Effecting change through dialogue: Habermas’ theory of communicative action as a tool in medical lifestyle interventions

Abstract

Adjustments of everyday life in order to prevent disease or treat illness afflict partly unconscious preferences and cultural expectations that are often difficult to change. How should one, in medical contexts, talk with patients about everyday life in ways that might penetrate this blurred complexity, and help people find goals and make decisions that are both compatible with a good life and possible to accomplish? In this article we pursue the question by discussing how Habermas' theory of communicative action can be implemented in decision-making processes in general practice. The theory of deliberative decision-making offers practical guidelines for what to talk about and how to do it. For a decision to be rooted in patients' everyday life it has to take into consideration the patient's practical circumstances, emotions and preferences, and what he or she perceives as ethically right behaviour towards other people. The aim is a balanced conversation, demonstrating respect, consistency and sincerity, as well as offering information and clarifying reasons. Verbalising reasons for one's preferences may increase awareness of values and norms, which can then be reflected upon, producing decisions rooted in what the patient perceives as good and right behaviour. The asymmetry of medical encounters is both a resource and a challenge, demanding patient-centred medical leadership, characterised by empathy and ability to take the patient's perspective. The implementation and adjustments of Habermas' theory in general practice is illustrated by a case story. Finally, applications of the theory are discussed.

A Communicative Action Approach to Evaluating Citizen Support for a Government's Smoking Policies

“…A growing number of studies apply the action theory empirically to the study of linguistic interactions in social and political processes (Barry, Stevenson, Britten, Barber, & Bradley, 2001;Leanza, Boivin, & Rosenberg, 2010;Sumner, 2001;Walseth & Schei, 2011;Webler, 1995). The study reported here expands on previous research on communicative action and legitimation in the United States (Chang & Jacobson, 2010a;Jacobson & Jun, 2006), by using it in the hybrid political system of the city-state of Singapore.…”

Shared decision‐making in tinnitus care – An exploration of clinical encounters

“…Walseth and Schei's (2011) application of Habermas’ ideas sets out a framework for the ideal consultation, proposing the appropriate content of a clinical encounter, what should be said and how it should be said. Within this framework, lifeworld is comprised of an objective world with empirical, factual medical knowledge; a social world comprised of the rules and norms of a social group; and a subjective world comprised of intentions, beliefs, and emotions (Walseth & Schei, 2011). Our data describe how these ‘worlds’ are incorporated into a clinical encounter for tinnitus.…”

“…Following the inductive data analysis, we explored existing theorizations of the kinds of activities observed in the encounters and of conceptualizations of the clinician-patient relationship. In particular, we examined our data alongside the theoretical construct of concordance (Elwyn, Edwards, & Kinnersley, 1999;Elwyn et al, 2003), the changing nature of the doctor-patient relationship (Wirtz, Crib, & Barber, 2006) and to Habermas' theory (1986) of communicative action, as applied medical encounters by Walseth & Schei (2011), which proposes a multifaceted lifeworld approach to care. Each of these theorizations of clinical encounters critiques the 'tradition' of a paternalistic clinician dominating the consultation with medical language and imposing recommendations onto a passive patient in comparison with an autonomous patient who is actively involved in shared decision-making and who directs the consultation towards a treatment decision which fits their lifeworld.…”

Patients’ and physicians’ experiences of atrial fibrillation consultations and anticoagulation decision-making: A multi-perspective IPA design

“…Nevertheless, Walseth & Schei (2011) This proposed content for medical consultations, according to Walseth & Schei (2011), would create an environment conducive to participatory decision-making. The findings of the current study support this case.…”

“…Previous effective initiatives in overcoming such barriers are: the use of multidisciplinary teams perhaps with specialist nurses (Hendriks et al, 2012); the use of new technologies (LaHaye et al, 2014); multifaceted interventions (Clarkesmith et al, 2013); and more flexible practice management (Wilson & Childs, 2002). It is conceivable that the use of multidisciplinary teams and specialist nurses in a more flexibly organised primary care setting (following existing approaches to care for e.g., diabetes, asthma) would support the inclusion of Walseth & Schei's (2011) three dimensions within consultations and would help foster rapport over time to help support patients' long-term drug management with follow-up appointments. In addition, the use of multifaceted interventions would maximise patient understanding (Watson & McKinstry, 2009;Fuller et al, 2004).…”