Discursive features of health worker-patient discourses in four Western Cape HIV/AIDS clinics where English is the lingua franca

Njweipi-Kongor, Diana Benyuei (2012-12)

Thesis (PhD)--Stellenbosch University, 2012.

Thesis

ENGLISH ABSTRACT: This is a qualitative analytical study that investigates the use of English as lingua franca (ELF) between doctors and patients with different L1 at four different HIV/AIDS clinics in the Western Cape. The study addresses a gap in medical research, especially in the field of HIV/AIDS, namely, a lack of sufficient data-driven analytical investigation into the linguistic and conversational nature of doctor-patient communication in ELF in this setting in South Africa. A literature review contextualises ELF, discourse analysis (DA), conversation analysis (CA) and genre theory providing a theoretical framework for the study. The methodology involves audio-recording and transcription of HIV/AIDS consultations conducted in ELF. From the genre perspective, the study investigates the different genres in and determines if HIV/AIDS consultations are a sub-genre of medical discourses. DA investigates what contextual, socio-cultural linguistic features characterise medical interaction in this multilingual context and what ELF linguistic strategies participants use to signal and resolve misunderstanding. CA investigates the turn organisation and turn-taking patterns in the consultations to assess participants’ contributions and identify different types of sequences that characterise them, aiming to understand how they enable the interactants play their roles as doctors and patients. The results reveal that HIV/AIDS consultations exhibit formal features of doctor-patient consultations in general and intertextually revert to other oral genres leading to the conclusion that, considering their purpose, participants and context, HIV/AIDS consultations are like all medical consultations and are a sub-genre of medical discourse. The macro analysis reveals that the interactants’ socio-cultural and multi-linguistic backgrounds do positively influence the nature of the interaction in this context as it highlights characteristic linguistic features of ELF usage like borrowing, linguistic transference from L1, the use of analogy, code-switching and local metaphors all resulting from processes of indigenisation and hybridisation. The results reveal few instances of misunderstanding, concurring with earlier studies that problems of miscommunication may be minimal when two languages and/or cultural groups interact. The micro analysis reveals that the turns in the consultation follow the pre-selection and recurrent speakership patterns and that despite the advocacy for partnership between doctors and patients in their contribution and negotiation of outcomes, the doctor unavoidably remains the dominant partner. S/he determines the course of the consultation by initiating more turns, asking most of the questions and often unilaterally deciding on topic changes. S/he has longer talking time than the patient in the sequences and the physical examination and prescription phases of the consultation while the patient is mostly portrayed almost as a docile participant yielding to the doctor’s requests and taking very little if any initiative of his/her own to communicate his/her views and desires. The study reveals instances of both patient and doctor initiated repair to resolve any misunderstanding, which improves the quality of the interaction and its outcomes such as adherence and treatment follow-up. The study further highlights the challenges faced in the field which impacted on the data, the most crucial being the complicated but necessary ethical procedures required to get participants’ consent to participate in the study.

AFRIKAANSE OPSOMMING: Hierdie kwalitatiewe analitiese studie ondersoek die gebruik van Engels as lingua franca (ELF) tussen dokters en pasiënte met verskillende eerstetaal (T1) by vier verskillende MIV/vigs-klinieke in die Wes-Kaap. Die studie werp die soeklig op ʼn leemte in mediese navorsing, veral op MIV/vigs-gebied, en bring ʼn gebrek aan datagedrewe analitiese ondersoek na die taalkundige en gespreksaard van dokter-pasiënt-kommunikasie in ELF in hierdie omgewing in Suid-Afrika aan die lig. ʼn Literatuuroorsig van navorsing kontekstualiseer ELF, genre-teorie, diskoersanalise (DA) en gespreksanalise (GA), en bied ʼn teoretiese raamwerk vir die studie. Die navorsingsmetode behels oudio-opnames en transkripsie van MIV/vigs-konsultasies in ELF. Uit die genre-oogpunt bestudeer die navorsing die verskillende genres in MIV-konsultasies, en bepaal of dié konsultasies as ʼn subgenre van mediese diskoers beskou kan word. Met behulp van DA stel die studie vas watter kontekstuele, sosiokulturele taaleienskappe mediese interaksie in hierdie veeltalige konteks kenmerk, en watter ELF-taalstrategieë deelnemers gebruik om misverstande aan te dui en op te los. Daarna ondersoek GA die beurtorganisasie en beurtmaakpatrone in die konsultasies, om deelnemers se bydraes te beoordeel en verskillende soorte kenmerkende sekwensies uit te wys, en uiteindelik te begryp hoe dít die onderskeie partye in staat stel om hul rolle as dokters en pasiënte te vervul. Die bevindinge dui daarop dat MIV-konsultasies formele kenmerke van dokter-pasiënt-konsultasies in die algemeen toon en intertekstueel by ander mondelinge genres aansluit. Dít lei tot die gevolgtrekking dat, gedagtig aan die doel, deelnemers en konteks, MIV-konsultasies soos enige ander mediese konsultasie is en as ʼn subgenre van mediese diskoers beskou kan word. Die makro-analise (DA) toon dat die onderskeie gespreksdeelnemers se sosiokulturele en veeltalige agtergronde ʼn positiewe uitwerking het op die aard van die wisselwerking in hierdie konteks, aangesien dit kenmerkende taalkundige eienskappe van ELF-gebruik, soos leenwoorde, taaloordrag vanaf die L1, die gebruik van analogie, koderuiling en plaaslike metafore, beklemtoon. Al hierdie eienskappe spruit uit prosesse van verinheemsing en hibridisering. Die studie toon min gevalle van misverstand, wat met die resultate van vorige navorsing ooreenstem, naamlik dat probleme van wankommunikasie minimaal is wanneer twee tale en/of kultuurgroepe met mekaar omgaan. Die mikro-ontleding (GA) dui daarop dat die beurte in die konsultasie die preseleksie- en herhalende sprekerspatrone volg en dat, ondanks die voorspraak vir ʼn vennootskap tussen dokters en pasiënte in hul bydraes en bedinging van uitkomste, die dokter onvermydelik die dominante vennoot bly. Hy/sy bepaal die verloop van die konsultasie deur meer beurte aan te voer, die meeste vrae te stel en dikwels eensydig te besluit om die onderwerp te verander. Hy/sy het ook ʼn langer spreekbeurt as die pasiënt in die gespreksekwensies sowel as in die fisiese-ondersoek- en voorskriffases van die konsultasie. Daarenteen word die pasiënt merendeels as ʼn bykans gedweë deelnemer uitgebeeld wat aan die dokter se versoeke toegee en weinig of geen eie inisiatief aan die dag lê om sy/haar sienings en behoeftes oor te dra. Die studie toon ook gevalle van sowel pasiënt- as dokteraangevoerde herstel om enige misverstand uit die weg te ruim, wat die gehalte van die wisselwerking én die uitkomste daarvan, soos behandelingsgetrouheid en nasorg, verbeter. Die navorsing beklemtoon voorts die gebiedspesifieke uitdagings wat die data beïnvloed. Die belangrikste hiervan is die ingewikkelde dog nodige etiese prosedures wat vereis word om persone se toestemming tot studiedeelname te verkry.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/71733
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