The theory of speech acts was developed and originated by Austin; later, Searle (1969) developed the theory further into more speech acts inspired by Wittgenstein’s use theory, Austin’s speech act theory, and Grice’s implicatures theory. Speech act theory is concerned with how the speaker can make his/her communicative goal clear through speech and how the listener can recognize and understand that intention (Austin, 1962; Searle, 1975). Austin (1962) claims that a speech act is a speaking unit that performs specific functions and that a single speech act can be further divided into three other acts: a locutionary act (the main act of speaking), an illocutionary act (when someone says something with a specific purpose with reference to the communicative intention of the speaker’s mind), and a perlocutionary act (refers to the effect of an utterance on the addressee).

Searle (1968) argued that sentences can have different strengths but one literal meaning. For example, according to context, they can have the force of a promise, prediction, threat, or warning, and “one and only one literal meaning” (Searle, 1968, p. 406). Speech acts are not merely spoken words. However, they are verbal actions that occur worldwide. This means that when someone says something, he/she does something using his/her words. Therefore, speech acts imply that the speaker performs an action that changes the current state of affairs (Mey, 2001, p. 96). Fought (2006) indicated that a speech act is an utterance that constitutes a social action. For instance, “give me that” is a directive speech act in which the speaker directs the receiver to perform an act. When utterances contain threats or elements of physical or mental harm, the speech act theory is appropriate to use (Haiman, 1993).

The speech act of advice is considered a face-threatening act (FTA) to people who receive the advice. Brown and Levinson (1987) employed the notion of face and clarified that every person has two types of face: positive and negative. A “positive face” refers to the desire to be approved of or appreciated by others, whereas a “negative face” refers to the freedom of action or the desire not to be imposed upon by others. Therefore, advice-givers tend to use various discourse strategies to make the advice seem acceptable by reducing the threat, such as using hedges, indirect advice, positive regard, etc. for politeness purposes. Holmes (1995) defined politeness as “an expression of concern for the feelings of others” (p. 3), and people can express their concern for others verbally and non-verbally. Spiers (1998) pointed out that politeness is used mainly to ease social interaction by providing a ritualistic form of verbal interaction that reduces the severe nature of many speech acts, such as commands, requests, questioning, advice, etc. In other words, the speaker maintains both his/her face and the face of the addressee in social interactions.

From the perspective of speech act theory, Searle (1969) defined the speech act of advising as “telling you what is best for you” (p. 67). He also, in his classification, classified advising within the directive category. Therefore, as a directive speech act, advising means that the recipient is required to perform an action according to the speaker’s desire; however, this action is for the sake of the recipient. The speech act advising implies the speaker’s authority and expertise and the recipient’s need for advice. Therefore, advising is different from other speech acts because it leaves acceptance to the recipient (Bouwmeester, 2010).

DeCapua and Dunham (1993) define advice as “opinions or counsel given by people who perceive themselves as knowledgeable, and/or who the advice seeker may think are credible, trustworthy, and reliable” (p. 519). Moreover, Tsui (1994) defines advice as “a directive which advocates a course of action for the benefit of the addressee, and in which the consequence of compliance is desirable” (p. 122). Regarding the theoretical concept of advice in the medical context, Van Poppel (2019) specified four felicity conditions for advising in the context of health:

Mićic (2013) indicated that the medical language is a register used by doctors; hence, it seems like an odd language outside the context of medicine. According to Bloom (1982), “medicine” can be defined as the science of preventing, treating, and diagnosing diseases. It also refers to the drugs used to treat any disease or injury. There are some characteristics of medical language, such as the extensive use of words that are largely related to the subject matter. This means that each word, phrase, or sentence uttered in the medical context is special and refers to medical jargon. In addition, medical language is characterized by the use of passivization and an impersonal style. Therefore, specialists use third-person rather than first-person pronouns (Mey, 2009). However, it is expected that a simple language used by doctors and patients will be understood.

Several studies have been conducted to investigate the speech act of giving health advice in different contexts, including radio advice programs (DeCapua and Dunham, 1993), TV health programs (Ahmed and Ahmed, 2019), Twitter (El-Dakhs, 2021), and online forums (Morrow, 2006; Kouper, 2010; Locher, 2013; Pung, 2017; Bates, 2021). For example, in the context of radio advice programs, DeCapua and Dunham (1993) examined the patterns in American English used by speakers (adults) when requesting and giving advice. The researchers collected data through calls from two different radio advice programs. The results showed that explanation, elaboration, and narration were the main strategies used by speakers when requesting and giving advice. These strategies were used by people to successfully interact with each other. It was observed that before advice-givers gave advice, callers gave a long clarification for the problem. Among these strategies, this study pointed out that narration was used more by both advice-seekers and advice-givers. The results also indicated that requests for advice by advice-seekers were implicit, sometimes vague, or included no requests at all. This is because the advice-seeker expects the request to be evident from the description of the problem. On the TV health programs, Ahmed and Ahmed (2019) examined the advice given in Arabic (Green Apple) and English (doctors) programs. The results showed that all pieces of advice in the two programs were used in polite expressions, which reflects the strong relationship between advising speech acts and politeness. The results also indicated a difference between the two programs regarding the types of politeness employed. It was found that in the English program, positive politeness strategies were used in all texts. However, in the Arabic program, negative politeness strategies were mostly used. In addition, the data clarified that in the English program, imperative sentences were used more than declarative ones, whereas in Arabic, the data showed more use of declarative sentences in comparison with imperative ones.

During the COVID-19 crisis on Twitter, El-Dakhs (2021) analyzed what advice-giving strategies the departments of health in Saudi Arabia and Australia provided to the public. The results showed that direct advice strategies were the most preferred among both Saudis and Australians. The use of direct advice strategies is preferred in the health domain. In terms of differences, the results indicate that Saudis preferred to use more direct advice strategies and external modifiers, whereas Australians used more conventional indirect strategies and internal modifiers. It also clarified that the Saudi health department, in terms of modifiers, used more religious expressions, whereas the Australian health department used some downgraders to try to sound reader-friendly and create engaging discourse.

Among peer advice interactions in an online community at LiveJournal.com on the topic of motherhood, Kouper (2010) studied how people take part in soliciting and giving advice, what strategies are used, and how they deal with the potential face threats in advice exchanges. The results showed that requests for information or opinions were the most common type of advice solicitation, followed by problem disclosures. It was also pointed out that requests for advice and problem disclosures were identified as systematically occurring in the data: “orientation, justification, and appreciation.” The use of these elements can vary frequently in terms of the frequency and positioning in the message. Therefore, messages that solicit advice vary in length, content, and structure. Such messages are often written in a narrative manner. It is often found that one message contains several questions or requests for advice. In addition, the results indicate that people in this community used all four strategies (hedged advice, direct advice, indirect advice, and descriptions of personal experiences) in advice-giving. The most common forms of advice were direct advice and sharing of personal experiences. However, in cases where there is greater sensitivity, people share personal experiences more often than hedged or indirect advice.

In an online forum among Malaysian women, Pung (2017) examined advice-seeking and advice-giving strategies and the influence of their culture. The results showed that the most frequently used strategies for advice-seeking were question-asking, followed by problem description, whereas an explicit request for advice was the least preferred strategy. However, for advice-giving strategies, the most preferred were giving or offering advice directly, followed by giving indirect advice, describing one’s own experiences, and providing general information. The findings also showed that the examination of many aspects of the interactions among women revealed participants’ cultural influence at the level of message content as well as the discourse.

Another study on an online forum, Bates (2021) investigated the mitigation strategies used when requesting and providing advice for recovery for people with eating disorders. The results showed that participants in the forum used different mitigation patterns for advice-seeking and advice-giving in the forum. For advice-seekers, the results indicated that mitigation devices and discursive moves were used to minimize the illocutionary force of a request and cope with the stress of the disorder. It was noticed that instead of directive acts, hedges were the most common mitigating devices in the data and were used by advice-seekers to soften the force of the request. On the other hand, for advice-givers, the findings revealed that affective appraisals, personal experience, empathy displays, and concessive patterns were the main discursive moves used by advice-givers to soften the message, express empathy, and reduce the advisee’s psychological vulnerability. Overall, it was observed that mitigation is an important way to deal with multiple stressors and multidimensional vulnerabilities in discourse.

Another communication context that receives attention in advice studies is the health domain. For example, Locher (2013) focused on computer-mediated advice regarding health issues and collected data from question-and-response letters in an online archive. An analysis of the data showed that the texts were segmented into “discursive moves.” The letters contained several parts, such as the problem, general information, explanation of points made, and farewells. While the analysis of the responses pointed out that there was both direct and indirect syntactic advice-giving, advice was included within the entire composition of the letters where the advice-seekers could make their own decisions by being given options. In addition, Morrow (2006) studied the discourse features of messages (postings and replies) posted on an Internet discussion forum on the topic of depression. The researcher classified these messages into three categories: problem messages (describing a problem), advice messages (responding to the problem messages), and thanks messages (written in response to the advice messages). The results showed that the discussion begins with “a problem message,” i.e., a presentation of the symptom by using metaphorical language to describe the medical problem, types of questions used to request advice, and the lack of direct requests for advice. This is usually followed by one or more advice messages in response. It was observed that sometimes there were many replies to the advice messages, either from the writer of the initial problem message as a “thanks message” or from others as “comments” on the advice messages. The results also indicated that the problem, advice, and thanks messages had similarities in terms of style but differed in terms of their discourse characteristics. In terms of the style, the researcher found that both the problem messages and the advice messages were written in an informal style, including the use of, for example, “u” for “you.” The author discussed three types of messages.

For the first type, Morrow (2006) revealed that problem messages were different in terms of structure and content. Some messages have three parts: an opening, a description of the problem, and a closing. However, not all of these parts could be found in all problem messages. The consistent part was a description of the problem. In addition, the findings indicated that there were relatively few direct requests for advice in “problem messages.” In addition, yes/no questions and WH questions were employed as a request for advice, and Morrow (2006) interpreted the use of yes/no questions when it was employed by patients with some competence in dealing with their problems. A similar use of yes/no questions was observed in Heritage and Sefi’s (1992) study on visiting nurses. They found that direct requests for advice were relatively few, and requests for advice were often in the form of yes/no questions that required confirmation. Heritage and Sefi (1992) explained the reason for using yes/no questions as a result of a desire to appear competent to handle one’s own affairs.

For the second type, advice messages, the results clarified that to make the advice less threatening to those who received it, advice-givers used different strategies to avoid that threat, such as, for example, showing empathy. It was observed that the advice-givers used an expression of empathy (as an opener) in most of the advice messages, saying, for example, “I just wanted to say that I am in the same boat as you.” Other expressions such as “good luck” or “take care” were used more in the closings to communicate a positive regard, and some expressions such as “feel free to talk to me” were used as offers. The results also showed that the majority of the advice-givers mentioned their own experiences before offering advice to advice-seekers. However, sometimes, advice-givers referred to someone else’s experience. In addition, sometimes when advice was not given, the advice-givers felt forced to explain the reason.

For the third type, thanks messages, the results showed that most expressed appreciation for the advice, and those messages were initiated with an expression of thanks in the opening sentence. In some cases, the writers admitted that they had done what was recommended. However, this was done without admitting that their actions aligned with the advice that they had received. Some thanks massages tended to be shorter. Overall, this study suggested that contextual factors affected the use of discourse patterns in terms of what the message writers said, what they avoided, and how they gave and received advice. In addition, Hinkel (1997) analyzed the responses to advice-giving and explored three types of advice-giving: direct, indirect, and hedged. Hinkel (1997) categorized advice that included hedges as hedged advice. In addition, Hinkel (2005) expanded the analysis to identify the types of hedges and relied on the system outlined by Brown and Levinson (1987), Hübler (1983), and Quirk et al. (1985). According to Hinkel (1997), hedges are defined as linguistic mitigating devices, e.g., particles, “tentativizers” (Brown and Levinson, 1987, p. 153), weakeners, and minimizers, employed to redress a potential FTA and reduce the speaker’s responsibility, for his or her cooperativeness, “informativeness, truthfulness, relevance, and clarity which on many occasions need to be softened for the reasons of face” (Brown and Levinson, 1987, p. 146). In addition, Hinkel (2005) analyzed and discussed the types of hedges in English, such as epistemic hedges, lexical hedges, possibility hedges, downtoners, assertive pronouns, and adverbs of frequency, which are affected by context.

Our review of previous studies shows that, to date, no study has attempted to investigate seeking and responding to advice in Arabic in the medical context through CMC, such as the use of a medical website. The current study aimed to fill this gap by investigating the discourse patterns of advice-seeking and advice responses to identify the strategies and structure in Arabic through CMC in the medical context.

The data for this study were collected in April 2022 from advice-seeking and advice-response messages on the Altibbi website (https://altibbi.com) about various symptoms in various health contexts, such as surgery, psychiatry, medicine, and ophthalmology. This website is one of the most important medical websites and is presented by a group of medical professionals who answer various health-related questions in Arabic. It is considered the first website in the Arab world to provide online medical consultation and certified information. It is set up as a site where patients with various medical problems can ask doctors about them freely and anonymously. At the time of data collection, the Altibbi website had more than 20 million users, more than 900,000 types of medical information, more than 137,343 doctors in service, more than 3,000,000 medical questions, and 4,350,504 medical consultations. There are more websites, but this one was chosen for the study of advice-seeking and advice responses for several reasons. First, it is certified by the ISO and is licensed. Second, it received the World Summit Award for the best online medical content for Arab readers. Therefore, this website provides a good context for studying advice-seeking and advice responses in the medical context.

The messages analyzed were posted from April 3–5, 2022. On this website, there were two filters. First, when choosing the type of question, we had the option to choose the most recent questions or the most frequently visited ones, but we opted for the former. The second filter was then classified. We did not determine any specific classification based on symptoms. However, we did a general search for all types of symptoms to obtain general data in the field. To obtain reliable results, we collected the data naturally and in the order the responses appeared on the website, without overlooking any questions or choosing any specific field. In addition, although there were some misspelled words in some sentences, no modifications were made. This process was performed manually by copying and pasting the data into an Excel file because of the ease of coding and extracting frequencies. The data consisted of 300 messages, including 150 advice-seeking messages and 150 advice-response messages. The advice-seeking messages were posted by 59 male and 91 female patients between the ages of 15 and 52. Their ages were divided into three groups to categorize the range of ages, and it was then found that the first group included 112 patients between the ages of 15 and 28; the second group included 11 people between the ages of 29 and 39; and the third group included 27 people between the ages of 40 and 52. In contrast, among the advice-responders, there were 123 male doctors, and 27 were female. All the personal information of doctors and patients was omitted in our research to protect their privacy, and we focused only on the language used in advice-seeking and advice responses. However, we only mentioned general types of information, such as age, gender, and the language of advice-seeking and advice responses. Although the website is public, and it requires no consent to access the data, the Institutional Review Board (IRB) at our university approved the study based on the procedures for collecting data and protecting the privacy of users of the website.

The advice-seeking messages were sent by patients to doctors asking for help with their problems, while the advice-response messages were sent by doctors in response to the advice-seeking messages. Those messages were written in Arabic except the use of some medical terms, whether by the patients or doctors, which were in English, such as the words “cloraxene,” “trichotillomania,” and so on. For advice-seekers, we included a header with age and gender identified but not names or photos. In addition, we included a classification that indicates what field the problem pertains to. In addition, there were topics and advice-seeking icons. However, we found that the topic-and advice-seeking icons usually had the same expressions used by patients or completed each other as one explanation. Therefore, in the analysis, we considered the topic and advice-seeking icons to be comments. On the other hand, for the advice-response messages, there were gender-and advice-response icons. Although the advice-seeker often received only one reply from a doctor, four advice-seekers received two replies from different doctors. Therefore, we relied on the first replies and neglected the second.

Two models were used in this study. First, Morrow’s (2006) model of code classification was used to analyze the data obtained in terms of the strategies of the speech act of advice-seeking. However, we found that some strategies were not available in our data, such as the advisory giver’s stance. In addition, we found that new expressions, such as “suffering from” or religious expressions, required new codes for strategies. These differences were due to the nature of the data as well as the Arabic context. Therefore, we used Morrow’s (2006) model, with some modifications, which was appropriate for Arabic data. In contrast, to analyze advice responses, Hinkel’s (1997) taxonomy of advice was used, which is divided into three classifications: direct advice, hedge advice, and indirect advice. However, the third classification (indirect advice) was not available because of the nature of the data and the medical context, as patients come to the site specifically to ask for help. Therefore, doctors, in giving advice, should use either direct advice or hedge advice.

Several steps were taken to analyze the postings of the speech act of advice-seeking and advice-response messages in terms of their strategies and construction. The data were collected by copying and pasting them into an Excel file to be coded based on Morrow’s (2006) and Hinkel’s (1997) work.

Reliability was established by the researchers. The first author analyzed the first 50 advice-seeking posts and the first 50 replies given independently, and they were revised by the second researcher to work out and agree upon a set of criteria for identifying the strategies employed in the messages. Discrepancies were resolved through discussion by adding new codes owing to the nature of the data. The same procedure was performed with the rest of the posts and replies in terms of analyzing, revising, and resolving discrepancies through discussion.

The following are some examples of the interactions that took place between patients and doctors in Arabic on the medical website. Two of these interactions are taken from the same situation: one example is a posting by the patient, and the other is a reply by the doctor. The Arabic text is followed by a transliteration (see Appendix A for Arabic symbols) and translation.

In Example 1, the patient began his posting by describing the medical problem: “My cumulative blood sugar is 5.9.” This was followed by using a yes/no question, such as “Am I diabetic?” There was no use of an opening or closing. In the response, the doctor started the reply by using “My dear brother” as an opening, followed by giving clarification/information as in “you are in the pre-diabetes stage, and you do not need treatment.” This was also followed by giving direct advice: “you must commit to improving your diet and exercise,” which was used to conclude the reply. Doctors employed various imperatives either with or without using “should” (see Table 1 for more examples).

In Example 2, the patient initiated her posting by requesting direct advice, i.e., “Tell me” and followed it by using a religious expression to thank the doctor in advance for the advice that will be given later, i.e., “may Allah reward you.” The patient followed her thanks by asking a question using a WH question, i.e., “What is the reason for tilting and moving one’s neck involuntarily towards the right or left side and the inability to move it forward when experiencing anxiety and tension?” The doctor began the reply by giving clarification/information, suggesting that a “Clinical examination is important,” followed by giving a direct advice, i.e., “You have to see a neurologist.” Patients used various imperatives when they asked for advice (see Table 2 for more examples).

In Example 3, the patient began the posting by describing the medical problem: “My eyes were exposed to the mobile flashlight for a long time, more than a quarter of an hour… not the first time.” This was followed by asking yes/no questions, such as “Am I in danger?” The patient concluded her posting by expressing feelings about herself, i.e., “I feel very worried,” which was intensified by using the adverb “very.” The doctor replied to the patient’s question: “Am I in danger?” with a yes/no answer when the doctor said “There is no risk.” At the same time, the doctor’s response can be considered a positive one. In addition, the doctor followed his response “There is no risk” by giving a direct advice: “it is better not to do it again,” in which the doctor advises the patient not to be exposed to the mobile flashlight again. In other examples, the doctors used hedges instead of using only imperatives in their advice, which are examples of hedge advice, as in, for instance, “it is possible to take…,” “you can take…,” “perhaps, you can take…,” etc. (see Table 3 for more examples).

In Example 4, the advice seeker initiated her posting by giving personal information about her patient, the baby, and mentioned that “my baby is 6 months old, followed by a description of the medical problem but not a general one. However, the mother of the patient used a strategy of “expressing suffering” when she said that “He is suffering from a severe cough with the presence of phlegm” to describe the problem in a very precise way. In addition, the mother of the patient used a WH question, “What is the best medicine for his condition?” The doctor replied to the question directly by giving clarification/ information without using any other strategies, responding with “Bronchicum,” which is a natural cough remedy.

In Example 5, the patient initiated the posting with a greeting, i.e., “Peace be upon you,” followed by a yes/no question: “are my test results normal?” The patient closed the posting with an expression of thanks and wished the doctor well during the holy month of Ramadan. The two strategies employed in the closing are considered positive politeness strategies.

The doctor replied to the greeting directly: “Peace be upon you and Allah’s mercy and blessings be upon you; happy Ramadan to all” as a response. The doctor followed the greeting response strategy of asking for more clarification by using questions such as “Sorry, are you complaining of palpitations? Feeling hot even in cold weather? Palms sweating?” The doctor employed more than one question to clarify the condition before giving the advice; however, these questions did not receive a response from the patient because of the nature of the website, which provides only a space for the posting and reply, but not additional responses.

The previous strategies employed by patients and doctors in advice-seeking and advice-giving are summarized in the following section to identify the most common strategies used in the online medical context in Arabic. Different strategies are employed by patients and doctors; however, they refer to advice-seeking and advice-giving in this context.

The second section also contains two subsections. The first focuses on the types of strategies as well as the types of compound strategies employed in advice-seeking by patients and how they construct their postings. In the second section, the types of strategies and compound strategies used by doctors in advice responses are explained, and how they construct their replies to the patients’ postings.