Health Communications

ICIC has made significant contributions to improvements in healthcare through its linguistic and intercultural communication research. Research at the Center is based on the premise that “disease and illness cannot be understood apart from their cultural context” and that effective communication comes from engaging cultural context through linguistics (Connor 2011).

Using an interdisciplinary-interdepartmental team science approach, we have identified language and culture-based factors and forms of interaction that impact patient adherence, decision making, and successful disease management.

Our multi-modal research methodology engages healthcare providers and patients as research partners, and thus results in the development of unique linguistic interventions.

The goals of such evidence-based interventions are to facilitate patient understanding of written medical information (health literacy) and to create tailored patient-centered messaging for healthcare professional use (healthcare communication).

Dr. Ulla Connor and an interdisciplinary-interdepartmental team have authored and presented widely on the topic of health literacy and healthcare communication.

Development of the CoMac Descriptor and Related Tools

ICIC began its transdisciplinary research in 2005 by involving scholars from the IU School of Medicine and Law at IUPUI and the School of Pharmacy at Butler University in an intercultural project on medication labeling. Results of our research indicated that understanding medication instructions depends on not only the quality of the writing but also on the ability of the patient (Connor et al. 2008, Wolf et al. 2006). To better understand the language/ability connection, from 2007 to 2010, ICIC directed a project with funding from Eli Lilly and Company Foundation to examine disease management of patients living with diabetes through studying patients’ own narratives. A team science approach was used to understand individuals’ worldviews and health beliefs that affect adherence: knowledge, confidence to act, attitudes, and emotions. We examined the words and language structures used by English, Spanish, and Chinese speakers. Three key insights emerged from this study:
  1. People see the world differently and have different perceptual views;
  2. People with different perceptual views use different language to describe the event;
  3. If you know how patients see themselves, then you can use differential language to communicate back to them in a more effective manner regardless of their native language.
The research produced a linguistic feature system, translatable to different languages; comparisons of language use and adherence patterns between native English-speaking patients and Latino patients; and recommendations for tailored communication strategies for health care providers working with patients suffering from chronic illness. ICIC’s transdisciplinary team of internal and external research fellows have produced a number of publications born out of this 2007-2010 funded research. In addition to a book-length volume (Antón & Goering, 2015), our research team co-authored four peer-reviewed articles and three book chapters. Team members have made over thirty presentations at national and international conferences on the subject. Influenced by these findings, ICIC went on to develop the CoMac Descriptor™, a survey that effectively segments patients into distinct clusters based on established linguistic parameters of locus of control, agency, and affect. A Patient Profile™ and Points of Emphasis™ were subsequently developed for healthcare providers (HCPs) to use in communicating with patients. These psycholinguistically informed communication tools include language cues that provide HCPs with communication strategies tailored to patient segmentation, allowing providers to talk to patients in ways matching patient worldviews and enhancing communication (Clark et al., 2012; Connor et al., 2015; Ellis et al., 2014). The CoMac related tools are commercially available and have been licensed in multiple research studies focusing on multiple conditions (e.g., diabetes, hypertension, ADHD, kidney disease). See for more information.

Linguistically and Culturally Relevant Healthcare for Diverse Populations

ICIC’s linguistically and culturally oriented health literacy expertise has also been utilized in projects involving research conducted in collaboration with IU partners. In 2011, ICIC partnered with the IU Polis Center on an externally-funded project, “Amputee Veteran Research Oral History Project.” The project studied the physical and mental health needs of Vietnam War veterans with combat-related amputations, also known as traumatic amputations. ICIC contributed to the project by using corpus linguistic methodology to quantify the features of the language used by two groups of veterans: a group consisting of veterans suffering from PTSD and a control group of veterans not suffering from the condition. A comparative analysis of patient narratives evidenced statistically significant differences in language use, e.g., in the use of personal pronouns, expressions of certainty, and negative and positive adjectives. In 2013, ICIC collaborated with the IU School of Medicine and the IU School of Informatics and Technology on the redesign of the Indiana University Melvin and Bren Simon Cancer Center's Online Cancer Portal with a “patient-centric” model of online information presentation (Buchenot et al. 2014). The project involved web designers, content experts, linguists, experts in informatics, and patients as research partners working together in mixed focus groups to facilitate the visitors’ navigation of the portal. The collaboration still continues, and the same team has recently submitted a grant proposal to understand online information-seeking behaviors of U.S. Latinos in Indiana, and to contribute to the continuing development of the portal by making it accessible to Indiana-based U.S. Latinos. Other projects have included a collaboration with the Indiana State Department of Health-funded research grant to investigate the use of personal journals for the facilitation of health communication with underserved parenting and pregnant teens.

Selected Publications

Books Antón, M., Goering, E. (Eds.). (2015). Understanding Patients’ Voices: A multi-method approach to health discourse. Amsterdam: John Benjamins. Journal articles Clark, M., Connor, U., Lauten, K., Mac Neill, R., & Sandy, R. (2011). Patient-centered research and adherence interventions [abstract]. Diabetes, 60 (suppl 1), A580. Skinner-MacDougall, D., Connor, U., & Johnstone, P.A.S. (2012). Comprehensibility of patient consent forms for radiation therapy of cervical cancer. Gynecologic Oncology, 125(3), 600-603. Connor, U., Antón, M., Goering, E., Lauten, K., Roach, P., Hayat, A., & Balunda, S. (2012). Listening to patients’ voices: Linguistic indicators related to diabetes self-management. Communication & Medicine, 9(1), 1-12. Clark, C.M., Connor, U., Lauten, K., Mac Neill, R., & Sandy, R. (2012). A linguistic approach to improving self-care and compliance. Journal for Patient Compliance, 2(4), 20-22. Antón, M., Connor, U., Lauten, K., & Balunda, S. (2012). An intercultural analysis of sources of medical information in Spanish-speaking diabetes patients. Rhetoric, Professional Communication, and Globalization: Special edition on culture and health communications, 3(1), 140-161. Bartlett Ellis, R. J., Connor, U., & Marshall, J. (2014). “Development of patient-centric linguistically tailored psychoeducational messages to support nutrition and medication self-management in type 2 diabetes: a feasibility study.” Patient preference and adherence, 8, 1399-1408. Connor, U., Neill, R. M., Mzumara, H., & Sandy, R. (2015). Development of the CoMac Adherence DescriptorTM: A linguistically based survey for segmenting patients on their worldviews. Patient Preference and Adherence, 9, 509–515. PubMed PMID: 25848230. PubMed Central PMCID: PMC4381900. Sandy, R., & Connor, U. (2015). Variation in medication adherence across patient behavioral segments: A multi-country study in hypertension. Patient Preference and Adherence, 9, 1-9. Connor, U., Kessler, L., de Groot, M., Mac Neill, R., & Sandy, R. (2019). Implementing person-centered communication in diabetes care: A new tool for diabetes care professionals. Patient Preference and Adherence, 13, 1443-1450. Book Chapters Connor, U., Goering, E., Matthias, M., & Mac Neill, R. (2010). Information use and treatment adherence among patients with diabetes. In M. Ruiz-Garrido, J. Palmer-Silveira, & I. Fortanet-Gomez (Eds.), English for professional and academic purposes (pp. 89-104). Amsterdam/New York: Rodopi. Connor, U., & Lauten, K. (2014). A linguistic analysis of diabetes patients’ talk: Reported adherence to healthy behaviors. In H. Hamilton & W.S. Chou (Eds.), The Routledge handbook of language and health communication (pp. 91-108). New York, NY: Routledge. Anton, M., Connor, U., Lauten, K., & Balunda, S. (2015). Contrastive methodological approaches to study health information sources by Spanish and English speaking patients. In M. Antón & E. Goering (Eds.). Understanding patients’ voices: A multi-method approach to health discourse (pp. 105-120). Amsterdam, Netherlands: John Benjamins. Connor, U., Guo, L., Gusich, J., & Dobson, K. (2015). Adapting methodology to diverse cultural contexts. In M. Antón & E. Goering (Eds.). Understanding patients’ voices: A multi-method approach to health discourse (pp. 123-134). Amsterdam, Netherlands: John Benjamins. Connor, U., & Rozycki, W. (2015). Conducting transdisciplinary research. In M. Antón & E. Goering (Eds.). Understanding patients’ voices: A multi-method approach to health discourse (pp. 147-154). Amsterdam, Netherlands: John Benjamins. Cortes, V., & Connor, U. (2016). Identifying behaviors through the study of patient talk in English and Spanish. In L. Pickering, E. Friginal, and S. Staples (Eds.). Talking at work: Corpus based explorations of workplace discourse (pp. 235-254). London, England: Palgrave McMillan Zou, M., Guo, L., Connor, U., Huang, F., Fang, L., Li, J., Liang, F., Liu, J., Niu, Y., Qiao, Y., Wu, Z., & Zhang, J. (2017). The role of mass media in transmission of health information as perceived by Chinese diabetes patients. In Li, A. Y. L., Zhang, K., & Chan, K. (Eds.), Multidisciplinary approaches to media literacy: Research and practice. Hong Kong: Hong Kong Baptist University and International Conference on Media Literacy.