title: Real-time feedback on nonverbal clinical communication. Theoretical framework and clinician acceptance of ambient visual design.
abstract: BACKGROUND
  This article is part of the focus theme of Methods of Information in Medicine on "Pervasive Intelligent Technologies for Health".
  
  
  BACKGROUND
  Effective nonverbal communication between patients and clinicians fosters both the delivery of empathic patient-centered care and positive patient outcomes. Although nonverbal skill training is a recognized need, few efforts to enhance patient-clinician communication provide visual feedback on nonverbal aspects of the clinical encounter.
  
  
  OBJECTIVE
  We describe a novel approach that uses social signal processing technology (SSP) to capture nonverbal cues in real time and to display ambient visual feedback on control and affiliation--two primary, yet distinct dimensions of interpersonal nonverbal communication. To examine the design and clinician acceptance of ambient visual feedback on nonverbal communication, we 1) formulated a model of relational communication to ground SSP and 2) conducted a formative user study using mixed methods to explore the design of visual feedback.
  
  
  METHODS
  Based on a model of relational communication, we reviewed interpersonal communication research to map nonverbal cues to signals of affiliation and control evidenced in patient-clinician interaction. Corresponding with our formulation of this theoretical framework, we designed ambient real-time visualizations that reflect variations of affiliation and control. To explore clinicians' acceptance of this visual feedback, we conducted a lab study using the Wizard-of-Oz technique to simulate system use with 16 healthcare professionals. We followed up with seven of those participants through interviews to iterate on the design with a revised visualization that addressed emergent design considerations.
  
  
  RESULTS
  Ambient visual feedback on non- verbal communication provides a theoretically grounded and acceptable way to provide clinicians with awareness of their nonverbal communication style. We provide implications for the design of such visual feedback that encourages empathic patient-centered communication and include considerations of metaphor, color, size, position, and timing of feedback.
  
  
  CONCLUSIONS
  Ambient visual feedback from SSP holds promise as an acceptable means for facilitating empathic patient-centered nonverbal communication.
authors: Andrea Hartzler, PhD, The Information School, Box 352840 Mary Gates Hall, Ste 370, University of Washington, Seattle, WA 98195-2840, USA, E-mail: andreah@uw.edu.
authors: A L
authors: AL
authors: Hartzler
authors: R A
authors: RA
authors: Patel
authors: M
authors: M
authors: Czerwinski
authors: W
authors: W
authors: Pratt
authors: A
authors: A
authors: Roseway
authors: N
authors: N
authors: Chandrasekaran
authors: A
authors: A
authors: Back
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005246:Feedback; D005260:Female; D006282:Health Personnel; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009633:Nonverbal Communication; D019370:Observation; D010817:Physician-Patient Relations; D057566:Self Report; D055815:Young Adult
keywords: Nonverbal communication; feedback; formative evaluation; information display; patient-provider communication; social signal processing; user-computer interface