I’m Jamie, an undergraduate studying Psychology and Linguistics at the University of Oxford. Having decided that being employed post-graduation would be ideal, I’d been looking around for internships that would help me explore the career paths I’m interested in, one of which is research. 

I wanted to understand the process of producing research (especially that relating to Psychology and Linguistics) and get an early idea of whether this path is right for me, making my summer research internship in the Health Communication and Behaviour Change Team at Oxford, supervised by Dr Charlotte Albury, very fitting – as the title states, they focus on Health Communication, which seemed to be an opportunity to explore the more applied side of Linguistics in a way that was directly beneficial to public health. I was also drawn to the Team’s qualitative approach, as I’ve been exposed mainly to research that uses quantitative methods almost exclusively and felt that a different perspective would be very valuable. 

From this internship, I had my first experience of conversation analysis, doing preliminary examinations of conversation transcripts from a clinical trial. I also participated in an introductory class to qualitative methods (a complete paradigm shift).

Any interesting preliminary observations from the transcripts?

I analysed real clinical conversations from a clinical trial where GPs offered weight loss advice to people living with obesity. Some GPs were able to offer free referrals for their patients to access dedicated support, whilst others could only give brief advice (reflecting the variability of what’s currently available through the NHS). Such advice was justified by referencing the specific risks of obesity – such as increased chance of diabetes or heart disease. An example of this can be seen in the transcript below, where the clinician specifically mentions diabetes as a health risk.

On the other hand, GPs that were able to offer a free referral to a weight-loss group (e.g., Slimming World) tended not to mention specific risks (unless the patient had pre-existing conditions, in which case these issues were referenced), merely stating that losing weight was beneficial. In the second example below, the clinician (the same one as in the other transcript) does not mention specific health risks. Instead, they state that the patient’s BMI is ‘very scary’ and seems to replace talking about specific health risks with the weight-loss referral.

It was as if GPs that had no interventions to offer felt the need to compensate for the lack of beneficial information they were able to give by justifying their advice in great detail, while those that were able to offer the referral didn’t feel such pressure. 

So maybe this difference can be explained by the need to avoid what conversation analysts call ‘interactional trouble’: needing to provide a certain ‘threshold’ of information for the contact to be seen as worthwhile. Other ways of managing interactional troubles (understandably prominent in discussions about weight) included the question tag ‘alright?’ and humour on both the part of the patient and GP, some in the form of jokes which varied greatly in quality. I was also surprised to see that imperatives were avoided – maybe to neutralise the paternalistic quality that consultations can easily take on. It’s possible that the interactional troubles present in these conversations have different sources despite their identical settings: the need for an exchange to be sufficiently beneficial for all parties, and levelling the possible power imbalances in interactions.

Nice. How has this experience helped you? What have you learned?

Ironically (given the focus of the internship), this is quite hard to express!

I’ve gained a much more balanced view on what academic research is like, and my skillset has been beefed up with methods of conversation analysis and an introductory grasp of qualitative methods. At first, it was unsettling to see that many clinicians didn’t follow the advice structure they were told to use (reflecting that participants in trials, despite being given scripts or templates, sometimes modify their speech according to the specifics of the interaction). It felt like ‘losing’ such a control variable made the collected results unreliable.

But this ‘complication’ turns out to be beneficial when considering the nature of real interactions – interactions shaped by the unique specifics of each situation. Then, deviations from researcher instructions can in fact give us insights into how conversations and their effects are constructed! This is a view that’s very different from what I’d perceived science (in Psychology, Linguistics, etc.) to be, and it’s exciting to have another perspective from which to consider. Real life is invaluable, especially when studying social phenomena, and this is a perspective that I now try to integrate into all the new topics I learn. 

And as I imagine it is with much health-related research, it’s been so rewarding to know what’s being done will directly benefit people. It’s also amazing that findings can be discovered just from examining transcripts – conversations that have already happened. Maybe more of the answers we look for are embedded in what has already been said – we need only look closer.