Conference Programme, Abstracts & Papers

Session 12 - Knowledge, Message and Communication
Chair: Timothy Harfield

Health Literacy
Peter Schulz and Kent Nakamoto
Health Care Communication Laboratory, School of Communication Sciences, University of Lugano, Switzerland

Health literacy has become a major issue on many nations’ priority lists and, for the WHO and European Union an important issue of public policy. Limited health literacy imposes an enormous burden to the healthcare system in many countries. Health literacy is also gaining attention in the research community. The term began to appear as a significant topic in the literature in the 1970’s and has been used to mean many things. Patient comprehension and compliance studies generally developed by physicians primarily concentrated on a very basic form of Health Literacy, whereas researchers interested in patient education looked at the mismatch between health information and patient reading abilities.
While we recognize that these skills – the ability to read and comprehend health related textual material – are foundational to a notion of health literacy, we believe that defining health literacy in this way creates a view that is overly objective. In a traditional sense, literacy would be measured objectively. The focus of traditional literacy assumes epistemic objectivity; that is, comprehension is objectively measurable. Ontological considerations play a limited role in this vision. With respect to health literacy, this epistemically objective knowledge is certainly an important component but ontological considerations (internalized ideas of good health) that are necessarily subjective play a central role. Indeed, health literacy can have no meaning separate from personal (internal) experience.
In our paper we’ll argue that literacy should be considered as something important to healthy choices and behavior and in that sense it has to be internalized; it has to be integral to the lived experience of the person. Being health literate therefore is not equal with a propositional knowledge; it’s not declarative, but it is even more than procedural; it’s procedural as it relates to the person. It is almost the person in an existential sense. It’s not only “what to do” but what doing something specific means for me in my own world (this person in its own world). We suggest, then, that Heath literacy is a characteristic internal to the individual—a form of practical wisdom—that reflects the individual’s understanding of the implications of health knowledge for his or her own good health.

The Interdependent Roles of Expert and Lay Knowledges in Making Sense of Medically Unexplained Symptoms
Marta Csabai and Katalin Szili
Institute for Psychology of the Hungarian Academy of Sciences, Budapest, Hungary

Medically unexplained symptoms - or "somatisation" phenomena - are very frequent in everyday medical practice. Earlier theories propoposed that explanations for these symptoms should be sought in patients' psychopathology and in their resistance to psychological explanations. The possibility that representations about the body and illness and doctor-patient interaction play part in symptom-formation has been mostly ignored. At the same time it has been increasingly recognised that the amazing growth of health-related informations may have different effects on people’s perceptions and beliefs about health and illness  and also it can change substantially the quality of doctor-patient relationship. The aim of our research was to analyse the discoursive patterns of ideas about somatisation among lay people and medical practitioners, and to see the connections between the two different forms of representations. 10 focus group interviews were conducted with 62 lay participants, and 25 semi-structured interviews were recorded with medical practitioners. By detailed content and discourse analysis we were able to show that the lay and professional discourses greatly overlap on issues of diagnosis, etiology and therapy. It was also possible to trace patterns of contemporary scientific theories about somatisation in lay narratives. These findings are in accordance with the emerging notion that in information societies lay and medical knowledges cannot be regarded as separate systems. Medical accounts of specific symptoms and interventions continually diffuse into lay discourse. However, despite the similarities of representations in our study neither the expert nor the lay participants considered communication between doctors and patients successful. It suggests that medically unexplained symptoms should be reconsidered both in terms of medical information management and of doctor-patient relationship.

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Ways of Seeing: Biomedical Perspectives on the Social World
Charlotte Humphrey
Division of Health & Social Care, King's College London, London, United Kingdom

In the health arena it has become axiomatic that a biomedical perspective is no longer sufficient on its own. Multidisciplinarity is increasingly regarded as a prerequisite for effective health care education, practice, policy and research. However, as has often been noted, other disciplines tend to be included only to the extent that their participation is compatible with biomedical values.
Conventional analyses of the limited success in achieving genuine multidisciplinarity attribute this to medicine’s professional dominance, which it is unwilling to relinquish, and its identification with science, whose hegemonic position in our culture leaves medicine confident that it has the right to lead. In this paper I will suggest that there is a further element in play, which is the way that medicine sees and understands the world.
The power of metaphors in shaping how we think and act is widely recognised. For example, the conceptualisation of bodies and organisations as machines, which has predominated since it was adopted by the mechanical philosophers of the 17th century, has had profound effects on how we explain and manage both. Growing appreciation of the limitations of this way of thinking has recently led to a resurgence of more organic models.
The pervasive use of visual metaphors for how we think is arguably even more influential in our understanding. Much has been written about the influence of visuality in semiotics, literature, design and even law, but its significance has been largely neglected in respect of medicine.  In this paper I suggest that when medicine adopted the science of the Enlightenment as its knowledge base it also embraced its visual mental map. This included not just a privileging of direct observation and the phenomenological characteristics of sight – abstraction, detachment and objectification – but also the convention developed in Western art for ‘picturing’ the world through geometric linear perspective.  I go on to consider how this “way of seeing” constrains the capacity to appreciate alternative points of view and, in the case of medicine, limits its willingness to concede legitimacy to other disciplinary approaches.