Health promotion in the internet: the language of NHS

Introduction . The promotion of health is a top priority of preventive medicine in the modern world. According to the WHO, unhealthy lifestyle takes the first place among all the factors, its share is 50% of all risks affecting health. These are, first of all, such factors as poor nutrition, physical inactivity, smoking and alcohol consumption, which is proven by several studies [1,2]. Obvious as this fact may seem, it is still necessary to improve health literacy in the public and to develop health awareness with all possible means including communicative ones [3]. This task could be performed in the most effective way in case health care practitioners collaborate with communication experts and linguists to create health promotion campaigns [4]. This collaboration can involve creation of various media texts, i.e. verbal, non-verbal audio and video material published on health related websites and internet portals.

The objective of this research is to analyze how the promotion of healthy lifestyle is performed in British media texts. The material of the research included 25 texts published in the official website of the National Health Service (NHS) of the United Kingdom. The NHS website is the UK's biggest health educational platform with more than 43 million visits per month. There are thousands of open-access articles, videos, tools and apps to help people make the best choices about their health and wellbeing.

According to the objective of this research this article has presented an overview of the website topics and structure as well as an analysis of communicative means developing health awareness and conveying health promotion issues. The authors have divided communicative techniques employed in the media texts into several categories based on the linguistic criterion (verbal vs nonverbal manifestation) and on the ‘author’s voice’ criterion, i.e. the author is identified as a doctor (‘expert voice’) or as a common person (‘common public voice’). The results will be discussed below.

The NHS website structure

Eat well subsection provides information on nutrient groups as well as their correct combination in the daily diet. It gives a link to the «Eat Well Guide» which is a colorful chart in which each segment represents daily products for a healthy diet. This is an effective communicative tool of health promotion: a combination of nonverbal (a graph and pictures) with verbal means (texts with relevant information on each product).

Each section is logical, easy to navigate and user-friendly. Readers can easily follow the links, find corresponding material, and learn the relevant information. All sections contain Page contents which adds to easy search and navigation through the website.

The expert voice

Obviously, health promotion should be done by health professionals. So most Live Well content is communicated to the audience from doctors’ perspective. We consider this a distinctive communicative technique used to inform and educated the audience in the most appropriate way. This ‘expert voice’ is authoritative, trustworthy, friendly and understanding at the same time. The authoritative stance ranges from the language of explanation and advice to the language of direct instruction and command.

• Example 1.    Explanation

‘Saturated and unsaturated fat

There are 2 main types of fat: saturated and unsaturated. Eating too many foods high in saturated fat can raise the level of cholesterol in your blood. Most people in the UK eat too much saturated fat. Foods high in saturated fat include…’ [5].

The expert voice here sounds authoritative and affirmative as it uses professional terms, e.g. saturated and unsaturated fat, cholesterol and simple clear-cut sentences.

The readers can easily find a concise definition of any term if necessary at one chick.

• Example 2.    Recommendation or advice

It's important to keep your cholesterol in check because high cholesterol levels increase your risk of heart disease and stroke.

If you have high cholesterol, you should talk to your GP about how you can lower it.

If you're aged 40 to 74, you can get your cholesterol checked as part of an NHS Health Check.

The expert voice here gives advice and recommendations and on what can be done in order to avoid high cholesterol level putting moderate pressure on the reader, e.g. it is important, you should, you can get.

• Example 3.    Command

Take action now and start losing weight.

Try to choose a variety of different foods from the 5 main food groups to get a wide range of nutrients [5].

Try Strength and Flex, a 5-week exercise plan for beginners to improve your strength and flexibility [5].

Due to the imperative sentences the expert voice sounds strong and powerful but not rude as the author shows concern to the reader’s health and the actions prescribed will definitely do good to their health.

Health promotion, however, is not only limited to direct urge or pressure on the reader. ‘The expect voice’ of the NHS website employ a range of reader-friendly communicative techniques which are aimed at shortening the distance between the reader and the author, building confidence and trust between them. This is done by means of colloquial language used to describe complicated or sensitive health issues and by colloquial abbreviations familiar to general public, by direct appeal to the reader, etc.

• Example 4.    Colloquial language

• a.    idiomatic expressions: keep an eye on portions you eat, feel your best, don’t skip breakfast

• b.    colloquial abbreviations or acronyms: veg (vegetables), GP (general practitioner) 24/7, TV, BMI (body mass index).

• c.    colloquial words for sensitive issues:

‘ Cutting down or stopping drinking is usually just the beginning, and most people will need some degree of help or a long-term plan to stay in control or completely alcohol-free.’ [5].

The common people voice

Healthy lifestyle promotion is a reciprocal activity, in which health practitioners direct efforts at their population. So an individual positive experience in health awareness development is a powerful communicative tool for any health promotion campaign [6]. We have indicated the ‘common people’ voice as a specific communicative technique in which healthy lifestyle experience is conveyed from the patient’s perspective. ‘A next-door neighbour’s experience could be supportive for people trying to make their own health choices as they tend to rely on the solutions which have worked out for others.

‘The common people’ voice is audibly heard from Live Well portal. This communicative technique is usually manifested by real life stories, i.e. narratives from the first person, an ordinary patient who has achieved positive results in solving a health problem

• Example 5.    A weight loss success story

"I have lost 2 stone and 4lbs. The weight loss plan has worked so well for me because I haven't seen it as a diet, but as a healthy way of eating and feeling great. It's unlike any other diet I have tried before [5] .

• Example 6.    A gastric band weigh loss surgery

"Eventually, I learnt about gastric band and gastric bypass surgery. A gastric band is where a band is fitted around the top of your stomach.

“This causes a feeling of fullness after eating a very small amount of food, and means that food must be eaten very slowly.

"My surgeon gave me lots of information about weight loss surgery, including all the risks as well as the benefits [5] .

‘The common people voice’ shares linguistic features such as colloquial language, first– person narrative as well as specific pragmatic features, e.g. real names, personal details including age, weight, etc. This ‘real life’ evidence make this communicative technique appealing and potentially more powerful.

Nonverbal means to promote health

Discussing the ‘expert voice’ and ‘common people voice’ techniques we have mainly focused upon verbal means of communication and illustrated them by a number of textual examples. However, health promotion in the internet provides a variety of nonverbal means of communication. They involve pictures, photos, diagrams, infographics, etc. The results of our analysis demonstrate that a media text of health promotion is a combination of verbal and nonverbal semiotic means.

The use of graphic images of objects or concepts as easily recognizable symbols is an effective way to communicate ideas and to influence the audience. This can be well illustrated by a Healthy Nutrition campaign launched by NHS in 2016. Healthy diet promotion was support by a release of the Eatwell Guide – the national standard of balanced nutrition, an important place in which was given to the program to increase fruits and vegetables intake in the British diet. The program was called 5 A Day and in the official NHS website it was symbolically represented by a pie chart with fruits and vegetables pictures. The chart was accompanied by a slogan to eat five servings of vegetables and fruits a day – Five A Day. We assume that the English letter A can act here not only as a preposition in , but also to symbolize the excellent mark which is indicated by the capital letter A in the British education system.

Conclusion. Health promotion is a challenging task of preventive medicine worldwide. This mission can be effectively supported by the communicative means and techniques especially in the internet. The analysis of the NHS official website has demonstrated that health awareness development and health promotion can be performed with the ‘expert voice’ and ‘common people’ techniques. Both are used to create a substantial pragmatic effect on the audience, to build up confidence and trust with the authors.

Health promotion texts involve distinctive verbal means such as colloquial language, acronyms and abbreviations, idiomatic expressions, first-person narrative to create a reader-friendly discourse for health promotion. Professional terms and their explanations, communicative functions of advice, recommendation and instruction contribute to a large extent to authoritative and trustworthy style of communication. Nonverbal communication including pictures, photos, diagrams, charts, tables, infographics is widely used in NHS health promotion, which seems an effective way to convey complicated health issues, to develop health awareness and to encourage actions.