Analysing Health Communication Gavin Brookes • Daniel Hunt Editors Analysing Health Communication Discourse Approaches Editors Gavin Brookes Daniel Hunt Department of and English School of English Language University of Nottingham Nottingham, UK Lancaster, UK

ISBN 978-3-030-68183-8 ISBN 978-3-030-68184-5 (eBook) https://doi.org/10.1007/978-3-030-68184-5

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Tis Palgrave Macmillan imprint is published by the registered company Springer Nature Switzerland AG. Te registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Contents

1 Discourse and Health Communication 1 Gavin Brookes and Daniel Hunt

2 Conversation Analysis: Questioning Patients About Prior Self-Treatment 19 Rebecca K. Barnes and Iris Z. van der Scheer

3 Interactional Sociolinguistics: Tracking Patient-Initiated Questions Across an Episode of Care 49 Maria Stubbe, Kevin Dew, Lindsay Macdonald, and Anthony Dowell

4 Narrative Analysis: DNA Testing and Collaborative Knowledge-Building in a CFS/ME Forum 81 Michael Arribas-Ayllon

5 Discursive Psychology: A Discursive Approach to Identity Work in Online Illness Talk 111 Joyce Lamerichs

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6 Corpus Linguistics: Examining Tensions in General Practitioners’ Views About Diagnosing and Treating Depression 133 Daniel Hunt

7 Poststructuralist Discourse Analysis: Investigating Representations of Knowledge and Knowledge-Related Subjectivities in an Online Forum on HPV Vaccination 161 Antoinette Fage-Butler

8 Discursive Ethnography: Understanding Psychiatric Discourses and Patient Positions Trough Fieldwork 189 Agnes Ringer and Mari Holen

9 Critical Discourse Studies: Mad, Bad or Nuisance? Discursive Constructions of Detained Patients in Polish Nursing Notes 215 Dariusz Galasiński and Justyna Ziółkowska

10 Multimodality: Examining Visual Representations of Dementia in Public Health Discourse 241 Gavin Brookes, Emma Putland, and Kevin Harvey

11 : Leadership and Team Communication in Emergency Medicine Training 271 Sarah Atkins and Małgorzata Chałupnik

12 Cognitive Approaches to Discourse Analysis: Applying Conceptual Blending Teory to Understandings of Disease Transmission 301 Olivia Knapton, Alice Power, and Gabriella Rundblad Contents vii

13 : Mind Style in an Autobiographical Account of Schizophrenia 333 Zsófa Demjén and

Index 357 Notes on Contributors

Michael Arribas-Ayllon is a Reader at Cardif School of Social Sciences, Cardif University. His work focuses on historical and applied approaches to the analysis of discourse and scientifc knowledge. His research interests include genetic testing, psychiatric genetics, genetic counselling, profes- sional ethics and the practice of digital therapies. His publications include Genetic Testing: Accounts of Autonomy, Responsibility and Blame (2011) and Psychiatric Genetics: From Hereditary Madness to Big Biology (2019). Sarah Atkins is a Senior Research Associate at the Aston Institute for Forensic Linguistics, where she works with a team of researchers on the ‘Forensic Linguistic Databank’ (FoLD), bringing to bear her experience on the ethics and policy considerations for research in a range of institu- tional settings. She has previously conducted applied linguistic research in a number of professional contexts, with a strong focus on healthcare, including an ESRC ‘Future Research Leaders’ award at the University of Nottingham (2013–16), from which the data and research underpinning her chapter originate. Rebecca K. Barnes is a Senior Qualitative Researcher in the Nufeld Department of Primary Care Health Sciences at the University of Oxford. She is also Principal Investigator for the One in a Million primary care consultations archive. She specialises in the application of CA methods to

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­interactions between patients and healthcare professionals with the aim of improving patient care. She has studied patient consultations in gen- eral practice and out-of-hours primary care for a variety of projects including the management of common infections. She has also pioneered the application of CA methods in clinical trials of talk-based interven- tions. Her fndings have informed e-learning for healthcare professionals with Health Education England. Gavin Brookes is a Senior Research Associate in the ESRC Centre for Corpus Approaches to Social Science at Lancaster University and associ- ate editor of the International Journal of Corpus Linguistics. His research interests include discourse analysis, corpus linguistics, multimodality and health communication. His recent publications in these areas include Obesity in the News: Language and Representation in the British Press with (forthcoming, Cambridge University Press), Corpus, Discourse and Mental Health with Daniel Hunt (2020) and Te Language of Patient Feedback: A Corpus Linguistic Study of Online Health Communication with Paul Baker and Craig Evans (2019). Małgorzata Chałupnik is Teaching Associate in Linguistics and Professional Communication in the School of English at the University of Nottingham. She conducts research in the area of professional com- munication, focusing in particular on leadership and interpersonal aspects of talk at work. Having worked on a number of projects funded by the university and ESRC, she has been involved in carrying out research, training and consultancy work with a wide range of public, private and third-sector organisations from across the UK. Zsófa Demjén is Associate Professor of Applied Linguistics at UCL Centre for Applied Linguistics, University College London. She special- ises in language and communication around illness and healthcare (humour, metaphor, narratives, impoliteness etc.). She is author of Sylvia Plath and the Language of Afective States: Written Discourse and the Experience of Depression (2015), co-author of Metaphor, Cancer and the End of Life: A Corpus-Based Study (2018), editor of Applying Linguistics in Illness and Healthcare Contexts (2020) and co-editor of Te Routledge Handbook of Metaphor and Language (2017). Notes on Contributors xi

Kevin Dew is Professor of Sociology at Victoria University of Wellington, New Zealand. He is a founding member of the Applied Research on Communication in Health (ARCH) Group. His research activities include studies of interactions between health professionals and patients, health inequities in cancer care decision-making and the social meanings of medications. His books include Te Cult and Science of Public Health: A Sociological Investigation (2012), Borderland Practices: Regulating Alternative Terapy in New Zealand (2003), Sociology of Health in New Zealand (2002, with Allison Kirkman) and Public Health, Personal Health and Pills: Drug Entanglements and Pharmaceuticalised Governance (2018). Anthony Dowell is Professor of Primary Health Care and General Practice at the University of Otago in Wellington, New Zealand. He co-leads­ the Applied Research on Communication in Health (ARCH) Group and is a practising GP who has worked in New Zealand, the UK and Central Africa. He undertakes research in community settings using quantitative and qualitative methodologies to investigate primary mental healthcare, communication between patients and health providers and the application of complexity and implementation science in healthcare settings. Antoinette Fage-Butler holds a PhD in Knowledge Communication from Aarhus University, Denmark, where she is an associate professor. Her research interests include trust and mistrust related to scientifc expertise, the communication of trustworthiness and risk, and cultural aspects of health communication. Methodologically, her research spans qualitative approaches to critically investigating discourse and genre and, more recently, quantitative approaches that scale up cultural analyses using large data sets. Dariusz Galasiński is a Professor at the Institute of Journalism and Social Communication, University of Wrocław, Poland. His research interests focus upon experience of mental illness, fatherhood and ­masculinity, and discourses of psychiatry. Recent publications on these topics include Men’s Discourses of Depression (2008, Palgrave), Fathers, Fatherhood and Mental Illness: A Discourse Analysis of Rejection (2013, Palgrave), Discourses of Men’s Suicide Notes (2017) and Discursive Constructions of the Suicidal Process with Justyna Ziółkowska (2020). xii Notes on Contributors

Kevin Harvey is Associate Professor of Discourse Analysis at the University of Nottingham. His research uses multimodal critical dis- course analysis to examine contemporary health communication, focus- ing particularly on health promotion and media representations of dementia. Mari Holen is Associate Professor at Roskilde University in Denmark. She does research in health policy and health strategies and how welfare institutions translate dominant ideas of health. For instance, she has been interested in the concepts of recovery and user involvement, which have been spread widely throughout the mental health system, and especially how these concepts are understood and what they do. Daniel Hunt is Assistant Professor of Discourse Analysis in the School of English, University of Nottingham. His research uses corpus linguis- tics and multimodal discourse analysis to understand contemporary health discourse, focusing particularly on how individuals and organisa- tions represent illness experiences and negotiate personal identities on digital media. His co-authored monograph with Gavin Brookes, Corpus, Discourse and Mental Health (2020), examines the discourse of online support groups for individuals with anorexia, depression and diabulimia. Olivia Knapton is Lecturer in Linguistics in the School of Education, Communication and Society at King’s College London. Her research interests lie in investigating subjective experiences of mental health prob- lems and communication of public health advice by the media and health authorities and fnding innovative ways to combine cognitive and discur- sive approaches to meaning. Across her research, Knapton explores dis- courses of anxiety about health and illness and the ways in which these discourses relate to issues of gender and women’s experiences of their bodies. Joyce Lamerichs is an Assistant Professor in the Department of Language, Literature and Communication at Vrije Universiteit Amsterdam. Her research interests lie in health interactions across difer- ent settings, and she is studying family consultations in neonatal critical care in Dutch hospitals. Her co-edited volume Children and Mental Health Talk together with Susan Danby, Amanda Bateman and Stuart Ekberg (Palgrave, 2020) highlights children’s social competence as con- Notes on Contributors xiii versational partners in settings in which their mental health and well- being are topicalised. Her work on online health interactions is aimed at exploring identity work in illness blogs, making use of insights from dis- cursive psychology and conversation analysis. Lindsay Macdonald is an Adjunct Research Fellow at the University of Otago in Wellington, New Zealand, and a founding member of the Applied Research on Communication in Health (ARCH) Group. She has brought her clinical background in nursing to a wide range of applied research projects on health communication and health promotion in the primary healthcare domain. Alice Power worked as a Research Assistant whilst undertaking her MA in English Language and Applied Linguistics at the University of Birmingham. She has interests in discursive representations of illness, health and the natural world. Emma Putland is a doctoral researcher at the University of Nottingham. Her PhD takes a mixed methods discourse analysis approach to investi- gate how people with experience of dementia (whether lived or as a carer/ loved one) situate themselves and their experiences of dementia in rela- tion to visual and linguistic media representations. Her broader research interests include health, environmental, age and gender-related­ discourses. Agnes Ringer is a part-time Lecturer at Roskilde University and clinical psychologist with the mental health services in the Capital Region of Copenhagen in Denmark. She holds a PhD in Mental Health and her research interests lie in the interplay between power, discourses and insti- tutions. In her clinical practice and research she focuses particularly on discursive approaches to mental health and psychotherapy. Gabriella Rundblad holds a PhD from Stockholm University and is Professor of Language and Cognition in the School of Education, Communication and Society at King’s College London. She is an expert on language, cognition and behaviour, focusing primarily on fgurative language and health communication. In her research, Rundblad utilises a wide range of methodologies, including discourse analysis, psycholin- guistic experiments, surveys, focus groups and interviews. xiv Notes on Contributors

Elena Semino is Professor of Linguistics and Verbal Art in the Department of Linguistics and English Language, and Director of the ESRC Centre for Corpus Approaches to Social Science, at Lancaster University, UK. She also holds a visiting professorship at Fuzhou University in China. Maria Stubbe is an Associate Professor at the University of Otago in Wellington, New Zealand. She leads the Applied Research on Communication in Health (ARCH) Group which investigates commu- nication issues in clinical practice using video recordings of authentic interactions between health professionals and patients. She is an interac- tional sociolinguist and qualitative health researcher and has published widely in the felds of pragmatics, language in the workplace and health communication. Her publications include Power and Politeness in the Workplace: A Sociolinguistic Analysis of Talk at Work (2015, co-authored with Janet Holmes). Iris Z. van der Scheer is a PhD candidate at University College London, UK. Previously, she has completed a Research Master’s in Linguistics from the University of Groningen, the Netherlands. Her research focuses on the development of strategies for the implementation of digital ­technologies in medical consultations by applying Conversation Analysis and other qualitative methods. Her broader research interests include health communication, innovation and implementation. Justyna Ziółkowska is Associate Professor of Psychology, University of Social Sciences and Humanities (SWPS), Poland. Her research focuses around discourse analysis of medical practices and experiences of mental problems. At present, she is studying representations of suicidal thoughts and attempt in individual and institutional discourses, with a particular focus on how patients construct their suicidal experiences and how they are represented in medical documentation. She is also interested in expe- riences and institutional records of psychiatric detention. List of Figures

Fig. 2.1 Phase structure of the acute primary care visit (adapted from Heritage and Clayman 2010: 105) including places where doctor-initiated questions about prior self-care might occur 26 Fig. 5.1 April’s website and blog 122 Fig. 5.2 Anthony’s blog 123 Fig. 6.1 Case vignettes for depression focus groups 143 Fig. 6.2 Sample concordance for depression 145 Fig. 6.3 Frequency plot for depression in each focus group 147 Fig. 10.1 Campaign image of a man with dementia holding a car key 250 Fig. 10.2 Campaign image of a woman with dementia holding a toothbrush 251 Fig. 10.3 Campaign image of a man with dementia holding toast 252 Fig. 11.1 Main participants of the simulation 281 Fig. 11.2 Percentage of direct versus indirect requests employed by each trainee doctor (candidates ordered by evaluation of their leadership—highest to lowest score) 286 Fig. 11.3 Percentage of instances when supportive moves (predomi- nantly grounders) were used to modify requests by the trainees (candidates ordered by evaluation of their leader- ship—highest to lowest score) 286

xv xvi List of Figures

Fig. 12.1 Mental spaces diagram for last week I had a cold 306 Fig. 12.2 Blending diagram for scientists’ war on Ebola 308 Fig. 12.3 Measles consensus 314 Fig. 12.4 Measles blending diagram 318 List of Tables

Table 3.1 ARCH Corpus: TP5-TS-GP09-21 (‘Nasal polyps’) 61 Table 3.2 Per consultation frequency (N) of all questions and rate/ min of patient questions 64 Table 4.1 Generic structure of forum thread 91 Table 4.2 Diferentiating evaluation as an activity-type 92 Table 6.1 Tematic groups and associated keywords for the focus group corpus 145 Table 11.1 Station completion times 282 Table 11.2 Types of requesting head acts (based on Blum-Kulka et al. 1989) 284 Table 11.3 Internal and external modifcations of head acts (based on Blum-Kulka et al. 1989) 284 Table 12.1 Te main ways that communicable diseases are spread 310 Table 12.2 How measles, typhoid, Ebola, hepatitis and fu are spread 312 Table 13.1 Over and underused pronouns in Henry’s chapters 342

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