nurturing communication by health professionals toward patients: a communication accommodation...

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Nurturing Communicationby Health ProfessionalsToward Patients:A CommunicationAccommodation TheoryApproachBernadette Watson & Cynthia GalloisPublished online: 12 Nov 2009.

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HEALTH COMMUNICATION, 10(4), 343-355 Copyright O 1998, Lawrence Erlbaum Associates, Inc.

Nurturing Communication by Health Professionals Toward Patients :

A Communication Accommodation Theory Approach

Bernadette Watson and Cynthia Gallois School of Psychology

The University of Queensland

This study explores the role of nurturing communication in distinguishing interpersonal and intergroup interactions between health professionals and patients, from the perspective of communication accommodation theory (CAT). Participants (47 men and 87 women) rated videotapes of actual hospital consultations on 12 goal and 16 strategy items derived from CAT. Health professionals in interpersonal interactions were perceived to pay more attention to relationship and emotional needs and to use more nurturant discourse management and emotional expression. These results point the way toward elucidating the perceived optimal balance in accommodative behavior, both group based and interpersonal, in these contexts, and they highlight the importance of nurturant communication to this process.

At the very core of health communication is the interaction between health professionals and their patients. Indeed, given the plethora of studies about such interactions, if there is a paradigm for the study of nurturing language and communication, this is probably it. In recent years, there has been a shift away from a biomedical model of health communication to one emphasizing the patient as central (Sharf & Street, 1997). Most of these studies have defined effective or competent communication by health professionals as nurturant communication, or at least as communication perceived by patients as satisfying and interpersonal. Although this trend is understandable, a number of problems have been raised with some of this work.

First, the large majority of studies on health professional-patient interactions have been criticized for their lack of theoretical rationale (see Cegala, McGee, & MkNellis, 1996; Street, 1991; Thompson, 1994, for discussions of this issue). Therefore, although we know a great deal about the behaviors by health professionals that are perceived by patients and potential patients as more satisfying and more competent, there is no overarching rationale to link such behaviors to important outcomes of the interactions, such as compliance with instructions from the health

Requests for reprints should be sent to Bernadette Watson, School of Psychology, The University of Queensland, Queensland 4072, Australia E-mail: bernadetC9psy.uq.oz.a~

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344 WATSON AND GALLOIS

professional and patient satisfaction. Compliance, indeed, has been seen as one outcome of considerable concern to health care providers (Thompson, 1994). During the past few years, some scholars (cf. Burgoon, 1992) have noted, for instance, that patient satisfaction does not necessarily lead to greater patient compliance with the doctor's instructions; in the case of male doctors, in fact, more aggressive communication appears to produce greater compliance (Burgoon, Birk, & Hall, 1991). It is essential to specify the antecedents, behaviors, and outcomes associated with health professional-patient interaction in a theoretically meaningful way. This study is an attempt to address this issue.

A second issue that has been raised about this literature is that most studies of encounters between health professionals and patients have considered them in interpersonal rather than intergroup terms. Of course, an interpersonal relationship does exist between a doctor (or other health caregiver) and a patient, and personality characteristics of the interactants can influence that relationship and the communicative strategies used. Street and Buller (1988), for example, found that physicians' nonverbal behavior varied as a function of the patient's personal characteristics. Nevertheless, the behavior of health professionals and patients is strongly governed by norms attached to the roles of each, and thus by the intergroup relationships between them. As part of the shift to perceiving the patient as more central in such interactions, there is a need to examine when and how health care professionals communicate with patients in intergroup as well as interpersonal terms.

A large body of research also attests to the difference in power between the roles of health professionals and patients (Beisecker, 1990; Coulthard & Ashby, 1975; Dryden & Giles, 1987; Fisher, 1983; Street & Buller, 1988). This power differential may be reflected in behaviors from greetings to good-byes, including naming rights, the determination of the interaction's structure, and who gets to initiate which sections of the interaction-indeed, every aspect of the interaction (Robinson, in press). It makes sense to think of these interactions in intergroup terms, but few researchers have attempted to do this in a systematic way.

One theory that is ideally suited to this situation is communication accommodation theory (CAT; Gallois, Giles, Jones, Cargile, & Ota, 1995; Giles & Coupland, 1991; Williams, Giles, Coupland, Dalby, & Manasse, 1990). The usefulness of CAT as a model for doctor-patient interaction, and for examining the outcomes of interactions such as patients' perceptions of health professionals' behavior, has been noted by others (e.g., Street, 1991). The model was designed to theorize the dynamics of intergroup encounters in many contexts and specifically to deal with the subtle ways that personal and social identity emerge and are negotiated in such encounters. Recently, scholars using and extending CAT have suggested that, in each intergroup encounter, interlocutors come to expect an optimal balance between intergroup and interpersonal communication. The extent to and the ways in which this balance emphasizes the interpersonal relationship varies with the intergroup and interpersonal history, as well as with goals, strategies, and behavior of the

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NURTURING COMMUNICATION AND ACCOMMODATION 345

participants (Gallois & Giles, 1998). This study used this aspect of CAT as a framework to explore the ways in which nurturant communication is perceived to occur in interactions between health professionals and patients. Perceptions of the relational qualities of these interactions are often more predictive of patient satisfaction than actual behavior (Street & Wiemann, 1987).

It is beyond the scope of this article to present all the details of CAT as it has developed in recent years (see Gallois & Giles, 1998; Gallois et al., 1995; Giles & Coupland, 1991; Williams & Giles, 1996, for fuller accounts in several contexts). Briefly, the theory proposes that participants come into an intergroup interaction with an initial orientation that is more intergroup or more interpersonal, depending on the sociohistorical relationships between the groups, the participants' own tendencies to view encounters in intergroup terms, and the interpersonal history between them. This initial orientation combines with the immediate situation to influence participants' goals and, therefore, their sociolinguistic strategies and behavior. In a dynamic way, each person's behavior influences the perceptions and responses of the others. At the end of the encounter, each participant is left with an evaluation of the others, which influences the participant's initial orientation in future interactions.

In this study, we have concentrated on the perceived goals and strategies of the health professional (rather than the patient). Recent versions of CAT include several main goals, which reflect the specific combination of intergroup and interpersonal relationships. The ones we focus on are attention to the communication needs of the other person, attention to the other person's emotional needs, attention to the communicative competence of the other person, and attention to the role of relationships between the participants. Two other goals, attention to the productive behavior of the other person and attention to face needs, were not studied in this article.

The goals are theorized to influence the choice of sociolinguistic strategy, which in turn influences verbal and nonverbal behavior. It should be noted that, although each goal tends to be associated with a strategy, there is no one-to-one correspon- dence. Instead, it is the overall choice and pattern of strategies that best reflects the main goal or goals (see Jones, Gallois, Callan, & Barker, 1995). Within recent versions of the CAT model, a number of strategies have been described. In this study, we focused on the strategies of discourse management, emotional expression, interpretability, and interpersonal control; we did not look at the approximation or face management strategies (see Giles & Coupland, 1991, and Giles, Coupland, & Coupland, 1991, for more details of the strategies).

The specific aim of this study was to explore the goals and strategies (in CAT terms) that distinguish interactions between health professionals and patients that are perceived to be more intergroup or more interpersonal. In particular, we were interested in the impact on perceptions of health professionals' nurturant communication, particularly the goals and strategies involving emotional needs. We did this by considering real interactions in situ, thus enabling us to capture ongoing behavior.

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The task of the health professional involves paying considerable attention to making sure that the patient understands the diagnosis and treatment. Given this, along with the very distinct roles of health professional and patient, we expected the differences between interactions perceived as interpersonal and intergroup to involve mainly the attention paid by the health professional to the patient's emotional and relationship needs. We also expected these goals to be realized in more accommodative behavior on discourse management and emotional or relationship management strategies, but not necessarily to differ on the other strategies.

METHOD

Selection of Intergroup and Interpersonal Interactions

The interactions used in this study were taken from an Australian television documentary series about a large metropolitan hospital, which featured interactions between patients and health professionals, usually doctors, in a wide variety of situations in the hospital environment. These interactions were videotaped in real time and in the actual settings, so that although the recordings became part of a television series, and were inevitably subject to editorial selection processes, they were real interactions between real health professionals and patients. Each extract consisted of a continuous and unedited stretch of time. Only extracts showing interactions with a focus on one health professional and one fully conscious adult patient were selected. Using these criteria, 25 extracts were selected, ranging from .68 to 2.55 min in length.

To determine the interactions perceived as most intergroup or interpersonal, 126 psychology students (29 men and 77 women; mean age = 19.5 years old) rated each extract on 18 items (which included "friendly", "respectful", "dominating", etc.). These were found in a subsequent principal components analysis to form an interpersonal-intergroup factor. Participants also assessed the naturalness, realism, and typicality of the interactions. Six extracts were selected for this study. These were the three most intergroup extracts and the three most interpersonal ones, with the constraint that one extract of each type included a male health professional and a female patient, a male health professional and a male patient, and a female health professional and a female patient (there were not enough extracts with female health professionals and male patients to include them). These extracts were also rated as natural, realistic, and typical of such interactions. Full details of the extracts can be obtained from Bernadette Watson.

Participants

One hundred thirty-four people (87 women and 47 men) participated in this study. Of these people, 127 were 1st-year psychology students who received extra credit

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toward their current psychology courses; the rest were older volunteers. The mean age of participants was 28.2 years (SD = 15.2).

Questionnaire

The questionnaire comprised three booklets. Two of these included ratings of the videotaped extracts; those items relevant to this study are described later. In addition, participants were asked a number of demographic questions and other questions as part of a larger project.

Goals. Twelve goal items were derived from CAT. Participants were asked to rate the importance of each item for both the health professional and patient on a 6-point scale ranging from 1 (not at all important) to 6 (very important). The items tapped the goals of attention to the communication needs of the other person, attention to emotional needs, attention to communication competence, and attention to, the role relations. A complete list of the items, arranged by goal type, appears in Table 1.

TABLE 1 Means for 12 Goals, by Type of Interaction and Sex Combination of Interactants

Health Professional's Goal - Attend to relationship needs

Encourage patient to ask questions Get to know patient as individual Understand patient's concerns Develop good relationship with patient

Attend to emotional needs Reduce patient's anxiety Reassure patient

Attend to patient's communicative competence Obtain information from patient Listen to patient

Attend to role relationship Control consultation Ensure patient understood what HP said Put across own point of view Explain symptoms to patient

Type and Sex Combination

Interpersonal Intergroup

MM FF MF MM FF MF

Note. M = male; P = female; HP =health professional.

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TABLE 2 Means for 16 Sociolinguistic Strategies, by Type of Interaction and

Sex Combination of lnteractants

Type and Sex Combination

Interpersonal Intergroup

Health Professional's Strategy MM FF MF MM FF MF

Discourse management Treat patient as an equal Maintain good relationship with patient Treat patient as an individual Ask questions of patient

Emotional expression Reassure patient Show liking for patient Acted to reduce patient's anxiety

Interpretability Express self clearly to patient Check understands patient Handle conversation competently Look comfortable with patient

Interpersonal Control Control conversation Decide on topics talked about Talk down to patient Intrude on patient's privacy Let patient express own opinions

Note. M = male; F = female.

Sociolinguistic strategies. Participants rated the health professional and patient on 16 items reflecting the sociolinguistic strategies in CAT. These items tapped discourse management, emotional expression, interpretability, and interpersonal control. The items were rated on a semantic differential-type 6-point scale ranging from 1 (not at all) to 6 (very much). A complete list of the items, grouped by strategy type, appears in Table 2.

Procedure

Participants were told that they would watch six videotaped segments, each depicting an interaction between a health professional and a patient. Participants were instructed that after watching the first segment they should answer the questions in Booklet 1. This procedure was followed for each of the other five segments. After completing the other measures in the study (which are not reported

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here), participants were shown the videotaped segments a second time, and they answered the remaining questions. Both the order of the videotaped segments and the order of questions about them were counterbalanced across participants.

RESULTS

Because the focus of this article is on nurturing communication and the extent to which health professionals are perceived to engender an interpersonal relationship with their patients, only results for the health professionals' communication goals and sociolinguistic strategies are presented.

Goals

A 2 x 2 x 3 multivariate analysis of variance (MANOVA) was conducted, with sex of participant as a between-subjects variable, and type of segment (intergroup or interpersonal) and sex combination of health professional and patient (male-male, female-female, or male-female) as within-subjects variables. The dependent variables were the 12 goal items. All post hoc Newman-Keuls analyses reported were significant (p < .01) unless specified otherwise. There was a significant main effect for sex of participant across the 12 items, F(12, 121) = 2.89, p < .001. Results of univariate analyses showed that women gave higher ratings than men on 6 of the 12 items, and there was a trend toward a significant difference on a further one. There were no interactions between sex of participant and the other independent variables.

There was a significant main effect of sex of interactants, F(24, 109) = 28.20, p < ,001, and univariate analyses showed significant differences for all 12 goal items. This effect was subsumed by a significant interaction between type of segment and sex of interactants, F(24, 109) = 17.90, p < .001, which follow-up analyses of variance (ANOVAs) revealed was significant for all 12 items (Item 9 atp < .01, all otlhers at p < .001), with effect sizes ranging from .09 to .34 (q = .04 for Item 9). Simple effects analyses and post hoc Newman-Keuls tests were conducted to determine where the significant differences lay. Table 1 presents cell means for the goal items, arranged in terms of larger goals derived from CAT. This interaction must be interpreted with care, as there was only one dyad in each of the six cells. Thus, only general patterns are reported.

As can be seen, health professionals in the interactions that had previously been rated as more interpersonal were perceived to place more importance on meeting the patient's communication needs (i.e., encouraging the patient to ask questions, understanding the patient's concerns, getting to know the patient as an individual, and developing a good relationship with the patient). A partial exception to this pattern appeared in the male-female interactions, in which the health professional who had been perceived as more intergroup nevertheless was rated as placing

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importance on this goal. Similarly, health professionals in the interpersonal interactions were rated as placing more importance on meeting the patient's emotional needs (i.e., on reassuring the patient and reducing the patient's anxiety). This effect was attenuated in the case of the female same-sex dyads, but in no case did the means cross over between interpersonal and intergroup interactions.

On the other hand, when attending to the patient's knowledge and competence was concerned, the health professionals in the intergroup interactions were in general rated as placing more importance on this goal. Thus, these health professionals were rated as attending more to obtaining information from the patient and listening to the patient. As Table 1 indicates, the difference was most marked for the mixed-sex dyads. Finally, health professionals in interpersonal and intergroup interactions were perceived as placing similar importance on the role relations with the patient (i.e., on controlling the consultation, putting across their own point of view, explaining the patient's symptoms, and making sure the patient understood). Where there were differences, in general health professionals in interpersonal dyads received higher ratings, although there were one or two exceptions to this.

Sociolinguistic Strategies

Participants rated a total of 16 sociolinguistic strategy items. In each case, the ratings were of the extent to which the health professional was perceived to use each strategy. Because the full analysis involved a large number of cells, the items were grouped into the four larger strategies (discourse management, emotional expression, interpretability, and interpersonal control) derived from CAT. These strategies are theorized to follow mainly from the goals of meeting communication needs, meeting emotional needs, attending to the other person's knowledge and competence, and attending to role relations, respectively (Giles et al., 1991). The items comprising each strategy were examined in a separate MANOVA, with sex of participant as a between-subjects variable and type of interaction and sex combination of interactants as within-subjects variables. As was the case for health professionals' goals, interactions between type of interaction and sex combination of interactants must be interpreted carefully, taking account of the fact that there was only one stimulus dyad per cell.

Discourse management strategy. Four items made up the discourse management strategy: The health professional (a) treated the patient as an equal, (b) asked questions, (c) maintained a good relationship with the patient, and (d) treated the patient as an individual. Results showed a multivariate main effect for sex of participant, F(4,123) = 2 . 7 6 , ~ < .05; women gave higher ratings than men on three items (all except "asked questions"). Sex of participant did not show significant interactions with the other independent variables.

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There was a significant main effect for type of interaction, F(4, 123) = 105.22, p < .001, and ANOVAs showed differences on all four items. There was also a significant main effect for sex combination of interactants, F(8, 119) = 33.676, p < .001, once again involving all four items. These main effects were subsumed in a significant interaction between these two variables, F(8, 119) = 18.32, p < .001, also involving all four items. This interaction was followed up by analysis of simple effects and post hoc Newman-Keuls tests; cell means are reported in Table 2, along with means from the other strategy items.

As can be seen from Table 2, health professionals in interpersonal interactions were rated as using the discourse management strategy more, with the exception of asking questions. In this last case, health professionals in all intergroup interactions were rated higher than those in interpersonal ones, in a reversal of the results for other items. The differences in means were less marked for mixed-sex interactions, because the health professional in the intergroup dyad was rated higher. In general, these results are quite similar to those for the associated goal, meeting the patient's communication needs.

Emotional expression strategy. Three items made up the emotional expression strategy: The health professional (a) liked the patient, (b) reassured the patient, and (c) reduced the patient's anxiety. There was a significant main effect for sex of participant, F(3, 125) = 2.79, p < .05; in this case, women's ratings were significantly higher than those of men on one item, "liking for the patient." Sex of participant showed no significant interactions with the other variables. There was a significant main effect for type of interaction, F(3, 125) = 86.23, p < .001; follow-up ANOVAs showed significant differences on all three items. There was also a significant main effect for sex combination of interactants, F(6,122) = 15.07, p < .001, once again involving all three items. These main effects were subsumed in a significant interaction between these variables, F(6, 122) = 9.11, p < .001, and ANOVAs revealed significant differences for all three items (see Table 2 for cell means).

The pattern of results is clear for emotional expression. In all cases, health professionals in the interpersonal interactions were rated as using this strategy more than those in intergroup ones. This effect was slightly attenuated for the female same-sex dyads, but the overall pattern does not change. Thus, the results for this strategy paralleled those for the associated goal, meeting the patient's emotional needs.

Interpretability strategy. Four items made up this strategy: the health professional (a) handled the conversation well, (b) was comfortable with the patient, (c) clearly expressed himself or herself, and (d) checked his or her understanding of the patient. There was a main effect of sex of participant, F(4, 122) = 2.43, p < .05, indicating higher ratings by women for all four items, but this variable did not

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interact with the other ones. There was a main effect for type of interaction, F(4, 122) = 13.78, p < .001, which follow-up ANOVAs revealed as involving all items except health professional checking patient's understanding. The main effect for sex combination of interactants, F(8, 118) = 23.22, p < .001, was significant at univariate level for all items. A significant interaction between type of interaction and sex combination of interactants also appeared, F(8, 118) = 13.68, p < .001.

As Table 2 shows, the mean differences between intergroup and interpersonal interactions for these items were not large, and there were several crossovers. Where differences did appear, interpersonal interactions were rated slightly higher, and the mixed-sex dyads also tended to receive higher ratings. Overall, however, this strategy was perceived to be used a great deal by all health professionals. This time, the match in results between strategy and goal was not so clear.

Interpersonal control strategy, Five items made up this strategy: the health professional (a) controlled the conversation, (b) decided on topics d conversation, (c) talked down to the patient, (d) intruded on the privacy of the patient, and (e) let the patient express himself or herself. For this analysis, there were no significant effects involving sex of participant. There was a main effect for type of interaction, F(5,123) = 21 .75 ,~ < .001, which involved all items except "the health professional intrudes on the privacy of the patient." There was also a main effect for sex combination of interactants, F(10, 118) = 45.13, p < .001, involving all five items. These effects were subsumed in a significant interaction between these variables, F(10, 118) = 47.98, p < .001, which also involved all five items.

As Table 2 shows, results for these items indicated only small differences between interpersonal and intergroup interactions, with the exception of female same-sex dyads. In this case, the health professional in the intergroup interaction was rated as using the strategy more. As expected, results for the item "let the patient express himself or herself," the pattern of means was the reverse of the other items, as high use of this strategy tends to reduce interpersonal control. Although there was some similarity between ratings on this strategy and the associated goal (attending to role relations), the results were not very clear.

DISCUSSION

The results of this study shed light on the communication goals and strategies used by health professionals who are perceived as behaving more interpersonally toward their patients, as opposed to those who are perceived as more intergroup. Thus, they give further insight into the optimal balance between intergroup and interpersonal behavior in what is ideally a positive intergroup interaction.

An important feature of these results is the clear indication that participants perceived few differences between more interpersonal and more intergroup interactions in terms of attention to role relations. Rather, they perceived that all health

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professionals were attending to controlling and leading the interactions. In addition, they perceived all health professionals as attending to the capacity of patients to give information and understand them clearly, although this appeared more strongly in the intergroup interactions (perhaps by default). Likewise, all health professionals were perceived as using the interpretability strategy. In another part of the project, participants rated these interactions quite positively, so that this intergroup behavior does not seem to be problematic.

This similarity on some goals and strategies, however, does not mean that there were no differences. Indeed, a clear distinction emerged between the two types of interactions on the goals of attending to relationship and emotional needs; health professionals rated as more interpersonal were rated higher on these items. It is worth noting that, for relationship needs, the items that best distinguished between interpersonal and intergroup interactions involved treating the patient as an individual and as an equal. Consonant with these goals, more interpersonal health professionals were rated as making more use of accommodative discourse management and emotional expression strategies. In a word, they were more nurturant, but they were no less concerned with managing the consultation and making sure the patient understood the situation.

In another part of the project, participants perceived that the patients would be more satisfied with, and likely to return to, the health professionals in the interpersonal interactions than the intergroup ones. Thus, from these results, a preliminary characterization of the optimal balance between interpersonal and intergroup behavior in this context emerges (cf. Gallois & Giles, 1998). Intergroup relationships between the health professional and the patient are maintained through nonaccornmodation in goals and strategies related to information transfer and the health professional's position as the leader of the interaction. Health professionals and patients can interact in complementary ways in these domains. On the other hand, it is important for health professionals to treat their patients as individuals, and to make sure their patients are calm and reassured. In addition, observers (potential patients) appreciate friendly behavior.

From a theoretical perspective, these results highlight the fact that there is not a continuum between intergroup and interpersonal behavior, but that they represent different, albeit correlated, dimensions (Gallois et al., 1995). In the context of the medical consultation, optimal behavior (as perceived by potential patients) may reflect a strong recognition that the patient is there for help and to be led, but also that the patient is an individual with specific needs and interests. The health professional can (perhaps should) recognize this individuality while still being the more powerful person in the interaction. Nurturant communication, in the form of emotional expression and discourse management strategies, seems well suited to achieving this goal.

It is important to remember that these results speak to only one medical context-the hospital setting-where patients are seriously ill and in most cases

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acutely ill. The optimal balance between intergroup and interpersonal behavior, and in particular the extent of the power difference between health professional and patient, is likely to be quite different where chronic illness is involved and also in contexts where the patient is not very ill. Beyond this, the context is likely to be different with different types of patient (e.g., in terms of socioeconomic status, age, and education level). Taking the perspective of CAT allows us to theorize these contexts separately, and to tease out the complexities of each one. This is an important task for future research. As these results show, nurturant communication by health professionals will be an essential element in determining the optimal balance between interpersonal and intergroup behavior and in producing satisfying interactions for patients.

ACKNOWLEDGMENTS

This study is drawn from Bernadette Watson's doctoral thesis project, and full details of the project can be obtained from her.

Bernadette Watson is a doctoral candidate in the School of Psychology at The University of Queensland, where Cynthia Gallois is a professor.

We thank Jeff Pittam for his helpful comments on an earlier version of this article.

REFERENCES

Beisecker, A. E. (1990). Patient power in doctor-patient communication: What do we know? Health Communication, 2, 105-122.

Burgoon, M. (1992). Strangers in a strange land: The PhD in the land of the medical doctor. Journal of Language and Social Psychology, 11, 101-106.

Burgoon, M., Birk, T. S., & Hall, 3. R. (1991). Compliance and satisfaction with physician-patient communication: An expectancy theory interpretation of gender differences. Human Communication Research, 18, 177-208.

Cegala, D. J., McGee, D. S., & McNellis, K. S. (1996). Components of patients' and doctors' perceptions of communication competence during a primary care medical interview. Health Communication, 8, 1-28.

Coulthard, M., & Ashby, M. (1975). Talking with the doctor. Journal of Communication, 25, 140-147. Dryden, C., & Giles, H. (1987). Language, social identity, and health. In H. Beloff & A. Coleman (Eds.),

Psychology survey 6 (pp. 115-139). Levister, England: British Psychological Society. Fisher, S. (1983). Doctor-patient talk: How treatment decisions are negotiated in doctor-patient

communication. In S. Fisher & A. Todd (Eds.), The social organization of doctor-patient communication (pp. 135-157). Washington, DC: Center for Applied Linguistics.

Gallois, C., & Giles, H. (1998). Accommodating mutual influence in intergroup encounters. In G. A. Barnett (Series Ed.) & M. T. Palmer & G. A. Barnett (Vol. Eds.), Progress in communication sciences: Vol. 14. Mutual influence in interpersonal communication: Theory and research in cognition, affect, and behavior (pp. 135-162). Stamford, CT: Ablex.

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Gallois, C., Giles, H., Jones, E., Cargde, A., & Ota, H. (1995). Communication accommodation theory: Elaborations and extensions. In R. Wiseman (Ed.), Interculiural and international communication annual: Intercultural communication theory (pp. 115-147). Thousand Oaks, CA: Sage.

Giles, H., & Coupland, N. (1991). Language: Contexts and consequences. Milton Keynes, England: Open University Press.

Giles, H., Coupland, N., & Coupland, J. (1991). Accommodation theory: Communication, context, and consequence. In H. Giles, J. Coupland, & N. Coupland (Eds.), Contexts of accommodation: Developments in applied sociolinguistics (pp. 1-68). Cambridge, England: Cambridge University Press.

Jones, E., Gallois, C., Callan, V. I., &Barker, M. (1995). Language and power in an academic context: The effects of status, ethnicity, and sex. Journal of Language and Social Psychology, 14,434461.

Robinson, J. (in press). Getting down to business: Talk, gaze, and body orientation during openings of doctor-patient interaction. Human Communication Research.

Sharf, B. F., & Street, R. L., Jr. (1997). The patient as a central construct: Shifting the emphasis. Health Communication, 9, 1-1 1.

Street. R. L., Jr. (1991). Accommodation in medical consultations. In H. Giles, J. Coupland, & N. Coupland (Eds.), Contexts of accommodation: Developments in applied sociolinguistics (pp. 131-156). Cambridge, England: Cambridge University Press.

Street, R. L., Jr., & Buller, D. (1988). Patients' characteristics affecting physicians-patient interaction. Human Communication Research, 15, 60-90.

Strest, R. L., Jr., & Wiemann, J. M. (1987). Patients' satisfaction with physicians' interpersonal involvement, expressiveness, and dominance. Communication Yearbook, 10,591-612.

Thompson, T. L. (1994). Interpersonal communication and health care. In M. L. Knapp & G. R. Miller (Eds.), Handbookof interpersonalcommunication (2nd ed., pp. 696-725). Newbury Park, CA: Sage.

Willliams, A., & Giles, H. (1996). Intergenerational conversations: Young adults' retrospective accounts. Human Communication Research, 23,220-250.

WiHliams, A., Giles, H., Coupland, N., Dalby, M., & Manasse, H. (1990). The communicative contexts of elderly social support and health: A theoretical model. Health Communication, 2, 123-143.

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nurturing communication by health professionals toward patients: a communication accommodation...

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