Evidence Based Health
Communication
Professor Paul Crawford
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Counselling based
Communication Skills Training
Knowledge acquisition in a social context
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Need for Evidence Based Health
Communication (EBHC)
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Health Language Research Group,
Nottingham, UK
Managed and Clinical Innovation Networks –
bringing evidence into NHS practice
Making language study relevant and
applicable in health care practice
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User/ carer involvement in designing and
delivering communication skills teaching/
curriculum design
Practice congruent skills learning and
assessment
Distance-learning MA in Health
Communication
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Learning the language of health care
Experiential learning - student centred
education based on active discovery
Problem-based Learning
Data-driven learning
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Information represented in digital form,
including voice, text, facsimile, & video
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Getting a "feel" for the language and action
of the healthcare encounter
Getting a closer account of patient and
professional communication and illness/
health experience
Providing a trigger to stimulate discovery in
the student
To facilitate deeper learning than textbook
study
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Making knowledge detailed, personal and
memorable for the student
Letting students view raw information and
search for meaning themselves
Facilitating the ‘student as teacher’ – selfdirected study
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Lack of research into adolescent
health language
Little data on spoken health
interaction
Internet health provision brings
opportunities to explore
adolescent health language.
Harvey et al (2007)
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Table 1: Keyword categorisation of health themes in AHEC
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Theme
Examples of keywords
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Sexual health
Sex, sexual, penis, pregnant, period, orgasm, AIDS,
infertile, STD, STI, sperm, contraception, HIV,
clitoris, vagina, vulva, PMS, erection, condom,
masturbate, gay, abortion, foreplay, intercourse,
virgin, unprotected, lesbian, oral, pill, ovulation,
herpes, thrush, chlamydia, pregnancy, tampon,
testicles, genitalia, viagra, scrotum, labia, glans,
ovaries, foreskin, balls, fanny, bisexual, miscarriage
Mental health
depression, depressed, suicide, suicidal, die,
overdose, antidepressants, cut, cuts, cutting, selfharm, scars, prozac, sad, unhappy, self, harm,
wrists, stress, stressed, ADHD, paranoid, mental,
mad, moods, sad, unhappy, crying, personality,
anxiety
Body weight/image Anorexia, anorexic, weight, size, overweight, fat,
obese, underweight, skinny, thin, bulimia, BMI,
exercise, diets, kilograms, KG, KGS, bulimia, calories
Drugs/alcohol
Drugs, cannabis, cocaine, heroin, pills, addicted,
alcohol, drunk, drinking, poppers, mushrooms,
marijuana, crack, ecstasy, addict, stoned, LSD,
cigarettes, dope
Medication
Medicine, medication, prescribed, antibiotics,
tablets, pill, pills
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I'm really depressed about splitting up with my boyfriend. I still like him and its
getting me down.
I am really chubby for ma age and i used to have a flat stomach, no rolls and be
very happy with my body, now i cant even see my belly button amongst the rolls
and my clothing is uncomfortable and i tend to feel very self concious about
people saying i'm fat - i sometimes cry about my problem, but my mum wont
listen and just tells me to get over it! please help me because i am very depressed,
i eat a healthy diet and get loads of excercise because my parents are fitness fraks
please help me . . . . . . .
i cant stop eating i am depressed and stuf but i need to know how to stop eqting
choclates and crisps as i am forever hungry i may have a habit of eating i dont
know wot is wrong with me and i am not fat i am skinny kind of just rite really
hi, im six months pregnant and starting to have some major regrets. i had sex
with 6 different people in one week and i dont know who the father is. my family
dont want ot support me, im in top sets but falling behond with my school work
and im really depressed. i have been taking alot of tablets for the pain, but my
life just seems so hopeless. please help me. pregnant slut
i am not happy with myself i am fat i get bullied and i am depressed
im so depressed, i think i am because i cant stop crying and i feel so worthless, im
17 and my boyfriend upsets me alot, ive been with him for 2 years now and he
means the world to me, i just feel so sad, my friends and family say its him, but
without him id b so much worse than i am now. help!
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I have depression, and it seems to be getting worse lately. i've been feeling horrible through most of the hols,
and i still do even though im back at school. i was thinking of dropping out, but ive decided to stay and drop a
subject instead. but how can i make myself feel better? i'm putting my family through a lot of grief.
dear Dr Ann, i have had depression since the age of 11/12 but have never spoken to anyone about it. recently
this depression has got to me more and i have started cuttin my wrist. . . . with some intent to kill myself. At
good times i don't want to do this so is there anything i can do to prevent it hapening next time i have another
long spell of depression?
i have depression alot of people say and they also say im becoming anorexic. my parents are saying i have an
eating disorder. ive looked at websites about anorexia and i have alot of the symptoms. such as:always
exercising, thinking your fat and afraid to gain weight, getting cold, depression, emotional issues, and some
other things. i dont know what to do, i think im fat and overweight, but ive tried not eating and exercising, but
it i only lose weight when i dont eat for periods of time. like i usually eat 1 meal a day at the most because my
mom forces me to. i want to lose weight fast.
i have severe clinical depression. i feel so bad i dont know what to do anymore. i took an overdose but my
friend found out and told someone so now i'm alive. i wish she never found out, i'd much rather be dead than
living a life that i hate. why do i feel like this? why do i have these terrible thoughts?
dear dr ann i have got depression and i self-harm! am i weird? and have you got any advice on what to do when
i feel like self-harming? thank love beki xoxoxoxox
I am seriously messed up. I have had depression for 18 months now. A year ago, I started councilling but it
didn't help. I was also put on Prozac but that did nothing. In January, I was sent to an adolescent acute
psychiatric unit, but I didn't feel better and took an overdose of 64 paracetemal. Hospital unfortunately saved
me from that, but I tried to drown myself, poison myself, slit my wrists. I also stopped eating. In a month, I
only ate 3 yoghurts and 2 fruit salads. Now I am in an eating disorder unit but I only get 3 hours of therapy a
week and I used to get 16, so how is such a short amount going to help me recover from depression, especially
as I don't get on with my therapist? My depression came before my eating problem I'm 95% sure. I've got to be
in the EDU until November at the earliest and that just makes me more depressed. Please help me before I try to
take my life again.
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Adoption of a medical-technical
vocabulary/clinical register
Self-pathologising
Use of direct, frank language on ‘suicide’
unlike in face-to-face exchanges
Vivid, unique portraits of psychological
distress
Provides sense of what distress feels like
from the inside rather than (as in diagnostic
manuals) from the outside.
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Cross-cultural language barriers can
jeopardise the therapeutic relationship
(Jacobs et al 2006)
Welsh speakers feel more comfortable and
confident when using Welsh with healthcare
staff (Misell 2000).
Overwhelming call to enhance language
awareness across the health and social care
sector in Wales.
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Lack of strategic planning in the delivery of
Welsh language healthcare services (Irvine et
al 2006).
Variation in levels of Welsh language
proficiency and attitudes amongst healthcare
professionals (Roberts et al 2007).
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The LLAIS scoping study (Roberts et al 2005)
suggested a need for more research on
language skills identification and
enhancement
An urgent need to expand the evidence base to
support best practice in language use in
healthcare in Wales and elsewhere
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Harvey, K.J, Brown, B., Crawford, P., Macfarlane, A. & McPherson, A. (2007) Am I Normal?
Teenagers, Psychosexual Health and the Internet. Social Science and Medicine 65: 771781.
Irvine F, Roberts G, Jones P, Spencer L, Baker C & Williams C (2006) Communicative
sensitivity in the bilingual healthcare setting: A qualitative study of language awareness.
Journal of Advanced Nursing 53, 4, 1-13.
Jacobs E, Chen A, Karliner L, Agger-Gupta N & Mutha S (2006) The need for more
research on language barriers in health care: a proposed research agenda. The Millbank
Quarterly 84, 1, 111-133.
Misell A (2000) Welsh in the Health Service: the Scope, Nature and Adequacy of Welsh
Language Provision in the National Health Service in Wales. Welsh Consumer Council,
Cardiff.
Roberts G, Irvine F, Jones P, Spencer L, Baker C & Williams C (2007) Language awareness
in the bilingual healthcare setting: a national survey. International Journal of Nursing
Studies. 44, 1177-1186.
Roberts G, Irvine F, Richardson J, Earles C, Gareth E & Prys R (2005) Report on a Scoping
Study of Language Awareness in Health and Social Care. University of Wales Bangor.