Language complexity of patient-physician chat communication on hypertension control: results of the cluster-randomised PIA study

TL;DR

This study found that simple language in patient-doctor chats helped improve blood pressure control over time.

Contribution

The study provides new insights into the language complexity of patient-physician chats and their impact on hypertension outcomes.

Findings

Messages from both patients and physicians mostly used simple or very simple language.

More frequent communication was associated with better blood pressure improvement.

Most messages focused on medication or treatment-related topics.

Abstract

High language complexity impairs patients’ understanding and medical outcomes. While messengers accelerate communication, the language complexity of chats between patients and providers is poorly studied. This study analyses language complexity and communication characteristics of chat data from the PIA study, which significantly improved blood pressure control after 6 to 12 months.

The cluster-randomised controlled PIA study enrolled 848 hypertension patients (412 intervention, 436 control) from 64 German general practices. The PIA technology enabled a secured communication of blood pressure readings, medication plans and messages. The chats were analysed regarding frequency, length, response time and content. Language complexity was measured using the Flesch index with seven levels from ‘hard’ to ‘very simple’. The study is registered in the German Clinical Trials Register (DRKS00012680).

In total, 4231 messages were sent between 24 general practitioners and 363 patients of the intervention arm between 09/20 and 09/21: 22% messages (n = 941) were automated (new medication plan or prescription available), while 78% were non-automated (n = 3290), with 41.1% of these messages originating from patients and 58.9% from practices. The average chat dialogue lasted 176.8 days (SD 9.8). Patients’ messages had a mean of 22.6 words (SD 22.6) compared to 16.8 (SD 19.4) by practices. Most messages (88.92%) from practices and 51.9% from patients addressed medication or treatments. Simple or very simple language was used in 90.5% of the messages both by patients and by physicians regardless of sociodemographic characteristics. BP improved with increased frequency of messages (p < 0.001).

This communication showed a remarkably low language complexity by physicians and patients and better control with more messages. The results support the use of digital communication for topics such as chronic hypertension care.

German Clinical Trials Register, DRKS00012680. Registered May 10th, 2019, https://www.drks.de/drks_web/setLocale_EN.do.

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