentions (Armitage & Conner, 2001), they were not a direct predictor or mediator of self-disclosure here. This result was surprising given prior links to FCP and health behavior via attitudes (Baiocchi-Wagner & Talley, 2013; Hovick et al., 2021). However, attitudes and conversation orientation were highly correlated in this study (r = .60) suggesting possible conceptual overlap between the two constructs.

Communication efficacy is one of the strongest and most consistent predictors of information seeking behaviors and intentions (Afifi, 2015) and health self-disclosure (Checton & Greene, 2012). Present findings bolster existing links between FCP to behavioral intentions via efficacy (e.g., Hesse & Rauscher, 2016), and they suggest conversation-oriented individuals are more likely to perceive they can communicate and, in turn, are more likely to disclose health information to their parents.

Results also demonstrate that, as hypothesized, FCP impact perceptions of normative behavior through a conditional indirect effect of injunctive norms on the descriptive. Our findings support both FCP (Ritchie, 1991; Sheinkopf, 1973; Tims & Masland, 1985) and TNSB (Rimal & Real, 2005) theories and demonstrate how examining descriptive and injunctive norms separately can provide a more nuanced understanding of the relationship between FCP and perceived norms. Although descriptive and injunctive norms were significantly correlated in this study (r = .71), a conditional effect would not have been detected using a single, subjective norm construct in our model. Conditional indirect effects of FCP via descriptive and injunctive norms should be considered in future research examining disclosures about multiple health issues, as perceptions of conversation and conformity orientation vary by conversational topic (Baxter & Akkoor, 2011).

This study’s findings also may be informative to parents who help young adults monitor chronic diseases, especially in contexts where health self-disclosure is linked to desirable health outcomes. For example, parents’ involvement in children’s type 1 diabetes symptom management is positively associated with positive health outcomes such as better treatment adherence, but parental involvement is likely impacted by adolescents’ disclosure (Berg et al., 2017). Normalizing conversations with parents about health also may encourage young adults’ self-disclosure. Studies in the context of genetics and family health history communication show families with more open conversation styles tend to be more willing to discuss family health history (Hovick et al., 2015). However, younger people may perceive their family health history contributions as less important than older people do (Rodríguez et al., 2016). In this case, non-disclosure of personal health information could contribute to gaps in knowledge regarding family health history, which could limit individual and healthcare provider knowledge of disease susceptibility. Therefore, health communication interventions should aim to build young adults’ communication efficacy and increase perceptions that parent-child health self-disclosures are normative and beneficial, particularly for those families with lower conversation orientation. For families with higher conversation orientation, approaches that build acceptance of parental involvement in medical decision-making may be the most beneficial and doing so may reduce some of the difficulties young adults experience navigating health systems (Castillo & Kitsos, 2017).

Limitations and Conclusion

This study was not without limitations. Our sample was predominantly white, female, in good health, and perceived high levels of conversation orientation. Health disclosures within our sample may have been forced in some situations, as participants (all under 26) were likely insured by their parents (90.9% insured). Due to the cross-sectional nature of this study, these findings may not be generalizable to samples that do not match these characteristics. Because these data were collected in 2017, we did not measure conformity orientation with updated measures (e.g., Hesse et al., 2017; Horstman et al., 2018). Our measures of self-disclosure did not measure potentially important moderators of self-disclosure identified in past literature (Checton & Greene, 2012). Because some health self-disclosure items were operationalized to include serious health conditions (e.g., cancer; Jourard, 1971), young adults may have reported that they were more likely to disclose. Future work should use measures that better differentiate serious and minor health concerns.

Despite these shortcomings, our results provide much needed support for the notion that conversation orientation may indirectly impact health communication behaviors via mediators such as communication efficacy and perceived norms. Future interventions targeting health self-disclosure in a familial context (e.g., family health history) should consider conversation orientation, communication efficacy, and perceived norms surrounding health self-disclosure.

Disclosure Of Potential Conflicts Of Interest

No potential conflict of interest was reported by the authors.

Additional information

Funding

Research reported in this publication was supported by National Cancer Institute of the National Institutes of Health under award number P50CA244431. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.