Development and evaluation of a program to improve clinician and patient communication during a telehealth consultation : C.R.I.S.P. Telehealth

Introduction: The delivery of health care in the 21st century will look like no other in the past. The fast paced technological advances that are being made will need to transition from the information age into clinical practice. The phenomenon of e-Health is the over-arching form of information technology and telehealth is one arm of that phenomenon. The uptake of telehealth both in Australia and overseas, has changed the face of health service delivery to many rural and remote communities for the better, removing what is known as the tyranny of distance. Many studies have evaluated the satisfaction and cost-benefit analysis of telehealth across the organisational aspects as well as the various adaptations of clinical pathways and this is the predominant focus of most studies published to date. However, whilst comments have been made by many researchers about the need to improve and attend to the communication and relationship building aspects of telehealth no studies have examined this further. The aim of this study was to identify the patient and clinician experiences, concerns, behaviours and perceptions of the telehealth interaction and develop a training tool to assist these clinicians to improve their interaction skills. Methods: A mixed methods design combining quantitative (survey analysis and data coding) and qualitative (interview analysis) approaches was adopted. This study utilised four phases to firstly qualitatively explore the needs of clients (patients) and clinicians within a telehealth consultation then designed, developed, piloted and quantitatively and qualitatively evaluated the telehealth communication training program. Qualitative data was collected and analysed during Phase 1 of this study to describe and define the missing 'communication and rapport building' aspects within telehealth. This data was then utilised to develop a self-paced communication training program that enhanced clinicians existing skills, which comprised of Phase 2 of this study to develop the interactive program. Phase 3 included evaluating the training program with 26 clinicians and results were recorded pre and post training, whilst phase 4 was the pilot for future recommendations of this training program using a patient group within a Queensland Health setting at two rural hospitals. Results: Comparisons of pre and post training data on 1) Effective communication styles, 2) Involvement in communication training package, 3) satisfaction pre and post training, and 4) health outcomes pre and post training indicated that there were differences between pre and post training in relation to effective communication style, increased satisfaction and no difference in health outcomes between pre and post training for this patient group. The post training results revealed over half of the participants (N= 17, 65%) were more responsive to non-verbal cues and were better able to reflect and respond to looks of anxiousness and confusion from a 'patient' within a telehealth consultation. It was also found that during post training evaluations, clinicians had enhanced their therapeutic communication with greater detail to their own body postures, eye contact and presentation. There was greater time spent looking at the 'patient' with an increase of 35 second intervals of direct eye contact and less time spent looking down at paperwork which decreased by 20 seconds. Overall 73% of the clinicians were satisfied with the training program and 61% strongly agreed that they recognised areas of their communication that needed improving during a telehealth consultation. For the patient group there was significant difference post training in rapport with a mean score from 42 (SD = 28, n = 27) to 48 (SD = 5.9, n = 24). For communication comfort of the patient group there was a significant difference between the pre and post training scores t(10) = 27.9, p = .002, which meant that overall the patients felt less inhibited whilst talking to the clinicians and more understood. Conclusion: The aim of this study was to explore the characteristics of good patient-clinician communication and unmet training needs for telehealth consultations. The study developed a training program that was specific for telehealth consultations and not dependent on a 'trainer' to deliver the content. In light of the existing literature this is a first of its kind and a valuable contribution to the research on this topic. It was found that the training program was effective in improving the clinician's communication style and increased the satisfaction of patient's within an e-health environment. This study has identified some historical myths that telehealth cannot be part of empathic patient centred care due to its technology tag.

The legitimacy disconnect: Exploring the why and how of CSR communication

Whilst there is a growing body of research considering corporate social responsibility (CSR) communication, calls have been made to consider the ‘how’ of CSR communication (Maon, Lindgreen, & Swaen, 2010). The challenge with exploring this however, is that communication research has largely been criticised for failing to consider the macro-phenomena impacting communication (Jones, Watson, Gardner, & Gallois, 2004; Lammers & Barbour, 2006). As such, limited attention has been given to who organisations need to indicate their responsiveness to in relation to CSR, and in turn, why they communicate about certain activities in their CSR reports. Without exploring these ideas, and hence, gaining an understanding of the macro-phenomena impacting CSR communication, we limit our understanding of the ‘how’ of CSR communication. As such, this study sought to explore both the why of CSR communication, and in turn, the implications this may have for the how of CSR communication. To do this, this study drew on the notions of institutional theory, legitimacy, and rhetoric, and explored propositions drawn from these concepts to consider the why and how of CSR communication. Extended abstract attached

Monitoring policy and actions on food environments : rationale and outline of the INFORMAS policy engagement and communication strategies

The International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support (INFORMAS) proposes to collect performance indicators on food policies, actions and environments related to obesity and non-communicable diseases. This paper reviews existing communications strategies used for performance indicators and proposes the approach to be taken for INFORMAS. Twenty-seven scoring and rating tools were identified in various fields of public health including alcohol, tobacco, physical activity, infant feeding and food environments. These were compared based on the types of indicators used and how they were quantified, scoring methods, presentation and the communication and reporting strategies used. There are several implications of these analyses for INFORMAS: the ratings/benchmarking approach is very commonly used, presumably because it is an effective way to communicate progress and stimulate action, although this has not been formally evaluated; the tools used must be trustworthy, pragmatic and policy-relevant; multiple channels of communication will be needed; communications need to be tailored and targeted to decision-makers; data and methods should be freely accessible. The proposed communications strategy for INFORMAS has been built around these lessons to ensure that INFORMAS's outputs have the greatest chance of being used to improve food environments.

Networked identity work as project development among co-creative communities

Networked identity work is the conscious negotiation or co-creation of identity, enacted by speaking and listening across differences among multiple publics, including those real and imagined, familiar and unknown, on and offline, present and future. It is a concept I explore extensively in research with queer Digital Storytellers who share their personal stories in public places to catalyse social change (Vivienne 2013). In this article I consider distinctions between ‘story’ and ‘identity’; ‘networking’ and ‘networked identity work’ and argue that the two concepts may be usefully employed in development of co-creative community projects. Finally I consider how variable definitions of co-creativity influence project development.

Mediating orientation and self-expression in the world of consumption : Australian and German lifestyle journalists' professional views

Despite having experienced rapid popularity over the past two decades, lifestyle journalism is still somewhat neglected by academic researchers. So far mostly explored as either part of wider lifestyle programming, particularly on television, or in terms of individual sub-fields, such as travel, fashion or food journalism, lifestyle journalism is in need of scholarly analysis particularly in the area of production, based on the increasing importance which the field has in influencing audiences’ ways of life. This study explores the professional views of 89 Australian and German lifestyle journalists through in-depth interviews in order to explore the ways in which they engage in processes of influencing audiences’ self-expression, identities and consumption behaviors. The article argues that through its work, lifestyle journalism is a significant shaper of identities in today’s consumer societies.

'The Australian we all aspire to be' : commemorative journalism and the death of the Crocodile Hunter

This article examines the news coverage the death of Steve Irwin, widely known as the Crocodile Hunter, generated in Australia. In line with past research on commemorative journalism, the study demonstrates the dominant discourses employed in the reporting of Irwin's death. It is argued that Australia's newspapers invoked a number of national myths, such as mateship, larrikinism and anti-elitism, in order to re-assert notions of Australian identity and social values and to deal with the grief over his loss. Most importantly, the study sheds new light on how news media deal with challenges to the dominant memorialising discourse. Past studies had not been able to investigate in much detail alternative discourses, but in examining Irwin's death, we are able to see how the media deal with such an unwanted interruption. It is argued that newspapers appropriated the alternative perspective within the mythical terms of their memorialising discourse, thereby not allowing it to disrupt the memorialisation itself and in fact further strengthening the process of mythologising the Crocodile Hunter.

Creative practices in the design studio culture : collaboration and communication

For the purpose of developing collaborative support in design studio environments, we have carried out ethnographic fieldwork in professional and academic product design studios. Our intention was to understand design practices beyond the productivity point of view and take into account the experiential, inspirational and aesthetical aspects of design practices. Using examples from our fieldwork, we develop our results around three broad themes by which design professionals support communication and collaboration: (1) use of artefacts, (2) use of space and (3) designerly practices. We use the results of our fieldwork for drawing implications for designing technologies for the design studio culture.

A participatory framework for researching and evaluating communication for development and social change

The growing dominance of project planning cycles and results-based management in development over the past 20 years has significant implications for the effective evaluation of communication for development and social change and the sustainability of these processes. These approaches to development and evaluation usually give priority to the linear, logical framework (or log frame) approach promoted by many development institutions. This tends to emphasize upward accountability approaches to development and its evaluation, so that development is driven by exogenous rather than endogenous models of development and social change. Such approaches are underpinned by ideas of preplanning, and predetermination of what successful out -comes look like. In this way, outcomes of complex interventions tend to be reduced to simple, cause-effect processes and the categorization of things, including people (Chambers and Pettit 2004; Eyben 2011). This runs counter to communication for development approaches, which prioritize engagement, relationships, empowerment and dialogue as important components for positive social change.

A place in the sun : the politics of place, identity and branding

There is no doubt that place branding is a powerful and ubiquitous practice deployed around the globe. Parallel to its acceptance and development as a distinct discipline is an understanding that place branding as responsible practice offers the means to achieve widespread economic, social and cultural benefits. Drawing on work around place and identity in cultural geography and cultural studies, this paper engages critically with this vision. Specifically, it challenges the widely-held assumption that the relationship between place branding and place identity is fundamentally reflective, arguing instead that this relationship is inherently generative. This shift in perspective, explored in relation to current responsible place branding practice, is central to the realisation of place branding as a force for good.

Optimising employee engagement with internal communication : a social exchange perspective

Drawing on principles of social exchange this thesis employs mediated regression to investigate the relationship between internal communication and employee engagement in the Australian workforce. Findings suggest organisations and supervisors should focus internal communication efforts toward building greater perceptions of support and stronger identification among employees in order to foster optimal engagement. This research contributes to public relations and management scholarship through understanding how perceived support and identification act as mediating mechanisms in the relationship between internal communication and employee engagement at the organisational and supervisory level.

Standards that we can 'own' : Threshold Learning Outcomes for Journalism, Public Relations, and Media & Communication Studies

This paper outlines the progress by the JoMeC (Journalism, Media & Communication) Network in developing TLO (Threshold Learning Outcome) statements for Bachelor-level university programs in the disciplines of Journalism, Public Relations and Media & Communications Studies. The paper presents the finalised TLO statement for Journalism, and outlines moves to engage discipline-based groups to further develop preliminary TLOs for Public Relations and Media & Communication Studies. The JoMeC Network was formed in 2011, in response to requirements that from 2014 all degrees and qualifications at Australian universities would be able to demonstrate that they comply with the threshold learning standards set by the Australian Qualifications Framework (AQF). The AQF’s threshold standards define the minimum types and levels of knowledge, skills and capabilities that a student must demonstrate in order to graduate. The Tertiary Education Quality and Standards Agency (TEQSA) will use the AQF’s threshold standards as a key tool in recording and assessing the performance of higher educational institutions, and determining whether they should be registered as Australian Higher Education Providers under the Higher Education Standards Framework. The Office of Learning & Teaching (OLT) places the onus on discipline communities to collaborate in order to develop and ‘own’ the threshold learning standards that can be considered the minimum learning outcomes of university-level programs in that field. With the support of an OLT Grant, the JoMeC Network’s prime goal has been to develop three sets of discipline-specific TLOs – one each for the Journalism, Public Relations, and Media & Communications Studies disciplines. This paper describes the processes of research, consultation, drafting and ongoing revision of the TLO for Journalism. It outlines the processes that the JoMeC Network has taken in developing a preliminary TLO draft to initiate discussion of Public Relations and Media & Communication Studies. The JoMeC Network plans to hand management of further development of these TLOs to scholars within the discipline who will engage with academics and other stakeholders to develop statements that the respective disciplines can embrace and ‘own’.

Online Gaming in Context : the Social and Cultural Significance of Online Games

There is little question of the social, cultural and economic importance of video games in the world today, with gaming now rivalling the movie and music sectors as a major leisure industry and pastime. The significance of video games within our everyday lives has certainly been increased and shaped by new technologies and gaming patterns, including the rise of home-based games consoles, advances in mobile telephone technology, the rise in more 'sociable' forms of gaming, and of course the advent of the Internet. This book explores the opportunities, challenges and patterns of gameplay and sociality afforded by the Internet and online gaming. Bringing together a series of original essays from both leading and emerging academics in the field of game studies, many of which employ new empirical work and innovative theoretical approaches to gaming, this book considers key issues crucial to our understanding of online gaming and associated social relations, including: patterns of play, legal and copyright issues, player production, identity construction, gamer communities, communication, patterns of social exclusion and inclusion around religion, gender and disability, and future directions in online gaming.

Health communication: A pilot study comparing perceptions of women with and without high functioning autism spectrum disorder

Research indicates significant health disparities for individuals with autism. Insight into characteristic sensory, cognitive, communication, social, emotional, and behavioural challenges that may influence health communication for patients with autism is vital to address potential disparities. Women with high functioning autism spectrum disorder (ASD) may have specific healthcare needs, and are likely to independently represent themselves and others in healthcare. A pilot study compared perceptions of healthcare experiences for women with and without ASD using on-line survey based on characteristics of ASD likely to influence healthcare. Fifty-eight adult female participants (32 with ASD diagnosis, 26 without ASD diagnosis) were recruited on-line from autism support organisations. Perceptions measured included self-reporting of pain and symptoms, healthcare seeking behaviours, the influence of emotional distress, sensory and social anxiety, maternity experiences, and the influence of autistic status disclosure. Results partially support the hypothesis that ASD women experience greater healthcare challenges. Women with ASD reported greater challenges in healthcare anxiety, communication under emotional distress, anxiety relating to waiting rooms, support during pregnancy, and communication during childbirth. Self-disclosure of diagnostic status and lack of ASD awareness by healthcare providers rated as highly problematic. Results offer detailed insight into healthcare communication and disparities for women with ASD.

Second language social networks and communication-related acculturative stress: The role of interconnectedness

Although a substantial amount of cross-cultural psychology research has investigated acculturative stress in general, little attention has been devoted specifically to communication-related acculturative stress (CRAS). In line with the view that cross-cultural adaptation and second language (L2) learning are social and interpersonal phenomena, the present study examines the hypothesis that migrants’ L2 social network size and interconnectedness predict CRAS. The main idea underlying this hypothesis is that L2 social networks play an important role in fostering social and cultural aspects of communicative competence. Specifically, higher interconnectedness may reflect greater access to unmodified natural cultural representations and L2 communication practices, thus fostering communicative competence through observational learning. As such, structural aspects of migrants’ L2 social networks may be protective against acculturative stress arising from chronic communication difficulties. Results from a study of first generation migrant students (N = 100) support this idea by showing that both inclusiveness and density of the participants’ L2 network account for unique variance in CRAS but not in general acculturative stress. These results support the idea that research on cross-cultural adaptation would benefit from disentangling the various facets of acculturative stress and that the structure of migrants’ L2 network matters for language related outcomes. Finally, this study contributes to an emerging body of work that attempts to integrate cultural/cross-cultural research on acculturation and research on intercultural communication and second language learning.

Theorising the impacts of digitally mediated social interaction on diasporic identity formation: A case of Chinese diaspora in Australia

With the scope of Chinese diaspora in Australia, this paper theorises the impacts of digitally mediated social interaction on diasporic identity formation in the new media landscape. People’s identity is the outcome of their social interactions with other individuals. In the new media landscape, digital media technologies are changing the way in which people communicate with others. On one hand, space and time are unprecedentedly compressed by media technologies so people can maintain more frequent and instant connections with others than before. On the other hand, the digital media technologies have constructed a virtual social space that might withdraw people from their physical social interactions. As we witness today, our social interactions are increasing digitally mediated, in the forms of posts and comments in social network sites, as well as the messages in social apps. As to the diasporic groups, this new media landscape is presenting a challenge to their identity formation. They physically live in the host countries but still keep close social and cultural connections with their homelands. Facilitated by digital media technologies, they are facing two platforms in which they can practice different identity performances: one is the digitally mediated social network; the other is the physical social network. In the case of Chinese diaspora, the situation is more complex due to the language factor and media censorship in Mainland China, which will be articulated in the main text. This paper aims to fill a gap between media studies and diaspora research. Most of existing research on the relationship between diasporic identity and media primarily focuses on the development of ethnic media institutions, and the production and consumption of ethnic media in the pre-digital media context. However, the process of globalisation and digital media technologies are increasing the homogeneity and hybridity of media content worldwide. In this new context, attributing the formation of different identities to the consumption of media content is arguable to some extent. Therefore, the overlapped area of new media studies and diaspora research still has space deserves further investigation.