Nonverbal behaviors during expressions of resistance in provider-patient interactions about diet, nutrition, and lifestyle changes: An integration with assessment of individual risk for heart attack

The provider-patient interaction often involves negotiations that extend beyond biomedical information and involve responding to patient cues. Nonverbal behavior provides cues to patient comfort and willingness to move forward with next steps in treatment, particularly when next steps in negotiation mean responding to customized risk information in ways that fit patient lifestyle. Nonverbal behavior provides cues that contextualize the ways the illness is connected to the patients' roles and relationships, and cues that indicate emotional responses and patient resistance to the provider's suggestions. This project examines the role of nonverbal communication behavior during moments of expressed resistance in videotaped interactions (N=168) between medical students and standardized patient educators in interactions involving diet, nutrition, and lifestyle changes in a case where an overweight, middle-aged male is concerned about his risk for a heart attack. Qualitative thematic analysis and examples illustrate the implications for recognizing what is left unspoken in the provider-patient interactions, and provides evidence that the unspoken dialogue betters predict ultimate outcomes than the direct verbal cues. Lifestyle behaviors, including diet and exercise, can be sensitive and emotionally charged subjects for patients to discuss with their physicians. Because of the sensitivity, nonverbal communication behaviors are likely to provide a more accurate insight into patient response than directly stated verbal behaviors. By examining the nonverbal behaviors during expressions of resistance during discussions about lifestyle behaviors, we are able to qualitatively describe the subtle nuances of these relationships and the ways nonverbal behaviors functions to contextualize subsequent impact on health outcomes.