Health literacy in clinical consultations: a case study about patient-nurse communication in a Norwegian rheumatology clinic

Background Health literacy refers to how people acquire, understand, communicate, and act on health information to improve their health.Aims The study aims to examine how health literacy manifests communicatively in patient-nurse consultations.Methods The study design is qualitative, with observational data from 10 video recordings of nurse-patient follow-up consultations in a rheumatology clinic. With a theme-oriented discourse analytic approach, we study health literacy in the interaction between the nurse and patient. The study combines analytic themes from professional discourse studies (frames, facework, rhetoric devices) with focal themes relevant to professional practice (knowledge types). It examines three representative examples to analyze how health literacy manifests in interaction.Results The analyses show how nurses and patients negotiate patients’ knowledge in relation to medical professional and nonprofessional frames during the consultation. Different knowledge types manifest communicatively, for example embodied, monitoring, and navigating knowledge. The nurses allow patients′ narratives; through facework, they negotiate, reformulate and expand the patients’ knowledge.Discussion Patients health literacy is expressed in their interactions with the nurses in the clinic and includes aspects regarding the patient self, institutional and professional aspects of the system, and social and cultural aspects of the community. The insights provided by this study may increase nurses’ awareness of how to nuance and activate patients’ health literacy throughout the consultation. The study enriches ethnographically based communication research on health literacy by integrating a discourse analytic approach with nuanced types of knowledge and illustrative examples from authentic cases.