Communication and relationships in exercise science

1. {
Communication and
Relationships
EXSC 450

2.  Identify strategies for communicating with clients who
have low health literacy
 Explain the factors that influence communication
 Identify strategies for building rapport
Lesson Objectives

3. HEALTH LITERACY
 Health literacy (HL)?
 Obtaining and understanding basic health information relevant to context
 Individuals lacking HL have been found to have more negative health
outcomes (Coughlin et al., 2020)
 Higher HL and higher levels of PA have been consistently linked
(Buja et al., 2020)
 Where providers go wrong:
 Use of technical and medical terminology in public communications (e.g., use of
cardiovascular disease instead of heart disease; discussing ventilatory threshold as
is; talking about chemical effects of particular diets)
 Relying on an inappropriate mode of communication (e.g., print materials for
persons with limited reading skills).
 Limited targeting of information and interventions to diverse cultural preferences
and practices (e.g., healthy eating tips would differ for African American and
Hispanic groups due to cultural preferences; Schouten & Meeuwesen, 2006).

4.  STRATEGIES FOR LOW HL (but really, everyone)
Slow down your
speech
Use “teach back”
method
Utilize
drawing/pictures-
give info in
multiple forms
Use ‘living room’
language
Limit amount of
info (2-3 main
points)
Davis et al., 2002; Greene & Ramos, 2020; Oates & Paasche-Orlow, 2009; Schubbe et al., 2020; Williams et al., 2002

5. Fig 2 from Mbanda et al.
(2020)
• Evidence favors
pictograms and
fewer words
(Mbanda et al., 2020;
Schubbe et al., 2020)
• Aids seem to
work better for
lower HL (Schubbe
et al., 2020)

6.  Physical environment
 Privacy
 Verbal
 We’ve covered many of
these. What previous skills
that we’ve discussed do you
think are good verbal
communication skills?
 OARS, RULE
 Prior tips re: low HL
Factors that Influence Communication
(Mostly from Martin et al., 2010)
 Nonverbal
 Body language
 Gaze/eye contact***
 Facial expression
 Body movement (e.g., head
nods, fidgeting)
 Tone (sort of verbal)
***Cultural influences on communication***
-Navajo patients: Caring communication, not rushing, positive focus,
recount the patient’s story (Carrese & Rhodes, 2000)
-Asian and Middle Eastern patients: eye contact differences
-Language discordance (Krystallidou et al., 2021)

7. Relationships and Rapport
 Developing trusting relationships with clients or patients
 A good working alliance strengthens patient outcomes and
adherence
 S&C (Tod et al., 2012)
 Rehabilitation (Brewer et al., 2020)
 Dietetics (Hancock et al., 2012)
 Occupational therapy (Taylor, 2020)
 Improvements in adherence in many settings such as rehab,
chiropractic care (e.g., Brewer et al., 2020; Lambers & Bolton, 2016; Lonsdale et al., 2017; Wright et al.,
2014)
 More positive dietary consultation experiences (Hancock et al., 2012)
 Building rapport is a skill that can be learned (Norfolk et al., 2009)
 A sample of S& C coaches felt this was a skill that novice
professionals lacked and presented problems early in their careers
(Szedlak et al., 2021)

8. Strategies for Building Rapport/Trust
 Valuing patient as an individual (small talk?)
 Use of humor
 Empathy and care
 Positive reinforcement
 Other strategies:
 Revisit all our good communication skills (e.g., empathy, listening, tone)
 Mirroring your client
Communication skills in PT
These strategies from Crom et
al., 2020; Greene & Ramos,
2020; Kava et al., 2020

9.  Application: What can you do?
 Listen! Allow your clients to tell their story.
 Don’t rush through information or use scientific jargon.
 Check frequently for understanding.
 Know your client’s level of literacy and convey info
appropriately.
 Provide comfort and assurance when appropriate.
 Don’t overload or give too much info at once.
 Suggest or provide memory aids (brochures, mnemonics, etc.)
These practical suggestions derived from the following studies: Crom et al., 2020;
Davis et al., 2002; Greene & Ramos, 2020; Kava et al., 2020; Oates & Paasche-Orlow,
2009; Williams et al., 2002
Wrap-up