Analysis of Patient Cues in Asynchronous Health Interactions: Pilot Study Combining Empathy Appraisal and Systemic Functional Linguistics

Abstract

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

A meta-narrative review of coding tools for healthcare interactions and their applicability to written communication

“…Although we contacted Pounds and De Pablos-Ortega, they confirmed that they are no longer involved in this empathy appraisal work. Therefore, we conducted a pilot study that combined empathy appraisal and SFL, with successful findings, which suggest that these two approaches complement each other [ 88 ]. This novel approach could supplement the coding tools that we review in this article and provide a complete picture of the interaction.…”

Digital empathy in behaviour change interventions: A survey study on health coach responses to patient cues

“…Drawing on Pounds’ framework, which categorises patient EOs and HCP empathic responses, we coded coach responses to EOs. While there is scarce research on the identification of these EOs in written health interactions, 31 , 32 to our knowledge, there is no research work on the connection between provider's responses and EOs. In addition, we identify the techniques in those empathic responses to explore the relationship between empathy and BC from a novel coding perspective.…”

Exploring the Intersection of Empathy and Behavior Change Techniques in Telehealth Coaching Messages: A Survey Study

“…Pounds' empathy appraisal framework outlines seven forms of EOs found in patient's cues and statements (Table 2). We combined this framework with an additional layer of SFL: the transitivity system [24]. This system allows us to systematically investigate how speakers construe their experience of the world by accounting for the participants involved, the processes (verbal groups), and the circumstances of this experience [25].…”

“…This system allows us to systematically investigate how speakers construe their experience of the world by accounting for the participants involved, the processes (verbal groups), and the circumstances of this experience [25]. We conducted a pilot study [24] to explore the linguistic structure and meanings of EOs in text messages exchanged between clients and their coaches within a digital health coaching intervention for pregnant women at risk of gestational diabetes [26]. Our ndings uncovered valuable insights that contribute to patient EO identi cation.…”