Approachability features and their application as a qualitative method of analysis for clinical healthcare interactions and ethnographic interviews
DOI:
https://doi.org/10.7146/qhc.148827Keywords:
Approachability, clinical healthcare interactions, interviews, qualitative analysis, rapport, trustAbstract
Background: Effective communication is crucial for positive health outcomes in clinical healthcare interactions. Patients value friendly, approachable, and informative clinicians who facilitate open communication and shared decision-making. Clinicians can use discourse features to influence how approachable patients and other clinicians believe them to be. Aims: To introduce and define the concept of approachability features as a qualitative analytical framework for investigating healthcare interactions and ethnographic interviews and to guide health communication researchers in their application. Methods: Drawing on existing literature on interpersonal pragmatics, rapport management, and healthcare communication to define and delineate the scope of approachability features, a step-by-step approach is provided for researchers to use and adapt the framework to suit diverse contextual and analytical needs. Two illustrative examples from existing studies are briefly described. Findings: The approachability features framework provides a versatile tool to gain insights into common discursive patterns used in healthcare interactions and to interpret their impact on the relationships between interlocutors. Researchers need to consider the importance of context as well as language and cultural adaptations. Conclusion: By introducing the approachability features framework, this paper contributes to the growing body of research on effective healthcare communication. It offers a structured, evidence-based analytical approach with applications across various health settings and topics.
References
Adolphs, S., Atkins, S., & Harvey, K. (2007). Caught Between Professional Requirements and Interpersonal Needs: Vague Language in Healthcare Contexts. In J. Cutting (Ed.), Vague Language Explored (pp. 62-78). Palgrave Macmillan UK. https://doi.org/10.1057/9780230627420_4
Barnes, R. K., & Woods, C. J. (2024). Communication in Primary Healthcare: A State-of-the-Art Literature Review of Conversation-Analytic Research. Research on Language and Social Interaction, 57(1), 7-37. https://doi.org/10.1080/08351813.2024.2305038
Barry, C. A., Stevenson, F. A., Britten, N., Barber, N., & Bradley, C. P. (2001). Giving voice to the lifeworld. More humane, more effective medical care? A qualitative study of doctor–patient communication in general practice. Soc Scie Med, 53(4), 487-505. https://doi.org/10.1016/s0277-9536(00)00351-8
Beach, M. C., Roter, D., Larson, S., Levinson, W., Ford, D. E., & Frankel, R. (2004). What do physicians tell patients about themselves? Journal of General Internal Medicine, 19(9), 911-916. https://doi.org/10.1111/j.1525-1497.2004.30604.x
Benwell, B., & McCreaddie, M. (2016). Keeping “Small Talk” Small in Health-Care Encounters: Negotiating the Boundaries Between On- and Off-Task Talk. Research on Language and Social Interaction, 49(3), 258-271. https://doi.org/10.1080/08351813.2016.1196548
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qual Res Psychol, 3(2), 77-101. https://doi.org/10.1191/1478088706qp063oa
Brookes, G., Harvey, K., & Adolphs, S. (2023). Discourse and health(care). In M. Handford & J. P. Gee (Eds.), The Routledge Handbook of Discourse Analysis (2nd ed., pp. 553-567). Routledge.
Caffi, C. (2007). Mitigation. Elsevier.
Carroll, S. M. (2019). Respecting and Empowering Vulnerable Populations: Contemporary Terminology. The Journal for Nurse Practitioners, 15(3), 228-231. https://doi.org/10.1016/j.nurpra.2018.12.031
Černý, M. (2010). Interruptions and overlaps in doctor-patient communication revisited. Linguistica Online.
Chien, L., Slade, D., Goncharov, L., Taylor, J., Dahm, M. R., Brady, B., McMahon, J., Raine, S. E., & Thornton, A. (2024). Implementing a ward-level intervention to improve nursing handover communication with a focus on bedside handover: A qualitative study. Journal of Clinical Nursing, 33, 2688–2706. https://doi.org/10.1111/jocn.17107
Coulehan, J. L., Platt, F. W., Egener, B., Frankel, R., Lin, C. T., Lown, B., & Salazar, W. H. (2001). "Let me see if i have this right...": words that help build empathy. Ann Intern Med, 135(3), 221-227. https://doi.org/10.7326/0003-4819-135-3-200108070-00022
Crawford, T., Roger, P., & Candlin, S. (2017a). The interactional consequences of ‘empowering discourse’in intercultural patient education. Patient education counseling, 100(3), 495-500. https://doi.org/10.1016/j.pec.2016.09.017
Crawford, T., Roger, P., & Candlin, S. (2017b). Tracing the discursive development of rapport in intercultural nurse–patient interactions. International Journal of Applied Linguistics, 27(3), 636-650. https://doi.org/10.1111/ijal.12166
Crawford, T., Roger, P., & Candlin, S. (2018). The consequences of diverse empathic responses in nurse-patient interactions: a discourse analysis. Journal of Communication in Healthcare, 11(2), 87-94. https://doi.org/10.1080/17538068.2018.1453435
Creswell, J. W., & Poth, C. N. (2017). Qualitative inquiry and research design: Choosing among five approaches (4th ed.). Sage.
Dahm, M. R. (2012). Coming to terms with medical terms–exploring insights from native and non-native English speakers in patient-physician communication. Hermes-Journal of Language and Communication in Business(49), 79-98. https://doi.org/10.7146/hjlcb.v25i49.97739
Dahm, M. R., & Crock, C. (2023). The pragmatics of diagnostic uncertainty: A closer look at hedges and shared understanding in diagnostic statements. In S. Bigi & M. G. Rossi (Eds.), A Pragmatic Agenda for Healthcare: Fostering inclusion and active participation through shared understanding (pp. 330-358). John Benjamins. https://doi.org/10.1075/pbns.338.14dah
Dahm, M. R., Ogden, K., Yates, L., Rooney, K., & Sheldon, B. (2015). Enhancing international medical graduates’ communication: the contribution of applied linguistics. Medical Education, 49(8), 828-837. https://doi.org/10.1111/medu.12776
Dahm, M. R., Slade, D., Brady, B., Goncharov, L., & Chien, L. (2022). Tracing interpersonal discursive features in Australian nursing bedside handovers: approachability features, patient engagement and insights for ESP training and working with internationally trained nurses. English for Specific Purposes, 66, 17-32. https://doi.org/10.1016/j.esp.2021.10.002
Dahm, M. R., & Yates, L. (2013). English for the workplace: Doing patient-centred care in medical communication. TESL Canada Journal, 30(Special Issue 7), 21-44.
Doherty, L. (2008). Terms of endearment. Nursing Standard, 23(13), 13.
Elo, S., & Kyngäs, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107-115. https://doi.org/10.1111/j.1365-2648.2007.04569.x
Forsey, J., Ng, S., Rowland, P., Freeman, R., Li, C., & Woods, N. N. (2021). The Basic Science of Patient–Physician Communication: A Critical Scoping Review. Acad Med, 96(11S), S109-S118. https://doi.org/10.1097/acm.0000000000004323
Giroldi, E., Veldhuijzen, W., Dijkman, A., Rozestraten, M., Muris, J., van der Vleuten, C., & van der Weijden, T. (2016). How to gather information from talkative patients in a respectful and efficient manner: a qualitative study of GPs’ communication strategies. Family Practice, 33(1), 100-106. https://doi.org/10.1093/fampra/cmv094
Goddu, A., O'Conor, K. J., Lanzkron, S., Saheed, M. O., Saha, S., Peek, M. E., Haywood, C., Jr., & Beach, M. C. (2018). Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record. J Gen Intern Med, 33(5), 685-691. https://doi.org/10.1007/s11606-017-4289-2
Goffman, E. (1974). Frame Analysis. Northeastern University Press.
Hall, J. A., Harrigan, J. A., & Rosenthal, R. (1995). Nonverbal behavior in clinician—patient interaction. Applied and Preventive Psychology, 4(1), 21-37. https://doi.org/10.1016/S0962-1849(05)80049-6
Handford, M. (2010). The Language of Business Meetings. Cambridge University Press. https://doi.org/10.1017/CBO9781139525329
Harrigan, J. A., Oxman, T. E., & Rosenthal, R. (1985). Rapport expressed through nonverbal behavior. Journal of Nonverbal Behavior, 9(2), 95-110. https://doi.org/10.1007/BF00987141
Healy, M., Richard, A., & Kidia, K. (2022). How to Reduce Stigma and Bias in Clinical Communication: a Narrative Review. Journal of General Internal Medicine, 37(10), 2533-2540. https://doi.org/10.1007/s11606-022-07609-y
Houchens, N., Engle, J. M., Palanjian, R., Saint, S., Townsend, W. A., Nasrallah, M., & Gupta, A. (2024). Effect of Clinician Posture on Patient Perceptions of Communication in the Inpatient Setting: A Systematic Review. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-024-08906-4
Hsieh, H.-F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qual Health Res, 15(9), 1277-1288. https://doi.org/10.1177/1049732305276687
Hudak, P. L., & Maynard, D. W. (2011). An interactional approach to conceptualising small talk in medical interactions. Sociology of Health & Illness, 33(4), 634-653. https://doi.org/10.1111/j.1467-9566.2011.01343.x
Jepson, M., Salisbury, C., Ridd, M. J., Metcalfe, C., Garside, L., & Barnes, R. K. (2017). The ‘One in a Million’ study: creating a database of UK primary care consultations. British Journal of General Practice, 67(658), e345. https://doi.org/10.3399/bjgp17X690521
Kadji, K., & Schmid Mast, M. (2021). The effect of physician self-disclosure on patient self-disclosure and patient perceptions of the physician. Patient Education and Counseling, 104(9), 2224-2231. https://doi.org/10.1016/j.pec.2021.02.030
Kraft-Todd, G. T., Reinero, D. A., Kelley, J. M., Heberlein, A. S., Baer, L., & Riess, H. (2017). Empathic nonverbal behavior increases ratings of both warmth and competence in a medical context. PloS One, 12(5), e0177758. https://doi.org/10.1371/journal.pone.0177758
Lipp, M. J., Riolo, C., Riolo, M., Farkas, J., Liu, T., & Cisneros, G. J. (2016). Showing you care: An empathetic approach to doctor–patient communication. Seminars in Orthodontics, 22(2), 88-94. https://doi.org/10.1053/j.sodo.2016.04.002
Locher, M. A. (2017). Reflective Writing in Medical Practice: A Linguistic Perspective. Multilingual Matters.
Locher, M. A., & Graham, S. L. (2010). Interpersonal Pragmatics Mouton. https://doi.org/10.1515/9783110214338
Macqueen, S., Collins, L., Brookes, G., Demjén, Z., Semino, E., & Slade, D. (2024). Laughter in hospital emergency departments. Discourse Studies, 26(3), 358-380. https://doi.org/10.1177/14614456231194845
Makoul, G., Zick, A., & Green, M. (2007). An Evidence-Based Perspective on Greetings in Medical Encounters. Archives of Internal Medicine, 167(11), 1172-1176. https://doi.org/10.1001/archinte.167.11.1172
Marcoux, A., Tessier, M.-H., & Jackson, P. L. (2024). Nonverbal behaviors perceived as most empathic in a simulated medical context. Computers in Human Behavior, 157, 108268. https://doi.org/10.1016/j.chb.2024.108268
McCartney, M. (2015). Margaret McCartney: Bad language. BMJ : British Medical Journal, 350, h2342. https://doi.org/10.1136/bmj.h2342
Mishler, E. G. (1984). The discourse of medicine: Dialectics of medical interviews. Greenwood Publishing Group.
Mondada, L. (2018). Multiple Temporalities of Language and Body in Interaction: Challenges for Transcribing Multimodality. Research on Language and Social Interaction, 51(1), 85-106. https://doi.org/10.1080/08351813.2018.1413878
Montgomery, T., Berns, J. S., & Braddock, C. H., III. (2020). Transparency as a Trust-Building Practice in Physician Relationships With Patients. JAMA, 324(23), 2365-2366. https://doi.org/10.1001/jama.2020.18368
Moore, R., Yelland, M., & Ng, S.-K. (2011). Moving with the times: Familiarity versus formality in Australian general practice [Journal Article]. Australian Family Physician, 40(12), 1004-1007. https://search.informit.org/doi/10.3316/informit.687123376512528
O’Grady, C. (2011). Teaching the communication of empathy in patient-centred medicine. In B. Hoekje & S. Tipton (Eds.), English language and the medical profession: Instructing and assessing the communication skills of international physicians (pp. 43–72). Emerald Group Publishing.
Parry, R., Pino, M., Faull, C., & Feathers, L. (2016). Acceptability and design of video-based research on healthcare communication: Evidence and recommendations. Patient Education and Counseling, 99(8), 1271-1284. https://doi.org/10.1016/j.pec.2016.03.013
Parsons, S. R., Hughes, A. J., & Friedman, N. D. (2016). ‘Please don't call me Mister’: patient preferences of how they are addressed and their knowledge of their treating medical team in an Australian hospital. BMJ Open, 6(1), e008473. https://doi.org/10.1136/bmjopen-2015-008473
Patton, M. Q. (2015). Qualitative research & evaluation methods: Integrating theory and practice (4th ed.). Sage Publications Inc.
Prince, E. F., Frader, J., & Bosk, C. (1982). On hedging in physician-physician discourse. Linguistics and the Professions, 8(1), 83-97.
Ragan, S. L. (2000). Sociable talk in women's health care contexts: two forms of non-medical talk. In J. Coupland (Ed.), Small talk (pp. 269-287). Routledge.
Roberts, C., & Sarangi, S. (2005). Theme-oriented discourse analysis of medical encounters. 39(6), 632-640. https://doi.org/10.1111/j.1365-2929.2005.02171.x
Roberts, C., Wass, V., Jones, R., Sarangi, S., & Gillett, A. (2003). A discourse analysis study of ‘good’ and ‘poor’ communication in an OSCE: a proposed new framework for teaching students. 37(3), 192-201. https://doi.org/10.1046/j.1365-2923.2003.01443.x
Robins, L., Witteborn, S., Miner, L., Mauksch, L., Edwards, K., & Brock, D. (2011). Identifying transparency in physician communication. Patient Education and Counseling, 83(1), 73-79. https://doi.org/10.1016/j.pec.2010.05.004
Schöpf, A. C., Martin, G. S., & Keating, M. A. (2015). Humor as a Communication Strategy in Provider–Patient Communication in a Chronic Care Setting. Qualitative Health Research, 27(3), 374-390. https://doi.org/10.1177/1049732315620773
Silverman, J., Kurtz, S., & Draper, J. (2016). Skills for communicating with patients (3rd ed.). CRC Press.
Sobczak, K., Leoniuk, K., Janaszczyk, A., & Pietrzykowska, M. (2017). Patients' Expectations as to Doctors' Behaviors During Appointed Visits. Health Communication, 32(4), 517-519. https://doi.org/10.1080/10410236.2016.1140285
Spencer-Oatey, H. (2000). Rapport management: A framework for analysis. In Culturally speaking: Managing rapport through talk across cultures (pp. 11-45). Continuum.
Spencer-Oatey, H., & Franklin, P. (2009). Promoting Rapport in Intercultural Interaction. In H. Spencer-Oatey & P. Franklin (Eds.), Intercultural Interaction: A Multidisciplinary Approach to Intercultural Communication (pp. 101-129). Palgrave Macmillan UK. https://doi.org/10.1057/9780230244511_5
Stokoe, E. (2013). The (In)Authenticity of Simulated Talk: Comparing Role-Played and Actual Interaction and the Implications for Communication Training. Research on Language and Social Interaction, 46(2), 165-185. https://doi.org/10.1080/08351813.2013.780341
Street, R. L. J. (2003). Communication in medical encounters: An ecological perspective. In T. L. Thompson, A. M. Dorsey, K. I. Miller, & R. Parrott (Eds.), Handbook of health communication. (pp. 63-89). Lawrence Erlbaum Associates Publishers.
Stubbe, M. (2017). Evolution by design: Building a New Zealand corpus of health interactions. In M. Marra & P. Warren (Eds.), Linguist at work: A festschrift for Janet Holmes (pp. 202-219). Victoria University Press
Suchman, A. L., Markakis, K., Beckman, H. B., & Frankel, R. (1997). A model of empathic communication in the medical interview. JAMA, 277(8), 678-682.
Tannen, D., & Wallat, C. (1987). Interactive frames and knowledge schemas in interaction: Examples from a medical examination/interview. Social Psychology Quarterly, 50(2), 205-216. https://doi.org/10.2307/2786752
Tobiano, G., Bucknall, T., Sladdin, I., Whitty, J. A., & Chaboyer, W. (2018). Patient participation in nursing bedside handover: A systematic mixed-methods review. International Journal of Nursing Studies, 77, 243-258. https://doi.org/https://doi.org/10.1016/j.ijnurstu.2017.10.014
Tobiano, G., Marshall, A., Bucknall, T., & Chaboyer, W. (2016). Activities Patients and Nurses Undertake to Promote Patient Participation. 48(4), 362-370. https://doi.org/10.1111/jnu.12219
Virtanen, H., Leino-Kilpi, H., & Salanterä, S. (2007). Empowering discourse in patient education. Patient Education and Counseling, 66(2), 140-146. https://doi.org/10.1016/j.pec.2006.12.010
Wallace, L. S., Cassada, D. C., Ergen, W. F., & Goldman, M. H. (2009). Setting the Stage: Surgery Patients' Expectations for Greetings during Routine Office Visits. Journal of Surgical Research, 157(1), 91-95. https://doi.org/10.1016/j.jss.2009.03.065
White, S., & Stubbe, M. (2022). “D’yuh like porridge”: Social talk as a relational, interactional, and clinical component of surgical consultations. Qualitative Health Communication, 1(1), 4-25. https://doi.org/10.7146/qhc.v1i1.125968
White, S. J. (2022). Developing a study protocol for research using conversation analysis to examine clinical consultations. Research Methods in Applied Linguistics, 1(3), 100028. https://doi.org/10.1016/j.rmal.2022.100028
White, S. J., & Preda, V. (2022). Communication as a clinical skill: a challenge in the delivery of safe and effective patient care. Australian Health Review, 46(1), 62-63. https://doi.org/10.1071/AH21082
Yates, L., Dahm, M. R., Roger, P., & Cartmill, J. (2016). Developing rapport in inter-professional communication: Insights for international medical graduates. English for Specific Purposes, 42, 104-116. https://doi.org/10.1016/j.esp.2016.01.006
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Maria R. Dahm

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles submitted to Qualitative Health Communication should not be submitted to or published in other journals.
Articles published in Qualitative Health Communication may be used (downloaded) and reused (distributed, copied, cited) for non-commercial purposes with reference to the authors and publication host.
For all publications published in the first four issues, i.e. 1(1), 1(2), 2(1) and 3(1), copyright is shared between the author and QHC. For all future publications, the author is the sole copyright holder.