Q&A: Healthline Media creates language guide to destigmatize health topics

Healthline Media recently announced the launch of its Conscious Language Guide, a tool that health care professionals can use to communicate with patients in a more “empathetic and non-stigmatizing” way, according to the organization.

The guide includes specific language suggestions for 11 health-related topics: autism; disability; food access and availability; food security; HIV; mental health; racism, race and ethnicity; sex and sexual health; sex vs. gender; substance use; and suicide.

“Conscious language isn’t about limiting what people can say, it’s about expanding representation and ultimately improving people’s health,” Dria Barnes, senior vice president of content and brand strategy at Healthline Media, said in a company press release. “Greater awareness of the words we use can help create a more humane, inclusive and effective health care system.”

Healio Primary Care spoke with Barnes and Bella De Soriano, senior manager of Public Health Integrity, Medical Affairs, at Healthline Media, to learn more about the purpose of the Conscious Language Guide, how it was developed, what physicians should know about it, and more.

Healio Primary Care: What is “conscious language,” and why did your organization develop a guide to promote it?

Barnes: Healthline Media defines conscious language as the intentional use of words and terms to create empathetic, inclusive and non-stigmatizing content. We are intentional in how we phrase and frame health topics so we don’t perpetuate bias that can contribute to health inequities and stigma.

Conscious language is about expanding representation and being intentional with our words, always with the goal of helping people improve their health and well-being.

We developed this guide first as an internal document, primarily for the editors and writers of Healthline Media’s brands that include Healthline, MedicalNewsToday, Psych Central and Greatist, so we can speak with our audience in a consistent way that’s person-, identity-, and empathy-first. Our audience is on a journey of health and well-being, and we want to be right there with them. And by showing the audience how we do that, we hope this work can be unifying for others to use against stereotypes, discrimination and harmful health narratives.

Healio Primary Care: How does conscious language improve communication between health care providers and patients?

Barnes: When a health care provider meets a person on their emotional level, greater trust results and can expedite physical healing. Using conscious language helps create an empathetic, inclusive and non-stigmatizing space for patients.

De Soriano: Conscious language also helps to see the person in their lived context to understand how the social determinants of health are important factors in a person’s health behaviors. These include the quality and availability of education, employment and health care as well as a person’s social and physical environments. Using conscious language to understand the social determinants for a patient can help improve patient-provider communication and be a way to work towards health equity.

Healio Primary Care: Can you give an example of how research has shown that careless words from health care providers can affect patients’ mental and physical health?

De Soriano: Unintentionally careless words can have an effect on both the provider and the patient. Language can influence how providers perceive people, which can influence clinical decision making. For patients, language choices that imply individual blame can lead to feelings of shame and judgement, which can be deterrents to taking medications as prescribed, seeking care and engaging with health care at all. On the clinician side, a study from the International Journal of Drug Policy surveyed 500 clinicians after they read vignettes using either the term “substance abuser” or “having a substance use disorder.” They found that those clinicians who read the vignette containing “substance user” agreed more often that punitive action should be taken.

On the patient side, qualitative interviews exploring barriers to lung cancer diagnosis found that patients wanted to wait to stop smoking before seeing a clinician as they were concerned with being blamed for their cancer or judged for still smoking while simultaneously seeking treatment. This can lead to worse outcomes as lung cancer is often already diagnosed at the later stages of the condition.

The importance of language goes even beyond the verbal patient-provider communication. Even language used in medical records has the ability to create a stereotyped and stigmatized patient narrative that follows a person throughout their health journey, which can negatively affect patient health. A study from the Journal of General Internal Medicine found that stigmatized language used in medical records was more associated with negative attitudes towards the patient.

Healio Primary Care: How were the guidelines developed? Did you seek expert input?

De Soriano: The guide draws from three main areas: the humanities, public health and communities and advocates who are the main experts.

Humanities such as anthropology, psychology, sociology and history provide an understanding as to how systems have shaped and continue to shape individual health, an important consideration to reducing bias in our online health information through intentional phrasing and framing.

Public health provides us with communication strategies to promote healthy behaviors, which includes tailoring content to specific audiences. This is especially pertinent for marginalized communities as tailoring can be more effective for these folks compared to general health messages.

We also needed to expand our definition of “expert” for the guide. While this has meant reliance on medical professionals — and we certainly maintain the medical integrity of our content — we knew we had to also incorporate community voices and perspectives to reflect people’s lived experiences and to provide nuance to differences in language across intersecting identities.

Healio Primary Care: During patient encounters, when should physicians use person-first language, and when should they use identity-first language?

Barnes: Person-first language sees the person before the condition, acknowledging that a condition is not who a person is. It’s something they have, not their identity. We suggest using identity-first language when a community has clearly identified that this is the language they prefer. For example, person-first language would be: A person with deafness may use assistive devices. Using identity-first language, you would say: A deaf person may use assistive devices.

De Soriano: When speaking with someone directly, such as during patient-provider encounters, the easiest way to know is to simply ask them or to listen to the words they use to describe themselves during conversation.

Healio Primary Care: The guide lists several language alternatives. Which ones do you think are most important and why?

Barnes: That’s a great question, and a tough one to answer. That’s because it’s challenging to prioritize the importance of language alternatives within this context, because the recommendations in the Conscious Language Guide are relevant to specific audiences — each of whom deserve representation and recognition equally. Using person-first, identity-first and empathy-first language are all significant for clinicians to help create an empathetic, inclusive and non-stigmatizing space for patients.

Healio Primary Care: What do you want physicians to take away from the Conscious Language Guide?

Barnes: The most important thing I hope physicians take away from the guide is a broader awareness of where biases currently exist, which is an important first step in improving health outcomes for people.

De Soriano: It’s important to emphasize that this isn’t about assigning blame or fault. Language choices are part of a larger system, the small parts of which add up to have a synergistic effect on population health. Systemic change can feel overwhelming, but we can facilitate small pockets of change that add up and being conscious in our language is one of those.

Healio Primary Care: Are you open to changing or adding to the language in the guidance based on new insights? Is it a living document, so to speak?

Barnes: Absolutely, this is a living document that we add to, revise and update regularly.

Healio Primary Care: Anything else to add?

Barnes: We’re grateful for Healio’s interest in learning more about this guide, and for sharing it — and the context behind it — more widely with the medical community.

References:

Conscious Language Guide. https://transform.healthline.com/language. Accessed Sept. 27, 2021.

Healthline Media publishes industry’s first digital Conscious Language Guide. https://www.healthlinemedia.com/news/healthline-media-publishes-industrys-first-digital-conscious-language-guide. Accessed Sept. 27, 2021.