Title: Optimising healthcare interactions: Politeness strategies among non-clinical healthcare providers and patients for improved public health outcomes in Tanzania
Abstract:
Effective health communication is essential to patient-centred care, positive health behaviour,and quality healthcare delivery. In primary and secondary healthcare settings, interactions between healthcare personnel and patients can influence trust, satisfaction, care-seeking behaviour, and the overall experience of healthcare services. However, health communication research has largely focused on doctor-patient and nurse-patient interactions, with limited attention to non-clinical healthcare providers such as receptionists, records personnel, front-desk staff, and pharmacists.These personnel often serve as patients’ first point of contact with healthcare facilities, making their communication an important part of the patient’s healthcare experience. This study examines politeness strategies among non-clinical healthcare providers and patients in public healthcare facilities in Nyamagana District, Mwanza, Tanzania, with a focus on how linguistic choices shape interpersonal interactions and manage communicative challenges at service points. Guided by Brown and Levinson’s (1987) Politeness Theory, this qualitative study examined the management of face-threatening acts in interactions between non-clinical healthcare providers and patients. Data were collected from four public healthcare facilities in Nyamagana District through non-participant observation and audio recordings of naturally occurring interactions at service points, complemented by semi-structured follow-up interviews with non-clinical healthcare personnel and patients. Qualitative content analysis was used to identify and classify communicative practices according to four politeness strategies: Positive politeness, negative politeness, off-record strategies, and bald-on-record delivery.The findings show that all four politeness strategies were used in interactions between non-clinical healthcare providers and patients, with positive politeness being the most frequently observed. Providers used solidarity markers, inclusive pronouns, and empathetic expressions to reduce social distance, create a supportive interactional environment, and encourage patient engagement. Negative Politeness was used to maintain respect and recognise patients’
autonomy, particularly during interactions involving personal or sensitive matters. Bald-on record expressions occurred less frequently and were mainly associated with urgent instructions or situations requiring direct communication. The findings also indicate that when politeness was not adequately maintained, patients experienced reluctance, misunderstanding, and reduced trust in healthcare services.The study demonstrates that politeness is an important aspect of communication between nonclinical healthcare providers and patients and can influence how patients experience and respond to healthcare services. Strengthening communication skills among non-clinical
healthcare personnel may therefore contribute to more respectful patient interactions, greater trust, improved service experiences, and more responsive healthcare delivery. The study recommends that health professional training and public health programmes give greater attention to interpersonal and socio-pragmatic communication skills among non-clinical healthcare personnel as part of efforts to promote patient-centred care and improve public health outcomes in Tanzania.
Keywords: Health Communication; Politeness Strategies; Non-Clinical Healthcare Providers;
Patient-Provider Interaction; Patient-Centred Care; Public Health; Tanzania.
