Here we offer information about skills that may help women with disabilities communicate effectively in relationships with others including their healthcare providers.
Our communication styles influence our mental, physical, and social health and wellness. Communicating effectively is a skill that can help build healthy relationships by reducing conflicts and anger. We know we are communicating better with our healthcare providers when we can clearly explain the problem and what we want, and they give us answers we can understand and use. To get the most out of healthcare services, we must manage fears and other feelings of not having power to control what happens to us. Medical providers still struggle to see people with disabilities, especially women, as equal members of the healthcare team. It is up to us to take control of our healthcare, as we would for anything else we purchase. This may be easier if we think of our medical providers as partners, each sharing important health information--we know our own bodies and medical providers know about medicine. The resources listed below include links to sources offering tips on communicating effectively with your doctor or other healthcare providers.
According to communication coach and counselor Ann Silvers, “Assertive communication is the ability to express positive and negative ideas and feelings in an open, honest and direct way. It recognizes our rights while still respecting the rights of others. It allows us to take responsibility for ourselves and our actions without judging or blaming other people.”1
Clear communication may help us deal with barriers to independent living. For example, a woman who uses a wheelchair is interested in attending a small dinner party with some coworkers in a restaurant that is not easily accessible to her (the only way for her to access the dining area is to enter through the storeroom door). This woman might contact her coworkers in advance and describe the access situation, stating that she is very interested in being part of the dinner party and asking them to consider meeting for dinner at a more accessible restaurant.
Our communication styles can help us connect or distance ourselves from others. Healthy communication can reduce our sense of isolation. It can increase our social support networks and enrich our lives in many ways. Effective communication can lead two persons to experience a sense of connectedness and mutual understanding. Ineffective communication however, can result in both people experiencing hurt and disappointment.
Communication that involves mostly “you” and “they” statements usually centers outside the self. With this type of communication, we relate to others without really sharing ourselves. It can actually diminish the quality of our relationships as well as our feelings and thoughts about ourselves. Another problem with “you” statements is that others may perceive them as unsolicited advice or aggressive statements. The other person may feel threatened and become self-protective. An example of a negative “you statement” is: “YOU should have told me this in the first place!” However, it is important to note that “you” statements are not always bad. They can actually play important positive roles in communication. An example of a positive “you” statement is: “You seem to be annoyed when I ask you for help. Would you please you tell me why?”
Effective communication expresses clearly what we want, think or feel. It is composed of behaviors such as active listening and the use of “I” statements.
Active Listening involves paying close attention to what the other person is saying and responding by nodding, maintaining eye contact, leaning forward, or engaging in other behaviors to communicate an understanding of what is being said. It also helps to clarify what the other person is saying. An example is “What I hear you saying is that you are angry that your personal assistant came to work late.” Additionally, an effective active listener does not interrupt until the other person finishes what they are saying.
"I” Statements reflect our inner thoughts and feelings. It is a type of communication that focuses on the feelings or opinions of the speaker. It is important to remember that “I” statements involve taking responsibility for our own thoughts and feelings. An example of an “I” statement is “I feel sad when you leave after our visits.” We do need to be careful that “I” statements are not simply “you” statements in disguise. For example, "I feel that you are bad-mannered.”
There are four styles of communicating with other people: passive, aggressive, passive-aggressive, and assertive.
Passive Communication denies your own rights, like when you say, "I'm wrong, you're right." Individuals avoid expressing their opinions or feelings, protecting their rights, and identifying and meeting their needs. They struggle to express anger or hurt.2 Passive communication is accepting directions from others without question or discussion.
Aggressive Communication is a style in which individuals express their feelings and opinions and advocate for their needs in a way that violates the rights of others.2 It says, "I'm right, you're wrong." It is an abuse of power over individuals who are in a subordinate or vulnerable position. You can recognize aggressive communication when someone speaks too loudly, constantly interrupts, and uses sarcastic, “put down,” or hurtful language such as “You always…” or “You never….”
Passive-Aggressive Communication is a style in which individuals appear passive on the surface but are really acting out anger in a subtle, indirect, or behind-the-scenes way.2 You can recognize this, for example, when a partner or personal assistant insists they are not upset with you and yet gives you the silent treatment,’ or makes you wait before giving you food or helping you with an urgent need.
Assertive Communication is a simple, straightforward and confident expression of beliefs, feelings, and opinions. It is a style in which individuals clearly state their opinions and feelings, and firmly advocate for their rights and needs without violating the rights of others.2 It takes some emotional control to communicate assertively. When someone says something hurtful or “pushes your button,” it is best to hold back on blowing up (aggressive) or agreeing, retreating, or saying nothing (passive). The assertive response would be to use a calm voice, say how what they said makes you feel, ask for clarification, and offer a better way to view the situation instead of attacking or ignoring the other person. Remember: When people are communicating assertively, they not only say what they are thinking, but they are also careful not to hurt other peoples’ feelings.
Nonverbal communication is the act of sharing information without the use of words. It can be more powerful—and even more influential—than what we say with words. It makes up about 70% of all communication. Experts say only 20% of the impact of our communication is from the words that we use.3 We communicate nonverbally through a variety of ways and senses including the sense of sight and touch. Effective non-verbal communication can be difficult for women with certain physical limitations. Although there are many types of nonverbal communication, below are four examples with implications for women with disabilities.
Facial expressions can often reveal our personalities, thoughts, and feelings. Women with limited control of the muscles in their face may feel self-conscious, especially when it affects their way of speaking. Facial exercises can sometimes improve control of expressions and coordinate them better with emotions. Smiling is a powerful way to communicate your values and emotions, so having control of the smile muscles is very important.
Gestures depend on upper body strength and coordination. If you don’t have much use of your arms or hands, you can depend more on facial expressions and eye contact to communicate. Be aware of your wanted or unwanted gestures and, if you can, practice coordinating them with your words and emotions. Remember also that gestures have different meanings depending on one’s culture. For example, thumbs up can be a sign of approval or an insult depending on the culture.
Posture can be a powerful way to express your state of mind such as being alert, bored, casual, or formal. Many disabilities affect posture due to weakened muscles, balance problems, or differences in bone structure. For women with cerebral palsy, spinal cord injury, and neuromuscular disorders, muscles of the back may be weak, resulting in a permanent slouch. Others may interpret this as a sign of boredom. Women with disabilities who don’t have much control of their posture can make up for this by depending more on eye contact, or by using gestures to communicate their state of mind.
Touch, which is considered the most intimate of our five senses, involves offering and receiving physical contact. Touch transfers personal energy and can promote physical and psychological well-being. The quality and location of touch communicates one’s intention and adds power to words. Women with disabilities may often feel deprived of touch. People without a disability may believe that touching a disabled woman is forbidden or may cause pain. A wheelchair can be a barrier to casual touch. To deal with these perceptions and beliefs, women with disabilities can offer touch first when feeling safe to put the other person at ease and communicate comfort. Touch can be compassionate or abusive. When touch is inappropriate or unwanted, and when a woman doesn’t have the ability to back away, she can feel out of control of her personal space and her body. She should tell the person to stop touching her and/or call for help.
- Burgoon, J. K., Manusov, V., & Guerrero, L. K. (2021). Nonverbal Communication (2nd ed.). Routledge.
- Cancer Care. (2019). The Value of Assertiveness When Talking to Your Doctor.
- Center for Integrated Healthcare. (2013). Assertive communication.
- Impact Factory. (2020). Assertive Communication - 6 Tips for Effective Use.
- Loncsak, H. (2021). What is Assertive Communication? 10 Real-Life Examples.
- National Institutes of Health. (2021, November 29). Clear Communication-- Talking to Your Doctor of Healthcare Provider.
- Next Avenue. (2018). How Can I Communicate Effectively With my Doctor?
- National Institute on Aging. (2020, February 03). Talking with you doctor: Preparing for a doctor’s appointment.
- Wilson, C. R. (2021). Your Definitive Nonverbal Communication Guide.
- World Institute on Disability. (n.d.). Peer support health access training program for disabled women.
- Silvers, A. (2020). What is assertive communication and behavior?
- University of Kentucky Violence Intervention and Prevention Center. (n.d.). The Four Basic Styles of Communication.
- Hull, R. H. (2016). The art of nonverbal communication in practice. The Hearing Journal, 69 (5), 22,24.