Oralizations in e-mail consultations: A study of general practitioners’ use of non-verbal cues in written doctor–patient communication

It is well-known that non-verbal cues are essential in doctor–patient communication. As doctor–patient communication is turning increasingly digital and written, it becomes relevant to explore the role of non-verbal cues in such communication genres. One more recent genre is the doctor–patient e-mail consultation. Research has found that while patients like e-mail consultations, they also miss facial expressions, eye contact, etc. In this study, we explored the different ways in which Danish GPs use non-verbal cues in e-mail consultations. We analysed 633 e-mail consultations written by 22 GPs. We applied the concept of oralization, which includes the use of emoticons and non-standard use of grammar and spatial arrangement. We found that the dominant types of oralizations were non-corrected spelling errors and lack of attention to capitalization. Overall, GPs used a limited number of other non-verbal cues. We discuss how these findings relate to norms of formality and professional context.

Health disparities and the digital divide within South African disadvantaged communities during the COVID-19 pandemic

The purpose of this article is to highlight how technologies, which have for centuries revolutionalized healthcare, have conversely increased health disparities among disadvantaged communities in South Africa during coronavirus disease (COVID-19). A hard lockdown imposed on the country in March 2020, as an initial measure of containment of the novel virus, became unfeasible due to detrimental, mostly economic effects on the economy. From 1 May, the government eased the lockdown restrictions and shifted the emphasis from containment to behaviour change measures using communication strategies that promoted adherence. Yet, even within disadvantaged communities, there have been differences in health-related access with differing levels of disadvantage. Secondary data were analysed from a cross-sectional quantitative survey conducted in ten disadvantaged communities in the Northern Cape and Gauteng Provinces involving 1742 participants. Results show that the lack of digital access to information created an obstacle to adherence to some recommended COVID-19-related behaviour change measures. Disparities existed between the two provinces’ disadvantaged communities based on an urban versus a rural province. The study emphasized the need to assess the extent of underlying obstacles to health equity and achievement of healthcare goals propagated by an interface between healthcare and socio-economic factors. Breakthroughs in healthcare, facilitated by virtual modes of communication may be undermined by a digital divide exacerbating disparities in disadvantaged communities.

Digitization of healthcare post COVID-19: Reimagining the role of health education and promotion

The digitization of health promotion and communication has become a major discourse in healthcare. This paper synthesizes my understanding of the role of health literacy, promotion, education and communication in ensuring effective digitization of healthcare and presents four key findings from a mental health promotion project. First, the pandemic has shown us more than ever how fragile we all are – health-seeking behaviour will increasingly take centre stage over the next decade. Second, why do people refuse to wear masks even though it increases the risk of mortality? Why are individuals not motivated to exercise despite downloading free health apps? Why do people keep eating unhealthy food even when they can afford healthier options? Why? The numbers cannot tell the whole story. Similarly, the proliferation of digital health technology cannot convince people to modify their behaviours nor promote meaningful use of e/m-health apps. Third, deliberate digital health promotion and communication is needed to leverage opportunities in health technology. Fourth, the world needs researchers and experts who understand the broader determinants of health attitudes and are knowledgeable in synthesizing valid health information across various technological platforms, in support of health system needs. I address the implications of my findings and discuss future directions for policy and practitioners.

Appreciating ‘schizophrenics’ online: Identification in mHealth

Medical science not only affects our lives in terms of health and disease but also transforms our more vital experiences. Nowadays, this statement has acquired special significance, given the adoption of information and communication technologies (ICT) by medical practice, the so-called eHealth. The great growth in the use of smartphone applications for managing mental distress has been coined as ‘pocket psychiatry’. Within this digital scape, many disease-specific apps such as ClinTouch, aimed at the self-management of psychosis, have been launched in the market. By using the analytical concept of ‘script’, the article aims to show how the psychiatric world-view embedded in ClinTouch defines a particular framework of action for ‘schizophrenic’ users to contest ‘external-identifications’. It is suggested that if the main endeavour is to promote mental health in the community, it is needed to go beyond the biomedical model to maximize the social participation of people with mental suffering in the use of ICT.

Older (65+) patients’ use of e-mail consultations: A Danish qualitative study using a Foucauldian framework

In Denmark, e-mail consultations (e-cons) are now supplementing conventional consultations with doctors and raising questions related to self-governing technology from the patient perspective. Interestingly, old patients are the most frequent users of this kind of consultation. This article examines how e-cons affect old people’s relationships with and perceptions of their general practitioners (GPs) regarding trust, self-governance and indirect/direct power. This qualitative study is based on interviews with twenty patients between 66 and 83 years old. Applying a thematic analysis in which four salient themes were identified, the study demonstrates that the patients perceive the GP as powerful, knowledgeable and busy; this corresponds with the power relationship between disciplinary institutions and individuals. At the same time, many patients use e-cons as a technology of self-governance, thereby taking responsibility for their own health while still being able to contact the clinic. In this way, patients achieve the potential for self-management, while clinics maintain their institutional power.

Culture-centred approach to digital health communication: Sustaining health, addressing inequalities, transforming structures

This essay examines critically the hegemonic discourses of digital health communication, attending to the role of digital technologies in expanding the reach of digital technologies while exacerbating inequalities in health outcomes. Drawing on a culture-centred approach, it foregrounds the role of communication infrastructures for voices at the margins of neo-liberal economies. These voices put forth an organizing logic of care that dismantle the ideology of neo-liberalism.

Influence of African Indigenous language media in COVID-19 digital health messaging

COVID-19 pandemic era has further energized humans to consider their health more than before, especially in the digital age when they experience a deluge of health information. This study, therefore, examined COVID-19 digital sources, health message types and how the use of African Indigenous language media enhanced people’s utilization of coronavirus health messages. Using an online questionnaire and in-depth interview data collection methods, respondents received preventive COVID-19 health messages on social distancing and personal hygiene from mostly interactive digital sources, which hardly infused African Indigenous language media in the health message. However, African Indigenous languages motivated respondents to utilize COVID-19 messages, though people still spread COVID-19 fake news through Indigenous media. Nonetheless, integrating African Indigenous language media into digital health communication can confer credibility on information sources. Still, there is a need to fight the use of digital media to spread fake news.

Platformization of healthcare communication: Insights from the early stage of the COVID-19 pandemic in Italy

Over the past few years, public health organizations have adopted new communication practices, such as social media communication, framed by the concepts of Health 2.0 and Medicine 2.0. These concepts need to be reconsidered in the light of the transformation of social media as digital platforms. This article aims to define and critically discuss the concept of the platformization of healthcare communication, investigating the impact of social media incorporation on the local health authorities’ Facebook communication during the early phase of the COVID-19 emergency in Italy. Findings show the progressive incorporation of the mechanisms of platformization by local health authorities and the progressive shift of their Facebook pages from connectors to complementors of healthcare communication and services during the early phase of the pandemic. Conclusions critically discuss the incorporation of social media into the communication strategies of the public healthcare sector.

Tackling online disinformation through media literacy in Spain: The project ‘Que no te la cuelen’

Media literacy of schoolchildren is a key political goal worldwide: institutions and citizens consider media literacy training to be essential – among other aspects – to combat falsehoods and generate healthy public opinion in democratic contexts. In Spain, various media literacy projects address this phenomenon one of which is ‘Que no te la cuelen’ (‘Don’t be fooled’, QNTLC). The project, which has been developed by the authors of this viewpoint, is implemented through theoretical–practical workshops aimed at public and private secondary pupils (academic years 2018–19, 2019–20 and 2020–21), based around training in fake news detection strategies and online fact-checking tools for students and teachers. This viewpoint describes and reflects on this initiative, conducted in 36 training sessions with schoolchildren aged 14–16 years attending schools in Madrid, Valencia and Barcelona. The workshops are based on van Dijk’s media literacy model, with a special focus on the ‘informational skills’ dimension. The amount of information available through all kinds of online platforms implies an extra effort in selecting, evaluating and sharing information, and the workshop focuses on this process through seven steps: suspect, read/listen/watch carefully, check the source, look for other reliable sources, check the data/location, be self-conscious of your bias and decide whether to share the information or not. The QNTLC sessions teach and train these skills combining gamification strategies – online quiz, verification challenges, ‘infoxication’ dynamics in the class – as well as through a public deliberation among students. Participants’ engagement and stakeholders’ interest in the programme suggest that this kind of training is important or, at least, attract the attention of these collectives in the Spanish context.

The paradox of pluralism: A key to interpreting the online public sphere in the time of ‘encastellation’

This viewpoint makes a theoretical effort to label the organization of the virtual sphere under new concepts: ‘encastellation’ and the ‘paradox of pluralism’. The former is a metaphorical synthesis of already-known concepts (selective exposure, polarization, homophily, echo chambers and filter bubbles). In the second case, we emphasize the existence of a ‘paradox of online pluralism’: the internet has increased the possibility for everyone to make their voice heard (in quantitative terms), but at the same time it appears to also be increasing the distance between voices, putting in jeopardy the achievement of the aims of the pluralist political system (in qualitative terms). In conclusion, we express doubts about the feasibility of the deliberative vision of democracy in the current virtual sphere.