On average only 6.8% of the participants found it difficult to understand the meaning of EL used in the English data. The findings show that participants’ attitudes towards the use of EL in online medical information differ in the six excerpts: while three excerpts with EL were preferred by most, the other three with non-EL were also favoured. On average, a neutral attitude emerged: close to a half of participants preferred EL and the other half non-EL. Twelve frames generated from the data explain why the participants made their choices as regards EL, non-EL, both or neither. The frames are categorised into three groups: language-focused, language-user-focused and diseased-focused. The first grouping consists of six frames: fluidity, informativeness, relevance, accuracy, clarity, and discourse management. They all adhere closely to cooperative principles and relevance theory framework . The second grouping consists of five frames: trustfulness, folk–individual, lay–professional, voluntary–involuntary and indifference. The third grouping is disease focused: choices were made closely linked to the nature of six diseases. This grouping is specific to medical communication.

The four theoretical frameworks reviewed here are relevant to the conceptualisation of EL: pragmeme theory, integrative pragmatics, frame theory and elasticity theory. They are adopted as a guide through the research of EL in the present study. They all focus on pragmatic meanings grounded in context and complement each other for the benefit of this study. Pragmeme theory states that a pragmeme refers to a situation or an act that captures the goal of the situation, e.g., online healthcare information dissemination. This study expects that there should be regular patterns or protocols of EL use. The EL pragmeme can be realised in different situations, which can be manifested, according to the integrative pragmatics, through the pragmatic behaviours of online website writers and the evaluations of observers. The two focuses highlighted in integrative pragmatics are empirical evidence and the importance of observers’ participation (metapragmatics), both of which are adopted in this study. Frame theory guides the reader through the investigation of the participants’ perceptions of and attitudes towards the use of EL in this study.

The English data show that the most prevalent elastic expression is may, which occurs 10 times more than the least frequent, sometimes. The second highest, some, occurs four times more than sometimes. This indicates that may is far more a favoured choice of word than the other nine words on the top-10 words list, underlined by the fact that medical information is a matter of probability rather than being categorical.

Quite a few elastic terms on the Chinese top-10 list are similar to their English counterparts or near-counterparts: keneng (可能) and may; chang (常)/tongchang (通常) and usually/often; hen (很) and very; geng (更) and more; duo (多)/xuduo (許多) and many/most. These cover epistemic, scalar and approximate stretchers. While the most frequently used general stretcher in Chinese is deng, the most commonly used general stretcher in English is things. In terms of how the four categories of EL are distributed, the Chinese and the English data exhibit two different patterns, i.e., SC-AQ-GE-EP and EP-AQ-SC-GE respectively. A series of comparisons of the most-used stretchers of each of the four categories in the Chinese and the English corpora yield some interesting findings. There is a clear preferred epistemic stretcher in online health information in Chinese and in English respectively, i.e. keneng (可能) and may.

Medical diagnoses and prognoses are often not clear-cut ‘facts’. Conveying these kinds of vague phenomena is a challenge to health professionals, but also a skill that they must master. This study analyses real-life medical data to generate communicative patterns and verified strategies that shape the ways in which professionals communicate uncertainty. The findings may help healthcare professionals to deliver medical information in ways more accessible to the public. Elasticity plays an integral role in imparting medical advice to patients effectively and affirming their choices. This study is the first to explore communication effectiveness in healthcare, paying special attention to the role of elasticity in language use and in an Australia–Taiwan comparison. This research adds a new dimension to the study of health communication and explores better ways to deliver medical information to the public, by challenging linear theories in linguistics and promoting non-linear concepts. Language cannot be totally held to a ‘correct’ standard, nor used just as one wishes. A ‘one size fits all’ rule for language use does not exist, and instead multiple standards guide our use of it.

The findings of this study can be explained by elasticity theory, frame theory, pragmeme theory and integrated pragmatics. For example, they show how language users carry out, adjust and adapt to the pragmeme of delivering online health information using EL in different and shifting contexts. This study supports the conceptualisations of these theories and more importantly it further develops elasticity theory through adopting enriched perspectives of pragmatics as well as metapragmatics.

There appears to be a combination of contributing factors that affect and shape the use of EL in the Chinese data: the nature of the medical condition (e.g. disease severity, sensitivity of mental conditions), the applications and restrictions of medicine (e.g. the groups suitable or unsuitable for vaccines), the society’s health policy (e.g. the groups eligible for free treatment), the written mode, the health professional’s stance towards the health information, and potentials and constraints of an elastic/vague term (e.g. keneng vs. sihu; hen vs. guodu). Social conventions in language use are also a significant factor, an issue that is further addressed in Chapter 6.

The methodology used in this study is data-driven and evidence-based. This approach strengthens the credibility of findings drawn out of the two corpora in Chinese and English. Most medical discourse studies focus primarily on spoken data, but this study focuses on written data, and the online data is the first written corpus of its kind. New findings regarding shared and culture-specific features of EL shed light on how and why language users stretch their words to increase efficiency of health communication. This study not only contributes to the conceptualisation of EL in healthcare discourse but also affords methodological significance to cross-cultural research of health communication. By examining pragmatic variations in the use of EL, we can develop strategies for improving communication in healthcare discourse. The findings also benefit the public by showing healthcare professionals how medical information may best be communicated through EL. The new insights and resources may also inform policy making by highlighting EL use as an important skill for healthcare professionals.

This chapter identifies various similarities and differences between the Taiwanese and Australian data. An approximate correlation was found between the severity of a disease and the difficulty of understanding EL. The intensity of items of EL in the excerpt also affects the perception of difficulty with EL. The more different elastic expressions there are in the excerpt, the higher the rate of difficulty the excerpt is likely to have. Our interview data further explain what makes it hard to understand EL. Some of the interview responses in Chinese correspond to those in English. Nevertheless, a striking difference was also identified as one response in the Taiwanese interview data was more oriented towards a perspective that considers society as a collective group or community, a phenomenon not found in the Australian data. Culture may also play a role, but culture cannot be simplified and reduced to one determinant held accountable for any given cultural differences. We suggest three broad factors that affect discourse comprehension difficulty caused by EL/VL: the reader, the health topic and the text.