Exploring communication and men’s health service use on an Australian health helpline

Abstract

The present thesis qualitatively examines a corpus of 196 calls to an Australian health helpline. The analysis focuses on exploring how the social action of delivering healthcare at a distance via telehealth (like helplines) is accomplished, as well as investigating the ways in which men, specifically, seek help using helplines. Telehealth is an emerging area of health service delivery that is growing in popularity due to its accessibility for patients who cannot or choose not to attend medical visits in-person. Health helplines are one form of telehealth that involves the provision of health information and advice over-the-telephone. Helplines exist for a huge number of health concerns, ranging from general counselling to more specialised medical information and support. Some helplines offer similar services to primary case consultations; for example, triage, physical assessment, and medical advice provision. However, helplines differ from face-to-face medical services due to the absence of visibility and reliance on verbal communication in order to accomplish the social action of help-seeking and healthcare provision. The ways in which helplines overcome this absence of visibility in order to deliver healthcare is not well reported in the current literature. In addition to this gap in knowledge, there is also little research that specifically explores men’s use of health helpline services. Men have been highlighted as a group who have much to benefit from telehealth services due to the consistent low uptake of traditional healthcare services by men globally. In contrast to traditional healthcare services, helplines are argued to suit men’s help-seeking preferences due to offering access to low cost, expert medical advice without the need to visit services in-person. Little is known, however, about how men use helplines for their healthcare needs. The analyses in the present thesis aim to bridge the gaps in knowledge described above. Conversation Analysis and Thematic Analysis were used, respectively, to analyse men’s calls to the Australian government-funded health helpline, Healthdirect Australia. These qualitative approaches were selected as they allowed for a focus on the social patterns and themes that underlie healthcare delivery and help-seeking. This thesis consists of three analytic chapters that explore the social actions, interactional strategies, and help-seeking behaviours deployed in the helpline data. The analytic findings indicate that: • Health helpline calls are highly structured medical encounters that have a similar organisational structure to primary care encounters (e.g., consist of problem-presentation, information-gathering, assessment, etc.), but also have inherent differences due to the nature of telephonic interaction and system design; • Specific social actions associated with medical encounters, like physical examination, require modification in order to be accomplished successfully in a health helpline environment; • Men’s actual health help-seeking behaviours are more versatile than the current rhetoric surrounding men’s health would suggest, which routinely positions men as a homogenous group who are disengaged from healthcare and reluctant to seek help for medical issues. The findings presented in the present thesis have important consequences for both clinical practice and future research. In terms of clinical practice, many of the findings included in the present thesis have practical applicability to telehealth service and call-taker training. Training call-takers to be mindful of the language they use when initiating medical tasks that may not be intuitive to callers is important for smooth call progression, and (if done well) could mitigate the need for frontline staff to manage administrative tasks. In addition, assisting call-takers to be more competent around collaboratively accomplishing self-examination may also lead to an increase in telehealth service use, as a lack of confidence in this area can prevent clinicians from offering telehealth such services. In terms of research, the present thesis highlighted the importance of examining naturally occurring instances of health interaction, particularly for the investigation of men’s help-seeking behaviours. The findings derived from men’s actual health interactions suggest that there is far more versatility within men’s help-seeking than mainstream literature suggests. Future research may build upon the findings in the present thesis by examining other interactional practices associated with successful telehealth delivery, as well as exploring the impact of cohort differences (e.g., age) on men’s health behaviours.