Online Program

Nonverbal behaviors during expressions of resistance in provider-patient interactions about diet, nutrition, and lifestyle changes: An integration with assessment of individual risk for heart attack

Monday, November 4, 2013

Ashley P. Duggan, PhD, Communication Department, Boston College, Chestnut HIll, MA
Ylisabyth S. Bradshaw, DO, MS, Department of Public Health & Family Medicine, School of Medicine, Tufts University, Boston, MA
Wayne Altman, MD, Department of Family Medicine, Tufts University School of Medicine, Boston, MA
Julie Wojno, Communication Department, Boston College, Chestnut Hill
Iliana Swick, Communication Department, Boston College, Chestnut Hill, MA
Katherine Donahue, Communication Department, Boston College, Chestnut Hill, MA
The provider-patient interaction often involves negotiations that extend beyond biomedical information and involve responding to patient cues. Nonverbal behavior provides cues to patient comfort and willingness to move forward with next steps in treatment, particularly when next steps in negotiation mean responding to customized risk information in ways that fit patient lifestyle. Nonverbal behavior provides cues that contextualize the ways the illness is connected to the patients' roles and relationships, and cues that indicate emotional responses and patient resistance to the provider's suggestions. This project examines the role of nonverbal communication behavior during moments of expressed resistance in videotaped interactions (N=168) between medical students and standardized patient educators in interactions involving diet, nutrition, and lifestyle changes in a case where an overweight, middle-aged male is concerned about his risk for a heart attack. Qualitative thematic analysis and examples illustrate the implications for recognizing what is left unspoken in the provider-patient interactions, and provides evidence that the unspoken dialogue betters predict ultimate outcomes than the direct verbal cues. Lifestyle behaviors, including diet and exercise, can be sensitive and emotionally charged subjects for patients to discuss with their physicians. Because of the sensitivity, nonverbal communication behaviors are likely to provide a more accurate insight into patient response than directly stated verbal behaviors. By examining the nonverbal behaviors during expressions of resistance during discussions about lifestyle behaviors, we are able to qualitatively describe the subtle nuances of these relationships and the ways nonverbal behaviors functions to contextualize subsequent impact on health outcomes.

Learning Areas:

Public health or related research
Social and behavioral sciences

Learning Objectives:
Identify five ways nonverbal behaviors indicate patient responses to risk information. Describe three primary types of nonverbal behaviors indicative of patient resistance. Describe the successful role of standardized patient educators in sensitizing clinical trainees to effectively present diet / lifestyle / nutrition counseling about risk information. 4) Identify four common ways health providers might miss subtle but important messages non-verbal messages.

Keyword(s): Communication, Nutrition

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because my research area is health communication; I developed and integrated the research component for describing communication behaviors in medical interactions. I am also an Associate Professor in Communication and Family Medicine.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.