Human+Communication+and+Speech+Chain+Model


 * Communication** is //“the act, by one or more persons, of sending and receiving messages that are distorted by noise, occur within a context, have some effect, and provide some opportunity for feedback”// (Devito 2, 2003).

=Speech Chain Model=

toc Communication can also be explained through the “speech chain model”:
 * In this model the **sender and receiver** are interchangeable.
 * The **message** is an exchange of information which may be dependent on the context.
 * The model also includes a **surface signal** which is the physical means of carrying/delivering the message. It refers the words, sounds, or images being exchanged.
 * In addition, the message holds a **deep meaning**. The deep meaning of the message deals with what is intended by the sender, what is understood by the receiver and how the content is related to the sender or receiver.
 * As a result the model is surrounded by some form of **social or physical context**. Society must adapt to a certain way of communicating depending on the social setting as well as the physical context itself which can exist in either the real or virtual world.
 * **Accommodation** also takes place in this model as both speakers try to engage in ways that can be adjusted to.

The following will demonstrate that by incorporating adaptive technologies with e-health, communication is enhanced at every level of the speech chain model, thus resulting in improved communication overall.

Sender/Receiver
As technology is becoming digitally innovative, health communication has changed to e-health communication.

//E-health is “the use of internet technology by the public, health workers, and others to access health and lifestyle information, services and support” (Wyatt and Liu).//

In the communication system of e-health, the sender and receiver are interchangeable in that the doctor may play the role of a sender or receiver and the patient may do the same. For the purpose of the speech chain model, it is wise to look at how the doctor influences this model from both the perspective of a sender or receiver.

The message may be delivered by the doctor, making him/her the sender.For example, the message may hold information about a certain drug that should be stopped or about test results.

It is the responsibility of doctors or other health administrators to ensure that if certain medical issues are posted on web sites, that those pages are accessible for all. There are many patients who may suffer from some sort of disability, thus a doctor must ensure that the message being delivered to the patient is accessible.

For many years there have been barriers to information. Patients were unable to view their medical records or even ask their doctors questions. Patients believed that no one is able to interpret their health better than their doctor, thus they would leave their lives in the hands of their doctor.

Breaking Barriers
The patient experiences many advantages in the form of both sender and receiver. As a sender, the patient can ask doctors questions related to one’s illness. Patients may overcome the barrier of not being able to communicate with their doctor via internet. Many patients in the past were passive and did not dare to challenge the judgment or recommendations of the physician. However, with the advent of e-health, the patients are now able to access a wide variety of resources on the Internet and question the results presented by the doctor, through research. This can now be done more easily by emailing the doctor instead of having to face the doctor in person and being afraid to ask questions. Thus, patients can now contribute to a communication process in which questions are answered by the doctor in terms that are understood by the patient.

Many other barriers that the patient once had can also be overcome with e-health. For example, patients can now determine how much they will participate in decisions about their health care. It has been proven that “shared decision making enhances patients’ self awareness and quality of life, improves their adherence to treatment plans, and leads to better health outcomes” (Jadad et al. 2004).

Therefore, e-health allows for communication to be enhanced by both the sender and receiver of the message. In addition, by giving patients second opinions, patient outcomes tend to improve and cost does not increase, thus, benefiting the doctor. By being able to access information on the World Wide Web, doctors can also research the illness of certain patients and provide better feedback.

All in all, there are many advantages for the patient by communicating with the doctor outside of consultations. In the past, doctors did not communicate via telephone or email as they were afraid of increasing their workload, reducing income and quality of life, or creating legal liability. Emails can however, enhance the patients’ adherence to prescribed medication, better inform doctors about the results of treatment or of adverse effects, and improve health outcomes.

Adaptive Technologies
Adaptive technologies also aid in the process of recovery for many patients who are disabled. Patients who are disabled can communicate with their doctors from the ease of their own home. Those who are visually impaired can use “screen readers” to help perceive the message. If text is not seen clearly, users can also use zoom text to magnify the screen. Those with motoric disabilities can use an alternative keyboard, mouse, or onscreen keyboard to avoid hand strain.

In addition, many patients who are hospitalized can also communicate with others. For example, [|PEBBLES] (Providing Education By Bringing Learning Environments to Students, is an innovation created to assist those students who are in hospitals. This innovation makes use of an audio-visual integration system in which classmates and teachers can communicate with those students lying on hospital beds. A robotic machine is placed in the hospital for the student to see and hear classmates and the teacher, and another is placed within the classroom for those students and teacher to communicate with the student in the hospital.

To view a video clip on how a student can use PEBBLES to communicate with classmates from the hospital and be engaged in a collaborative learning process, click [|here]. This video shows that patients who have long-term or medical issues do not have to miss school and can participate in the classroom.

(Please Note: Quick Time is required in order to view the clip, click on the link to download: http://www.apple.com/quicktime/download/win.html)

**Surface and Deep Levels of Message**
In order for the doctor and patient to communicate over the Internet, surface signals must be used wisely. Both doctor and patient would use surface signals such as words, sounds, and images. The doctor in particular must insure that all surface signals are clearly presented in order to avoid any misinterpretation. If the doctor is seen and heard using applications such as iMovie, then intonation plays a key role, in that the doctor must use pitch levels that are perceived clearly to the patient. In the same way, the patient must make use of intonation when asking questions. As a result, the pitch of the voice would be slightly higher when asking a question. This way the doctor understands that a question is being asked.

Deep meanings of the message are intended and understood differently from both sides of the model. What is intended by the doctor can be understood differently by the patient and vice versa. As a result, some drawbacks occur in e-health. For example, if the doctor is sending an email he/she must ensure that the message being carried across the channels and displayed on the computer screen of the patient is clear. Because non-verbal cues such as body gestures, or facial expressions are not seen in text, it may be difficult for both parties to understand the deep meaning of the message. In addition, bypassing can also occur when the deep meaning is the same but the sender/receiver is unaware. For example, when emailing a patient or doctor miscommunication can occur., if the same words are used and there is different meaning, or if different words are used but there is the same meaning. In addition, there are some set backs with not having that face-to-face interaction with a doctor. Symptoms may sometimes seem to lead to one disease or illness but with a closer look it could be something totally different. With face-to-face interaction the doctor could check blood pressures, breathing patterns, observe changes in weight, look at the appearance of skin, etc. With such observences the doctor may come across something important that might totally change the diagnosis. In certain situations face-to-face interactions with a doctor are much imprtant and valuable then a simple virtual context.

Furthermore, when creating a web site with health information, web designers that work for doctors should ensure that accessibility issues are taken into consideration. For example, colours that are different in contrast should be used to avoid problems for those with colour blindness. Therefore, when communicating e-health information online both the doctor and patient should be aware of factors that may affect the interpretation of the deep meaning of the message.

**Social and Physical Context**
As society moves more into a digital world, technological advancements tend to create benefits for society as a whole. Social context differs when the physical context is changed. For example, social context is different when engaged in face-to-face communication than when in a virtual conversation. The doctor and patient would communicate differently face-to-face than when communicating through the Internet. The e-health social setting creates more ease for the patient as he/she does not feel a sense of authority by the doctor. It creates equality in society as the patient communicates at the same level as the doctor via the Internet. Contrastingly, when one is in a doctor’s office, the patient feels a sense of shyness or ignorance and does not tend to communicate as openly as he/she would virtually. According to Jadad, Rizo, and Enkin, research evidence has proven that telephone calls and emails are ways to compliment follow up care (Jadad et al. 2004).

//Phone calls and probably email can enhance patients’ adherence to prescribed medication, better inform healthcare providers about the results of treatment or of adverse effects, and improve health outcomes (Jadad et al. 2004).//

In addition, consumers are becoming more responsible, in terms of their health, as interactive information that is becoming increasingly accessible through the Internet.

//Information technology and consumerism are synergistic forces that promote an "information age health care system" in which consumers can, ideally, use information technology to gain access to information and control their own health care, thereby utilizing health care resources more efficiently (Eysenbach 2004).//

The following diagram depicts this notion:

Click [|here] to view a larger version of image. //The focus of traditional medical informatics is shifting from health professionals to consumers//

Therefore, e-health communication creates better social standards for both patients and doctors by engaging in the physical context virtually.

**Accommodation**
Accommodation is difficult to achieve in e-health communication. If you take the example of a doctor sending test results underlining the fact that the patient is diagnosed with cancer, it will be perceived differently than when the doctor is explaining something about medication. Moreover, since technologies, especially computers, are not always reliable, it is important for the patient and doctor to try to accommodate to the changes. For example, when the doctor and patient engage in a virtual conversation, it is important for the two (sender/receiver) to accommodate to each others rate of speech, loudness, timing, vocabulary, etc. For instance, a doctor should try to use terms which are understood by the patient, thus accommodating the patient. However, if the doctor fails to accommodate, the conversation becomes more strained. Since majority of the emails that are sent are displayed in text, cues such as facial expressions are lost and thus the message may not be interpreted as clear than it otherwise would be. However, if software such as iMovie is used to deliver an image and sound based message than non-verbal cues and intonation can be heard and seen. But, there can be times when such software programs do not work efficiently. For example, if only audio is displayed and no video is seen or vice versa, than the patient or doctor will have lower speech intelligibility. Thus, speech intelligibility plays a key role in accommodating doctors and patients. Lastly, adaptive technologies are accomodating those patients who are not able to perceive messages and are also creating a sense of equality as seen in the above example of "PEBBLES".

=Conclusion=

Overall, e-health is an evolving concept in society. As new technologies are being developed, such as adaptive technologies, e-health communication is enhanced at all levels of the speech chain model. E-health has created benefits for both the sender and receiver as they communicate in the form of a doctor or patient. Adaptive technologies have created benefits for patients as they can take part in an e-health relationship with doctors. Moreover, accessibility issues are being resolved as new technologies are being developed. Lastly, by designing such technologies communication as a whole is improved.

=Works Cited=

Devitio, J. Human Communication. Boston: Allyon & Bacon, 2003.

Eysenbach, Gunther. “Recent advances: Consumer health informatics”. 9 November 2004. __BMJJournals__. 24 February 2006. .

Jadad et al. “I am a good patient, believe it or not”. 9 November 2004. __BMJJournals__. 2 February 2006. .

“PEBBLES”. Centre for Learning Technologies: Ryerson University. 2 February 2006. .

Wyatt, J.C. and J.L.Y Liu. “Basic concepts in medical informatics”. __Jech.com__. 2 February 2006. .

Images courtesy of: http://www.ryerson.ca/pebbles/index.html

http://www.ryerson.ca/pebbles/photo1.html

http://bmj.bmjjournals.com/content/vol320/issue7251/images/large/eysg1839.f1.jpeg