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Koenis MM, Vroman H, Brand PLP, van Woerden CS. Child participation during outpatient consultations: a mixed methods study. Eur J Pediatr 2024; 183:3019-3028. [PMID: 38639794 PMCID: PMC11192691 DOI: 10.1007/s00431-024-05566-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Abstract
Although children wish to be included in their own healthcare, they recognize a gap between their right to be heard and their ability to become involved. Despite adaptation of medical consultation styles which suit a more patient-centered approach, data on the current state of child participation in clinical encounters are missing. We aimed to assess actual child participation in a Dutch pediatric clinic. Children aged 4-18 years visiting a pediatric outpatient clinic for consultation after general practitioner's referral were included. Sixteen consultations of six pediatricians were recorded and transcribed verbatim. Quantitative measurement included word count and speech turn; conversation analysis with qualitative appraisal provided data on participatory behavior. Quantitative child participation equaled parent participation in turns (28% vs 29%, respectively), but remained limited in words (relative contribution 11% for child, 23% for parent and 66% for pediatrician). Children spoke on average six words per speech turn. Child age correlated positively with participation in words (p = 0.022, r = 0.566) and turns (p = < 0.001, r = 0.746). Children were mostly involved during social history taking, introduction, and physical examination but did not actively speak during the decision-making process. Children took an active role by instigating talks. Qualitative facilitators included appropriate language and verbal or non-verbal child allocated turns. Adults involved children by asking them questions and verifying their opinions or plans with the child. Teenagers participated most during the entire consultation, while younger children were more likely to lose their focus by the end of the conversation. CONCLUSION Despite increased turn taking, children's verbal participation remains low in pediatric consultations. If pediatricians and parents maintain a triadic conversation style throughout every stage of the medical encounter, child participation may increase. WHAT IS KNOWN • Verbal child participation varies between 4 and 17%, measured in turns, words, speech time, or utterances. • Child participation is limited to social talk, laughter, and providing medical information. WHAT IS NEW • Child speech turns equal parental speech turns (28%), but average relative word count remains low (11%). • Three percent of the children's turns are defined a "contributing in decision making, giving their opinion or give consent," which equals three turns per consultation.
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Affiliation(s)
- Maud M Koenis
- Department of Pediatrics, Bravis Hospital, Boerhaaveplein 1, 4624 VT, Bergen op Zoom, the Netherlands
| | - Heleen Vroman
- Department of Science, Bravis Hospital, Bergen op Zoom, the Netherlands
| | - Paul L P Brand
- Isala Academy, Department of Medical Education and Faculty Development, Isala Hospital, Zwolle, the Netherlands
- Wenckebach Institute for Medical Education, University Medical Centre Groningen, Groningen, the Netherlands
| | - Christiaan S van Woerden
- Department of Pediatrics, Bravis Hospital, Boerhaaveplein 1, 4624 VT, Bergen op Zoom, the Netherlands.
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Ranzani F. "Doing being a good parent" in the pediatric clinic: Parents' knowledge displays in advice requests on infants' everyday care. Soc Sci Med 2024; 351:116964. [PMID: 38823376 DOI: 10.1016/j.socscimed.2024.116964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/06/2024] [Accepted: 05/09/2024] [Indexed: 06/03/2024]
Abstract
Parents and pediatricians play pivotal roles in promoting a nurturing environment for children's growth and development, especially during the critical first thousand days of life. Given the challenges involved in infant care and rearing, parents often rely on pediatricians' professional support in a wide range of daily caregiving practices as diverse as complementary feeding, hygiene management, pacifier use, or sleep routines. Nevertheless, little attention has been devoted to the in vivo observation of how parents actually request advice on babies' everyday care, and how pediatricians attend to such requests. By adopting a conversation analysis approach to a corpus of 23 videorecorded Italian pediatric well-child visits, the article explores the different ways through which parents navigate the face-threatening activity of soliciting the pediatrician's advice on infants' everyday care and management. The analysis illustrates that parents overall display (different degrees of) prior knowledge and competence on the topics brought to the pediatrician's attention while, at the same time, acknowledging the pediatrician's expertise and professional role. In this way, I argue that parents display themselves as competent, knowledgeable, caring, and therefore "good parents". After discussing the results, in the concluding remarks I point to what seems to be a cultural change in parent-healthcare provider interactions.
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Affiliation(s)
- Federica Ranzani
- Department of Education Studies, University of Bologna, Via Filippo Re, 6, 40126, Bologna, Italy.
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Taylor GD, Exley C, Innes N, Vernazza CR. Young people's and adults' views and experiences of decision-making to manage compromised first permanent molars: a qualitative study. Int J Paediatr Dent 2024. [PMID: 38803044 DOI: 10.1111/ipd.13217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/27/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Little information on young people's and adults' views and experiences on decision-making for managing compromised first permanent molars (cFPM) exists. AIM To establish young people's and adults' views and experiences of decision-making for managing cFPM. DESIGN Face-to-face (online) semi-structured interviews were undertaken using an iteratively designed topic guide. Participants aged 12-65 were purposively sampled with recruitment from different dental clinics (three primary care, an out-of-hours emergency and one dental hospital). Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS Three themes were generated from young people's interviews (n = 9): (i) influencing factors; (ii) long-term considerations; and (iii) shared decision-making. Three themes were generated from adults' interviews (n = 13): (i) influences that affect decisions; (ii) perceptions of the specialist's role; and (iii) importance of shared decision-making for children and young people. CONCLUSION Several factors influenced decision-making; for young people, professional opinions were important, and parental/peer influences less so. For adults, it was based on decisions on their prior experiences. Adults felt young people were abnormal if referred to a specialist. Young people wanted autonomy in decision-making to be respected; in reality, their views were rarely heard. There is potential to increase young people's involvement in shared decision-making for cFPM, which aligns with their aspirations.
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Affiliation(s)
- Greig D Taylor
- School of Dental Sciences, Newcastle University, Newcastle, UK
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Catherine Exley
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Nicola Innes
- School of Dentistry, Cardiff University, Cardiff, UK
| | - Christopher Robert Vernazza
- School of Dental Sciences, Newcastle University, Newcastle, UK
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
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Karni-Visel Y, Dekel R, Sadeh Y, Sherman L, Katz U. "You Have to Find a Way for This Child to Be at the Center": Pediatric Cardiologists' Views on Triadic Communication in Consultations on Congenital Heart Defects. HEALTH COMMUNICATION 2024:1-12. [PMID: 38557305 DOI: 10.1080/10410236.2024.2329422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Congenital heart defects (CHDs) are present at birth and require ongoing management of personal, family, and medical aspects of care, including communication between family and medical staff. Effective communication is considered one of the main objectives of patient-centered care. Communication in pediatric medicine is especially challenging because it includes children and their parent(s), and children's cognitive and communication skills are still developing. Based on the model of behavior in pediatric communication , this study focused on pediatric cardiologists' views of the roles of children, parents, and physicians in the triadic encounter and their experiences in communicating information on pediatric CHDs in medical encounters. Semi-structured interviews were conducted with 17 experienced pediatric cardiologists and cardiac surgeons (five women and 12 men) at three medical centers in Israel. The grounded theory approach was used to identify three main categories: (1) the positioning (centrality) of the child in the setting (ideal vs. actual situation), (2) addressing parents' emotional needs, and (3) the physician's role as mediator between parent(s) and child. In each category, three elements are discussed: The physician's agenda, obstacles and challenges, and the physician's practical methods. Physicians strongly support children's involvement in triadic encounters yet face challenges in effectively integrating them into the information exchange process during cardiology consultations. Struggling to balance the principles of patient- and family-centered care, and without clear guidelines, they rely on their personal beliefs and experiences to formulate communication strategies that address parents' and children's needs.
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Affiliation(s)
- Yael Karni-Visel
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University
| | - Rachel Dekel
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University
| | - Yaara Sadeh
- School of Social Work, University of Haifa
- Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer
| | - Liat Sherman
- Pediatric Heart Institute, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer
| | - Uriel Katz
- Pediatric Heart Institute, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer
- Sackler School of Medicine, Tel-Aviv University
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Jenkins L, Hepburn A, Potter J, Macdougall C. "Are you otherwise fit and well?": Past medical history questions in UK paediatric consultations. PATIENT EDUCATION AND COUNSELING 2024; 121:108104. [PMID: 38151430 DOI: 10.1016/j.pec.2023.108104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/09/2023] [Indexed: 12/29/2023]
Abstract
Accurate diagnosis and treatment depend upon detailed knowledge of both the child's presenting symptoms and their past medical history. However, the process of soliciting past medical history has never been subject to systematic scrutiny in actual clinical practice. OBJECTIVE To examine the function of the question "are you otherwise fit and well?" to elicit a child's general medical history in UK paediatric allergy outpatient consultations. METHODS Examination of 30 video-recorded UK paediatric outpatient consultations involving children (2-10 years), caregivers, and one doctor. We identified, transcribed, and interrogated 13 examples, deploying the systematic and rigorous method of conversation analysis to elucidate the question's micro-design elements and their consequences for the consultation's trajectory. RESULTS Asking "Are you otherwise fit and well?" is built to efficiently solicit a problem-free report of good health. Nonetheless patients can and do raise other relevant matters. In practice, the question initiates several interactional matters simultaneously: establishing/resolving (mis)understandings of "fitness" and "wellness"; negotiating opportunities for children's participation; and importantly, a shift towards discussing more general wellbeing. CONCLUSION Past medical history questions unavoidably generate broader interactional matters which are skilfully resolved in real-time between clinicians, caregivers, and children. PRACTICE IMPLICATIONS Clinical training could be greatly enhanced by integrating insights into the interactional consequences of asking questions, particularly in the complex multiparty environment of paediatrics. While the question 'Are you otherwise fit and well' clearly serves an important function, clinicians should be alert to the possible problems it might raise, especially when directed towards younger children.
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Affiliation(s)
- Laura Jenkins
- School of Social Sciences and Humanities, Loughborough University, UK.
| | - Alexa Hepburn
- School of Communication and Information, Rutgers University, USA
| | - Jonathan Potter
- School of Communication and Information, Rutgers University, USA
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Shirokov A. Responsibility to report symptoms: Pursuing symptom reports from children in pediatric encounters. PATIENT EDUCATION AND COUNSELING 2024; 121:108107. [PMID: 38145918 DOI: 10.1016/j.pec.2023.108107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/09/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE The paper focuses on cases in which children disconfirm a symptom previously reported by their parents and analyzes how doctors and parents continue asking questions to elicit symptom confirmation from children. METHODS The study employs Conversation Analysis (CA) to examine 50 video recordings of Russian-language pediatric consultations with 4 pediatricians and approximately 50 children. RESULTS The findings indicate two strategies used by participants to pursue symptom confirmation. First, calibrating question design via changing the questions' format and narrowing the questions' topical agenda to specify what kind of information is expected from the child. Second, changing the questions' format (from content to polar) without adjusting the topical agenda. CONCLUSION The paper argues that engaging children in medical consultations might be challenging because they do not orient to, and so do not perform a responsibility that is institutionally expected from patients, in particular, reporting medically-relevant information. PRACTICE IMPLICATIONS The analysis shows that using polar questions about everyday activities and experiences relevant to the child and pursuing symptom reports by gradually narrowing down the questions' topical agenda can be an effective way to secure medically-relevant information.
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Affiliation(s)
- Aleksandr Shirokov
- School of Communication and Information, Rutgers University, New Brunswick, USA.
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Williamson FA, Lester JN, Woods C, Kaye EC. Questions to promote child-centered care in racially discordant interactions in pediatric oncology. PATIENT EDUCATION AND COUNSELING 2024; 121:108106. [PMID: 38123375 DOI: 10.1016/j.pec.2023.108106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To examine questioning practices in racially discordant interactions and describe how these practices engendered child-centered care. METHODS We used applied conversation analysis to analyze a collection of 300 questions directed to children across 10 cases involving children of color and their families in disease reevaluation appointments in pediatric oncology. RESULTS Our analysis generated two patterns: 1) both the pediatric oncologists' and caregivers built upon one another's talk to enable the child's conversational turn, and 2) the oncologists' reformulated requests as questions to invite the child's permission and cooperation for completing exams and understanding symptoms. CONCLUSION Children, pediatric oncologists, and caregivers coordinated their actions to enable children to participate as recipients of and respondents to questions. The analysis of real-time interactions illuminates practices for centering children in clinical encounters and the benefits of doing so. PRACTICAL IMPLICATIONS This study's findings have implications for defining competencies and practices for fostering child-centered communication, creating training materials based on real-time encounters, and identifying strategies for humanizing pediatric patient experiences.
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Affiliation(s)
| | - Jessica Nina Lester
- Department of Counseling Education and Psychology, Indiana University, Bloomington, USA
| | - Cameka Woods
- St. Jude's Children's Research Hospital, Memphis, USA
| | - Erica C Kaye
- St. Jude's Children's Research Hospital, Memphis, USA
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8
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Ta CGA, Woo BKP. Understanding the varying social factors affecting pediatric participation during medical visits. PATIENT EDUCATION AND COUNSELING 2023; 116:107950. [PMID: 37632979 DOI: 10.1016/j.pec.2023.107950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/05/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Carolyn Gia An Ta
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, USA.
| | - Benjamin K P Woo
- Department of Psychiatry & Biobehavioral Science, University of California, Los Angeles, CA, USA
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9
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van Woerden CS, Vroman H, Brand PLP. Child participation in triadic medical consultations: A scoping review and summary of promotive interventions. PATIENT EDUCATION AND COUNSELING 2023; 113:107749. [PMID: 37126992 DOI: 10.1016/j.pec.2023.107749] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/15/2023] [Accepted: 04/10/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVES To promote patient centered care, children with health issues should be supported to participate in consultations with health care professionals. We aimed to summarize, in a scoping review, the evidence on child participation in triadic encounters and its promotive interventions. METHODS Two researchers systematically searched four major databases, and included studies on child participation in medical consultations. A synthesis of quantitative and qualitative data was made. RESULTS Of 1678 retrieved records, 39 papers were included: 22 quantitative, 14 qualitative and 3 mixed-methods studies. Child participation, measured by utterances, turns or speech time, ranged between 4% and 14%. Participation increased with age. Equidistant seating arrangements, child-directed gaze and finding the appropriate tone of voice by the physician promoted child participation. Despite all facilitative efforts of doctors and parents, such as social talk, eHealth tools or consultation education, no increase in child participation was observed over the last 50 years. CONCLUSIONS Children continue to participate only marginally in medical consultations, despite their desire to be involved in various aspects of the clinical encounter and their right to have their voice heard. PRACTICE IMPLICATIONS Health care professionals should provide more opportunities for children to participate in triadic medical encounters and create an inclusive environment.
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Affiliation(s)
| | - Heleen Vroman
- Department of Science, Bravis Hospital, Bergen op Zoom, the Netherlands
| | - Paul L P Brand
- Isala Academy, Department of Medical Education and Faculty Development, Isala Hospital, Zwolle, the Netherlands; UMCG Postgraduate School of Medicine, University Medical Center, University of Groningen, the Netherlands
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10
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Saron H, Bray L, Carter B, Wilkinson C. Communication during children's X-ray procedures and children's experiences of the procedure: A scoping review. Radiography (Lond) 2023; 29 Suppl 1:S87-S95. [PMID: 36872135 DOI: 10.1016/j.radi.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/28/2023] [Accepted: 02/10/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Communication is a central part of radiological procedures and influences children's experiences. Previous research concentrates on communication and experiences during complex radiological procedures such as magnetic resonance imaging (MRI). Less is known about the communication that occurs with children undergoing procedures, such as non-urgent X-ray procedures, or the impact communication has on a child's experience. OBJECTIVES This scoping review examined evidence relating to the communication which occurs between children, parents and radiographers during children's X-ray procedures and how children experience undergoing X-ray procedures. KEY FINDINGS The comprehensive search identified eight papers. Evidence shows that radiographers dominate communication during X-ray procedures, with their communication in many cases being instructional, closed and limiting the opportunities for children to be involved. Evidence indicates that radiographers have a role in facilitating children in actively engaging in communication during their procedure. The papers that sought children's first-hand experiences highlight children's mainly positive experiences of having an X-ray, and the importance of informing children about their X-ray before and during the procedure. CONCLUSIONS The scarcity of literature highlights a need for research exploring communication during children's radiological procedures and children's first-hand experiences of undergoing these procedures. Findings highlight a need for an approach that recognises the importance of dyadic (radiographer and child), and triadic (radiographer, parent and child) communication opportunities during an X-ray procedure. IMPLICATIONS FOR PRACTICE This review highlights a need for an inclusive and participatory approach to communication that recognises children's voice and agency in X-ray procedures.
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Affiliation(s)
- Holly Saron
- Faculty of Health, Social Care and Medicine, Edge Hill University, UK.
| | - Lucy Bray
- Faculty of Health, Social Care and Medicine, Edge Hill University, UK
| | - Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, UK
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Golembiewski EH, Espinoza Suarez NR, Maraboto Escarria AP, Yang AX, Kunneman M, Hassett LC, Montori VM. Video-based observation research: A systematic review of studies in outpatient health care settings. PATIENT EDUCATION AND COUNSELING 2023; 106:42-67. [PMID: 36207219 DOI: 10.1016/j.pec.2022.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/13/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To examine the use of video-based observation research in outpatient health care encounter research. METHODS We conducted a systematic search of MEDLINE, Scopus, Cochrane and other databases from database inception to October 2020 for reports of studies that used video recording to investigate ambulatory patient-clinician interactions. Two authors independently reviewed all studies for eligibility and extracted information related to study setting and purpose, participant recruitment and consent processes, data collection procedures, method of analysis, and participant sample characteristics. RESULTS 175 articles were included. Most studies (65%) took place in a primary care or family practice setting. Study objectives were overwhelmingly focused on patient-clinician communication (81%). Reporting of key study elements was inconsistent across included studies. CONCLUSION Video recording has been used as a research method in outpatient health care in a limited number and scope of clinical contexts and research domains. In addition, reporting of study design, methodological characteristics, and ethical considerations needs improvement. PRACTICE IMPLICATIONS Video recording as a method has been relatively underutilized within many clinical and research contexts. This review will serve as a practical resource for health care researchers as they plan and execute future video-based studies.
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Affiliation(s)
| | - Nataly R Espinoza Suarez
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Department of Family Medicine and Emergency Medicine Laval University Quebec, Canada.
| | - Andrea P Maraboto Escarria
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Department of Obstetrics and Gynecology Hospital Angeles Lomas Mexico City, Mexico.
| | - Andrew X Yang
- Mayo Clinic Alix School of Medicine Rochester, MN, USA.
| | - Marleen Kunneman
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Medical Decision Making, Department of Biomedical Data Sciences Leiden University Medical Center Leiden, the Netherlands.
| | - Leslie C Hassett
- Division of Endocrinology, Diabetes, Metabolism and Nutrition Department of Medicine Mayo Clinic, Rochester, MN, USA.
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Mayo Clinic Libraries Mayo Clinic, Rochester, MN, USA.
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Ekberg K, Ekberg S, Weinglass L, Herbert A, Rendle‐Short J, Bluebond‐Langner M, Yates P, Bradford N, Danby S. Attending to child agency in paediatric palliative care consultations: Adults' use of tag questions directed to the child. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:566-585. [PMID: 35089602 PMCID: PMC9304193 DOI: 10.1111/1467-9566.13437] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 12/02/2021] [Accepted: 01/07/2022] [Indexed: 06/18/2023]
Abstract
Children's agency in their own lives is increasingly recognised as important, including within paediatric health care. The issue of acknowledging child agency is complex in the context of paediatric palliative care, where children have serious and complex conditions that often impact their ability to verbally communicate with others. This study explores how clinicians and parents/guardians direct talk towards a child patient when they are present in a consultation. Conversation analysis methods were used to examine 74 video-recorded paediatric palliative care consultations. Detailed turn-by-turn examination of the recorded consultations identified the recurrent use of a practice described by linguists as a 'tag question', which follows some statement (e.g. 'he loves that, don't ya'). Both clinicians and parents/guardians often directed these tag questions towards the child patient. Analysis demonstrated how these tag questions: (1) validated the child's epistemic authority over what was being said and (2) made a child's response a possible, but not necessary, next action. The findings are discussed in relation to the sociology of child agency and how this agency is acknowledged and displayed within and through social interaction. This research provides direct evidence of children's competence as informants about their own symptoms.
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Affiliation(s)
- Katie Ekberg
- School of Early Childhood and Inclusive EducationQueensland University of TechnologyBrisbane CityQueenslandAustralia
| | - Stuart Ekberg
- School of Psychology & CounsellingQueensland University of TechnologyBrisbane CityQueenslandAustralia
- Centre for Healthcare TransformationQueensland University of TechnologyBrisbane CityQueenslandAustralia
| | - Lara Weinglass
- School of Early Childhood and Inclusive EducationQueensland University of TechnologyBrisbane CityQueenslandAustralia
| | - Anthony Herbert
- Children’s Health Queensland Hospital and Health ServiceBrisbane CityQueenslandAustralia
- Centre for Children's Health ResearchBrisbane CityQueenslandAustralia
- School of NursingQueensland University of TechnologyBrisbane CityQueenslandAustralia
| | - Johanna Rendle‐Short
- College of Arts and Social SciencesAustralian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Myra Bluebond‐Langner
- Louis Dundas Centre for Children’s Palliative CareUniversity College London Great Ormond Street Institute of Child HealthLondonUK
- Department of Sociology, Anthropology and Criminal JusticeRutgers UniversityCamdenNew JerseyUSA
| | - Patsy Yates
- Centre for Healthcare TransformationQueensland University of TechnologyBrisbane CityQueenslandAustralia
- Faculty of HealthQueensland University of TechnologyBrisbane CityQueenslandAustralia
| | - Natalie Bradford
- School of NursingQueensland University of TechnologyBrisbane CityQueenslandAustralia
| | - Susan Danby
- School of Early Childhood and Inclusive EducationQueensland University of TechnologyBrisbane CityQueenslandAustralia
- Australian Research Council Centre of Excellence for the Digital ChildQueensland University of TechnologyBrisbane CityQueenslandAustralia
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13
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Yuan S, Humphris G, MacPherson LMD, Ross AL, Freeman R. Communicating With Parents and Preschool Children: A Qualitative Exploration of Dental Professional-Parent-Child Interactions During Paediatric Dental Consultations to Prevent Early Childhood Caries. Front Public Health 2021; 9:669395. [PMID: 34055728 PMCID: PMC8149946 DOI: 10.3389/fpubh.2021.669395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to explore communication interactions and identify phases adopted by dental professionals with parents and their young children and to examine the hypothesis that successful social talking between the actors together with the containment of worries allows the formation of a triadic treatment alliance, which leads to achieving preventive dental treatment goals. Conversation analysis of the transcribed data from video recordings of dental professionals, parents and preschool children when attending for preventive dental care was conducted. The transcriptions were read, examined and analysed independently to ensure the trustworthiness of the analysis. The transcriptions were explored for interactive patterns and sequences of interaction. Forty-four individual consultations between dental professionals, parents, and preschool children were recorded. The number of communication behaviours was 7,299, with appointment length ranging from 2 min 10 s to 29 min 18 s. Two patterns of communication were identified as dyadic (between two people) and triadic (between three people) interactions within a continuous shifting cycle. The three phases of communication were social talking, containing worries and task-focusing. Social talking was characterised by shifts between dyadic and triadic communication interactions and a symmetry of communication turns and containing worries. This typified the cyclical nature of the triadic and dyadic communication interactions, the adoption of talk-turn pairs, and triadic treatment alliance formation. Task-focusing pattern and structure were different for dentists and extended-duty dental nurses. For dentists, task-focusing was characterised by a dyadic interaction and as an asymmetrical communication pattern: for extended-duty dental nurses, task-focusing was typified by symmetrical and asymmetrical communication patterns within dyadic and triadic interactions. Empathy and understanding of the young child's emotional needs during containing worries allowed the formation of the triadic treatment alliance and with this treatment alliance, the acceptance of interventions to prevent early childhood caries during “task-focusing.” This qualitative exploration suggests that dyadic and triadic communication interactions are of a dynamic and cyclical quality and were exhibited during paediatric dental consultations. The communication phases of social talking, containing worries and task-focusing were evident. Successful social talking signalled the entry to containing worries and triadic treatment alliance formation which permitted the preventive goals of the consultation to be achieved (task-focusing). Future work should generate additional data to support the hypotheses created here namely that, social talking and containing worries triggers an integral pathway to task-focusing and the achievement of preventive dental goals.
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Affiliation(s)
- Siyang Yuan
- Dental Health Services Research Unit, University of Dundee, Dundee, United Kingdom
| | - Gerry Humphris
- Health Psychology, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Lorna M D MacPherson
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Alistair L Ross
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Ruth Freeman
- Dental Health Services Research Unit, University of Dundee, Dundee, United Kingdom
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