Communication is the primary tool of all health, nutrition, and wellness educators, coaches, and counselors. Communication is also a skill that health professionals can develop to improve their client relationships and overall success.
Unlike informal, daily communication with friends and family, communication in a healthcare environment, including health coaching and counseling, must be carefully thought out and practiced. There are multiple communication interactions that must take place before clients begin to work toward their desired health behaviors, and communication with their support network continues to have a central role in their success.
What, exactly, does health communication entail? What are some of the components of effective communication that health, wellness, and nutrition coaches and counselors can practice and implement?
This article introduces you to a model of health communication to better understand what takes place as you interact with your client. Then it offers five components of health communication as presented by health education and counseling experts.
The Model of Health Communication
All forms of verbal communication, and many forms of written communication, can be divided into a four-step process that repeats itself as a cycle.
Dr. Thomas Gordon summarizes these steps succinctly:
- The speaker says words.
- The listener hears the speaker’s words.
- The listener decodes the speaker’s words, meaning the listener forms an idea about what they thought the speaker meant.
- The listener processes the information further, often with a back and forth with the speaker, to come closer to understanding what the speaker actually meant.
In health communication, and in communication in general, the speaker’s intended message can be distorted in three different ways:
- First, the speaker’s words may not have been heard properly by the listener. Maybe there are distractions, language and pronunciation differences, or loud noises.
- Second, the speaker may not communicate clearly due to difficulty expressing thoughts. This can occur due to language limitations or dealing with complex emotions, ideas, or thoughts the speaker has not fully processed.
- Third, the listener can distort the message during the decoding process, which is when the listener analyzes and forms conclusions about what the speaker is trying to communicate. During the decoding process, biases and past experiences can have a strong influence on the listener’s interpretation of the speaker’s message.
Nutrition, health, and wellness counselors and coaches can avoid some of the communication roadblocks by implementing the key components of effective communication and counseling explained in the next section.
Key Components in Effective Communication in Counseling and Coaching
Note: These components described below are based on the text Nutrition Counseling & Education Skill Development by Kathleen D. Bauer and Doreen Liou. This is also the text used in several AFPA certifications courses.
Use Counseling Focuses and Intentions When Formulating Responses
When you communicate with your client during a coaching or counseling session, it is not like having a conversation with a friend or family member. It is important that you modify casual communication behaviors like talking about yourself, making exaggerated facial or verbal expressions, and being quick to fill in the silence with questions, comments, or anecdotes. When your client shares information with you or asks a question, you can formulate your response by first identifying a counseling focus and intent.
A counseling focus is where you place your emphasis on a response during a counseling and education session. The focus should align with the wider counseling objectives or what your client, with your support, wants to achieve in your counseling sessions.
A counseling intent (or intention) is the rationale for selecting a particular response.
The counseling focus and intent should both align with the counseling focus, trauma-informed communication principles, and your personal communication style.
Counseling response intents can fall into three main categories:
- To acknowledge. You might choose to affirm, show respect, identify observations, rephrase what you are hearing, and affirm the worthiness and importance of your client’s feelings and experiences. Here, you may want to build your relationship further, encourage your client to continue talking, and build rapport.
Example: I hear you saying that your doctor didn’t acknowledge your knee pain, even though that is why you set the appointment. That must have been frustrating.
- To explore. If you want to clarify an idea, obtain more information, or gain deeper insight, you might want to ask questions, provide information and ask for their thoughts, or ask for clarification.
Example: You mentioned that you don’t feel safe going to the gym in the community center to exercise. Would you feel comfortable elaborating more on why you feel unsafe?
- To challenge. If you recognize an opportunity for your client to think critically about their thoughts or actions, recognize contradictions, or want them to think about taking a different course of action, then your response intent could be to respectfully challenge your client.
Example: Thank you for sharing your frustrations with the number of servings of vegetables in the weekly meal plan your dietitian gave you. I see here in your food frequency questionnaire that you were accustomed to eating the same number of servings of vegetables before starting your meal plan. Has something changed? Or is there something else about the meal plan that is bothering you?
Use Effective Nonverbal Communication and Behavior
Body language researcher Albert Mehrabian was one of the first scientists to break down the components of face-to-face conversation. He found that communication is 55% nonverbal, 38% vocal, and 7% words only.
Vocal communication includes elements like volume, stress, inflection, and speed. Nonverbal communication includes body language, eye contact, facial expressions, gestures, energy level, posture, and even the space you leave between yourself and another person.
In general, people tend to trust nonverbal behavior more than verbal communication because so much of our body language and facial expression is not under conscious control.
As health coaches and counselors, it is imperative that you learn to be aware of your nonverbal communication and adopt behaviors that are conducive to building trust and rapport with your client.
Here are some examples of nonverbal modes of communication and ineffective and effective behaviors for health counselors and coaches:
- Space: Ineffective behaviors would be leaving too much space or getting too close. Effective behaviors would be approximately arm's length or the distance your client communicates is comfortable for them.
- Posture: Ineffective behaviors would be slouching, too rigid, or leaning away from your client. Relaxed, attentive posture with a slight lean toward your client communicates open ears and focus on the client.
- Eye contact: Ineffective behaviors include absence (such as looking down at notes or your cellphone for long periods of time).
- Facial expression: Ineffective behaviors may include facial expressions that do not match your feelings, a scowl, or a blank, absent look. Effective behaviors would be facial expressions that match your or your client’s feelings or a relaxed smile.
Harmonize Verbal and Nonverbal Behavior
Coaches and counselors can practice harmonizing their body language with that of their client. This is referred to as synchrony.
Synchrony is a popular sales technique to establish rapport with potential clients. This is because when you mirror your client’s body language, volume, and silence, you increase your client’s sensitivity and communicate empathy.
Do not mirror your client’s nonverbal behavior to the extreme or to a point where it appears you are trying to be more like them than yourself or mocking your client.
Analyze Nonverbal Communication Behavior in Your Client
Just like your client will consciously or subconsciously be aware of your nonverbal communication, you should make a point to make note of your client’s nonverbal communication behavior. By observing their nonverbal communication, you will gain clues about what your client is thinking or feeling.
Take a few moments to think about what some of the following nonverbal behaviors might mean about a person’s thoughts or feelings:
- Crossed arms
- Clenched fists
- Eyes wide and eyebrows raised
- Lack of eye contact
- Shaking head
- Biting the lip
- Tapping feet
- Sitting on the edge of the seat
Nonverbal communication norms differ across cultures and can also be a reflection of habit or of a health condition. For example, you might think that a client who is sweating profusely is very nervous, but they may have a thyroid disorder or be experiencing hot flashes.
In this sense, it is important that coaches do not jump to conclusions when observing nonverbal communication but instead use them as clues. When appropriate, and with their permission, you can ask about nonverbal behaviors you may notice.
Identify and Minimize Communication Roadblocks
Communication roadblocks are obstacles individuals put up that block communication, depth, and exploration of certain topics. They are the antithesis to the principles of motivational interviewing.
For health, wellness, and nutrition counselors and coaches, communication roadblocks could include imposing their own views, opinions, biases, judgments, experiences, and prejudices on clients. They dismiss the client’s experiences, opinions, values, and emotions and place the counselor’s or coach’s as the ultimate truth.
Some examples of roadblocks include:
- Ordering or commanding
- Warning or threatening
- Giving unsolicited advice
- Moralizing or preaching
- Withdrawing, distracting, or changing the subject
In certain circumstances, some roadblocks are appropriate if you feel the counseling session needs to take a new direction. Try to avoid using roadblocks abruptly, and only do so after you have listened to your client and understood their message.
Nonverbal, vocal, and oral communication work together to send messages to others. Listeners interpret these elements consciously and subconsciously and then process them to understand others, form their own opinions, and decide how to respond.
For health educators, counselors, and coaches, this process must be taken very seriously, as it is a central element in supporting clients to adopt healthy behavior changes.
In this article, you learned about the central elements of health communication, and you learned about some of the components that can help you be a more effective listener and speaker. These skills are further developed in AFPA’s coaching and counseling certifications.
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