Evidence Based Health Communication Professor Paul Crawford

Traditional approaches in health communication teaching & learning Counselling based Communication Skills Training Knowledge acquisition in a social context

Time for a change? Need for Evidence Based Health Communication (EBHC)

Our programme for change – Practice-Congruent Evidence 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

Our programme for change Education User/ carer involvement in designing and delivering communication skills teaching/ curriculum design Practice congruent skills learning and assessment Distance-learning MA in Health Communication

New approaches to the teaching of communication Learning the language of health care Experiential learning - student centred education based on active discovery Problem-based Learning Data-driven learning

Data Information represented in digital form, including voice, text, facsimile, & video

Data-driven learning 1 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

Data-driven learning 2 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

Adolescent Language 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)

Ask Dr Ann

The Teenage Health Freak Website (www. teenagehealthfreak. org)

Keyword analysis: categorisation of health themes Table 1: Keyword categorisation of health themes in AHEC ___________________________________ Theme Examples of keywords ___________________________________ 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, cuts, cutting, selfharm, scars, prozac, sad, unhappy, self, harm, wrists, 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, 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, pills

Emails: Depressed 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!

Emails: Depression 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 xoxox 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.

Insights 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.

Welsh language and health communication Cross-cultural language barriers can jeopardise 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.

Getting to grips 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).

LLAIS, Bangor University The LLAIS scoping study (Roberts et al 2005) suggested a need for more research on language skills identification and enhancement

The future? An urgent need to expand the evidence base to support best practice in language use in healthcare in Wales and elsewhere

References Harvey, K. J, Brown, B. , Crawford, P. , Macfarlane, A. & Mc. Pherson, 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.