Working with Practitioners

Angharad John, 2nd year

Report on and critically evaluate a set of research outputs/publications from projects where applied linguists and practitioners have worked in partnership

This essay will examine the research outputs from a Research Excellence Framework (REF) Impact case study in the health domain. Undertaken by the University of Nottingham’s School of English, the study is titled: Raising Awareness of Adolescent Health Communication (University of Nottingham, 2014). The aim of this research was to “enhance practitioner-patient communication” (University of Nottingham, 2014, particularly when it came to adolescents and young people, and to better understand the ways that teenagers express worries they have about their health.

The Health Language Research Group was set up in 2002, which was an “interdisciplinary sub-group” (University of Nottingham, 2014) of the Centre for Research in Applied

Linguistics (CRAL). The research team in this group consisted of Ronald Carter, Professor of Modern English Language, Svenja Adolphs, Professor of English Language and Linguistics and Dr Louise Mullany, Associate Professor in Sociolinguistics (UoN, 2014). The researchers developed working relationships with Dr Aidan MacFarlane and Dr Ann McPherson, who were paediatricians working in the NHS at the time, and the co-creators of the Teenage Health Freak website (Teenage Health Freak, n.d.). This website allowed teenagers to submit health-related questions which were then answered by GPs (UoN, 2014). These questions were converted into data for one output of this research, which was a 2-million-word corpus created from the roughly 113,000 healthrelated questions that were submitted via the ‘Ask Doctor Ann’ (THF, n.d.) function (UoN, n.d.). When submitting the questions, adolescents were also able to specify their gender and age by using a drop-down list, however this was not essential. The corpus used this data to break down the words most commonly used, as well as the median number of words in questions sent by each age and gender.

The contents of the corpus were then judged against “CRAL’s multi-million word general English holdings” (UoN, 2014). This allowed researchers to identify terms that had a proportionally high usage (Harvey et al., 2007). From this, it was found that the most common topics queried were: sex, pregnancy and relationships; body parts; body changes; weight and eating; smoking, drugs and alcohol (UoN, 2014). An encyclopaedia containing 100 words on these topics was then created to aid health practitioners. The aim was for it to bring to light any trends in “adolescent sociolinguistic style and register” (UoN, n.d.). It showed the frequency of use of each word across different genders and age groups, as well as some examples of how the words were used in context. Some challenges faced while creating the encyclopaedia included converting the data from spreadsheet into XML (that is: Extensible Markup Language (FileInfo, 2022)) format, as well as finding and deleting duplicate messages that were sent on the same date (UoN, n.d.). Correction of spelling as often as possible was also necessary (UoN, n.d.). Obviously, in some cases this would have been difficult or even impossible, depending on whether the word was intelligible or distinguishable from another similar word which would have made sense in the same context.

The third output of this project was a booklet designed to be accessible for a practitioner audience, and to provide health practitioners with more information on how adolescents express health worries, titled “Am I Normal?” (Harvey et al., 2007). It explains the background of the Teenage Health Freak (Teenage Health Freak, n.d.) website and the corpus, and points out that previously, sexual health research has found that young people will often use “vague terms and euphemisms” (Harvey et al., 2007) when talking about their body, however, while using the website they explained their concerns in “meticulous detail” (Harvey et al., 2007). It also advises that practitioners could learn useful communication lessons by analysing this bank of health language (Harvey et al., 2007). It was hoped that this publication would contribute to the “continuous professional development” (UoN, n.d.) of groups of practitioners within the NHS, while also being useful to adolescents, parents and teachers.

Until this point, not much linguistic research into adolescent health had been carried out. It was also noted that GPs generally wanted to better understand how young people viewed health and illness (UoN, 2014). The researchers’ decision to analyse the online communication was therefore an effective one for several reasons. Firstly, typing out questions anonymously online is a far less daunting prospect for a self-conscious teen than trying to articulate concerns to a doctor or parent face-to-face, especially if they are worried about the adult asking them uncomfortable questions in return. Being able to submit questions anonymously makes it more likely that the adolescents would share what is genuinely bothering them, meaning that the data would show a much wider picture of adolescents’ real concerns, not just what they would normally be willing to share with an adult. This also applies to the type of words they might use. When talking to adults, words considered rude or taboo might be avoided, but as mentioned in Harvey et al. (2007), more direct anatomical language is included in the questions. This shows that a corpus made up of online submissions more accurately reflects natural adolescent language and perspectives, as opposed to, for example, one made up of words used by adolescents in a doctor’s surgery. Furthermore, the reach of this project was fairly wide. As the data was gathered online, there were no geographical barriers that stopped teenagers from providing questions. The 113,000 responses resulting in a 2-million word corpus indicates the moderately large scale of the project.

The main problem being addressed in this study was health practitioners'’ lack of knowledge of adolescent communication, and how best to respond to this style. As a result of the research, GPs stated that they felt more informed, and were able to engage “more effectively and confidently” (UoN, 2014) with teenage patients. Several GPs who read the ‘Am I Normal?’ (Harvey et al., 2007) booklet commented that it gave them more “knowledge and insight” (UoN, 2014) into adolescent communication. They also explained that the booklet helps to highlight the fact that teens often have “hidden agendas” (UoN, 2014) and concerns when consulting with GPs, and it details the best ways to make young patients comfortable enough to have conversations about said agendas. Ideally, the most successful outcomes for young people from this study would have been more effective treatment, or feeling less intimidated and instead better understood by their health practitioner. This could then result in more positive attitudes towards talking to a GP, and improve overall confidence in the NHS. These comments exhibit that, according to the practitioners at least, the real-world challenges that were being addressed in this research were done so successfully.

In terms of ethical aspects, there is a question over whether teenagers were aware their questions would be collected and used for research purposes. As the Teenage Health Freak Website is no longer live, it is difficult to determine whether anything was displayed on the ‘Ask Doctor Ann’ (THF, n.d.) function explaining this. As the questions are anonymous, this would not be such a serious problem, but it is a particularly sensitive area given that these are the questions of minors.

It is mentioned that this research was carried out as a result of “demands” (UoN, 2014) from GPs, so it could be inferred that relationships between practitioners and researchers were initially strained. It is arguable that the main priorities of each group would be different from each other. This would have not been a significant issue for earlier research as the Teenage Health Freak website was designed by GPs, who obviously understood the values of GPs’, for example, strict protocol and patient confidentiality; hence the anonymity of the questions submitted. It would therefore be more interesting to know where they stood on the ethics of research, and whether it was explained on the THF website that these questions would be recorded and analysed. The NHS is a huge stakeholder in this research, not necessarily in financial terms, but the outcomes of this research would make significant differences. Good results from the research would lead to better relationships with young patients and parents, and even a more positive overall image. There is even the potential for better funding, although this is a bold, oversimplified statement to make given the complexity of the NHS structure. The project also worked in collaboration with Medikidz (Medikidz, n.d.), a company which makes accessible health materials for children and young people, who managed to secure £42 000 worth of funding from the Horizon Digital Economy Research Institute (UoN, 2014). This is another example of differing values and priorities working in partnership, as Medikidz is an “enterprise” (UoN, 2014) which has to consider making profit, while the NHS and researchers would have had the service they were providing as their main focus.

In terms of dynamics, researchers are likely to have faced pressure, as they were the ones providing the - arguably overdueservice to GPs. The GPs also had vested interest in this research; many might have felt on a personal level that they want to learn to communicate better with adolescents. Particularly if they work with them often, their job could have become easier and more rewarding with the better knowledge on how to communicate with them effectively.

In conclusion, the research for this REF Impact case study did succeed in identifying common linguistic patterns of adolescents when discussing their health and anatomy, and as a result was able to give guidance to practitioners on how best to communicate with young patients.

References

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Harvey, K.J., Brown, B., Crawford, P., Macfarlane, A., McPherson, A. (2007). Am I normal?’ Teenagers, sexual health and the internet. Social Science & Medicine (65), 771–781.

Medikidz. (n.d.). Medikidz. Medikidz. http://www.medikidz.com/

Teenage Health Freak. (n.d.). Teenage Health Freak. Teenage Health Freak. http://www.teenagehealthfreak.org/ https://ref2014impact.azurewebsites.net/casestudies2/refservic e.svc/GetCaseStudyPDF/31746

University of Nottingham. (2014). Raising Awareness of Adolescent Health Communication. Research Excellence Framework 2014, Impact Case Studies.

University of Nottingham. (n.d.). Teenage Health Freak Corpus: Overview. Centre for Research in Applied Linguistics.

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University of Nottingham. (n.d.). Teenage Health Freak Corpus: The data Transformation Process. Centre for Research in Applied Linguistics. THFdataPreparation - The University of Nottingham

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