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Electronic communication between patients and general practitioners (GPs), known as e-consultations, was introduced in Denmark as a cost-effective and convenient means for patients to access their GP and receive test results as well as answers to quick questions. Research on e-consultations internationally has found that patients are generally very positive, while doctors are more hesitant. Most studies of e-consultations have involved survey or interview methodologies, while studies of their content, form or language are limited. In this study, we address this gap by proposing that genre may be a productive concept for comprehending textual aspects of e-consultations. We explore the following two questions: (1) what are the generic characteristics of the e-consultation?; and (2) do e-consultations belong to the email genre? Based on an analysis of two Danish corpora of patients’ first turns in e-consultations with their GPs, we identify an underlying move structure: subject, opening, update, problem presentation, request, argumentation, closing. We argue that the e-consultation is an example of an email genre with identifiable conventions, which are both specific to the communicative function of e-consultations and aligned with generic features of emails.

Pregnant women, particularly first-time mothers-to-be, often experience anxiety about the forthcoming birth, as well as feelings of vulnerability and loneliness (McLeish & Redshaw, 2017). There is, at the same time, growing understanding of the importance of wellbeing in healthy pregnancies (WHO, 2016), and that professionals can assist with the psychosocial challenges of transitioning to motherhood (Midwives, 2012). In Denmark, midwife-led group antenatal consultations are used to help pregnant women exchange ideas and create social networks (Brot & Poulsen, 2013). Although the learning that occurs in such settings has previously been investigated (Nisbeth Jensen & Fage-Butler, 2016), we know little about their emotional aspects. The aim of this paper is to explore women’s experiences of interpersonal aspects of encountering other pregnant women in antenatal group consultations. Using a phenomenological interpretative methodology (Smith et al., 2009), I analysed 16 semi-structured interviews of women who had experienced antenatal group consultations in Aarhus, Denmark. Findings reflected two overarching themes: the mainly positive emotional impact of encountering others, as concerns were normalised and fears were assuaged; identification with others where the pregnant body and a common approximate due date generated feelings of solidarity. The findings are discussed in relation to the centrality of corporality to human experience (Merleau-Ponty, 2014 [1974]), responsibility for the other (Levinas, 2006), and the I-Thou basis for relationships (Buber, 1984). This study highlights the emotional value of breaking with the clinical dyad for certain patient groups. References Brot, C., & Poulsen, A. (2013). Anbefalinger for Svangreomsorgen [Recommendations for antenatal care] Retrieved from https://www.sst.dk/da/udgivelser/2015/~/media/C18BD8F183104A8384F80B73B155826D.ashx Buber, M. (1984). I and Thou (R. Gregor-Smith, Trans.). New York: Scribner. Levinas, E. (2006). Humanism of the Other. Chicago, IL: University of Illinois Press. McLeish, J., & Redshaw, M. (2017). Mothers’ accounts of the impact on emotional wellbeing of organised peer support in pregnancy and early parenthood: A qualitative study. BMC Pregnancy and Childbirth, 17(28), 1-14. doi:10.1186/s12884-017-1220-0 Merleau-Ponty, M. (2014 [1974]). Phenomenology of perception (D. A. Landes, Trans.). Abingdon: Routledge. Midwives, R. C. o. (2012). Maternal emotional wellbeing and infant development: A good practice guide for midwives Retrieved from https://www.rcm.org.uk/sites/default/files/Emotional Wellbeing_Guide_WEB.pdf Nisbeth Jensen, M., & Fage-Butler, A. (2016). Antenatal group consultations: Facilitating patient-patient education. Patient Education and Counseling. doi:10.1016/j.pec.2016.07.032 WHO. (2016). WHO recommendations on antenatal care for a positive pregnancy experience Retrieved from http://apps.who.int/iris/bitstream/10665/250796/1/9789241549912-eng.pdf

Lack of sufficient sleep is associated with a range of health consequences (Hillman & Lack, 2013), and is considered a significant public health issue (WHO, 2004). In response to the problem of poor sleep hygiene (Irish, Kline, Gunn, Buysse, & Hall, 2015), some doctors are now prescribing sleep apps to their patients (So, 2014). Given the rapid pace of citizens’ entanglement with these technologies, there is a need for greater focus on the sociocultural implications of these developments, for example, in relation to issues of identity, subjectivity and power (Lupton, 2014, 2015). In this paper, I employ Foucauldian discourse analysis (Foucault, 1972) to analyse the discursive construction of sleep app-users, using as data the “Bedtime” app (iOS 10) for iPhones, pop-up information about using the app on the iPhone, and the app’s promotional video. The main findings are that potential “Bedtime” app-users are constructed as self-determining in some areas yet lacking self-control in others, as needing help, as victims in their life circumstances, as sensitive to stimuli and as quantifiable. I argue that the construction of the m-patient evident in the data has more in common with the biomedical patient than the e-patient (Fage-Butler & Anesa, 2016).

Online health forums provide patients with important, relatively secure spaces for sharing narratives, raising concerns, asking questions, and advising and supporting one another (Sillence 2013), where both “experiential knowledge” (Caron-Flinterman et al. 2005) and shared scientific knowledge are considered valuable informational currency. An aspect raised on online patient forums where knowledge and support are very valuable relates to pregnant women’s decisions regarding the choice of homebirth as opposed to hospital birth, particularly due to women’s concerns that homebirths, while preferable for many personal reasons, may result in greater health risks to both self and baby. This paper contributes to current research into online patient communication by exploring the question: “How do pregnant women discuss the potential risks and benefits associated with homebirths on online patient forums?” It uses a combination of Foucauldian discourse analysis (Willig 2013) and Luhmannian semantic analysis (Andersen 2003) to explore the discursive construction of the risks and gains of homebirth on two open access online forums. Whilst the findings reflect women’s acknowledgement of ongoing political debates regarding health and safety, medicalization and patient empowerment, risks have also intensely personal meanings for women, amongst other things as they relate to the potentially serious impact of personal decisions and attendant culpability. This paper sheds important light on sociocultural debates which also reflect seasoned tensions in professional midwifery - the tensions between the natural and the scientific/medicalized, the normal and the abnormal, and the institutional and the private. It also provides important insights into women’s priorities which can support midwives counselling women, and can be considered an important study of how online forums provide discussion spaces where politically and personally sensitive issues are debated by the decision-makers themselves.

Introduction and objectives: The doctor-patient dyad has constituted the main paradigmatic relationship in Western medicine, and provided a central focus for health communication research and clinical teaching endeavors. With new technologies, other constellations are enabled, such as patient-patient communication, which is increasingly taking place in online patient communities. One novel offline setting which can support patient-patient communication is the group consultation where an individual healthcare professional and a group of patients engage. The purpose of this study is to investigate how patient-patient communication unfolds in a group consultation with a midwife in order to identify its communicative strengths and weaknesses. Methods: Using a sequential multi-methods design, we performed eight individual interviews with pregnant women from a Danish antenatal clinic about their experiences of two group consultations, followed by an observation study of group consultations at the same clinic. Results: Analysis identified the value of placing patients together, as it helped to normalize pregnancy which otherwise can be medicalized in the healthcare setting. The sharing of personal experiences had a reassuring effect, and the power of experiential knowledge became clear when second-time pregnant women shared their experiences with women who were pregnant with their first baby, prompting new sets of questions and answers. Interviewees highlighted the fact that group composition affected their experiences of this consultation mode, and stated that further patient-patient communication could be facilitated in group consultations.Discussion/Implications: Group consultations offer new possibilities in terms of patient engagement, where pregnant women not only participate in their own health and wellbeing, but also in that of others. Further research is necessary to investigate the exciting communicative potential of group consultations and to establish how they can be improved in order to facilitate greater patient involvement. Introduction and objectives: The doctor-patient dyad has constituted the main paradigmatic relationship in Western medicine, and provided a central focus for health communication research and clinical teaching endeavors. With new technologies, other constellations are enabled, such as patient-patient communication, which is increasingly taking place in online patient communities. One novel offline setting which can support patient-patient communication is the group consultation where an individual healthcare professional and a group of patients engage. The purpose of this study is to investigate how patient-patient communication unfolds in a group consultation with a midwife in order to identify its communicative strengths and weaknesses. Methods: Using a sequential multi-methods design, we performed eight individual interviews with pregnant women from a Danish antenatal clinic about their experiences of two group consultations, followed by an observation study of group consultations at the same clinic. Results: Analysis identified the value of placing patients together, as it helped to normalize pregnancy which otherwise can be medicalized in the healthcare setting. The sharing of personal experiences had a reassuring effect, and the power of experiential knowledge became clear when second-time pregnant women shared their experiences with women who were pregnant with their first baby, prompting new sets of questions and answers. Interviewees highlighted the fact that group composition affected their experiences of this consultation mode, and stated that further patient-patient communication could be facilitated in group consultations.Discussion/Implications: Group consultations offer new possibilities in terms of patient engagement, where pregnant women not only participate in their own health and wellbeing, but also in that of others. Further research is necessary to investigate the exciting communicative potential of group consultations and to establish how they can be improved in order to facilitate greater patient involvement.

Critical genre analysis (CGA) investigates the impact of context on genres by analyzing interdiscursivity (the integration of discourses in genres), but there has been a shortage of discussion of specifi c methods. This paper demonstrates that Foucauldian discourse analysis (FDA) - specifi cally, statement function analysis - constitutes a very useful approach with which to analyze interdiscursivity in CGA. Analysis of the move of "priorities/goals" (Cornut et al. 2012) in three strategic plans produced by British hospitals using FDA reveals three main discourses: strategic management, public service accountability, and patient centeredness. As interdiscursive analysis reveals the discursive foundations of organizational practices, CGA is well-positioned to make many valuable contributions to organizational research.

Background and objectives: The group consultation, where a medical professional engages simultaneously with a group of patients, is increasingly being used in healthcare encounters. Its introduction has been associated with two perceived advantages: 1) that it can provide a more economically sustainable way of transferring health information than the individual consultation and 2) that it can deliver positive patient education outcomes such as new opportunities for learning. Whilst the clinical dyad has been the subject of considerable research, there are many empirical and theoretical gaps in our understanding of the group consultation. Our specific focus is on interpersonal communication in group consultations, with specific focus on patient-patient communication. This paper presents findings from a research project on pregnant women’s experiences of group consultations with a midwife in the Danish setting. Methods: Using a sequential mixed methods design, we first performed a discourse analysis of the written materials provided to the women about the group consultations. In the second step, we interview the women about their experiences of the group consultations. Findings: The analysis of the written materials found the juxtaposition of biomedical and patient empowerment discourses; these findings form the backdrop to the interviews, which are currently being undertaken. Conclusions: This study not only presents empirical findings on a relatively new, but increasingly used, setting for client-professional encounters where expertise is distributed among professionals and clients, it also discusses the implications for practice, theory and ethics.

The interpersonal dimension of patient forums: How patients share their knowledge and experiences in response to posted questionsAntoinette Fage-Butler&Matilde Nisbeth JensenThe internet has revolutionized the way that patients acquire medical information, freeing them of reliance on their doctor; seeking out health information online is now the third most popular activity after internet searches and e-mail (Timimi 2012). This paper examines one of these sources of online information, namely, the patient forum where patients provide other patients with information and support on a particular medical condition. Whilst doctor-patient communication in the clinical situation has been the topic of extensive research, very little is known about how patient-patient communication is managed in online situations such as patient forums. The purpose of this paper is thus to address that gap by examining how patients manage the relational and informational (Step et al. 2009: 369) aspects of communication in online patient forums. Whilst a typical minimal interactional structure of the patient forum exchange is question and answer, we focus on responses to questions that have been posted on patient forums.This paper reports on the findings of a thematic analysis (Braun & Clarke 2006) of an online thyroid disease patient forum that investigates how interpersonal aspects are negotiated where patient expertise is involved. We find that biomedical advice is available, often imparted through anecdotes and tips that situate biomedical information in relation to personal experience, whilst relational communication is characterized by expressions of empathy and support that emphasize the commonality of both patients’ experience. We draw on the empirical basis of the paper to discuss a number of implications for existing models of health communication which have yet to catch up with the impact of recent technological developments such as online patient forums. Keywords • Online patient forums• Patient-patient communication• Relationship formationReferencesBraun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77-101. Step, M. M., Rose, J. H., Albert, J. M., Cheruvu, V. K., & Siminoff, L. A. (2009). Modeling patient-centered communication: Oncologist relational communication and patient communication involvement in breast cancer adjuvant therapy decision-making. Patient Education and Counseling, 77, 369-378. Timimi, F.K. (2012). Medicine, morality and health care social media. BMC medicine, 10(1), 83.

Background and objective: Although theoretical perspectives on the doctor-patient relationship have characteristically assumed the temporal and physical co-presence of doctor and patient, the advent of email in doctor-patient communication has brought with it a different communicative reality. New technologies come with significant implications as, amongst other things, they impose practices and identities on participants (Malater 2007). The purpose of this integrative literature review is thus to investigate how the advent of email as a medium of communication affects the doctor-patient relationship. Methods: Using the methodology of the integrative literature review (Whittemore and Knafl 2005), 38 articles identified from database searches from 2002-2012 are grouped and evaluated under three headings: the content of email exchanges, patients’ perspectives on email communication and doctors’ perspectives on email communication. Findings: Analysis reveals that greater enthusiasm is generally more evident amongst patients than doctors for email as a medium of communication. Patients identify numerous advantages with email including the possibility of greater empathy due to the informality of the medium, convenience, freedom from the clinical gaze, pseudo-anonymity and greater opportunities for reflection, whilst doctors express concerns about confidentiality, time and the challenge of conveying empathy electronically. Implications: The impact of email on the doctor-patient relationship has hitherto been addressed obliquely, indicating the need for more research in this area. Empirical work could also valuably support the development of theories that would reflect this new communicative reality, replacing outdated ones.

Ever since the introduction of the ERASMUS program 25 years ago and the adoption of the Bologna Declaration in 1999, universities in what is now the European Union have become increasingly international in terms of their student body and staff composition, a development in part supported by the universities through their discursive construction of themselves, not least on their websites, as international institutions. From a Bourdieuan perspective, this development, which necessarily involves the meeting of a variety of academic traditions, is of great interest in itself. It is also interesting, however, to investigate whether the online constructions are consistent with offline discourses and what the implications might be in terms of, for example, field positioning. This presentation investigates the case of Aarhus University, contrasting its discursive construction of itself as an international institution with the linguistic landscape of the university campus in Aarhus.

There is general consensus amongst patients, academics and regulatory agencies that mandatory PILs, which accompany all medication in the EU, do not communicate effectively with patients. This is problematic as patients have stated that they want to receive information on their medication; they are, moreover, entitled to this information; the information has important health and safety consequences; and ethically it can be argued that PILs ought to be written in a way that respects patients’ needs and vulnerabilities. There are many reasons why PILs fail to communicate effectively with patients. This PhD considers three of these: • the poor communication of risk in PILs • patients’ lack of trust in PILs • the failure of these texts to meet patients’ needs These three aspects are interrelated. Patients have defined the poor communication of risk as being an aspect of these texts not meeting their needs adequately. Trust has been linked to successful risk communication in the literature, and according to trust theory, trust may be a byproduct of discourses of care, whereby receivers’ needs are met. The dissertation is an example of applied research, seeking to identify possible solutions to existing ineffectivities, where ‘The aim is to take theoretical insights and apply these in real-world situations’ (Hart, 1998, p.46). Patient centered communication was chosen as a theoretically-inspired possible solution to the three problems described above. In emphasizing the value and humanity of the patient, patient centeredness seemed a valuable way of addressing patients’ complaints that PILs do not meet their needs. As patients had identified the poor communication of risk as an aspect of these texts not meeting their needs, patient centeredness also offered the possibility of improving the communication of risk in PILs. Moreover, patient centeredness is an empathetic communication style that respects the patient as a human being (Balint, 1969), which can generate trust. One hurdle needed to be overcome, and that was “translating” patient centeredness, which is almost exclusively associated with the interactive situation (Holmström & Röing, 2010), for the medium of print. I performed such a translation by considering the affordances of print as opposed to live interaction, developing the evaluative optic of patient centeredness for texts. The dissertation takes a discursive approach, employing the methodology of Foucauldian discourse analysis to unpack the discourses in PILs. As the problems with PILs are communicative, the approach that is adopted in this PhD is to identify and analyze the discursive correlates of sender, message and receiver. The message relates to the discourses of risk and trust generation (discourses that generate trust). The receiver is the patient, discursively constructed. The sender is reflected in the subject positions that are present in the discourses of risk and trust generation and the discursive construction of the patient. Foucauldian discourse methodology thus offers ways of analyzing these three basic communicative elements. Analyzing these three aspects was undertaken in order to be able to interface the findings of the analysis with the same three aspects in patient centered communication theory. Thus, the subject positions in the discourses revealed the discursive presence of the pharmaceutical companies which could be examined using the patient centeredness theories that related to the sender (often the medical practitioner); the discourses of risk and trust could be analyzed and compared to what is said about the message in patient centeredness theory; and the discursive construction of the patient could be analyzed and related to the patient in patient centeredness theory. Two corpora of PILs from the UK form the objects of analysis in this PhD. The corpora were constructed using two different sampling strategies. Corpus 1 was constructed using the strategy of maximum variation; the result is a corpus (N=14) which is intended to reflect the diversity that is present across the genre. Corpus 2 consists of one PIL that is characterized by greater focus on patients’ needs and greater alignment with the patients’ perspective than one generally finds in the genre, chosen using the strategy of deviant case sampling. The problem statement that drew on the aforementioned elements and provided direction to the dissertation is formulated as follows: On the basis of an empirical investigation using the methodology of Foucauldian discourse analysis, the purpose of this dissertation is to examine PILs from a patient centered perspective, with particular focus on the discourses of risk and trust generation and the discursive construction of the patient, in order to provide better understandings of how these discursive objects are constructed in PILs, and suggest ways in which PILs can become more patient centered. Specifically, this means that the two corpora are analyzed using Foucauldian discourse analysis to identify the components of the discourses. Here, Foucault’s (1972) theories of statement and statement function were pivotal to the analysis. The findings of the analysis were examined relative to theories of risk, trust and the patient (as appropriate), to identify which theoretical perspectives predominated. The findings of the analysis were also examined from the perspective of patient centeredness, to identify which of the statement functions supported patient centeredness. This lead to the production of a list of patient centered statement functions associated with the discourses of risk and trust generation and the discursive construction of the patient. This list of patient centered statement functions is useful as it has applicability: it should help to support the writing of more patient centered PILs. Of course, consideration would need to be given to how these statement functions could convert into expressions in PILs, as statement functions relate to Discourse (Gee, 1996, p.6), rather than to language. The PhD ends by taking an explorative approach to the question of how one might make PILs more patient-centered. This involves taking four of the PILs from Corpus 1, considering the scope for greater patient centeredness in these texts. The list of patient centered statement functions just described, as well as aspects of patient centeredness theory that were not found or were underrepresented in Corpus 1 and 2, are used to examine whether the four PILs in question could become more patient centered. From this it was found that it was more appropriate to include patient centered statement functions in PILs for chronic and psychological conditions (e.g. treatments for rheumatoid arthritis and depression) than for minor, acute, physical conditions (e.g. indigestion and bacterial eye infections). The main practical implication of this finding is that the appropriateness of including greater patient centeredness in PILs seems contingent on the nature of the condition the medication is treating. Empirically, this PhD contributes to PIL research by using discourse analysis to plot significant tracts of the discursive landscape of mandatory PILs, identifying statement functions that support patient centeredness, and indicating the scope for, and constraints on, greater patient centeredness. Theoretically, it contributes to health communication research by undertaking an initial redefinition of patient centeredness theory for the medium of text, and it contributes to trust research by using trust theory to define a means of analyzing trust using a discourse perspective. Methodologically, it contributes to Foucauldian research by clarifying to what extent Foucauldian discourse analysis may be considered a methodology, devising strategies necessary for the analysis, and indicating how Foucauldian discourse analysis can be used to promote understanding of a communication problem.

In the extant literature, there is no shortage of different appreciations of what communication ‘is’ and what communication ‘does’. From a functionalistic perspective, we have the transmission model of communication (e.g., Shannon & Weaver, 1949), from a hermeneutical perspective, we have the interaction model of communication (e.g., Schramm, 1954), and from a social constructivist / social constructionist perspective we have different versions of the transactional model of communication (e.g., Barnlund, 1970; Rogers & Kincaid, 1981). The most recent offspring of the social constructivist / social constructionist take on communication is to view “communication-as-constitutive” (Cooren et al., 2011: 1149). Typically, communication-as-constitutive it is epitomized in the so-called CCO principle. The CCO principle stands for “communication constitutes organization” (e.g. Putnam et al. 2009; Schöneborn, Blaschke 2014). Without delving deeper into the matter at this point, let it suffice to say that – for various reasons – for the CCO principle, ‘social reality’ is subsumed under “organization”. In my paper, I will take my point of departure in the CCO principle, as it is undoubtedly the current capstone of communication theory, I will, however, do so from a critical perspective. My point of departure will be a critical reading of formative papers from within the three schools of thought that currently dominate the CCO conversation. That is, the school of thought that propagates elements of speech act theory, primarily of a Searlean persuasion (e.g., Coreen, 2000), the school that builds on Giddens’ structuration theory (e.g., McPhee & Zaug, 2000), and the school that adheres to a Luhmannian legacy (e.g., Blaschke et al., 2012). Using my critical remarks as stepping stones, I will go on to present a radical constructivist (von Glasersfeld, 2015[1995]) view on communication that takes into consideration what communication ‘is’ and what it ‘does´ as seen from the perspective of Knowledge Communication. The paper ends with this appreciation of communication being modelled under the caption of co-actional communication. Barnlund DC 1970. A transactional model of communication. In: Sereno KK and Mortensen, CD (eds.) Foundations of Communication Theory. New York: Harper, 83-102.Blaschke, S.; Schöneborn, D.; Seid, D. 2012. Organizations as networks of communication episodes: Turning the network perspective inside out. Organization Studies, 33, 879-906.Coreen, Francois 2000. The Organizing Property of Communication. John Benjamins. Coreen, Francois; Kuhn, Timothy; Cornelissen, Joep P.; Clark, Timothy 2011. Communicating, Organizing and Organization: An Overview and Introduction to the Special Issue. Organization Studies, 32(9), 1149-1170.McPhee, Robert D.; Zaug, Pamela 2000. The Communicative Constitution of Organizations: A Framework for Explanation. The Electronic Journal of Communication, 10(1 and 2), 1-13.Rogers, Everett M.; Kincaid, Lawrence D. 1981. Communication networks: toward a new paradigm for research. University of Michigan: Free Press. Shannon, Claude; Weaver, Warren 1949. The mathematical theory of communication. Urbana: University of Illinois Press. Schramm, Wilbur L. 1954. The process and effects of mass communication. Urbana: University of Illinois Press.Putnam, Linda L.; Nicotera, Anne M.; McPhee, Robert D. 2009. Communication Constitutes Organizations. In: Putnam, L. L. & Nicotera, Anne M. (eds.) Building Theories of Organizations: The Constitutive Role of Communication. New York: Routledge, 1-20.Schöneborn, Dennis; Blaschke, Steffen 2014. The Three schools of CCO thinking: interactive dialogue and systematic comparison. Management Communication Quarterly 28(2): 285-316.von Glasersfeld, Ernst 2015[1995]. Radikaler Konstruktivismus : Ideen, Ergebnisse, Probleme. Frankfurt am Main: Suhrkamp.