Does language matter for health outcomes in behaviour change interventions?

This dissertation aims to identify the challenges of the current approach to fidelity of delivery in behaviour change interventions and to show how a linguistic and interactional approach can provide insights into the communicative aspects of content delivery of interventions. The aims are pursued through three research studies investigating face-to-face video-mediated interactions in a behaviour change intervention for pregnant women at risk of developing gestational diabetes mellitus. The data comes from recordings from a larger randomised controlled trial project that aims to investigate the implementation and effectiveness of an mHealth-supported behaviour change coaching program. The focus of the dissertation is to investigate whether there is a correlation between how health coaches communicate with pregnant women and pregnant women’s motivation to engage in lifestyle changes to reduce the risk of developing gestational diabetes. The dissertation thus wants to contribute to the existing knowledge and assumptions about patient-centred communication and behaviour change interventions. The main objective of Study 1 is to describe the current research-based methodology for developing and delivering behaviour change interventions by reviewing pertinent literature within the research domain. The study reveals that the current approach to communication is monologic. Research on the fidelity of content delivery in behaviour change interventions relies on behaviour change techniques without considering clients' reception of these techniques in a sequential context. The study further discusses the need to focus on the expressed emotions by clients in behaviour change interventions. Study 2 investigates interactional data from a behaviour change intervention, focusing on clients’ emotional displays and health coaches’ responsiveness to the emotional displays. The study uses the method of The Verona Coding Definitions of Emotional Sequences. By extending the sequential angle in counselling sequences, the study finds a correlation between empathic and emotion-acknowledging responses to clients' expressed emotions and clients' engagement with the intervention.

Using Systemic Functional Linguistics, Study 3 examines the grammar of clients' expressed emotions and one coach's response in counselling sequences from Study 2. The study aims to clarify whether the extent of patient-centeredness in the coach's response can be identified in her linguistic choices. Thus, the study discusses the linguistic choices made by the coach to adapt to clients' choices. In the analysis, parts of the mentalization theory are included eclectically, as these are seen to be linguistically reflected. The parts seem to be linked to both interpersonal and intrapersonal skills arising through conversation and are typically observable in interactions.

Overall, this dissertation aims to identify and clarify the potential of the linguistic how rather than the linguistic what concerning the delivery of intervention content. The dissertation finds that the ability of professionals to make intervention content accessible and feasible for the individual client's conditions and needs is attributable to a dialogic, patient-centred, and emotion-acknowledging approach evident through language choices and responsiveness.