Nonverbal behavior in telehealth visits: A narrative review

• Published in: Patient education and counseling 2025-03, Vol.132, p.108600, Article 108600
• Main Authors: Duffy, Conor M.C., Benotsch, Eric G.
• Format: Article
• Language: English
• Subjects: Nonverbal behavior; Nonverbal communication; Patient-provider communication; Telehealth; Telemedicine
• ISSN: 0738-3991; 1873-5134; 1873-5134
• DOI: 10.1016/j.pec.2024.108600

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. 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. 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. 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. 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. •It is difficult to make eye contact and interpret gestures in telehealth.•Few quantitative studies have examined nonverbal behavior (NVB) in telehealth.•Most prior research uses qualitative methods to examine patient/provider perspectives.•Future quantitative research should examine associations between NVB and patient experiences/outcomes.