• Improving Your Communication Skills

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    This level 2 standard micro unit  is designed to help you gain the necessary knowledge and understanding to help you communicate in a variety of care settings.

    We envisage that it will take you approximately 6 hours to complete the unit (but you work through it at your own pace).  By the end of the unit you will be able to identify:

    • Different forms of communication
    • What affects the way we communicate
    • How to be an effective communicator


      • Erasmus logo
        This project has been funded with support from the European Commission. This publication [communication] reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.

    • What is communication?

      What is communication?

      Communication is commonly thought of as just speaking and writing clearly. Communication involves many other aspects such as body language, listening skills and identifying potential barriers that may exist to communication and then developing strategies to overcome these barriers. People who work in health and social care need to be able to communicate well so they can develop positive relationships and share information with others. Communication is a key to good interpersonal skills, which are very important for care work. This means that people who work in health and social care should be good listeners as well as good at speaking in way that others understand. As a care worker, you will need to be able to communicate with a wide range of people of different age and from different backgrounds and culture. Some of these people may have problem communicating, so it is important to have an understanding of the different ways of communication.

      Communication is a skill we learn very early in life as a way of getting our basic needs met. Communication is essentially a process were we send and receive messages. For effective communication we have to make sure there is mutual understanding and therefore it is not just important to be able to communicate clearly it is also just as important to listen.

      In this unit you will find out about:

      • the different types of communication;
      • What affects the way we communicate,
      • how to be a more effective communicator.

      Sources used for this module:



      Elizabeth Rasheed, Mary Anne Crittenden, and Alison Hetherington. BTEC Level 2 First Health and Social Care. London, GBR: Hodder Education, 2010.







      • Types of Communication

        Different types of communication

        We can essentially divide communication into the following categories:

        • verbal and non-verbal

        • formal and informal

        • One-to-one communication and group communication.

        An interesting piece of research has shown that:

        • 7% of what we communicate is based on vocabulary.

        • 38% of what we communicate is based on voice inflections.

        • 55% of what we communicate is based on non-verbal behaviours


        Verbal communication

        Verbal communication refers to the use of sounds and language to relay a message. When we talk about verbal communication it is necessary to mention vocal variety.

        Vocal variety in speech is a way to communicate by changing the sound of your voice using different speeds and tones while speaking. Good vocal variety helps keep the audience or individual engaged and helps clue them in on your meaning, feelings, or emphasis.  Talking in a flat, monotone way (unchanging in pitch; without intonation or expressiveness), can unduly affect the level of communication. The way that words are stressed in a spoken dialogue can offer a different meaning to what is being said.

        Click on Exercise 1 - Word stress (bottom of the page)

        For effective spoken communication you need to ensure that you speak clearly. Try to give clear instructions. Use appropriate language.

        Click on Additional activity - verbal communication  (bottom of the page)

        Another aspect to consider is candour. This is the ability to effectively communicate openness and frankness in discussion. Professional carers need to be able to do this in a sensitive way, using the appropriate tone and consideration but also to ensure that they are clearly understood by the client or patient.

        As care professionals, we may need to consider clients or patients that may have difficulties in speech such as coordination problems after having a stroke, loss of speech due to emotional trauma or congenital deformities affecting the way speech is formed.

         Click on Candour quiz  (bottom of the page)


        Non-verbal communication

        pain in the arse 

        'Of course I'm listening to you and how you're suffering. Don't you see me making eye contact, striking an open posture, leaning towards you and nodding empathetically?'

         Although we often think of verbal communication as significant form of communicating, a large amount of communication does not require words. We call this non-verbal communication.

        Non-verbal communication is often called body language. Body language can be defined as how we unconsciously use our bodies and faces for communicating and consists of things like facial expression, touch and gestures, eye contact or non-contact and the way we sit, stand and hold our bodies (posture) & head motion. 

         body lang




        Facial expressions can often give away what people are thinking even when they do not realise it.

        When combined with other aspects of body language such as gestures, this can reveal a lot about how a person is feeling and responding.

        For example smiling, eye contact and having our arms unfolded can be a sign of positive communication.

        Body 2

        There are also negative connotations too from body language. For example avoiding eye contact, frowning and having our arms crossed.

        Exercise 4- test yourself

        Answer questions

        1. What does the term nonverbal communication mean?

        2. Give three examples of positive nonverbal communications:

        3. Give three examples of negative nonverbal communications:

        4. What percentage of the meaning of a spoken statement comes from the actual words spoken?

        5. If someone speaks in a monotone, what does this mean and what influence does this have on his or her communications?

        6. “Vocal variety” means which of the following? (Tick one)

        􀂅 a) Traveling comedy shows of the 1920s

        􀂅 b) the ability of a speaker to use inflections and pitch

        􀂅 c) The ability of the speaker to use breathing techniques and do impersonations

        1. During a meeting between you and a co-worker, he or she moves a chair from behind the desk and asks you to sit down to discuss something. You could interpret this nonverbal communication to mean: (tick one)

        􀂅 a) He or she is trying to conclude this meeting quickly.

        􀂅 b) He or she is distracted.

        􀂅 c) He or she is ready to listen to you attentively.

        1. When a person crosses his or her arms during a conversation, this is an indication that: (tick one)

        􀂅 a) the person may not be in agreement.

        􀂅 b) the person is totally supportive of the other person’s views and opinions.

        1. Nonverbal communication skills are important to be a good communicator. (tick one)

        􀂅 a) True

        􀂅 b) False

        Click on the answers to Exercise 4 at the bottom of the page

        Now move on to exercise 5 by clicking on the link at the bottom of the page. The answers to this exercise can also be found at the relevant link at the bottom of the page.

        Signs, Symbols and Pictures

        symbol     no ent          seee

        Signs and symbols are very common in public spaces, making sure that as many people as possible have the information they need.

        Sometimes people use signs to communicate. If you cannot speak or are in foreign country you may use or picture board or Makaton.


        Makaton is a language programme using signs and symbols to help people to communicate. It is designed to support spoken language and the signs and symbols are used with speech, in spoken word order.


        British Sign Language (BSL)

        British Sign Language is a sign language spoken in the United Kingdom , and is the first or preferred language of some deaf people in the UK.

        Now try:  British sign Language  - Exercise 6 at the bottom of the page. The answers to this exercise are also at the bottom of the page.


        Braille is a system of raised dots that can be read with the fingers by people who are blind or who have low vision.


        Objects of reference

        Objects of reference are any objects that represent other things (e.g. teddy bear for children represent safety, photographs for adults can good memories).


        Technological aids

        Aids can be laptops, hearing aids, mobile phones, telephones, hearing loops, specialised speech output devices etc. Computer technology can be a great help to people with communication difficulties. For example people, who are deaf can communicate with close ones through email or messages or people who have vision problem may use audio books for reading.



        Context refers to the background to the communication and the circumstances in which it takes place. You may need to adapt your preferred method of communication to make sure you are understood and to minimise any potential communication difficulties.

        Formal & Informal Communication

        Formal communication

        Formal communication follows the proper conventional, grammatical and cultural rules, usually used in communication with strangers and in an official situations.

        Informal communication

        Informal communication is a use of familiar terms, such as nicknames, slang and jargon, used with friends and people very well known.

        Now try Exercise 7 on formal and informal communication below.


      • What affects the way we communicate?

         Communication is a two-way process, and the key elements needed are as follows:

        • Sender- the person starting the conversation

        • Message- what the sender wishes to communicate

        • Medium- the method of communication

        • Receiver- the person who receive the message and interprets it 

        • Understanding- the message has to be correctly interpreted by the receiver

        • Feedback- the receiver has to show that he or she received and understood the message

        This can be represented as a Communication Cycle


         What affects communication?

        Thinking about the communication cycle, you can observe that any interruptions to the cycle can cause difficulties with communication. Messages can get lost or be incomplete. Each part of the cycle has equal importance.

        Sensory difficulties

        This refers to people who have problem with hearing or vision. If you cannot see well or hear well, you are most likely to miss verbal or non-verbal signals. The term ‘sensory deprivation’ refers to person who has no hearing or no vision or both.

        Language issues

        If you do not speak the same language, this can be a significant barrier to communication. In this situation, without an interpreter or even a phrase book, you are more likely to heavily depend on body language to understand what a person is trying to communicate.

        In France when you greet someone, you may be expected to kiss them on both cheeks whilst clasping their hands. In India, it may be bad manners to touch the person at all.

        Try Exercise 8 at the bottom of the page

        Formal and informal language

        When speaking to someone we do not know, it is probably advisable to speak more formally. This is language that follows the proper grammar and cultural rules. Informal language can be used with people we are more familiar with and often involves using familiar terms such as: acronyms, nicknames, jargon, dialect and slang. However, even with someone you are familiar with, using informal language can still sometimes lead to miscommunication and in some situations should be avoided.


        Acronyms are words formed from the initials of other words (e.g. NHS, GPS).


        Jargon can be defined as specialist words or expressions used by a profession or group that are difficult for others to understand. Jargon is often related to technical words and acronyms e.g. BP (medical shorthand for blood pressure), IT firewall (something that protects your computer from cyber-attack).


        Slang is an informal language typically restricted to a particular context or group of people. For example in parts of London people use rhyming slang to represent words and phrases: ‘mince pies’ = eyes, ‘Have a butchers’ = ‘Have a butchers hook’ = have a look.


        Dialect words are specific to a local geographical area. In some parts of the North of England for example, a small back alley way is often referred to as a ginnel.

        Now try Exercise 9- Jargon, slang, dialect and acronyms at the bottom of the page

         Personal barriers


        Emotions can act as barriers to effective communication. When people are upset, angry or distraught they often have difficulties in decoding or interpreting the message that is being conveyed. A person’s emotional state has to be considered and dealt with before communicating important information.


        Anxiety can cause similar problems when communicating. It can prevent a realistic assessment of what is being said. When communicating information, a very anxious person will most likely not take in most of what has been said to them.


        Depression cause feelings of hopelessness and isolation, which can prevent communication. An isolated or depressed person most likely takes a consistent, negative view of the world and may not value anything that is said to them.


        Aggression of any sort can be a barrier to communication because it often leads to people being frightened. Aggression can be categorised as both verbal aggression, as in shouting or raising one’s voice, and physical aggression (or intimidation), such as towering over the other person, coming physically close or behaving in a threatening manner.  

        Intellectual barriers

        Mental health

        Mental health issues or mental illness, can unduly affect communication. For example, if a person is on heavy medication or undergoing a paranoid episode which may affect their ability to understand what is said to them, then it is possible that only very basic communication would be effective in this situation.

        Learning difficulties

        People with learning difficulties can have a problem expressing themselves (e.g. not be able to process information, remember things well, coordination problems). Conditions such as autism and Asperger’s syndrome where a person may struggle with body language and social cues, may require a simple, formal and unambiguous approach to communication for better understanding.


        Dementia involves gradual deterioration of intellectual capacity. As a result, people with dementia also tend to be unaware of the real world, people or places and forget what they have been told.

        Other barriers

        Environmental factors

        A noisy location, poor lighting etc., may impede effective communication. A person with hearing difficulties in a noisy room which is poorly lit will struggle to hear a person speaking and hinder the ability to lip read.

        Misjudgements and misunderstanding

        Conversation topics related to religion, politics, cultural differences etc. and presented as jokes, can sometimes be source of misunderstanding and tension.


        Behaviour that is appropriate at home does not necessarily mean that is appropriate at work. Physical contact (such as a hug) when greeting a family member could be misinterpreted at work if you did the same thing with a work colleague.

        Writing & Reading (including emails and texts)

        "If any man wishes to write in a clear style, let him first be clear in his thoughts."

        Johann Wolfgang von Goethe

        Sometimes a document, an email or text message can be misinterpreted if the message writer is not particularly skilled at using language in the right order or leaves important words or phrases out of the message.

        For instance, it is confusing to say “I rode a black horse in red pajamas,” because it may lead us to think the horse was wearing red pajamas. The sentence becomes clear when it is changed to “Wearing red pajamas, I rode a black horse.”

        Interestingly, how the message is structured in terms of grammar is more important than the words being spelled correctly when interpreting its correct meaning.

        Now try Exercise 10: Scrambled Word Test below

        You can also try Exercise 11 - Reading exercise below

      • Self assessment

        How much do you know?

        1. Can you say “hello” in four different languages?
        2. Find out, what organisations support people who use an alternative form of communication( internet)

        3. Explain why a person with hearing problem would benefit from improved lighting in his/her setting?

        4. How does sitting in a circle compere to rectangular table help?

        5. Guess the emotions on the picture

        6. Describe three examples of when sights, symbols and pictures are useful forms of communication

        7. What do we mean by the expression “barriers to communication”?

        8. Identify three barriers to communication and explain how they could be overcome.

        9. Why is social isolation a barrier to communication? Explain your answer.

        10. What do we mean by the expression “active listening”?

        11. How can speaking too slowly and with lots of hesitation affect communication?




      • Stroke -specific education framework (Ssef)

        If you click on the link http://www.stroke-education.org.uk/ it will take you to a website that will help you to create an individualized knowledge and skills passport.  This passport will automatically update when you have completed an Ssef registered course.

        Ssef is free to all.

        • Effective communication

          Tips on how to be more effective

          Communication is a skill that requires practice. Effective communication is to ensure that the message you send to the other person is received, accurately interpreted and understood and responded to appropriately. To communicate effectively, we need to be aware of the hidden messages we may be giving out unconsciously because our words may not always match our actions. It it useful exercise to observe other people communicating (sometimes known as ‘people watching’).

          Be observant when you are in social situation and you will learn a lot about how people communicate. 


          When communicating it’s best to try to establish if there are any communication issues with the person you are interacting with such as language needs, preferences and any other barriers.

          You need to establish whether a formal or informal approach is needed i.e. should you address the client as Mr … rather than using their first name. Initially it is wise to not use informal names such as ‘lovie’, ‘darling’ or ‘old timer’. As the relationship between the client or patient becomes more relaxed, then it may be appropriate to use some informal language if appropriate.

          Overcoming communication difficulties

          There are a number of strategies that can be used to minimise specific communication difficulties.

          Poor sight or blindness

          • Ask what the person is able to see.
          • Make sure they are wearing the correct glasses.
          • Make sure they have any required aids or equipment.
          • If they are blind, speak to them as you approach so they know you are there.
          • Use language to describe surrounding.

          Hearing difficulties

          • Make sure you are face-to-face and at the same level. Try not to have your face in shadow.
          • Make sure it is as quiet as possible.
          • Do not shout but speak normally, slowly and clearly, giving time to lip-reading.
          • Use gestures.
          • Use pictures and write messages.
          • Learn \Makaton or how to sign.

          Language issues

          • Use pictures and symbols.
          • Be on guard about making assumtions.
          • Do not use jargon, acronyms or slang.


          • Learn to become aware of the signs if someone is becoming upset or angry.
          • Learn how to better recognise anxiety and depression.
          • Try to remain calm and speak calmly.
          • Learn about managing challenging behavour.
          • Carefully choose the time and place where you have difficult conversation. Be sensitve to confidentiality and avoid speaking in areas where there is distraction.
          • Remember that you may have to repeat information later and to carefully note what you have said.

          Intellectual difficulties

          • Learn about the most common intelectual difficulties in your area.
          • Share knowledge and good practice of what works with other staff members.
          • Be really patient, repeating things slowly when necessary.
          • Encourage people with intelectual difficulties to join support groups.


          *If you need more information about intelectual difficulties click on the links below:





          Down’s syndrome


          Asperger’s syndrome


          Envronmental factors

          • Choose the time and setting for communication carefully. This can be just as important as the conversation.
          • Make sure the environment is comfortable, quiet, at the correct temperature and has enough light.

          Preventing misunderstanding  - quick check

          • Always check for understanding/use appropriate language.
          • Learn about different cultures.
          • Do not make assumptions.
          • Try different ways to get your message across.
          • Be aware of gender differences.
          • Be aware of any disibilites that may affect communication.

          General strategies for overcoming communication difficulties

          1.  Communicate when the service user is at their greatest level of alertness.
          2.  Give sufficient time for the conversation and take breaks to allow the service user to regroup if they become confused.
          3.  Make sure the place where you communicate has sufficient light and quietness to enable communication to take place.
          4.  Face the person, maintain eye contact, speak clearly and address the service user by their preferred name.
          5.  Use simple language, keep instructions simple and give simple choices.
          6.  Check whether the service user understands what you are saying.
          7.  Listen without interrupting and don’t rush the service user into a response.

          Active listening

          Active is to be intensely involved. You have to really listen and ask the right questions.

          Good habits

          You should try to:

          • Pay attention

          • Watch your body language

          • Show you are listening

          • Check your understanding

          • Be open and not to pre-judge

          Active listening bad habits

          The following is a list of ten bad habits of listening. Look at the list and identify some that you may be guilty of committing when communicating with others. Be honest with yourself!

          􀂅 I interrupt often or try to finish the other person’s sentences.

          􀂅 I jump to conclusions.

          􀂅 I am often overly parental and answer with advice, even when not requested.

          􀂅 I make up my mind before I have all the information.

          􀂅 I am a compulsive note taker.

          􀂅 I don’t give any response afterward, even if I say I will.

          􀂅 I am impatient.

          􀂅 I lose my temper when hearing things I don’t agree with.

          􀂅 I try to change the subject to something that relates to my own experiences.

          􀂅 I think more about my reply while the other person is speaking than what he or she is saying.

           Seven Levels of Listening

          Listening can occur at several levels. This can be categorised as follows:

          1 Not listening: Not paying attention to or ignoring the other person’s communications.

          2 Pretend listening: Acting like or giving the impression that you are paying attention to another person’s communications, but in actuality not really paying attention to that individual.

          3 Partially listening: Only focusing on part of the other person’s communication or only giving it your divided attention.

          4 Focused listening: Giving the other person you’re undivided attention to his or her communication.

          5 Interpretive listening: Going beyond just paying attention but really trying to understand what the other person is communicating.

          6 Interactive listening: Being involved in the communications by asking clarifying questions or acknowledging understanding of the communication.

          7 Engaged listening: Being fully engaged in communications involves listening to the other person’s views, feelings, interpretations, values, etc., concerning the communication and sharing yours as well with the other person(s). In engaged listening, both parties are given the opportunity to fully express their views, feelings, and ideas.

          Speech patterns

          Tone of voice can convey different feelings, it is possible to say words in different tone of voice, perhaps with a slight emphasis on some words rather than other, and yet to convey a different meaning.

          Questioning technique

          Open-ended questions

          Open questions are a good way for drawing out more information from people during conversation (e.g. what, how, when). 

          Closed-ended questions

          Closed questions are those which can be answered by a simple "yes" or "no,".

          Funnel questions

          Funnel questions are another way of obtaining information. This technique involves starting with general question and asking for more information in each point. A doctor often uses this line of questioning with patients to help make a diagnosis.

          Now try: Open, funnel or closed questions? Quiz below

        • Evaluation time

          Here you can let us know how you found this unit and what worked for you, or not!