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Routledge Studies in Language, Health and Culture
Series Editor: Olga Zayts-Spence
University of Hong Kong, Hong Kong

This series has several distinctive features. First, it investigates health communication
through linguistic lenses. The contributions to the series in the form of research
monographs or targeted edited volumes will introduce the readers to a range of
linguistic approaches, including, but not limited to (critical) discourse analysis,
sociolinguistics, multimodal analysis, corpus analysis, conversation analysis, etc.
Second, what will bring these versatile approaches together in the series is that
they will draw on authentic empirical data from a range of healthcare contexts
(e.g. acute care, traditional medicine, secondary care), going beyond the traditional
doctor-patient encounters and expanding the focus of inquiry to online healthcare
provision, interprofessional communication, etc.
Second, the series focuses specifically on contexts outside of the mainstream
English-dominant healthcare contexts. The series solicits proposals from contributors
working on healthcare communication in Asia-Pacific, South America, continental
Europe, etc., putting to the forefront the growing body of research representing
versatile sociocultural and linguistic contexts.
Third, it is expected that some contributions will focus on multicultural and
multilingual healthcare encounters, thus making the series of relevance to a broad
readership around the world.
In line with some of the core principles of linguistic research in healthcare
contexts, the series will encourage contributions that, in addition to advancing
the linguistic field, will also stress relevance to professional practice (Sarangi and
Candlin 2011). The editor will invite, where appropriate, healthcare and medical
professionals in a relevant field to critically review and endorse, or to write a short
foreword to the contributions. This feature will encourage a trans-disciplinary
dialogue between linguistic and health communication scholars and healthcare and
medical professionals, thus increasing the potential readership.

Language, Health and Culture

Problematizing the Centers and Peripheries of Healthcare Communication
Research
Olga Zayts-Spence and Susan M. Bridges

For more details on the series, please visit: www.routledge.com/Routledge-Studies-in-Language-

Health-and-Culture/book-series/RSLHC
Language, Health and Culture
Problematizing the Centers
and Peripheries of Healthcare
Communication Research

Edited by Olga Zayts-Spence

and Susan M. Bridges
First published 2024
by Routledge
4 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
605 Third Avenue, New York, NY 10158
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2024 Olga Zayts-Spence and Susan M. Bridges
© 2024 selection and editorial matter, Olga Zayts-Spence and Susan M.
Bridges; individual chapters, the contributors
The right of Olga Zayts-Spence and Susan M. Bridges to be identified as
the authors of the editorial material, and of the authors for their individual
chapters, has been asserted in accordance with sections 77 and 78 of the
Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or
utilised in any form or by any electronic, mechanical, or other means, now
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any information storage or retrieval system, without permission in writing
from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered
trademarks, and are used only for identification and explanation without
intent to infringe.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library
ISBN: 978-0-367-55963-2 (hbk)
ISBN: 978-0-367-55964-9 (pbk)
ISBN: 978-1-003-09586-6 (ebk)
DOI: 10.4324/9781003095866
Typeset in Bembo
by Apex CoVantage, LLC
Contents

List of figures vii

List of contributors viii
Acknowledgements x
List of abbreviations xii

1 Introduction 1
OLGA ZAYTS-SPENCE

2 Resisting responsibility for decision-making during

medical consultation: a conversation analytic study
in Singapore 20
NI-ENG LIM, GIM-THIA NG AND KANG KWONG LUKE

3 How to make an unacceptable choice for a patient

acceptable: an examination of the decision-making
process in Japanese medical settings 41
MICHIE KAWASHIMA

4 Resistance to treatment recommendations:

an interactional resource to increase information exchange
and promote shared decision-making in
medical encounters 60
NAN CHRISTINE WANG

5 Exploring end-of-life care in palliative care consultations

in Hong Kong 82
DAVID MATTHEW EDMONDS, OLGA ZAYTS-SPENCE
AND JACQUELINE YUEN KWAN YUK
vi Contents

6 Communicating health knowledges across clinic and

community: the case of sex characteristics in plurilingual
Hong Kong 101
BRIAN W. KING

7 The “mad consultant dealing with mad people”:

a discursive historical approach to tensions regarding
mental health stigma in Hong Kong 119
HANNAH SHIPMAN AND OLGA ZAYTS-SPENCE

8 The discursive construction and negotiation of genetic

knowledge in an online health forum in Mainland China 138
ZHENGPENG LUO AND OLGA ZAYTS-SPENCE

9 Improving intergenerational communication: a case

study of interactions between medical students and
senior citizens in a Japanese community 154
RINTARO IMAFUKU, KOJI TSUNEKAWA, CHIHIRO KAWAKAMI
AND KAZUHIKO FUJISAKI

10 Conclusion: advancing healthcare communication

research in ‘Global Peripheries’ 173
DAVID MATTHEW EDMONDS AND OLGA ZAYTS-SPENCE

Index193
Figures

1.1 Communicative modes of health communication 2

1.2 The role of language in mediating health 3
1.3 Possible main participants of linguistic healthcare communication
research6
1.4 Processes of a linguistic health communication project 7
9.1 Overview of speech functions 157
Contributors

Susan M. Bridges is Director of the Centre for the Enhancement of Teaching and
Learning (CETL), Professor of Practice at the Academic Unit of Social Contexts
and Policies of Education at the University of Hong Kong. Contact: sbridges@
hku.hk
David Matthew Edmonds is a postdoctoral fellow and a member of the Research
and Impact Initiative for Communication in Healthcare (HKU RIICH) at the
School of English, the University of Hong Kong. Contact: [email protected]
Kazuhiko Fujisaki is a professor at the Medical Education Development Center at
Gifu University, Japan. Contact: [email protected]
Rintaro Imafuku is an assistant professor at the Medical Education Development
Center at Gifu University, Japan. Contact: [email protected]
Chihiro Kawakami is an assistant professor at the Medical Education Development
Center at Gifu University, Japan. Contact: [email protected]
Michie Kawashima is an associate professor at the Kyoto Sangyo University in
Japan. Contact: [email protected]
Brian W. King is an assistant professor at the School of English, the University
of Hong Kong. He is the Leader of the Research Cluster of the Research and
Impact Initiative for Communication in Healthcare (HKU RIICH) on Com-
municating Sex Variation. Contact: [email protected]
Ni-Eng Lim is an assistant professor and part of the Medical Humanities Research
Cluster at the School of Humanities, Nanyang Technological University in Sin-
gapore. Contact: [email protected]
Kang Kwong Luke is Professor of Linguistics and the Director of the Medical
Humanities Research Cluster at the School of Humanities, Nanyang Techno-
logical University in Singapore. Contact: [email protected]
Zhengpeng Luo is an assistant professor at the Institute of Linguistics and Applied
Linguistics, School of Foreign Languages, Peking University. Contact: zhengpen-
[email protected]
 Contributors ix

Gim-Thia Ng is pursuing a doctorate in educational psychology at the UCL

Institute of Education, University College London, UK, and was previously a
research associate at Nanyang Technological University (NTU). Contact: gim.
[email protected]
Hannah Shipman is a genetic counsellor with the North West Thames Regional
Genetics Service and Lecturer in the MSc in Genetic and Genomic Counselling
programme at Cardiff University, the UK. Contact: hannahshipman@hotmail.
com
Koji Tsunekawa is an associate professor at the Department of Institutional Research
for Medical Education at Gifu University, Japan. Contact: [email protected]
Nan Christine Wang is an associate professor in the School of Public Administra-
tion at Hunan University. Contact: [email protected]
Jacqueline Yuen Kwan Yuk is a clinical assistant professor (geriatrics and pallia-
tive medicine) at the Li Ka Shing Faculty of Medicine of the University of Hong
Kong (HKU). Contact: [email protected]
Olga Zayts-Spence directs the Research and Impact Initiative for Communica-
tion in Healthcare (HKU RIICH) at the University of Hong Kong. Contact:
[email protected]
Acknowledgements

First of all, we would like to thank all the contributors to this volume for their
enthusiasm toward this project, for sharing their research with us and for being
patient throughout the editing process. The preparation of this volume occurred in
the midst of the COVID-19 pandemic. On the one hand, this has made the topic
of health communication all the more important. On the other hand, it did pose
some challenges as similar to the rest of the academic world. We had to juggle our
academic work and teaching online while also dealing with COVID-19–imposed
restrictions, quarantine and family obligations. We thank all the contributors for
their hard work and for providing inspiration to us and the readers of this volume
for the research to come.
We would also like to thank Katie Peace, Routledge senior publisher, for her tre-
mendous professionalism and enthusiasm for this project and for promoting health
communication research in Asia. Your forward-thinking vision is inspiring and your
work ethic is incredible.
We are grateful for the brilliant and inspiring colleagues in our research group,
the Research and Impact Initiative for Communication in Healthcare at the Uni-
versity of Hong Kong (HKU RIICH). In particular, we would like to thank Brian
W. King, Zoe Fortune, Mariana Lazzaro-Salazar, Jack Pun Kwok Hung, Jacqueline
Yuen Kwan Yuk and Katharine Alder. In addition, we would like to thank all of
the long-term clinical collaborators on our projects; in particular, Mary HY Tang
and Brian HY Chung, with whom we have been very lucky to work. Your unfail-
ing support, generosity with your time and critical attention to research ideas are
much appreciated. Finally, we truly appreciate your enthusiasm for our collaborative
endeavours, which has made this journey of exploring health communication in
Asia truly enjoyable and gratifying.
Two incredible mental health organizations, Mind Hong Kong and City Mental
Health Alliance, are our long-term collaborators. Thank you for allowing us to con-
tribute to the important endeavour of de-stigmatizing mental health. We are grateful
to Lucy Lord, Hannah Reidy, Carol Liang, and other members of the Mind Hong
Kong Board and City Mental Health Alliance Advisory Board. Working with all of
you has been humbling and hugely inspiring.
Our thanks are also due to Vincent Tse Wai Sum for his high-quality editing
support of this volume, and for painstakingly and meticulously ensuring that all
 Acknowledgements xi

the contributions in this volume were edited to the last dot. We are also grateful to
David Matthew Edmonds for stepping into the project in its final stages and not only
contributing a chapter but also helping with copyediting the contributions.
Last but not least, we are grateful to our spouses, Andrew Spence and Michael
Bridges for always being there for us and for stepping in with childcare, household
and endless other responsibilities to allow us more research time.
Olga Zayts-Spence and Susan Bridges
Abbreviations

ACP Advance care planning

AD Advance directives
AIH Artificial insemination by husband
CPA Cardiopulmonary arrest
DCT Direct-to-consumer testing
DSD Disorders of sex development
EoL End-of-life
IVF In-vitro fertilization
SDM Shared decision-making
TCM Traditional Chinese medicine
1 Introduction
Olga Zayts-Spence

This volume problematizes the idea of ‘Global Centres’ and ‘Peripheries’ in health-
care communication research. We use these two concepts of ‘Global Centres’ and
‘Peripheries’ to present carefully selected examples of the rich tradition of linguistic
research in healthcare settings in several designated geographical locations in Asia1—
namely, Hong Kong, Mainland China, Singapore and Japan (what would be tradi-
tionally referred to as ‘Peripheries’). This volume also demonstrates the dynamic and
expanding world-class research that originates from these ‘peripheral’ contexts—in
the case of this volume, Asia. As such, this volume challenges the binary, subjective
and parochial view of the dominance of the Anglo-American (‘central’) research
tradition in the healthcare communication field.
In this volume, we do not aim to engage in an extended discussion of the
­distinction between ‘Global Centres’ and ‘Peripheries’ (or their synonymous meta-
geographical and political metaphors, e.g., Global South/Global North, First
World/Third World; Western/non-Western), as it is by now well-established that
the relationship between these concepts is complex and intertwined (see Buch-
holz 2018 for an extended discussion; also Milani and Lazar 2017; Pennycook and
Makoni 2019). Briefly, this distinction originally referred to the unequal power
relationships and distributions of economic and other goods and resources between
Europe, North America and Australia and the rest of the world. The metaphors of
the ‘Centres’ and ‘Peripheries’ have since been extended to other areas and aspects
of social life and intellectual domains. There are very specific connotations that
have historically been associated with the two terms. Crudely, the ‘Centres’ are
understood as being superior and more developed, whereas the ‘Peripheries’ are less
developed and in need of being supported and ‘enlightened’ by the ‘Centres’. Our
interest in this volume lies with the growing relationship between these research
traditions and the intertwining of the theoretical, methodological, and epistemo-
logical perspectives of knowledge from the ‘Centres’ and the ‘Peripheries’, and
the distinct ‘voice’ that research on healthcare communication from ‘peripheral’
contexts is gaining. The contributions in this volume attest to this synergy between
the research traditions and demonstrate that the knowledge of local social, cultural
and historical contexts puts researchers in and from the ‘Peripheries’ in an advanta-
geous position of being able to really engage with and impact positively their local
healthcare communication practices.

DOI: 10.4324/9781003095866-1
2 Olga Zayts-Spence

As the title of the volume suggests, the contributions take a very specific view of
health communication. Namely, all contributions examine different healthcare sites
through linguistic lenses. The importance of communication in successful healthcare
delivery is now widely recognized. There is also a growing acknowledgement that
applied linguistics as a discipline, with its empirically-driven and language-focused
analyses and findings, could make a strong contribution towards improving health-
care communication and, as a result, healthcare outcomes (e.g., Brookes and Hunt
2021; Demjén 2020). This movement within the health communication field to
include linguistics is reminiscent of what was labelled ‘the linguistic turn’ ­(Alvesson
and Kärreman 2000) within organizational research in early 2000, providing new
ways of thinking about the role of language use within social activities. By anal-
ogy, we could talk about the ‘linguistic turn’ within the health communication
field. Health communication examined from a linguistic perspective focuses on
diverse communicative activities realized through different communicative modes,
such as text, talk and other semiotic modes (e.g., gestures, body language, gaze,
images, emoticons, emojis used in digital communication, etc.), and their interfaces
(Figure 1.1). In particular, digital health communication makes extensive use of
these ‘other semiotic modes’ and has become more widespread during the COVID-
19 pandemic when face-to-face contact between patients and clinicians and other
healthcare providers was limited or not possible at all (Edmonds et al. 2022).
In the last two decades, linguistic studies of healthcare communication have been
growing exponentially in both ‘Global Centres’ (e.g., Baker and Brookes 2022;
Brookes and Hunt 2021; Eggins et al. 2016; Harvey and Koteyko 2013; Semino
et al. 2017; Slade et al. 2015) and ‘Peripheries’ (e.g., Zayts and Kang 2010; Ying
2022 and other contributions in Routledge Studies in Language, Health and Cul-
ture (Routledge n.d.); see also contributions in Demjén 2020; Hamilton and Chou
2014). In Asia, in particular, the field has been growing rapidly in the last two dec-
ades (Kawashima 2019; Luke et al. 2008; Luo et al. 2020; Pun 2022; Pun and Wong
2022; Xu and Bridges 2021; Zayts et al. 2022; see also contributions in Watson and
Krieger 2020). Many of these studies have noted that language mediates every activ-
ity in healthcare, a statement with which we strongly align. Thinking about health
more broadly as “a state of complete physical, mental and social wellbeing, and not
merely an absence of disease or infirmity” (World Health Organization n.d.), we
could go as far as to assert that language serves as one of the main mediators between

Figure 1.1 Communicative modes of health communication