April 7-9, 2022 • Hyatt Regency • Lexington, KY
Communication Strategies to Promote Comprehensive Well-being
Communication Strategies to Promote Comprehensive Well-being
Abstract: A Systematic Review of Complementary and Integrative Health (CIH) Communication Using Observational Data in Biomedical Settings
Background. Complementary and integrative health (CIH) encompasses a wide breadth of health care practices that include non-conventional biomedical diagnostic techniques, treatments, and wellness/healing practices. CIH use is diverse and highly prevalent worldwide. Patients hesitate to communicate with biomedical clinicians about CIH use. Methodological choices affect what is and is not measurable. Much prior CIH research relies on self-reported data, yet survey and interview methods are inadequate to examine the nuances of conversational interaction. Observational methods are ideal to directly study CIH communication because they maintain environmental validity of situated communication behavior, minimize recall error common to self-reported measures, and preserve the sequenced action sequences needed to fully contextualize social communication practices. Objective. We systematically reviewed published articles using observational data to study CIH communication in biomedical settings. Our overall goal was to investigate the value of observational research methods to the study of CIM communication between biomedical clinicians, patients, and caregivers. Methods. Following PRISMA guidelines, we identified peer-reviewed publications from seven databases between January 2010-December 2020. Titles and abstracts were first screened for inclusion, then full studies were coded using explicit criteria. A standard checklist was modified to assess article quality. Article quality was assessed using the JBI Critical Appraisal Checklist for Qualitative Research. Results. A total of 11,793 total articles met the search criteria with less than 1% (n=10) that used observational methods within biomedical settings included in the final review. Articles had a range of observational data types (direct observation, participant observations, audio recording with transcripts). Eight studies featured observational data centrally when reporting results and incorporated transcripts of actual CIH conversations. Most articles used multiple or mixed methods that included observational techniques, but only a few studies used observational data as the only data source. Some studies report using observational data, but findings do not make explicit how observational data was used to generate the results. Articles used observational data in two major ways: to describe CIM communication as a process to characterize interactional dynamics of CIH communication and to associate CIH communication with provider, patient, and health system characteristics to correlate communication behavior with proximal and intermediate health outcomes. Discussion. Observational data are unique because they document people’s actual verbal and embodied communication rather than self-reported behavior. Observations can be analyzed using qualitative, quantitative, and multiple method analytic techniques, which makes these data particularly valuable. Observational methods are under-utilized to study CIH communication, and current research using observational methods offers an incomplete picture of CIH communication in biomedical settings. Not explicitly reporting how data are used obscures the usefulness and strengths/limitations of each different data type. Future research should standardize how observational data are collected and reported to increase comparability across settings. Further, because CIH refers to different treatment and healing modalities with little in common, future research on CIH communication should investigate CIH modalities separately to discern the unique communication that may be required to properly advise and counsel patients when used in integrated with biomedical care.