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ABSTRACT
Background
In Norwegian hospitals, patients with newly diagnosed inflammatory joint disease are offered consultations with nurses, to address health issues related to their diagnosis and treatment. This study examines how issues of trust manifest in the communication between nurses and patients in clinical encounters; of particular interest are the accounts of trust and distrust toward online health information (OHI) linked to patients’ eHealth literacy.
Methods
Video-recorded observational data were collected from 16 primary nurse–patient consultations and 10 follow up consultations in a Norwegian hospital setting. Rhetorical discourse analysis was applied to examine the conversations, focusing on the rhetorical devices that were expressed by the nurses and the patients, such as justifications, contrasting, character work, and reported speech.
Results
The nurses acknowledged patients’ references to online search activities related to health information while expressing their own reservations about OHI. The nurses explicitly and implicitly advised patients on specific eHealth literacy strategies, namely, to consult trustworthy sources, such as patient organizations; to trust the medical knowledge conveyed by health personnel; to distrust non-professional health advice online; and to avoid self-diagnosis based on health information sought on the Internet.
Conclusions
Through the use of rhetorical devices, the nurses implicitly addressed eHealth literacy strategies in their communication with patients, including the importance of critically assessing the trustworthiness of health information. This complex communicative task requires a sensitivity toward patients’ eHealth literacy levels.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Informed consent
The nurses were given information orally in several meetings, and they completed a written consent form, which they were required to sign prior to participation. Patients were given oral and written information two weeks prior to data collection. They were asked again before turning on the camera and recording the consultation, in addition to providing their written consent.
Authors’ contributions
The authorship is in accordance with the Vancouver Recommendations. C.B.L. was responsible for editing the entire manuscript, including the background, methods, analysis, and discussion. H.G. contributed substantially to all parts of the manuscript. All the authors have read and agreed to the published version of the manuscript.
Additional information
Funding
Notes on contributors
Cathrin Brøndbo Larsen
Cathrin Brøndbo Larsen, MSc, Registered Nurse at St.Olavs University Hospital and Ph.D. Candidate at Center for Professional and Academic Communication (SEKOM), Norwegian University of Science and Technology (NTNU). Research Interests: Public health, Global health, ehealth literacy, health communication, discourse analysis, qualitative research, interdisciplinary communication, nurse-patient interaction. Methodological approaches involves interviews and ethnographic fieldwork.
Heidi Gilstad
Heidi Gilstad, PhD, is Associate Professor at the Center for Professional and Academic Communication (SEKOM), Norwegian University of Science and Technology (NTNU). Research interest: Professional discourse studies, eHealth literacy, health language, digital divide, interdisciplinary communication, and diversity. Methodological approaches include ethnographic fieldwork, interviews, and document analysis.