Touch, communication and affect: a systematic review on the use of touch in healthcare professions.

Abstract

Background: The following systematic review explores the uses and understandings of physical, human-to-human touch engagements in healthcare professions. Given its central importance as both a diagnostic tool and a form of non-verbal communication, this review sought to understand the communicative, social and affective dimensions of touches a part of healthcare, medical or nursing interventions. We attempt to understand how touch communication seems to be structured in the literature, and what tends to be communicated via touch, but also to highlight how the dogmatic distinction between 'instrumental' and 'expressive' touches might have obscured a socio-affective matrix within all touches.

Methods: The synthesis produced was informed by 36 empirical studies involving either direct observation of touch practices, or recollection and discussion with healthcare professionals. The studies were selected from five databases in March 2022. In order to minimise risks of bias, the corpus was screened by two independent reviewers and underwent quality appraisal through the Mixed Methods Appraisal Tool. The final dataset was then analysed, synthesised and presented according to the principles of thematic synthesis.

Results: We outline how medical touch has been mostly categorised as either 'instrumental' or 'expressive', with only the latter usually described as serving a communicative purpose, despite its lower incidence. We further highlight how touch seems to be operating across a fragile boundary between 'reassuring presence' and 'control', and thus requires carefulness by practitioners, and an understanding of boundaries. Then, we describe how the literature presented gender, cultural background and personal preference as elements influencing the use and perception of touch. Lastly, touch-mediated communication has been presented in some of the literature as a co-produced practice based on bodily, affective and contextual mutual attunement. Such an understanding radically reconfigures the patient as an active co-participant, as well as pushing against the conceptual boundary between instrumental and expressive touch, recognising how to affect cuts across human-made dichotomies.

Conclusion: We argue that communication might happen in all instances of touch, while also advocating for empirical work to outline and describe the adaptive physical dynamics (e.g. changes in speed, pressure, temperature) that regulate and alter even medical procedures for communicative purposes. We also discuss the need for social scientists to radically re-conceptualise not only the theoretical scaffolding behind medical touch, but also the methodologies deployed to investigate it-advocating for a renewed attention to bodily and interactional dynamics, particularly through the deployment of (micro-)phenomenological tools, broader ethnographical engagements, or sensors for automatic recognition of bio-signals.

Limitations: The review could be at risk of bias given it sampled only studies written in English, French, Italian, Spanish and Finnish, thus not highlighting potentially different cultural and theoretical perspectives emerging from non-EuroAmerican contexts. Moreover, only 36% of studies included discuss patients' perspectives.

Systematic review registration: This review was not registered.