Association between nonverbal communication during clinical interactions and outcomes: a systematic review and meta-analysis

Patient Educ Couns. 2012 Mar;86(3):297-315. doi: 10.1016/j.pec.2011.07.006. Epub 2011 Aug 6.


Objective: To conduct a systematic review and meta-analysis of studies reporting associations between patients' and clinicians' nonverbal communication during real clinical interactions and clinically relevant outcomes.

Methods: We searched 10 electronic databases, reference lists, and expert contacts for English-language studies examining associations between nonverbal communication measured through direct observation and either clinician or patient outcomes in adults. Data were systematically extracted and random effects meta-analyses were performed.

Results: 26 observational studies met inclusion criteria. Meta-analysis was performed for patient satisfaction, which was assessed in 65% of studies. Mental and physical health status were evaluated in 23% and 19% of included studies, respectively. Both clinician warmth and clinician listening were associated with greater patient satisfaction (p<0.001 both). Physician negativity was not related to patient satisfaction (p=0.505), but greater nurse negativity was associated with less patient satisfaction (p<0.001). Substantial differences in study design and nonverbal measures existed across studies.

Conclusion: Greater clinician warmth, less nurse negativity, and greater clinician listening were associated with greater patient satisfaction. Additional studies are needed to evaluate the impact of nonverbal communication on patients' mental and physical health.

Practice implications: Communication-based interventions that target clinician warmth and listening and nurse negativity may lead to greater patient satisfaction.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review
  • Systematic Review

MeSH terms

  • Health Services Needs and Demand
  • Humans
  • Nonverbal Communication*
  • Outcome Assessment, Health Care*
  • Patient Satisfaction*
  • Physician-Patient Relations*