1.4 Communication Competence

Learning Objectives

  • Define communication competence.
  • Explain each component of the definition of communication competence.
  • Discuss strategies for developing communication competence.
  • Discuss communication apprehension and employ strategies to manage this.

Communication is common in that it is something that we spend most of our time doing. Still, making sense of and improving communication takes competence learned through deliberate study and personal reflection. So, to get started on your road to competence, we propose that you do two things. First, challenge yourself to see the value of studying communication in your health field. Apply the concepts we are learning to your personal and professional lives and find ways to make this class help you achieve your goals. Second, commit to using the knowledge you gain in this class to improve your communication and the communication of those around you. Become a higher self-monitor, which means starting to notice your communication more. We all know areas where we could improve our communication, and taking this class will expose us even more. But you have to be prepared to put in the time to improve; for example, it takes effort to become a better listener or to give better feedback. If you start these things now, you will be primed to take on more communication challenges presented throughout this book.

The ability to communicate effectively is often included as a primary undergraduate learning goal, along with other vital skills like writing, critical thinking, and problem-solving. You may not have heard professors or university administrators use the term communication competence. Still, as we learn more about it in this section, you will see how communication competence can benefit you in many aspects of your life. Though this resource focuses on professional communication in health studies, strategies for developing communication competence are not limited to this. Watch the following video and consider how communication competence leads to effective communication in health care.

Watch: Effective Communication Can Save Lives

Video Transcript (see Appendix B 1.4)

The video discusses effective communication in the healthcare setting

Defining Competence

We have already defined communication, and you probably know that to be competent at something means you know what you are doing. When we combine these terms, we get the following definition: communication competence refers to the knowledge of effective and appropriate communication patterns and the ability to use and adapt that knowledge in various contexts (Cooley & Roach, 1984, p. 25). To better understand this definition, let’s break apart its components.


Three people facing in different directions.  One person is facing forward not speaking, another is holding their hand to their ear to listen and a third person is speaking loudly.
Figure 1.4.1. Developing communication competence can bring many rewards, but it also requires time and effort.

The first part of the definition we will unpack focuses on knowledge. The cognitive elements of competence include knowing how to do something and understanding why things are done the way they are (Hargie, 2011, p. 9). People can develop cognitive competence by observing and evaluating the actions of others. Cognitive competence can also be developed through instruction. Since you are currently taking a communication class, you are encouraged to observe the communication concepts you are learning in the communication practices of others and yourself. This will help bring the concepts to life and also help you evaluate how professional communication matches up with communication concepts. As you build a repertoire of communication knowledge based on your experiential and classroom knowledge, you will also develop behavioural competence.

The second part of the definition of communication competence that we will unpack is the ability to use communication effectively. Individual factors affect our ability to do anything. Not everyone has the same athletic, musical, or intellectual ability. At the individual level, a person’s physiological and psychological characteristics affect competence. In terms of physiology, age, maturity, and communication ability affect competence. In terms of psychology, a person’s mood, stress level, personality, and level of communication apprehension (level of communication anxiety) affect competence (Cooley & Roach, 1984, p. 25). All of these factors will either help or hinder you when you begin to apply the knowledge you have learned to actual communication behaviours. For example, you might know strategies for communicating interpersonally. Still, interpersonal communication anxiety kicks in when you are in front of a client, peers, or colleagues, and may prevent you from fully putting that knowledge into practice.

The third part of the definition we will unpack is the ability to adapt to various contexts. Whether something is deemed competent or not is based on social and cultural context, which makes it impossible to have a single standard for communication competence (Cooley & Roach, 1984, p. 25). Social variables such as status and power affect competence. In a social situation where one person — say, a professor — has more power than another (for example, a student), the professor is typically the person who sets the standard for competence. Cultural variables such as race and nationality also affect competence. A Taiwanese woman who speaks English as an additional language may be praised for her competence in the English language in her home country but be viewed as less competent in North America because of her accent. In summary, although we have a clear definition of communication competence, there are no definitions for how to be competent in any given situation since competence varies at the individual, social, and cultural levels.

Even though no guidelines for or definitions of competence will be applicable in all situations, each professional body within the field of health studies identifies many aspects of competence related to communication. The primary focus has been on competencies related to speaking, listening, therapeutic relationships, and working effectively together (Rider & Keefer, 2006). Scholars suggest health studies students taking a communication class should be able to effectively perform the following competencies in terms of speaking, listening, therapeutic communication, and teamwork:

  • state ideas clearly
  • communicate ethically
  • recognize when it is appropriate to communicate
  • identify their communication goals
  • select the most appropriate and effective mode and techniques of communication for the situation
  • demonstrate mutuality through collaboration and cooperation
  • identify and manage misunderstandings
  • manage conflict
  • be open-minded about another’s point of view, cultural and ethnic beliefs, practices, and language
  • actively listen

(Morreale et al., 1998; Rider & Keefer, 2006)

While most of these are skill-focused rather than interpersonally or culturally focused, they provide a concrete way to assess your communication competencies and prepare yourself for professional speaking, listening relationship building, and teamwork, which is often skill-driven.

Developing Competence

Knowing the dimensions of competence is an important first step toward developing competence. Everyone reading this book already has some experience with and knowledge about communication. After all, you have spent many years explicitly and implicitly learning to communicate. For example, we are explicitly taught the verbal codes we use to communicate. On the other hand, although there are numerous rules and norms associated with nonverbal communication we rarely receive explicit instructions about it. Instead, we learn by observing others and through trial and error with our own nonverbal communication. Competence obviously involves both verbal and nonverbal elements, but it also applies to many situations and contexts. Communication competence is needed in order to understand communication ethics, develop cultural awareness, use computer-mediated communication, and think critically. Competence involves knowledge, motivation, and skills. It is not enough to know what good communication consists of — you must also have the motivation to reflect on and better your communication, and the skills needed to do so.

With regard to competence, we all have areas where we are skilled and areas where we have deficiencies. In most cases, we can consciously decide to work on our deficiencies, which may take considerable effort. There are multiple stages of competence that we challenge you to assess as you communicate in your daily life: unconscious incompetence, conscious incompetence, conscious competence, and unconscious competence (Hargie, 2011, p. 9).

Before you have built up a rich cognitive knowledge base of communication concepts, and practiced and reflected on skills in a particular area, you may exhibit unconscious incompetence, which means you are not even aware that you are communicating in an incompetent manner. Once you learn more about communication and have a vocabulary to identify concepts, you may find yourself exhibiting conscious incompetence. This is when you know what you should be doing, but realize that you are not doing it as well as you could. However, as your skills increase you may advance to conscious competence, meaning that you know you are communicating well at the moment, which will add to your bank of experiences to draw from in future interactions. When you reach the stage of unconscious competence, you communicate successfully without straining to be competent. However, reaching the stage of unconscious competence in one area or with one person does not mean you will always stay there. We are faced with new communication encounters regularly, and although we may be able to draw on the communication skills we have learned about and developed, it may take a few instances of conscious incompetence before we can advance to later stages.

Students assume that individuals working in health-related environments have a high level of communication competence, and may be hard on themselves for being at the stage of conscious incompetence, where they catch themselves communicating poorly with regard to a concept recently studied. It is important to note that just because they know the concepts and definitions does not mean they can always put them to good use. We are all imperfect and fallible, and if we expect to be perfect communicators after studying this, then we are setting ourselves up for failure. However, when we do mess up, it is important to reflect on it. And now you are starting to do the same thing, which is to notice and reflect on your communication ability within the field of health studies. That already puts you ahead of most people.


A woman is looking at her reflection in a mirror.
Figure 1.4.2. Becoming more mindful of your communication and the communication of others can contribute to your communication competence.

One way to progress toward communication competence is through the ability to monitor yourself. This is also known as self-monitoring. This is the ability to focus on your behaviour, and in turn, determine how to behave in the situation. In every speaking situation, most people will have an internal gauge of what they might say next or not say. Some people never give any thought to what they might say to others. These individuals would have low self-monitoring skills, in which what you see is what you get. Other people may have high self-monitoring skills and pay attention to every little thing: how they stand, where their eyes move, how they gesture, and maybe even how they breathe. They pay attention to these minor details because they are concerned with how the message might come across to others. Competent communicators have a balance of high and low self-monitoring, in which they realize how they might be perceived, but they are not overly focused on all the details of themselves.

Another way to progress toward communication competence is to become a more mindful communicator. A mindful communicator actively and fluidly processes information is sensitive to communication contexts and multiple perspectives and is able to adapt to novel communication situations (Burgoon et al., 2000). Becoming a more mindful communicator has many benefits, including achieving communication goals, detecting deception, avoiding stereotypes, and reducing conflict. Whether or not we achieve our day-to-day communication goals depends on our communication competence. Various communication behaviours can signal that we are communicating mindfully. For example, when an instructor asks a health studies student to paraphrase their understanding of the instructions they were just given shows that the instructor is aware that verbal messages are not always clear, that people do not always actively listen, and that people often do not speak up when they are unsure of instructions for fear of appearing incompetent or embarrassing themselves. Some communication behaviours indicate that we are not communicating mindfully, such as withdrawing from a client or instructor or engaging in passive-aggressive behaviour during a period of interpersonal conflict. Most of us know that such behaviours lead to predictable and avoidable conflict cycles, yet we are all guilty of them. Our tendency to assume that people are telling us the truth can also lead to negative results. Therefore, a certain amount of tentativeness and mindful monitoring of a person’s nonverbal and verbal communication can help us detect deception.

Activity: Check Your Understanding

Overcoming Anxiety

Whether you will give your first oral presentation in this class or another class, you may be one of many students in a health studies communication course to face anxiety about communication in general or public speaking in particular.


A woman is looking down with a worried expression on her face.
Figure 1.4.3. Communication apprehension and public speaking anxiety are common but can be managed productively.

Decades of research conducted by communication scholars show that communication apprehension is common among college students (Priem & Solomon, 2009, p. 260). Communication apprehension (CA) is fear or anxiety experienced by a person due to actual or imagined communication with another person or persons (Priem & Solomon, 2009). Communication apprehension can include multiple forms of communication, not just public speaking. Of post-secondary students, 15% to 20% experience high-trait CA, meaning they are generally anxious about communication. Furthermore, 70% of post-secondary students experience some traits of CA, which means that addressing communication anxiety in a class like the one you are taking now will benefit most students (Priem & Solomon, 2009, p. 260). Public speaking anxiety is a type of CA that produces physiological, cognitive, and behavioural reactions in people when faced with a real or imagined presentation (Bodie, 2010, p. 72). Physical reactions such as “sweaty palms, perspiring, a fast pulse, shallow breathing, cold extremities, flushed skin, nausea, trembling hands, quivering legs or butterflies in the stomach are the bodies response to the release of hormones such as adrenaline” (Engleberg et al., 2005). Additionally, CA can lead others to make assumptions about communication competence that may be unfavourable. Even if you are intelligent, prepared, and motivated, CA and public speaking anxiety can detract from your communication and lead others to perceive you in ways you did not intend. Communication apprehension is a common issue faced by many people, so you are not alone. There are ways that you can manage your anxiety:

Top 10 Ways to Reduce Speaking Anxiety

  1. Remember, you are not alone. Public speaking anxiety is common, so do not ignore it — confront it.
  2. You cannot literally “die of embarrassment.” Audiences are forgiving and understanding.
  3. It always feels worse than it looks.
  4. Take deep breaths. It releases endorphins, which naturally fight the adrenaline that causes anxiety.
  5. Dress professionally to enhance confidence.
  6. Channel your nervousness into positive energy and motivation.
  7. Start your outline and research early. Better information equals higher confidence.
  8. Practice and get feedback from a trusted source.
  9. Visualize success through positive thinking.
  10. Prepare, prepare, prepare! Practise is a speaker’s best friend.

Key Takeaways

  • Communication competence refers to the knowledge of effective and appropriate communication patterns and the ability to use and adapt that knowledge in various contexts.
  • To be a competent communicator, you should have cognitive knowledge about communication-based on observation and instruction, understand that individual, social, and cultural contexts affect competence, and adapt to those various contexts.
  • Integrating skills: Developing communication competence in speaking and listening will help you in not just academic but professional contexts.
  • Levels of communication competence include unconscious incompetence, conscious incompetence, conscious competence, and unconscious competence.
  • To develop communication competence, you must become a more mindful communicator and self-monitor at a higher level.
  • Communication apprehension (CA) refers to fear or anxiety experienced by a person due to real or imagined communication with another person or persons. Public speaking anxiety is a form of CA that specifically focuses on anxiety about giving a public presentation. Both are commonly experienced by most people and can be managed using various strategies.


  1. What aspects of communication do you think are “common sense?” What aspects of communication do you think require more formal instruction or study?
  2. What communication concept has appealed to you most so far? How can you see this concept applying to your life?
  3. Complete a communication self-assessment. What are your strengths as a communicator? What are your opportunities for growth? What can you do to start improving your communication competence?


Bodie, G. D. (2010). A racing heart, rattling knees, and ruminative thoughts: Defining, explaining, and treating public speaking anxiety. Communication Education, 59(1), 70–105. https://doi.org/10.1080/03634520903443849

Burgoon, J. K., Berger, C. R., & Waldron, V. R.  (2000). Mindfulness and interpersonal communication. Journal of Social Issues, 56(1), 105–127. https://doi.org/10.1111/0022-4537.00154

Cooley, R. E., & Roach, D. A. (1984). A conceptual framework. In R. N. Bostrom (Ed.), Competence in communication: A multidisciplinary approach. SAGE.

Engleberg, I. N., Wynn, D. R., & Roberts, M. (2015). Think: Interpersonal communication (1st Canadian Edition). Pearson Education.

Hargie, O. (2011). Skilled interpersonal interaction: Research, theory, and practice (5th ed.). Routledge.

Morreale, S., Rubin, R. B., & Jones, E. (1998). Speaking and listening competencies for college students. National Communication Association.

Priem, J. S., & Solomon, D. H. (2009). Comforting apprehensive communicators: The effects of reappraisal and distraction on cortisol levels among students in a public speaking class. Communication Quarterly, 57(3), 259–281. https://doi.org/10.1080/01463370903107253

Rider, E. A., & Keefer, C. H. (2006). Communication skills competencies: Definitions and a teaching toolbox. Medical Education, 40(7), 624–629. https://doi.org/10.1111/j.1365-2929.2006.02500.x

Image Attributions

Figure 1.4.1.  Communication by Paul Shanks. Licensed under CC BY-NC 2.0.

Figure 1.4.2. Woman Beautiful by Allesandro Zangrilli. In the public domain.

Figure 1.4.3. day 339 butterflies by Ana C. Licensed under CC BY-NC-ND 2.0.

Media Attributions

Talent and Skills Hub. (2021, January 18). How effective communication can save lives in the healthcare setting [Video]. YouTube. https://www.youtube.com/watch?v=M8rVXVN9DZk&t=1s

Attribution Statement

Content adapted, with editorial changes, from:​

University of Minnesota Libraries Publishing. (2013). Communication in the real world [Adapted]. https://open.lib.umn.edu/communication/

Licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

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Professional Communication Skills for Health Studies Copyright © 2023 by Chute, A., Johnston, S., & Pawliuk, B. is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

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