Nonverbal behavior in telehealth visits: A narrative review

Objectives: To synthesize findings from research examining nonverbal behavior (NVB) in telehealth. Use of telehealth has increased substantially in recent years-thus, it is critical to identify nonverbal strategies that facilitate positive patient-provider communication in this context.

Methods: Four peer-reviewed databases were searched: PubMed, PsycINFO, CINAHL, and EMBASE. Following a review of abstracts and full texts by the first author, 50 studies met inclusion criteria.

Results: The role of six NVBs- gaze, facial expression, gesture, head movement, proxemics, and posture- has been examined in the context of telehealth. Most included studies assessed patients' and providers' perspectives of NVB in telehealth. There was a lack of research examining nonverbal behaviors, and their associations with patient-centered outcomes, in naturalistic clinical settings.

Conclusions: While this review identified some promising nonverbal strategies to facilitate patient-provider rapport in telehealth, there is a need for future research that objectively measures NVBs and examines relationships between these behaviors and patient-centered outcomes.

Practice implications: Potential strategies for providers to enhance quality of communication in telehealth include gazing at the camera (vs. the screen), mirroring patients' facial expressions and head movements, leaning forward, and exaggerating gestures and facial expressions.