Online platforms and smartphone applications that facilitate patient-provider communication are examples of how digital technologies support human interaction. Telehealth enables clinical encounters when physical consultations are not possible, and evidence confirms that face-to-face and remote healthcare encounters have comparable efficacy. Furthermore, research shows that patient-provider communication and relationship influence patient outcomes. However, we lack studies on what happens during these interactions, particularly in text-messages conversations, from a linguistic or behavioral perspective. Our research methods will evolve alongside our communication channels. Currently, there is an overall preference for qualitative methods in patient-provider communication research. Some authors argue that quantitative measures (clinical measurements, questionnaires) lack an understanding of the patients' experiences, whereas qualitative approaches (interviews, focus groups) provide the full picture. Others suggest their combination to interpret interactions thoroughly. As a result, it is often difficult for a communication researcher to choose between one or more approaches. We conducted a mini-review of qualitative approaches, such as corpus linguistics and conversation analysis, as well as quantitative approaches, such as analysis of variance and temporal pattern detection, for patient-provider communication analysis. Additionally, we distinguish relevant communicative features in synchronous or live interactions, such as video-calls, and asynchronous interactions, such as non-instant messaging. We further discuss these methods' potential for combination and their applications in digital communication research. We aim to guide researchers to choose a methodology for digital interaction studies. Our recommendations are based on these approaches' ability to answer a research question, and we suggest a mixed-methods approach in future digital communication research.

Background Lifestyle-related diseases are among the leading causes of death and disability. Their rapid increase worldwide has called for low-cost, scalable solutions to promote health behavior changes. Digital health coaching has proved to be effective in delivering affordable, scalable programs to support lifestyle change. This approach increasingly relies on asynchronous text-based interventions to motivate and support behavior change. Although we know that empathy is a core element for a successful coach-user relationship and positive patient outcomes, we lack research on how this is realized in text-based interactions. Systemic functional linguistics (SFL) is a linguistic theory that may support the identification of empathy opportunities (EOs) in text-based interactions, as well as the reasoning behind patients' linguistic choices in their formulation. Objective This study aims to determine whether empathy and SFL approaches correspond and complement each other satisfactorily to study text-based communication in a health coaching context. We sought to explore whether combining empathic assessment with SFL categories can provide a means to understand client-coach interactions in asynchronous text-based coaching interactions. Methods We retrieved 148 text messages sent by 29 women who participated in a randomized trial of telecoaching for the prevention of gestational diabetes mellitus (GDM) and postnatal weight loss. We conducted a pilot study to identify users' explicit and implicit EOs and further investigated these statements using the SFL approach, focusing on the analysis of transitivity and thematic analysis. Results We identified 164 EOs present in 42.37% (3478/8209) of the word count in the corpus. These were mainly negative (n=90, 54.88%) and implicit (n=55, 60.00%). We distinguished opening, content and closing messages structures. Most of the wording was found in the content (n=7077, 86.21%) with a declarative structure (n=7084, 86.30%). Processes represented 22.4% (n=1839) of the corpus, with half being material (n=876, 10.67%) and mostly related to food and diet (n=196, 54.92%), physical activity (n=96, 26.89%), and lifestyle goals (n=40, 11.20%). Conclusions Our findings show that empathy and SFL approaches are compatible. The results from our transitivity analysis reveal novel insights into the meanings of the users’ EOs, such as their seek for help or praise, often missed by health care professionals (HCPs), and on the coach-user relationship. The absence of explicit EOs and direct questions could be attributed to low trust on or information about the coach’s abilities. In the future, we will conduct further research to explore additional linguistic features and code coach messages. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620001240932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380020

BACKGROUND Lifestyle-related diseases are among the leading causes of death and disability. Their rapid increase worldwide has called for low-cost, scalable solutions to promote health behaviour changes. Digital health coaching has proved to be effective to this aim, with the rising use of text-based interventions. In order to guarantee coaching fidelity and effectivity, there is a need for research in the field of linguistics as a core element of these interventions. State-of-the-art research has considered wording but lacks grammar analysis and the meanings originated from the speaker’s linguistic choices. When investigated, these choices can disclose the speaker’s experiences of the world, their relationship with the receiver and the interpretation of their wording as a text message. Furthermore, empathy is associated with these meanings, and becomes pivotal during coaching for a successful coach-user relationship and positive patient outcomes. OBJECTIVE We aim to analyse user cues in a digital health intervention and contribute to future research on coach communication. METHODS We tested a combination of empathy and a linguistic approach to code 148 text messages sent by 29 women recruited in a randomized trial on tele-coaching for the prevention of gestational diabetes and postnatal weight loss. RESULTS We identified 143 empathic opportunities present in 42.37% of the word count in the corpus. These were mainly negative (82.2%) and implicit (60%). We distinguished opening, content and closing messages structures. Most of the wording was found in the content (86.2%) with a declarative structure (86.3%). Processes represented a 22.4% of the corpus, with half being material (10.7%) and related to food and diet (26.9%), physical activity (26.9%), and lifestyle goals (11.2%). CONCLUSIONS The combination of empathy and linguistic analysis showed promising results. Our findings reveal preliminary insights on the coach-user relationship. The absence of explicit empathic opportunities and direct questions could be attributed to a low trust or information on the coach's abilities. We will be conducting further research to explore additional linguistic features and code coach messages. CLINICALTRIAL Trial registered on the Australian New Zealand Clinical Trials Registry (ANZCTR) with registration number ACTRN12620001240932.

, as well as internationally, there is a wish for enhanced collaboration between primary care and the psychiatric sector in the treatment of patients with depression. On the basis of interviews with general practitioners and psychiatrists, the article demonstrates that the two groups of professionals have diverging approaches to depression: the general practitioners employ a constructionist, bottomup approach, indicating that they view depression as a dynamic and negotiable entity, while the psychiatrists treat depression as essentialist and employ a top-down approach to depression, indicating that this group of professionals has a more static understanding of depression. This difference is constituted by the two groups' reports of habitual language use. Consequently, the general practitioners use causative constructions, modality and pronouns denoting visible referents, while the psychiatrists use copula constructions, generic referents and less modality. These different understandings of depression may have implications for future collaboration. While most studies of health care communication are interactionally framed, this study can be regarded as a contribution to examining health care communication in a context of representation, that is, how medical professionals talk about their profession and their patients, rather than how they communicate with their patients. This study of reported language use is inspired by a framework of reported speech and thought originally intended for written, predominantly literary text. In order to make the phenomenon suited to shed light on understandings of depression in spoken language, it is framed in a grammatical context and the methodological implications of doing so are discussed.

In Denmark and internationally there is a push for enhanced collaboration between general practice and the psychiatric sector in the treatment of patients with depression. Linguistic and other qualitative studies into doctor-patient interaction have shown that general practitioners (GPs) and psychiatrists have different understandings of depression, which could hamper collaboration. The present study adds to linguistic research of the understanding of depression in the two sectors by examining healthcare communication in a context of representation: how doctors talk about their patients in interviews, rather than how they communicate with their patients in consultations. We demonstrate that the two groups of doctors have diverging representations of patients with depression. Most GPs present patients as individuals whose condition is explained by psychosocial circumstances; whereas psychiatrists predominantly present patients as categories. This difference is evidenced by how the two groups respond to the interviewer’s elicitation of patient stories. The GPs employ personal or specific narrative genres, whereas the psychiatrists use general narrative genres, indicating that the two groups occupy their own separate spaces within what is termed the narrative field. We also demonstrate that these different representations concur with variations in interactional patterns in the interview context, enhancing the gap between the professional identities of the two groups of doctors and, consequently, their conceptualizations of depression. The difference between the groups could be suggestive of cultural differences between the two sectors, caused by their different roles and working conditions in the health care system, which could pose a challenge to future cooperation.