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UBC Theses and Dissertations

"Western world's apart?" A comparison of patient information websites on depression in Canada, the United States and England Keay, Aimee Lee


Healthcare information differs among the United States, Canada and England. Through a critical discourse analysis of fifteen websites on depression from these countries, this thesis reveals how linguistic differences and differences in the websites’ use of visual features persuade readers of the merits of different treatments. The analysis reveals that the trends are complex. However, England’s websites lean more towards talking therapy, the United States’ websites emphasize pharmaceutical intervention, and Canadian websites endorse the use of antidepressants where they mention treatment. These findings are illustrated through a comparison of vocabulary, grammatical, visual and ordering features (building from Fairclough’s 1989 framework). This thesis also reveals that patients from the United States, Canada and England are portrayed as in possession of differing levels of importance in the treatment-decision-making process with physicians. Of particular significance is the Canadian websites’ portrayal of patient deferral to expert physicians. By frequently referencing “your doctor,” using marked grammar for healthcare experts, and providing a reader with limited information on treatment options, Canada’s websites assert a traditional biomedical model of power relations. The patient is secondary to the physician. The United States’ privatized healthcare system indicates that websites from the United States would portray patient input as especially significant. However, it is England’s websites that suggest a high level of patient influence. Stressing patient involvement on England’s websites is perhaps indicative of the NHS’s 2012 constitution, which emphasizes that decision-making should be based on a model of concordance not compliance (Segal 2007). These findings highlight how the different healthcare models of each country might affect the information provided to patients. Above all, this research raises questions about the role of patient information websites, and about the different discursive strategies that subtly persuade a reader to view depression, treatment and their input in decision-making differently. England, United States and Canada all make use of the DSM IV-TR diagnostic criteria and operate under a biomedical model of medicine, but these websites suggest that potentially depressed patients are approached differently in each of these countries.

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