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'''Problematic
== History ==
Austin Babrow<ref>[
== Concepts ==
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Babrow identified four distinct manifestations, or forms, of problematic integration:
# Divergence - occurs when there is a difference between reality and our desired outcome, and refers to a situation in which the outcome is uncertain or unknown
# Ambiguity - occurs when it is unclear or highly uncertain what the probability or value of an object is uncertain. Babrow stated that in such situations, the outcome is unknown, and the probability of the outcome is restricted.
# Ambivalence - occurs when an individual has to choose between two similarly valued or mutually exclusive alternatives.
# Impossibility - has a firm outcome. A response of denial can occur, and this can lead to conflict.
The first of these integrative predicaments, divergence, arises when there is a discrepancy between what we believe to be true or to be likely to occur and what we want to be true (the desired outcome). Ambiguity arises when the probability or value of an object (i.e., situation, outcome, thing, etc.) is unclear or highly uncertain. Babrow explained, that “in ambiguous situations, neither the outcome, nor the probability of the outcome is known, though the latter has restrictions” (Babrow, 1992, p. 112). Uncertainty occurs when an unknown factor obscures or complicates the development of one's orientation (probability and evaluation) toward an outcome. Ambiguity has also been described as uncertainty about what is unknown. Ambivalence is borne from one of two conditions: (1) an individual is forced to choose between two similarly valued alternatives; or (2) an individual is forced to choose between mutually exclusive alternatives. The last form of PI, impossibility, occurs upon the realization or belief that an outcome is will not happen. Impossibility is recognized as different from a form of divergence, because only impossibility denotes a sense of certainty.<ref>Babrow, Austin S.; “Communication and Problematic Integration: Milan Kundera’s “Lost Letters” in The Book of Laughter and Forgetting”, Communication Monographs, 1995, Vol. 62, pp. 285-6.</ref> Responses to impossibility can range from a sense of futility, to one of increased motivation to deny the impossibility. All of these situations give rise to conflict.
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===The role of communication in problematic integration theory===
Communication is both a source of, a medium, and a method for resolving conflict.<ref>Babrow, Austin S.; “Communication and Problematic Integration: Milan Kundera’s “Lost Letters” in The Book of Laughter and Forgetting”, ''Communication Monographs'', 1995, Vol. 62, pp. 286.</ref> Communication is a source of problematic integration in that knowledge and evaluative orientations are the result of communication, probabilistic and evaluative orientations are based on and developed through message and [[meaning-making]] (forms of communication), and communication is itself "an object of thought" and is therefore an object "of probabilistic and evaluative orientations."<ref>Babrow, Austin S.; “Communication and Problematic Integration: Milan Kundera’s “Lost Letters” in The Book of Laughter and Forgetting”, ''Communication Monographs'', 1995, Vol. 62, pp. 286-7.</ref> It is also possible that a person experiencing problematic integration will seek new information or new sources of information to bolster or reinforce a desired probabilistic or evaluative orientation. This could also be seen engaging in as a form of [[cognitive dissonance]]. Communication is seen as a medium of problematic integration because communication inherently involves or is based on probabilistic and evaluative orientations, or communication is about probability and value. Communication is influenced by and formed from [[culture]]; thus, communication is a medium of PI, as and the formation of probabilistic and evaluative orientations derives from cultural frameworks. Lastly, communication is a resource for PI as we try to resolve and manage conflict caused by problematic integration through communication (internal, interpersonal, etc.).<ref>Babrow, Austin S.; “Communication and Problematic Integration: Milan Kundera’s “Lost Letters” in The Book of Laughter and Forgetting”, ''Communication Monographs'', 1995, Vol. 62, pp. 286.</ref>
Because communication may be a source, medium, and/or method for resolving problematic integration, it is possible for conflict to manifest as "extended chains" of problematic integration. Such extended chains occur through forms, foci, and layers of experience.<ref>Bradac, James J.; “Theory Comparison: Uncertainty Reduction, Problematic Integration, Uncertainty Management, and Other Curious Constructs”, ''Journal of Communication'', September 2001, Vol. 51, No. 3, pp. 461-2.</ref> By extended chains, it is meant that experiences of problematic integration and efforts to resolve problematic integration may lead to development of a new form of PI. As conflict between probability and value develops around a focal point (or topic), it can lead to conflict regarding a new topic (e.g., stress and anxiety about earning an end-of-year bonus at work can lead to new worries about [[personal
===Critique and analysis===
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Problematic Integration Theory (PI) falls under the socio-psychological and socio-cultural communication traditions. PI began with a focus on intra- and inter-personal contexts, but has been applicable in many contexts, including interpersonal, small group, and organizational; thus, it has a broad scope of application.<ref>Babrow, Austin S.; “Uncertainty, Value, Communication, and Problematic Integration”, Journal of Communication, September 2001, Vol. 51, No. 3, pp. 568.</ref> PI is considered an interpretive/hermeneutic approach of theory rather than positivistic/empirical (i.e., predictive) or critical.<ref>Babrow, Austin S.; “Uncertainty, Value, Communication, and Problematic Integration”, ''Journal of Communication'', September 2001, Vol. 51, No. 3, pp. 570.</ref>
=== Problematic Integration Theory and Pregnancy ===
Ashley Archiopoli applies Problematic Integration Theory in her research to examine how [[Pregnancy|pregnant]] women have been able to cope and build resilience during the [[COVID-19]] pandemic. Through a qualitative analysis of interviews with pregnant women, Archiopoli found that these women used strategies including reframing, using support systems, and engaging in [[self-care]] to manage the impact of the pandemic on their pregnancy.<ref>{{Cite journal |last=Archiopoli |first=Ashley |title=Coping and Resilience: Reframing What It Means to Have a Good Pregnancy During COVID-19 |url=https://link.springer.com/chapter/10.1007/978-3-030-77344-1_17 |journal=Risk, Systems & Resilience |series=Risk, Systems and Decisions |year=2021 |pages=279–291 |doi=10.1007/978-3-030-77344-1_17 |isbn=978-3-030-77343-4 |s2cid=238960089 |via=Springer|url-access=subscription }}</ref>
Kami A. Kosenko uses Problematic Integration Theory to explore the various ways that individuals experience [[infertility]] and the impact this has on their sense of identity and belonging. She examines the various forms of integration that can be experienced in the context of infertility – including positive, negative and ambivalent – and the various factors which shape the integration process, such as the couple relationship, social environment, the medical system, and the individual's own beliefs and values. She argues that infertility can be a source of disruption to an individual's sense of identity, and that focusing on the integration process and the various factors which influence it can help individuals better manage their experience of infertility.<ref>{{Cite journal |last=Kosenko |first=Kami A. |title=Foci and Forms of Problematic Integration in the Context of Infertility |url=https://academic.oup.com/ct/article-abstract/31/4/613/5846217?redirectedFrom=fulltext |journal=International Communication Association |volume=31 |issue=4 |pages=613–632 |via=Oxford Academic}}</ref>
Babrow's theory shares some common ideas with Uncertainty Management Theory (UMT), which was developed by Dale Brashers (2007, A theory of communication and uncertainty management. In B. Whaley & W. Samter (Eds.), Explaining communication theory (pp. 201–218). Mahwah, NJ: Lawrence Erlbaum). For a comparison of the perspectives, see Bradac (2001).<ref>Bradac, James J.; “Theory Comparison: Uncertainty Reduction, Problematic Integration, Uncertainty Management, and Other Curious Constructs”, ''Journal of Communication'', September 2001, Vol. 51, No. 3, pp. 463-4.</ref>▼
Beth Sundstrom uses Problematic Integration Theory to analyze how pregnancy ambivalence and contraceptive effectiveness can be integrated in contraceptive decision-making. Understanding how these PI factors interact with each other can help provide more effective contraceptive counseling and improve contraceptive outcomes. (Sundstrom et al., 2017)<ref>{{Cite journal |last=Sundstrom |first=Beth |title=Integrating Pregnancy Ambivalence and Effectiveness in Contraceptive Choice |url=https://www.tandfonline.com/doi/full/10.1080/10410236.2016.1172294 |journal=Health Communication |year=2017 |volume=32 |issue=7 |pages=820–827 |doi=10.1080/10410236.2016.1172294 |pmid=27420543 |s2cid=4631001 |via=Taylor & Francis Online|url-access=subscription }}</ref>
=== Problematic Integration Theory and Chronic Illness ===
PI has been used within the realm of [[Health Communication]] studies in order to assess methods of educating, and communicating with, patients facing a variety chronic or life-threatening conditions. In 2003, Babrow received the prestigious Woolbert Award for scholarship of exceptional originality and influence from the National Communication Association [http://www.natcom.org/nca/Template2.asp?sid=9] for his work with PI.▼
Maria G. Checton's findings indicate that a patient and their partner mutually influence each other in the management of [[Chronic condition|chronic illness]], and that communication and [[Sympathy|emotional support]] are vital components of successful management. Furthermore, participants identified the need for [[Health professional|medical professionals]] to acknowledge the partner's role and provide support to both the patient and their partner. This highlights the importance of integrating the patient and their partner in the management of chronic illness, which is what problematic integration theory aims to do.<ref>{{Cite journal |last=Checton |first=Maria G. |title= Patients' and partners' perspectives of chronic illness and its management|url=https://psycnet.apa.org/doiLanding?doi=10.1037%2Fa0028598 |journal= Families, Systems, & Health|year=2012 |volume=30 |issue=2 |pages=114–129|doi=10.1037/a0028598 |pmid=22709325 }}</ref>
Jennifer E. Ohs uses Problematic integration theory to understand how [[Family|family members]] come to a shared understanding of an [[End-of-life care|end-of-life decision]], how they experience challenges in the process, and how they respond to those challenges. Communication, [[negotiation]], and [[understanding]] between family members may require outside help such as professional counseling or spiritual guidance to facilitate the process. Successful integration of perspectives is essential for families to reach a decision about end-of-life care.<ref>{{Cite journal |last=Ohs |first=Jennifer E. |title=Problematic Integration and Family Communication about Decisions at the End of Life |url=https://www.tandfonline.com/doi/full/10.1080/15267431.2017.1348947 |journal=Journal of Family Communication |year=2017 |volume=17 |issue=4 |pages=356–371 |doi=10.1080/15267431.2017.1348947 |s2cid=148645921 |via=Taylor & Francis Online|url-access=subscription }}</ref>
Elisia L. Cohen applies PI to her research to understand the complexities of the experience of [[African-American women|African American women]] to are treated for [[cancer]]. In her research, Cohen found that African American women often confront a double stigma when dealing with cancer and must negotiate their identity in order to claim cancer as their own. This process of naming and claiming cancer has been found to be an important part of the healing process for African American women, as it allows them to take [[ownership]] of their experience and create a sense of agency. Through this study, Cohen provides an important insight into the complexities of cancer and the role of identity in the healing process.<ref>{{Cite journal |last=Cohen |first=Elisia L. |title=Naming and Claiming Cancer among African American Women: An Application of Problematic Integration Theory |journal=Journal of Applied Communication Research |year=2009 |volume=37 |issue=4 |pages=397–417 |doi=10.1080/00909880903233176 |pmid=20160969 |pmc=2760846 }}</ref>
===Related work: Cognitive Dissonance Theory & Uncertainty Management Theory===
PI theory is an extension of [[Cognitive dissonance|Cognitive Dissonance Theory]]. ''Cognitive Dissonance Theory'' is a psychological concept that explains how individuals attempt to reduce the discomfort they experience when they are presented with conflicting beliefs, ideas, or values. It suggests that people will attempt to make things consistent in order to reduce the dissonance they feel. We can differentiate between the two theories by thinking about Cognitive Dissonance Theory as a theory that focuses specifically on the psychological discomfort of conflicting beliefs, ideas, or values. Problematic Integration Theory examines how individuals perceive, evaluate, and respond to uncertain situations, without necessarily implying that a resolution to the situation is necessary or desirable.
▲Babrow's theory shares some common ideas with [[Uncertainty management theory|Uncertainty Management Theory (UMT)]], which was developed by Dale Brashers (2007, A theory of communication and uncertainty management. In B. Whaley & W. Samter (Eds.), Explaining communication theory (pp. 201–218). Mahwah, NJ: Lawrence Erlbaum). For a comparison of the perspectives, see Bradac (2001).<ref>Bradac, James J.; “Theory Comparison: Uncertainty Reduction, Problematic Integration, Uncertainty Management, and Other Curious Constructs”, ''Journal of Communication'', September 2001, Vol. 51, No. 3, pp. 463-4.</ref>
== Current usage ==
The complexity of PI and the multiplicity of its manifestations makes it difficult to operationalize, measure, and apply. However, this breadth of scope also indicates that it may have extremely wide-ranging applications and opportunities for research.<ref>Bradac, James J.; “Theory Comparison: Uncertainty Reduction, Problematic Integration, Uncertainty Management, and Other Curious Constructs”, ''Journal of Communication'', September 2001, Vol. 51, No. 3, pp. 466.</ref> Because the concepts within PI are based on cultural definitions, PI is seen as being overly responsive to external conceptual influences; thus, making it potentially falsifiable.<ref>Bradac, James J.; “Theory Comparison: Uncertainty Reduction, Problematic Integration, Uncertainty Management, and Other Curious Constructs”, ''Journal of Communication'', September 2001, Vol. 51, No. 3, pp. 468.</ref>
▲PI has been used within the realm of [[Health Communication]] studies in order to assess methods of educating, and communicating with, patients facing a variety chronic or life-threatening conditions. In 2003, Babrow received the prestigious Woolbert Award for scholarship of exceptional originality and influence from the National Communication Association [http://www.natcom.org/nca/Template2.asp?sid=9] for his work with PI.
PI has been used extensively in analysis of the health care system, particularly in regard to communication between health care providers and patients. The health-care system inherently involves communication between health-care providers (e.g., doctors, nurses, various therapists, dietitians, social workers, counselors, etc.), patients, and members of the patient's social and support network (e.g., family members, friends, members of support groups, etc.). Because understanding and communicating diagnoses, prognoses, treatment plans, expectations, and more can be complicated and because this communication relies on the communication skills of the various people involved, health-care situations offer ample opportunity to examine problematic integration. Research in this area has revealed that information is used to decrease and increase uncertainty, depending on the situation. In some cases, patients may seek information to reduce stressful uncertainty. However, in other cases, the care team and the patient may need to increase uncertainty in order to increase optimism and allow for re-evaluation of a given situation.<ref>Brashers, Dale E., Daena J. Goldsmith, and Elaine Hsieh; “Information Seeking and Avoiding in Health Contexts”, ''Human Communication Research'', 2002, Vol. 28, No. 2, pp. 261-2.</ref> PI has been used to study communication involving various medical issues, including breast cancer,<ref>Dennis, Michael Robert, Adrianne Kunkel, and Joann Keyton; “Problematic Integration Theory, Appraisal Theory, and the Bosom Buddies Breast Cancer Support Group”, Journal of Applied Communication Research, Ed. 36, pp. 415-436.</ref><ref>Ford, Leigh A., Austin S. Babrow, and Cynthia Stohl; “Social Support Messages and the Management of Uncertainty in the Experience of Breast Cancer: An Application of Problematic Integration Theory”, Communication Monographs, 1996, Vol. 63, pp. 189-207.</ref> the treatment of diabetes in the elderly, end-of-life issues, and pregnancy.<ref>Matthias, Marianne Sassi and Austin S. Babrow; “Problematic Integration of Uncertainty and Desire in Pregnancy”, Qualitative Health Research, 2007, Vol. 17, pp. 786-798.</ref><ref>Matthias, Marianne Sassi; “Problematic Integration in Pregnancy and Childbirth: Contrasting Approaches to Uncertainty and Desire in Obstetric and Midwifery Care”, Health Communication, 2009, Vol. 24, No. 1, pp. 60-70.</ref>
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== References ==
Babrow, Austin S. (1992). Communication and problematic integration: Understanding and diverging probability and value, ambiguity, ambivalence, and impossibility. ''Communication Theory'', 2(2),
Berger, C. R. (1986). Uncertain outcome values in predicted relationships: Uncertainty reduction theory then and now. ''Human Communication Research'', 13,
Berger, C. R. (1987). Communicating under uncertainty. In M. E. Roloff & G. R. Miller (Eds.), ''Interpersonal processes: New directions in communication research''. Beverly Hills, CA: Sage.
Berger, C. R., & Calabrese, R. J. (1975). Some explorations in initial interaction and beyond: Toward a developmental theory of interpersonal communication. ''Human Communication Research'', 1,
Einhorn, H. J., & Hogarth, R. M. (1987). Decision making under ambiguity. In R. M. Hogarth & M. W. Reder (Eds.), ''Rational choice: The contrast between economics and psychology'' (pp. 41–66). Chicago, IL: University of Chicago Press.
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Festinger, L. (1957). ''A theory of cognitive dissonance''. Stanford, CA: Stanford University Press.
Hines, S.C., Babrow, A.S., Badzek, L., & Moss, A. (2001). From coping with life to coping with death: Problematic integration for the seriously ill elderly. ''Health Communication'', 13(3),
Lerner, M. J. (1980). ''The belief in a just world: A fundamental delusion''. New York: Plenum.
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