Christopher J. Koenig

Purpose: Telephone motivational coaching has been shown to increase urban veteran mental health treatment initiation. However, no studies have tested telephone motivational coaching delivered by veteran peers to facilitate mental health treatment initiation and engagement. This study describes pre-implementation strategies with 8 Veterans Affairs...

This article uses the theoretical and methodological framework of Grounded Practical Theory (GPT) to provide a lens for analyzing and interpreting discourse as a situated form of social action in routine Type 2 diabetes visits. Drawing on a total data-set of 400 audio-recorded routine visits, we randomly selected 55 visits for qualitative analysis....

Background Shared decision-making in rheumatoid arthritis (RA) care is a priority among policy makers, clinicians and patients both nationally and internationally. Demands on patients to have basic knowledge of RA, treatment options, and details of risk and benefit when making medication decisions with clinicians can be overwhelming, especially for...

OBJECTIVE To describe returning veterans’ transition experience from military to civilian life and to educate health care providers about culture-centered communication that promotes readjustment to civilian life. METHODS Qualitative, in-depth, semi-structured interviews with 17 male and 14 female Iraq and Afghanistan veterans were audio recorded,...

Complementary and integrative health (CIH) use is diverse and highly prevalent worldwide. Prior research of CIH communication in biomedical encounters address safety, efficacy, symptom management, and overall wellness. Observational methods are rarely used to study CIH communication and avoid recall bias, preserve ecological validity, and contextua...

Contemplative science has made great strides in the empirical investigation of meditation practices, such as how mindfulness, compassion, and mantra practices impact health and well-being. However, meditation practices from the Vajrayana Buddhist tradition that use mental imagery to transform distressing beliefs and emotions have been little explor...

This entry discusses terminology, definitions, and research examining communication about complementary and integrative healthcare (CIH) between patients and clinicians. The terminology of modern CIH is deeply intertwined with the history and acceptance of CIH forms as legitimate therapies worldwide. Health communication scholarship began with exam...

Interactional sensitivity is a type of communication work that has been used to analyze health communication encounters. Understood as an aspect of patient‐centered communication, interactional sensitivity happens when a clinician tailors their interactional and embodied communication to the particulars of a patient's lifeworld experiences, prefere...

Sociologist and psychiatrist Elliot Mishler's monograph titled The Discourse of Medicine: Dialectics of Medical Interviews builds on critical theory and social phenomenology to propose that people's use of language in their everyday lives is different from the specialized languages professionals use for specialized work in various professional sett...

Academy of Communication in Healthcare (ACH) is a nonprofit organization whose stated mission is to serve as “the professional home for all those who are committed to improving communication and relationships in healthcare.” ACH works collaboratively with its sister organization EACH: International Association for Communication in Healthcare to cre...

The study of discourse has a long history in health communication, healthcare, and medical communication. This entry pairs conversation analysis and discourse analysis. While each approach has a unique history, methods, and aims, both approaches have a broad scope, and both approaches obscure the lines between theory and method traditionally drawn...

Purpose To determine the effectiveness of telephone motivational coaching delivered by veteran peers to improve mental health (MH) treatment engagement among veterans. Methods Veterans receiving primary care from primarily rural VA community‐based outpatient clinics were enrolled. Veterans not engaged in MH treatment screening positive for ≥1 MH p...

Objectives A systematic review to analyze communication rates of complementary and integrative health (CIH) and analyze how communication terms, such as “disclosure,” are measured and operationalized. Methods We searched seven databases for studies published between 2010-2018 with quantitative measurements of patients’ communication of CIH to a bi...

Background Although web-based psychoeducational programs may be an efficient, accessible, and scalable option for improving participant well-being, they seldom are sustained beyond trial publication. Implementation evaluations may help optimize program uptake, but few are performed. When the US Department of Veterans Affairs (VA) launched the web-b...

Scholarship in the field of health communication is broad, with interdisciplinary contributions from researchers trained in a variety of fields including communication, nursing, medicine, pharmacy, public health, and social work. In this paper, we explore the role of “health communication boundary spanners” (HCBS), individuals whose scholarly work...

How to best engage rural veterans in mental health care is challenging and a topic of public health concern. Rural-dwelling veterans experience greater mental health burden and poorer outcomes than their urban counterparts, making rural veteran engagement in mental health care a public health concern. In this article, we describe how institutional...

As human trafficking research increases, attention to ethical research methods with trafficking survivors is important to ensure equitable processes and reliable results for policy and social services. This article first describes Photovoice, a participatory research method that asks individuals to take photos and then to narrate the significance o...

Purpose: Patients with advanced cancer and oncologists deliberate about early-phase (EP) trials as they consider whether to pursue EP trial enrollment. We have limited information about those deliberations and how they may facilitate or impede trial initiation. This study describes these deliberations and their relationship to trial initiation. P...

BACKGROUND Although web-based psychoeducational programs may be an efficient, accessible, and scalable option for improving participant well-being, they seldom are sustained beyond trial publication. Implementation evaluations may help optimize program uptake, but few are performed. When the US Department of Veterans Affairs (VA) launched the web-b...

Background The Veterans Access, Choice and Accountability Act (hereafter, Choice Program) seeks to improve access to care by enabling eligible Veterans to receive care from community providers. Veterans Affairs (VA) primary care providers (PCPs) play a key role in making referrals to community specialists, but their frontline experiences with refer...

Background: Some veterans face multiple barriers to VA mental healthcare service use. However, there is limited understanding of how veterans' experiences and meaning systems shape their perceptions of barriers to VA mental health service use. In 2015, a participatory, mixed-methods project was initiated to elicit veteran-centered barriers to usin...

According to recent Congressional testimony by the Secretary for Veterans Affairs (VA), improving the timeliness of services is one of five current priorities for VA. A comprehensive access measure, grounded in veterans’ experience, is essential to support VA’s efforts to improve access. In this article, the authors describe the process they used t...

Background: Mental health smartphone apps provide support, skills, and symptom tracking on demand and come at minimal to no additional cost to patients. Although the Department of Veterans Affairs has established itself as a national leader in the creation of mental health apps, veterans' attitudes regarding the use of these innovations are largel...

Military veterans who could benefit from mental health services often do not access them. Research has revealed a range of barriers associated with initiating United States Department of Veterans Affairs (VA) care, including those specific to accessing mental health care (e.g., fear of stigmatization). More work is needed to streamline access to VA...

Introduction: Consultations are the traditional method of communication between generalist and specialist providers managing patients with specialty care needs. Traditional written consultations have limitations, including inadequate clinical information and inappropriate, or unclear consultation questions. Teleconsultations minimize these limitat...

Objective: Patient and clinician goal alignment, central to effective patient-centered care, has been linked to improved patient experience and outcomes, but has not been explored in rheumatoid arthritis (RA). This study aimed to explore goal conceptualization among RA patients and clinicians. Methods: Seven focus groups and one semi-structured...

60 Background: Late-stage cancer patients (LSCPs) face complex choices as they exhaust standard treatment options, including whether to seek enrollment in an early phase (EP) clinical trial and how they may engage palliative care. Existing research describes patient-level decisional motivations, but less is known about the process by which patients...

Purpose: Discussions between oncologists and advanced cancer patients (ACPs) may touch on the complex issue of clinical trial participation. Numerous initiatives have sought to improve the quality of these potentially difficult conversations. However, we have limited data about what ACPs know about clinical research as they enter such discussions...

Most chronic illness management occurs outside clinics and hospitals, in the everyday lives of individuals. We use data from semi-structured interviews with 37 veterans from Southeastern Louisiana and Northern California to illustrate how “health work” for mental health concerns are shaped by place. Using health work as an orienting concept for ana...

Findings related to the Veterans Choice Act Third-Party Contractors

Background: Expert guidelines recommend reducing or discontinuing long-term opioid therapy (LTOT) when risks outweigh benefits, but evidence on the effect of dose reduction on patient outcomes has not been systematically reviewed. Purpose: To synthesize studies of the effectiveness of strategies to reduce or discontinue LTOT and patient outcomes...

Electronic health record (EHR) implementation may affect time allocation during patient visits.¹ Clinicians may use EHRs in silence, risking lower patient satisfaction,² or by multitasking while talking with patients. Concurrent multitasking (performing ≥2 tasks simultaneously) is associated with increased error risk and time to complete tasks.³ We...

Objectives The Veterans Choice Program (Choice) gives eligible military Veterans the option to receive care from approved non-VA community providers. Choice program implementation requires complex coordination of administrative processes among three medical systems: Veterans Health Affairs (VA); third party administrators or Choice contractors, e.g...

Background Participant recruitment is an ongoing challenge in health research. Recruitment may be especially difficult for studies of access to health care because, even among those who are in care, people using services least often also may be hardest to contact and recruit. Opt-out recruitment methods (in which potential participants are given th...

In current theory, critical medical anthropologists assert that complementary and integrative health (CIH) is marginalized in U.S. health care, and that medical professionals support the hegemony of biomedicine. In this study, social scientists and medical professionals worked together to develop a Veteran-centric measure of what constitutes care f...

Consultations are the traditional method of communication between generalists and specialists managing patients with specialty care needs. Videoconferencing health information technology enables generalist and specialist providers to co-manage patients with complex chronic illness and can facilitate workplace learning about specialty care. This stu...

Based on focus group and individual interviews with 26 combat veterans, this qualitative thematic analysis examines the psychosocial and interpersonal consequences of killing in war. It describes the consequences that veterans identify as most relevant in their lives, including postwar changes in emotions, cognitions, relationships, and identity. F...

This presentation describes a diversity of mental health engagement strategies among rural veterans in two US geographical regions. Engagement in care is defined as actions taken by patients to benefit from healthcare services to which they have access. Findings suggest that veterans’ experiences of engagement may take a range of forms and practice...

Consultations are the traditional method of communication between generalists and specialists managing patients with specialty care needs. Videoconferencing health information technology enables generalist and specialist providers to co-manage patients with complex chronic illness and can facilitate workplace learning about specialty care. This stu...

This poster describes the qualitative results of an evaluation of the VA’s SCAN-ECHO program, a telemedicine program that partners specialists located in large, urban, academic medical centers with generalists located in medium or small, sub-urban or rural community base settings. The overall aim of the program is to facilitate knowledge transfer b...

This presentation presents a qualitative evaluation of the VA’s SCAN-ECHO, a program modeled on UNM’s Project ECHO, that uses videoconferencing to partner specialty and general providers managing complex chronic illness. This presentation uses Discourse Analysis to show one way in which specialists and generalist exchange knowledge through video co...

One of the priorities of the VA is to improve veterans’ access to health care. This presentation compares and contrasts a national sample of 80 veterans’ experiences of accessing mental health care with an established conceptual SOTA Access Model.

The aim of this study was to develop a process for measuring sensitivity in provider-patient interactions in order to better understand patient-centered communication. We developed the Process of Interactional Sensitivity Coding in Healthcare (PISCH) by incorporating a multi-methodic investigation into conversations between physicians and their pat...

This poster presents preliminary results for an evaluation of the VA’s SCAN-ECHO program that uses videoconferencing to partner specialist and generalist providers for knowledge exchange about specialty care problems. Using video recordings of video consultations between specialists and generalist providers discussing Hepatitis C and liver disease,...

This manuscript argues that immigrant Asian Indians use primary care normatively for urgent medical problems rather than for routine prevention. However, we show that Asian Indians deviate from this norm during culturally salient lifecourse events and with social support from family and local social networks. I am senior author for this manuscript.

Veterans with posttraumatic stress disorder (PTSD) symptoms frequently present to primary care providers (PCPs) and are reluctant to seek out or accept referrals to specialty mental health care. Most PCPs have not been trained to assess for and manage symptoms of PTSD. Web-based programs are increasingly used for medical education, but there are no...

Background: Health care providers manage complex medical, psychological, and social health problems of their primary care patients. Regular exposure to patient trauma narratives associated with gang violence, experiences of war, or other violent social problems can lead to compassion fatigue and professional burnout. Self-care for providers is reco...

In this publication, Evelyn Ho (first author) and I outline the history and development of communication between providers and patients about Complementary and Alternative Medicine (CAM) and critique current research in light of recent contributions of discourse analysis to studying this important area of research.

In this forthcoming book, this chapter outlines the approach and uses of Conversation Analysis for studying the interactional dynamics of provider-patient communication in actual medical settings.

BACKGROUND: Handoffs are communication processes that enact the transfer of responsibility between providers across clinical settings. Prior research on handoff communication has focused on inpatient settings between provider teams and has emphasized patient safety. This study examines handoff communication within multidisciplinary provider teams i...

Objective: To empirically investigate the ways in which patients and providers discuss Complementary and Alternative Medicine (CAM) treatment in primary care visits. Methods: Audio recordings from visits between 256 adult patients aged 50 years and older and 28 primary care physicians were transcribed and analyzed using discourse analysis, an em...

This article applies a culture-centered approach to analyze the dietary health meanings for Asian Indians living in the United States. The data were collected as part of a health promotion program evaluation designed to help Asian Indians reduce their risk of chronic disease. Community members who used two aspects of the program participated in two...

Language barriers may prevent clinicians from tailoring patient educational material to the needs of individuals with limited English proficiency. Online translation tools could fill this gap, but their accuracy is unknown. We evaluated the accuracy of an online translation tool for patient educational material. We selected 45 sentences from a pamp...

This article reflects on the role of technology in teaching two LSI research methods courses with a focus on ethnography of communication and discourse analysis, respectively. Presented as case studies, we describe two LSI scholars’ experiences and explain our choices in using technology to teach these two undergraduate LSI courses. We describe how...

Background: South Asians in Northern California make up 10% of the population, and represent a racial/ethnic minority group at increased risk for cardiovascular disease (CVD). Culture largely shapes the development of individuals, yet few studies have explored cultural factors that inform lifestyle and health maintenance in this at-risk population....

This is an unpublished conversation analytic article that examines a particular kind of sequence that occurs in multi-unit turns, such as storytelling or extended narratives in conversational interaction. This paper documents what I call an "oblique sequence" in which a recipient interjects her- or himself into the teller's turn in order to ask a c...