The use of nonverbal communication when assessing witness credibility: a view from the bench.

The aim of this article is to provide a better understanding of how, in practice, judges use nonverbal communication during bench trials. The article starts with an overview of legal rules on how judges are supposed to assess witness credibility and use nonverbal communication, and briefly addresses the impact of those rules on lower courts and the limited data about judges in bench trials. Subsequently, we present the methods and the results from an online survey carried out with Quebec judges. While a number of judges have beliefs consistent with the scientific literature, findings reported in this article show that many judges have beliefs inconsistent with the scientific literature, and many are silent on culture-related differences in nonverbal behavior. The article ends with a discussion on the implications of the results for scholars and practitioners, including why findings reported in this article are cause for concern for adversarial justice systems.

Patterns of Verbal and Nonverbal Communication During Sex.

Sexual communication functions as an important relational process expediating satisfying sexual experiences (Sprecher & Hendrick, 2004). Much of the existing literature on sexual communication concerning sexual pleasure biases verbal communication (Babin, 2012). This study adds to the existing research regarding patterns of communication surrounding sex and during sex through qualitative analysis. Further, this inquiry focused on participants' full histories, rather than their tendencies within any current relationship. We analyzed 78 qualitative interview transcripts from participants between the ages of 18 and 69. Participants reported a reluctance to communicate anything but pleasure, discomfort, or dislike during sex to avoid discouraging their partners. Though participants reported a perception that communicating pleasure served as encouragement and affirmation to their partners, most preferred to communicate pleasure nonverbally. Some participants reported a tendency to communicate pain or dislike verbally. Some preferred communication about sexual topics only before or after sexual activities. Participants shared that a high level of comfort with their partner increased sexual communication. How sexual partners communicate sex not only affects pleasure but can only affect intimacy between partners and health. This adds to the scant literature on nonverbal communication during sex and some people's preference for that style (Blunt-Vinti et al., 2019).

Pain assessment tools in adults with communication disorders: systematic review and meta-analysis.

BACKGROUND: Verbal communication is the "gold standard" for assessing pain. Consequently, individuals with communication disorders are particularly vulnerable to incomplete pain management. This review aims at identifying the current pain assessment instruments for adult patients with communication disorders. METHODS: A systematic review with meta-analysis was conducted on PubMed, PEDRO, EBSCOhost, VHL and Cochrane databases from 2011 to 2023 using MeSH terms "pain assessment, "nonverbal communication" and "communication disorders" in conjunction with additional inclusion criteria: studies limited to humans, interventions involving adult patients, and empirical investigations. RESULTS: Fifty articles were included in the review. Seven studies report sufficient data to perform the meta-analysis. Observational scales are the most common instruments to evaluate pain in individuals with communication disorders followed by physiological measures and facial recognition systems. While most pain assessments rely on observational scales, current evidence does not strongly endorse one scale over others for clinical practice. However, specific observational scales appear to be particularly suitable for identifying pain during certain potentially painful procedures, such as suctioning and mobilization, in these populations. Additionally, specific observational scales appear to be well-suited for certain conditions, such as mechanically ventilated patients. CONCLUSIONS: While observational scales dominate pain assessment, no universal tool exists for adults with communication disorders. Specific scales exhibit promise for distinct populations, yet the diverse landscape of tools hampers a one-size-fits-all solution. Crucially, further high-quality research, offering quantitative data like reliability findings, is needed to identify optimal tools for various contexts. Clinicians should be informed to select tools judiciously, recognizing the nuanced appropriateness of each in diverse clinical situations. TRIAL REGISTRATION: This systematic review is registered in PROSPERO (International prospective register of systematic reviews) with the ID: CRD42022323655 .

Trofinetide Treatment Demonstrates a Benefit Over Placebo for the Ability to Communicate in Rett Syndrome.

BACKGROUND: Trofinetide was approved by the US Food and Drug Administration for the treatment of Rett syndrome (RTT) in March 2023. Benefiting the ability to communicate in RTT is often identified as the most important caregiver goal for new therapies. This analysis reports the communication-related end points from the phase 3 LAVENDER study of trofinetide in RTT. METHODS: Females with RTT, aged five to 20 years, were randomized 1:1 to trofinetide or placebo for 12 weeks. Secondary efficacy end points related to communication were based on change from baseline to week 12 and included the caregiver-rated Communication and Symbolic Behavior Scales Developmental Profile™ Infant-Toddler Checklist (CSBS-DP-IT) Social Composite score (key secondary end point; scores ranged from 0 to 26 [higher scores indicated better communication]) and novel clinician rating scales (0 [normal] to 7 [severe impairment]) measuring the ability to communicate choices nonverbally (RTT-COMC) and verbally (RTT-VCOM). RESULTS: Trofinetide demonstrated a statistically significant difference versus placebo for the CSBS-DP-IT Social Composite score (least squares mean [LSM] difference = 1.0; 95% confidence interval [CI], 0.3 to 1.7; P = 0.0064; Cohen's d effect size = 0.43) and a nominally significant difference for the RTT-COMC (LSM difference: -0.3; 95% CI, -0.6 to -0.0; P = 0.0257; Cohen's d effect size = 0.36). As expected, there was no difference for the RTT-VCOM. CONCLUSIONS: Significant treatment benefit for trofinetide versus placebo was observed in scales measuring the ability to communicate. These scales may be appropriate for future clinical studies in RTT and other neurodevelopmental disorders.

Older adults' communication with an interactive humanoid robot : Expectations and experiences of older adults in verbal and nonverbal communication with a socially interactive humanoid robot: a mixed methods design in Germany.

BACKGROUND AND OBJECTIVE: One possible approach to counter singularization and loneliness of older adults is the development and implementation of socially interactive robots. Little is known about the expectations and experiences of older adults with socially interactive humanoid robots. MATERIAL AND METHODS: In a mixed-methods design study, user expectations before interaction and the experience and evaluation of verbal and non-verbal communication after interaction with a robot were assessed. Semi-structured interviews were conducted after the interaction. RESULTS: The majority of older adults expected verbal communication. After the interaction the evaluation of the quality of verbal communication differed. Participants did not expect any form of nonverbal communication. Nonverbal communication was highlighted as particularly positive. Gestures, facial expressions, and body movements were described as confidence building. CONCLUSION: The robot's ability to communicate nonverbally might positively influence older adults' experience of communication with the robot. In the development of socially interactive robots non-verbal communication should be given more consideration in order to contribute to successful human-robot interaction.

Descriptive Analysis of Social Interaction and Communication Skills of Autistic Children According to Sibling Status and Characteristics.

OBJECTIVE: Sibling relationships in early childhood can have a positive impact on children's social interaction and communication skills. Similarly, autistic children can benefit from interactions with their siblings, who can serve as readily available partners for social interaction. However, there is a lack of research on the effects of siblings based on specific characteristics of the sibling. Therefore, the aim of this study is to compare social interactions and communication skills of autistic children based on sibling status and characteristics. METHODS: We conducted a retrospective data review involving 895 autistic children and their siblings at Seoul National University Bundang Hospital. Variety of diagnostic assessments or questionnaires were administered. Based on the characteristics of the data, Quade's test for nonparametric analysis of covariance was used to compare autism-related symptoms and levels of functioning of the autistic child according to 1) sibling status, 2) birth order, 3) sex, and 4) diagnosis of the sibling. Pearson correlation was used to explore associations between the sibling age gap and different clinical scores. RESULTS: Having siblings was associated with fewer difficulties in restricted and repetitive behaviors. Based on the comparison of the Autism Diagnostic Interview-Revised scores, autistic children with multiple siblings demonstrated better nonverbal behaviors. Autistic children with autistic siblings experienced greater difficulties in social interactions and communications, such as peer relationships, sharing enjoyment, and engaging in social imitative play. CONCLUSION: The study revealed differences in social interactions and communication skills of autistic children based on sibling status, birth order, affected sibling, age gap, and sex.

Best practices for communication while wearing facemasks: A scoping review.

INTRODUCTION: Facemasks are an important piece of personal protective equipment (PPE) to mitigate the spread of respiratory illnesses, but they can impede communication between patients and healthcare providers. The purpose of this scoping review is to identify effective communication practices while wearing facemasks. DESIGN: Scoping review using a systematic search of articles from the PubMed, CINAHL, and Embase databases. METHODS: The PEO (population, exposure, outcome) methodology was selected for this systematic scoping review. The population of interest (P) includes humans of all ages (children, adults, and older adults); the exposure of interest (E) is PPE that covers the mouth (i.e., facemasks); and the outcome of interest (O) is successful or unsuccessful communication practices. The Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals appraisal guidelines were used to determine the level and quality of the research. RESULTS: Thirty-nine articles met the inclusion criteria. Seventeen of these were high- or good-quality research studies, and the remaining 22 were non-research articles included with separate analysis as part of the scoping review. The 17 articles encompassed 2656 participants. The highest quality evidence indicated that standard surgical masks have the least impact on speech perception compared to other non-transparent mask types, and that recognizing emotions is less accurate with facemasks, necessitating compensatory actions (i.e., reducing extraneous noise, using a microphone to amplify voice, and employing clear speech). Evidence was contradictory regarding the use of transparent masks. Evidence was of limited quality for other non-verbal and verbal communication strategies. CONCLUSION: Awareness of communication challenges is crucial when wearing facemasks. More high-quality studies are needed to evaluate communication techniques when speakers are wearing facemasks. Basic strategies such as selecting an appropriate mask type, reducing extraneous noise, using microphones, verbalizing emotions, and employing clear speech appear to be beneficial. CLINICAL RELEVANCE: The findings of this scoping review highlight the importance of considering communication challenges while wearing facemasks in the healthcare settings. The review suggests that selecting an appropriate mask type, reducing extraneous noise, verbalizing emotions, and employing clear speech are some strategies that may be effective in mitigating the impact of facemasks on communication between patients and healthcare providers.

[Pictograms for assessing pain quality in foreign language-speaking patients: a quality improvement study]. / Piktogramme zur Erfassung der Schmerzqualität bei fremdsprachigen Patient_innen.

Pictograms for assessing pain quality in foreign language-speaking patients: a quality improvement study Abstract. Background: Numerical assessment instruments allow foreign language patients to quantify their pain. However, for a complete assessment of the pain situation, the description of pain quality is also important. Problem: To assess pain quality completely, the treatment team lacked a tool. Objective: Foreign language-speaking patients can communicate their pain to the treatment team and are actively involved in the treatment process. The treatment team develops tools for recording the quality of pain and reflects on their experiences. Method: In a practice development project, pictograms of the Iconic Pain Assessment Tool 2 (IPAT2) where chosen to assess pain quality. The pictograms were prepared for everyday use, tested, and evaluated. Results: With the help of pictograms, quality of pain of 72 patients was documented almost 50% more frequently than before the study. The nursing team experienced IPAT2 as helpful in obtaining information and deepening the quality of the relationship. A feeling of being seen and understood emerged. Discussion: Pictograms are a valid method for nonverbal pain assessment. However, there is a risk of misunderstanding. The study only allowed an external assessment of patient's perceptions. An empirical investigation of the patient's view would be desirable. Conclusions: Further use and development of pictograms for communicating with foreign language-speaking patients are recommended.

Videoconferencing Applications for Training Professionals on Nonverbal Communication in Online Clinical Consultations.

OBJECTIVES: The use of videoconferencing technologies for clinician-patient online consultations has become increasingly popular. Training on online communication competence through a videoconferencing application that integrates nonverbal communication detection with feedback is one way to prepare future clinicians to conduct effective online consultations. This case report describes and evaluates two such applications designed for healthcare professionals and students in healthcare-related fields. METHODS: We conducted a literature review using five databases, including the Web of Science, Scopus, PubMed, ACM, IEEE, and CINAHL in the spring of 2022. RESULTS: We identified seven studies on two applications, ReflectLive and EQClinic. These studies were conducted by two research groups from the USA and Australia and were published between 2016 and 2020. Both detected nonverbal communication from video and audio and provided computer-generated feedback on users' nonverbal communication. The studies evaluated usability, effectiveness in learning communication skills, and changes in the users' awareness of their nonverbal communication. The developed applications were deemed feasible. However, the feedback given by the applications needs improvement to be more beneficial to the user. The applications were primarily evaluated with medical students, with limited or no attention given to questions regarding ethics, information security, privacy, sustainability, and costs. CONCLUSIONS: Current research on videoconferencing systems for training online consultation skills is very limited. Future research is needed to develop more user-centered solutions, focusing on a multidisciplinary group of students and professionals, and to explore the implications of these technologies from a broader perspective, including ethics, information security, privacy, sustainability, and costs.

Communication board in locked-in syndrome: a practical interaction method with the patient.

Locked-in syndrome is a neurological condition characterized by tetraplegia, mutism, preservation of vertical eye movement, superior eyelid movement, and intact consciousness, making it impossible for the patient to communicate properly. We herein describe a case to analyze the practice of developing a method of communication for a patient with locked-in syndrome. Two communication boards were created, adapted to the Portuguese language, as well as a shortcut to inquire about the physical and emotional patient's well-being. We had difficulty with the initial communication board, due to the patient's low education level, so we adapted a new one to the patient's social context, including a shortcut to inquire about physical and emotional well-being. The communication board had a positive impact on treatment development and the patient's life.

A síndrome do encarceramento é uma condição neurológica caracterizada por tetraplegia, mutismo, preservação do movimento vertical dos olhos, movimento palpebral superior e consciência intacta, impossibilitando a comunicação adequada do paciente. Descrevemos um caso para analisar a prática de criação de um método de comunicação em um paciente com síndrome do encarceramento. Foram criadas duas pranchas de comunicação, adaptadas à língua portuguesa, e um atalho para indagar sobre o bem-estar físico e emocional do paciente. Tivemos dificuldade com a prancha de comunicação inicial em razão da baixa escolaridade do paciente, então criamos uma nova prancha de comunicação adaptada ao seu contexto social. A nova prancha tinha um atalho para indagar sobre o bem-estar físico e emocional do paciente. A prancha de comunicação teve impacto positivo no desenvolvimento do tratamento e na vida do paciente.

Sounds like a fight: listeners can infer behavioural contexts from spontaneous nonverbal vocalisations.

When we hear another person laugh or scream, can we tell the kind of situation they are in - for example, whether they are playing or fighting? Nonverbal expressions are theorised to vary systematically across behavioural contexts. Perceivers might be sensitive to these putative systematic mappings and thereby correctly infer contexts from others' vocalisations. Here, in two pre-registered experiments, we test the prediction that listeners can accurately deduce production contexts (e.g. being tickled, discovering threat) from spontaneous nonverbal vocalisations, like sighs and grunts. In Experiment 1, listeners (total n = 3120) matched 200 nonverbal vocalisations to one of 10 contexts using yes/no response options. Using signal detection analysis, we show that listeners were accurate at matching vocalisations to nine of the contexts. In Experiment 2, listeners (n = 337) categorised the production contexts by selecting from 10 response options in a forced-choice task. By analysing unbiased hit rates, we show that participants categorised all 10 contexts at better-than-chance levels. Together, these results demonstrate that perceivers can infer contexts from nonverbal vocalisations at rates that exceed that of random selection, suggesting that listeners are sensitive to systematic mappings between acoustic structures in vocalisations and behavioural contexts.

Effects of Customized Communication Training on Nonviolent Communication, Nonverbal Communication, and Self-Acceptance: Evidence from Korean Nursing Students.

Background: We aimed to investigate the effects of a nonviolent and nonverbal communication and self-acceptance training program among Korean nursing students. Methods: We enrolled students in nursing departments at three universities in Busan Metropolitan City, South Korea. The students were randomly allocated to the experimental (n = 38) and control groups (n = 36); subsequently, they completed questionnaires before and after training. Data were collected on March 2023. The experimental group was enrolled in a program comprising 390 minutes of lecture, practice, role play, discussion, and reflection in 8-h daily sessions, with a total of eight sessions. The training sought to allow students to understand and practice nonviolent and nonverbal communication. Data were analyzed using descriptive statistics, chi-square tests, and a paired t-test. Results: Compared with the control group, the experimental group showed a significant post-intervention improvement in the nonviolent communication scores (t = -2.442, P= 0.020); however, there were no significant between-group differences in the post-intervention nonverbal communication or self-acceptance scores. Conclusion: Customized communication training programs are required to address communication competencies among medical personnel, including nursing students. Moreover, it is crucial to set standards for communication competency. Specifically, from a long-term perspective, a continuous educational strategy is required to effectively improve the communication capabilities of nursing students in Korea. It is possible to develop training programs that can systematically improve communication competency among nursing students.

A systematic review of assessment instruments for linguistic precursors during child development, ages 6 to 18 months.

Linguistic precursors (gaze, joint attention, gestures, social interaction, etc.) have a predictive value over the course of child development. The aim of the present review is to analyze the content structure, and the theoretical perspective, of assessment instruments that focus on linguistic precursors for the 6-18-month age group. The search was achieved through the following citation databases: BVS, MEDLINE/PubMed, Web of Science, SciELO, Redalyc, Web of Science, Google Scholar, as well as the American Speech-Language-Hearing Association (ASHA). Elegible articles were obtained using the following terms: "neuropsychological tests," "nonverbal communication," "child language" and "infant" as well as their equivalents in Spanish and Portuguese. Twenty-six assessment instruments were found to be compatible with the eligibility criteria. From the results, 19 instruments explore various domains of linguistic precursors, while 7 are task-specific proposals. Five instruments are aimed at early detection of signs of Autistic Spectrum Disorder. The implementation of Bruner's model of communicative functions was found on 15% of the instruments. This article provides timely information for clinicians who work with children during early stages of development, in relation to the methodical monitoring, assessment and accompaniment of infants and toddlers during the prelinguistic stage.

Determinants of Communication Failure in Intubated Critically Ill Patients: A Qualitative Phenomenological Study from the Perspective of Critical Care Nurses.

AIM: To explore what factors determine communication with awake intubated critically ill patients from the point of view of critical care nursing professionals. BACKGROUND: Impaired communication frequently affects mechanically ventilated patients with artificial airways in the intensive care unit. Consequences of communication breaches comprise emotional and ethical aspects as well as clinical safety, affecting both patients and their conversation partners. Identification of determining factors in communication with awake intubated patients is needed to design effective action strategies. DESIGN: A qualitative phenomenological approach was used. METHODS: Semi-structured interviews were used as the data collection method. A total of 11 participants from three intensive care units of three Majorcan public hospitals, selected by purposive sampling, were interviewed. FINDINGS: Three major themes regarding the communication determinants of the awake intubated critically ill patients were identified from the interviewees' statements: factors related to the patient (physical and cognitive functionality to communicate, their relational and communicative style and their personal circumstances), to the context (family presence, ICU characteristics, workload, availability/adequacy of communication aids, features of the messages and communication situations) and, finally, those related to the professionals themselves (professional experience and person-centredness). CONCLUSIONS: The present study reveals determinants that influence communication with the awake intubated patient, as there are attitudes and professional beliefs. RELEVANCE TO CLINICAL PRACTICE: The discovery of relations between different kinds of determinants (of patient, context or professionals) provides a multi-factor perspective on the communicative problem which should be considered in the design of new approaches to improve communicative effectiveness. This study is reported according to the COREQ checklist.

Evaluation of Eye Gaze Dynamics During Physician-Patient-Computer Interaction in Federally Qualified Health Centers: Systematic Analysis.

BACKGROUND: Understanding the communication between physicians and patients can identify areas where they can improve and build stronger relationships. This led to better patient outcomes including increased engagement, enhanced adherence to treatment plan, and a boost in trust. OBJECTIVE: This study investigates eye gaze directions of physicians, patients, and computers in naturalistic medical encounters at Federally Qualified Health Centers to understand communication patterns given different patients' diverse backgrounds. The aim is to support the building and designing of health information technologies, which will facilitate the improvement of patient outcomes. METHODS: Data were obtained from 77 videotaped medical encounters in 2014 from 3 Federally Qualified Health Centers in Chicago, Illinois, that included 11 physicians and 77 patients. Self-reported surveys were collected from physicians and patients. A systematic analysis approach was used to thoroughly examine and analyze the data. The dynamics of eye gazes during interactions between physicians, patients, and computers were evaluated using the lag sequential analysis method. The objective of the study was to identify significant behavior patterns from the 6 predefined patterns initiated by both physicians and patients. The association between eye gaze patterns was examined using the Pearson chi-square test and the Yule Q test. RESULTS: The results of the lag sequential method showed that 3 out of 6 doctor-initiated gaze patterns were followed by patient-response gaze patterns. Moreover, 4 out of 6 patient-initiated patterns were significantly followed by doctor-response gaze patterns. Unlike the findings in previous studies, doctor-initiated eye gaze behavior patterns were not leading patients' eye gaze. Moreover, patient-initiated eye gaze behavior patterns were significant in certain circumstances, particularly when interacting with physicians. CONCLUSIONS: This study examined several physician-patient-computer interaction patterns in naturalistic settings using lag sequential analysis. The data indicated a significant influence of the patients' gazes on physicians. The findings revealed that physicians demonstrated a higher tendency to engage with patients by reciprocating the patient's eye gaze when the patient looked at them. However, the reverse pattern was not observed, suggesting a lack of reciprocal gaze from patients toward physicians and a tendency to not direct their gaze toward a specific object. Furthermore, patients exhibited a preference for the computer when physicians directed their eye gaze toward it.

Analysis of Nursing Students' Nonverbal Communication Patterns during Simulation Practice: A Pilot Study.

Therapeutic communication, of which nonverbal communication is a vital component, is an essential skill for professional nurses. The aim of this study is to assess the possibility of incorporating computer analysis programs into nursing education programs to improve the nonverbal communication skills of those preparing to become professional nurses. In this pilot observational study, the research team developed a computer program for nonverbal communication analysis including facial expressions and poses. The video clip data captured during nursing simulation practice by 10 3rd- and 4th-grade nursing students at a university in South Korea involved two scenarios of communication with a child's mother regarding the child's pre- and post-catheterization care. The dominant facial expressions varied, with sadness (30.73%), surprise (30.14%), and fear (24.11%) being the most prevalent, while happiness (7.96%) and disgust (6.79%) were less common. The participants generally made eye contact with the mother, but there were no instances of light touch by hand and the physical distance for nonverbal communication situations was outside the typical range. These results confirm the potential use of facial expression and pose analysis programs for communication education in nursing practice.

Childhood Non-verbal Communication Scale (CNCS): Turkish Adaptation and Psychometric Properties.

Introduction: Nonverbal communication (NC) skills develop dramatically during the first year of life. Especially in children with Autism Spectrum Disorder (ASD), inadequacies in these skills in the early period negatively affect language development later. Therefore, early recognition of ASD symptoms is the first step in the diagnosis. The test to screen ASD at the earliest age is the Modified Checklist for Autism in Young Children/M-CHAT in Turkey. However, this test can be used for 18 months or later. In the present study, we aimed to adapt the Childhood Nonverbal Communication Scale (CNCS) to Turkish, which was developed in Iran to evaluate NC skills in children from birth to 18 months and determine psychometric properties. Methods: This cross-sectional and methodological study was conducted in 3 provinces and included 323 parents of children who are normally hearing and 3-18 months old. Sociodemographic form, Ankara Development Screening Inventory, CNCS-Turkish form, and LittleEARS Auditory Questionnaire were applied. Results: CNCS Turkish form consisting of 37 questions shows a two-factor structure. The reliability coefficient of the 37-item scale is highly reliable (KR-20=0.937). It also had good convergent validity based on a significant correlation between total scores and LittleEARS results (r=0.804, P<0.001). According to the normative curve plotted by the CNCS total score for age, NC skills progressed with a steep slope from 3 to 12 months and then progressed gradually until 18 months. Conclusions: Childhood Nonverbal Communication Scale (CNCS) is a promising tool showing good validity and reliability in Turkish.

Measuring Dyspraxia in Autism using a Five-Minute Praxis Exam.

Background: Difficulties with praxis, the ability to perform learned skilled movements, have been robustly demonstrated in autism spectrum disorder (autism). However, praxis assessment is not routinely included in autism characterization batteries, in part because it is traditionally time consuming to administer and score. We test whether dyspraxia in autism can be captured with a brief measure. Method: Youth with autism (n = 41) and matched typically developing controls (n = 32), aged 8 to 16 years, completed a 5-minute praxis battery. The 19-item battery included four subtests: gesture to command, tool use, familiar imitation, and meaningless imitation. Video recordings were coded for error types and compared to participant characterization variables. Results: Consistent with research using a lengthy battery, autistic youth made more errors overall, with a large effect size. Groups demonstrated similar distributions of error types, suggesting that dyspraxia in autism is not limited to a particular error form. In the autism group, praxis was associated with adaptive functioning, but not autism traits. Conclusions: A shortened battery is sufficiently sensitive to praxis differences between autistic and typically developing youth, increasing the feasibility of including praxis within clinical assessments or larger research batteries aimed at testing relationships with downstream skills.

Face coverings differentially alter valence judgments of emotional expressions.

Face masks that prevent disease transmission obscure facial expressions, impairing nonverbal communication. We assessed the impact of lower (masks) and upper (sunglasses) face coverings on emotional valence judgments of clearly valenced (fearful, happy) and ambiguously valenced (surprised) expressions, the latter of which have both positive and negative meaning. Masks, but not sunglasses, impaired judgments of clearly valenced expressions compared to faces without coverings. Drift diffusion models revealed that lower, but not upper, face coverings slowed evidence accumulation and affected differences in non-judgment processes (i.e., stimulus encoding, response execution time) for all expressions. Our results confirm mask-interference effects in nonverbal communication. The findings have implications for nonverbal and intergroup communication, and we propose guidance for implementing strategies to overcome mask-related interference.

Enhancing Nonverbal Communication Through Virtual Human Technology: Protocol for a Mixed Methods Study.

BACKGROUND: Communication is a critical component of the patient-provider relationship; however, limited research exists on the role of nonverbal communication. Virtual human training is an informatics-based educational strategy that offers various benefits in communication skill training directed at providers. Recent informatics-based interventions aimed at improving communication have mainly focused on verbal communication, yet research is needed to better understand how virtual humans can improve verbal and nonverbal communication and further elucidate the patient-provider dyad. OBJECTIVE: The purpose of this study is to enhance a conceptual model that incorporates technology to examine verbal and nonverbal components of communication and develop a nonverbal assessment that will be included in the virtual simulation for further testing. METHODS: This study will consist of a multistage mixed methods design, including convergent and exploratory sequential components. A convergent mixed methods study will be conducted to examine the mediating effects of nonverbal communication. Quantitative (eg, MPathic game scores, Kinect nonverbal data, objective structured clinical examination communication score, and Roter Interaction Analysis System and Facial Action Coding System coding of video) and qualitative data (eg, video recordings of MPathic-virtual reality [VR] interventions and student reflections) will be collected simultaneously. Data will be merged to determine the most crucial components of nonverbal behavior in human-computer interaction. An exploratory sequential design will proceed, consisting of a grounded theory qualitative phase. Using theoretical, purposeful sampling, interviews will be conducted with oncology providers probing intentional nonverbal behaviors. The qualitative findings will aid the development of a nonverbal communication model that will be included in a virtual human. The subsequent quantitative strand will incorporate and validate a new automated nonverbal communication behavior assessment into the virtual human simulation, MPathic-VR, by assessing interrater reliability, code interactions, and dyadic data analysis by comparing Kinect responses (system recorded) to manually scored records for specific nonverbal behaviors. Data will be integrated using building integration to develop the automated nonverbal communication behavior assessment and conduct a quality check of these nonverbal features. RESULTS: Secondary data from the MPathic-VR randomized controlled trial data set (210 medical students and 840 video recordings of interactions) were analyzed in the first part of this study. Results showed differential experiences by performance in the intervention group. Following the analysis of the convergent design, participants consisting of medical providers (n=30) will be recruited for the qualitative phase of the subsequent exploratory sequential design. We plan to complete data collection by July 2023 to analyze and integrate these findings. CONCLUSIONS: The results from this study contribute to the improvement of patient-provider communication, both verbal and nonverbal, including the dissemination of health information and health outcomes for patients. Further, this research aims to transfer to various topical areas, including medication safety, informed consent processes, patient instructions, and treatment adherence between patients and providers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46601.