Evelyn Y. Ho

Health Communication With Chinese Americans About Type 2 Diabetes

Purpose Chinese Americans are at high risk for type 2 diabetes and face some health disparities that can be attributed to language barriers, cultural differences, and access to care. The purpose of this article is to review current literature and establish best practices regarding health communication about type 2 diabetes for Chinese Americans. The authors reviewed clinical research literature from January 2000 to April 2011 to assess current knowledge about providing diabetes management guidance to Chinese Americans. Conclusions To improve health communication and dissemination of health information to Chinese Americans regarding diabetes and diabetes management, research scholars, health care providers, and diabetes educators can analyze current health messages by source, message, audience, channel, and destination characteristics. Extensive research has led to clear guidelines focusing on language-appropriate materials, an understanding of Chinese food beliefs and family practices, and the importance of culturally competent health care providers. However, many Chinese Americans are using Chinese foods and medicinal herbs with little communication between patients and providers about these practices. Although Chinese Americans are not a homogenous group, this article points to a set of cultural considerations that health care providers should address when working with Chinese Americans. By attending to various qualities of health messages, efforts at diabetes prevention and management may be greatly enhanced.

Improving Clinical Communication and Promoting Health through Concordance-Based Patient Education

In recent years, communication education has been used as a means of improving the clinician–patient relationship and promoting health. The focus of these interventions has primarily centered on clinician training. An area that has received less focus, although equally important, is training patients to be good communicators. The purpose of the paper is to first introduce clinician–patient ‘concordance’ as a conceptual framework for patient communication education. Second, we provide a review and critique of the literature on existing patient communication interventions. Finally, we conclude with a discussion of two specific patient populations that face challenges and obstacles in clinician–patient communication and preliminary work we are doing in these areas: complementary and alternative medicine users and the medically underserved.

Negotiating complementary and alternative medicine use in primary care visits with older patients

OBJECTIVE To empirically investigate the ways in which patients and providers discuss Complementary and Alternative Medicine (CAM) treatment in primary care visits. METHODS Audio recordings from visits between 256 adult patients aged 50 years and older and 28 primary care physicians were transcribed and analyzed using discourse analysis, an empirical sociolinguistic methodology focusing on how language is used to negotiate meaning. RESULTS Discussion about CAM occurred 128 times in 82 of 256 visits (32.0%). The most frequently discussed CAM modalities were non-vitamin, non-mineral supplements and massage. Three physician-patient interactions were analyzed turn-by-turn to demonstrate negotiations about CAM use. Patients raised CAM discussions to seek physician expertise about treatments, and physicians adopted a range of responses along a continuum that included encouragement, neutrality, and discouragement. Despite differential knowledge about CAM treatments, physicians helped patients assess the risks and benefits of CAM treatments and made recommendations based on patient preferences for treatment. CONCLUSION Regardless of a physicians stance or knowledge about CAM, she or he can help patients negotiate CAM treatment decisions. PRACTICE IMPLICATIONS Providers do not have to possess extensive knowledge about specific CAM treatments to have meaningful discussions with patients and to give patients a framework for evaluating CAM treatment use.

Behold the Power of Qi: The Importance of Qi in the Discourse of Acupuncture

Traditional Chinese medicine (TCM) has recently gained a great deal of popular and scholarly attention. However, little work in this area has examined how people actually talk about TCM as a health care system and its implicit assumptions about health, illness, and treatment. Based on ethnographic fieldwork conducted in an acupuncture community, I describe a Qi-based speech code examining the importance and necessity of Qi (most simply translated as energy) in acupuncture discourse. Proper descriptions of acupuncture require explicit mention and acknowledgment of Qi as well as a grounding in its philosophy and explanatory system. Practitioners are taught to feel Qi and use this phrase as a discursive marker of expertise. Finally, Qi is also used in the competing rhetorics of Chinese and Japanese acupuncture. This study has important implications for understanding the culturally situated nature of health and illness in the United States and the consequences of these particular constructions as elucidated through close examination of conversations between practitioners.

Teaching patients how to talk with biomedical providers about their complementary and alternative medicine use.

OBJECTIVE The goal was to examine the feasibility and impact of a face-to-face communication skills training intervention based on a current public health campaign to encourage patients to talk about complementary and alternative medicine (CAM) with their biomedical health providers. METHODS Current CAM users were invited to complete a survey about current/past CAM use and communication with biomedical providers before beginning a communication skills training workshop. In the 6-month period following the training, participants were asked to record information on any CAM conversations with those providers. RESULTS Of the 38 participants who received training, 32 finished the entire study. Over half of those participants reported discussing CAM in post-training visits with biomedical providers. Participants initiated the conversation in most cases, and were more likely to disclose CAM use than they were to ask questions about CAM. Participants who talked about CAM were significantly more likely to perceive CAM as relevant to their visit, compared with individuals who did not talk about CAM. CONCLUSIONS Participants positively evaluated this patient communication workshop. Consistent with previous research, most CAM conversations were patient-initiated. PRACTICE IMPLICATIONS These findings reinforce the importance of patient education interventions for improving patient-provider communication in general, and CAM communication specifically.

Assessing the cultural in culturally sensitive printed patient-education materials for Chinese Americans with type 2 diabetes.

Type 2 diabetes affects Chinese Americans at an alarming rate. To address this health disparity, research in the area of cultural sensitivity and health literacy provides useful guidelines for creating culturally appropriate health education. In this article, we use discourse analysis to examine a group of locally available, Chinese- and English-language diabetes print documents from a surface level and deep structure level of culture. First, we compared these documents to research findings about printed health information to determine whether and how these documents apply current best practices for health literacy and culturally appropriate health communication. Second, we examined how diabetes as a disease and diabetes management is being constructed. The printed materials addressed surface level culture through the use of Chinese language, pictures, foods, and exercises. From a deeper cultural level, the materials constructed diabetes management as a matter of measurement and control that contrasted with previous research suggesting an alternative construction of balance. A nuanced assessment of both surface and deeper levels of culture is essential for creating health education materials that are more culturally appropriate and can lead to increased health literacy and improved health outcomes.

Cultural Resources for Health Participation: Examining Biomedicine, Acupuncture, and Massage Therapy for HIV-Related Peripheral Neuropathy

In this article we use a culture-centered approach to understand peoples experiences of treatment options for human immunodeficiency virus (HIV)-related peripheral neuropathy. We present from often unheard and marginalized voices the stories of how people live with this chronic illness and negotiate treatment options. Based on individual and group interviews, participants reported that biomedical pills were an important context for understanding decision making regarding neuropathy treatment. While most people spoke of the necessity of these drugs for their survival, they also expressed deep resentment and frustration with biomedically prescribed pills. Complaints about the pills worked to frame the holistic alternatives of acupuncture and massage therapy as better options for neuropathy and to establish a foundation for understanding how participants made particular health treatment decisions. Through strategically refusing certain drugs and choosing holistic treatments instead, participants asserted agency and control over their health decision making. By choosing holistic therapies, these clients were able to make choices about their neuropathy treatment in light of the many issues surrounding drug toxicity and treatment efficacy.

“Have You Seen Your Aura Lately?” Examining Boundary-Work in Holistic Health Pamphlets

An increasing number of people in the United States are using holistic therapies. Both encouraging and informing this trend in growth, printed leaflets are a popular and important medium for holistic health practitioners. Using a discourse analytic approach, the author analyzed pamphlets and printed texts distributed at a holistic health fair. These texts reflect and construct specific understandings of holistic health and proper health care. Understood through the notion of boundary-work, pamphlets demarcated holism as the proper way of conceptualizing health and health care. However, holistic medicines boundaries are quite porous, as these practices are also legitimized through the use of scientific conventions and the practice of integration, both commonly associated with biomedicine.

The Ethnography of Communication as Applied Methodology: Insights from Three Case Studies

Based on three case studies in organizational, health, and institutional settings, we show that research processes and outcomes can have different logics for scholars in the field, for clients, and other participants. We illustrate how applied work prompts researchers to reflect on their shifting research goals and outcomes in the context of interaction with participants and clients.

A Case Study of the Neti Pot’s Rise, Americanization, and Rupture as Integrative Medicine in U.S. Media Discourse

ABSTRACT In a period of only one decade in the United States, the neti pot shifted from obscure Ayurvedic health device to mainstream complementary and integrative medicine (CIM), touted by celebrities and sold widely in drug stores. We examine the neti pot as a case study for understanding how a foreign health practice became mainstreamed, and what that process reveals about more general discourses of health in the United States. Using discourse analysis of U.S. popular press and new media news (1999–2012) about the neti pot, we trace the development of discourses from neti’s first introduction in mainstream news, through the hype following Dr. Oz’s presentation on Oprah, to 2011 when two adults tragically died after using Naegleria fowleri amoeba-infested tap water in their neti pots. Neti pot discourses are an important site for communicative analysis because of the pot’s complexity as an intercultural artifact: Neti pots and their use are enfolded into the biomedical practice of nasal irrigation and simultaneously Orientalized as exotic/magical and suspect/dangerous. This dual positioning as normal and exotic creates inequitable access for using the neti pot as a resource for increasing cultural health capital (CHC). This article contributes to work that critically theorizes the transnationalism of CIM, as the neti pot became successfully Americanized. These results have implications for understanding global health practices’ incorporation or co-optation in new contexts, and the important role that popularly mediated health communication can play in framing what health care products and practices mean for consumers.