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Studies on doctor-patient communication focus predominantly on dyadic interactions between adults; even when the patient is a child, the research focus is usually on doctor-parent interaction. The aim of this review study is to evaluate the state of the art of research into doctor-parent-child communication, and to explore the specific role of the child. Researchers have focused on diverse aspects of the communication in this triad, and, as a result, knowledge gained from studies in this area is poorly integrated. Most of the studies have ignored the implications of a child's presence in medical encounters. Although all studies claim to examine the interaction in the doctor-parent-child triad, most research methodologies used are based on dyads. Our claim. however, is that, because the interactional dynamics of a triad differ fundamentally from those of a dyad, triadic analyses are a prerequisite for a full account of the communication between doctor, parent and child. Suggestions are formulated for an adequate research frame regarding triads.
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Social Science and Medicine 52 (2001) 839–851
Doctor–parent–child communication. A (re)view of the
literature
Kiek Tates*, Ludwien Meeuwesen
Department of General Social Sciences, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands
Abstract
Studies on doctor–patient communication focus predominantly on dyadic interactions between adults; even when the
patient is a child, the research focus is usually on doctor–parent interaction. The aim of this review study is to evaluate
the state of the art of research into doctor–parent–child communication, and to explore the specific role of the child.
Researchers have focused on diverse aspects of the communication in this triad, and, as a result, knowledge gained from
studies in this area is poorly integrated. Most of the studies have ignored the implications of a child’s presence in
medical encounters. Although all studies claim to examine the interaction in the doctor–parent–child triad, most
research methodologies used are based on dyads. Our claim, however, is that, because the interactional dynamics of a
triad differ fundamentally from those of a dyad, triadic analyses are a prerequisite for a full account of the
communication between doctor, parent and child. Suggestions are formulated for an adequate research frame regarding
triads. #2001 Elsevier Science Ltd. All rights reserved.
Keywords: Doctor–child communication; Physician–patient interaction; Triads; General practice; Medical conversation; Literature
review
Introduction
Although the first studies on doctor–patient commu-
nication took place in a pediatric setting (Korsch, Gozzi
& Francis, 1968; Freemon, Negrete, Davis & Korsch,
1971; Korsch & Negrete, 1972), it is surprising that the
specific role of the child in medical conversation has not
been considered a point of interest. Research focuses
mainly on dyadic interactions between adults. Even in
the case of a doctor–parent–child triad, the child’s
contribution is frequently ignored (Pantell et al., 1982;
Tannen & Wallat, 1983; Aronsson & Rundstro
¨m, 1988,
1989), as is illustrated by Korsch et al. (1985, p. 865): ‘In
paediatrics patient refers to the patient’s parent, most
commonly the mother. Hence the patient and parent will
be referred to interchangeably’. Korsch probably set the
tone for this by identifying the parent as the patient,
implicitly disregarding the child. Review studies hardly
pay attention to doctor–child communication or to the
influence of the presence of a third participant (Roter et
al., 1988; Waitzkin, 1990; Charon et al., 1994; Ong et al.,
1995; Boon & Stewart, 1998).
There are, however, theoretical as well as clinical
indications that the child’s role in medical conversation
deserves special attention. Children appear to be able to
understand more about concepts of health and illness
than generally has been assumed (Lewis et al., 1984;
Colland, 1990; Holtzheimer et al., 1998; Hosli, 1998). It
has been demonstrated repeatedly that a more direct
communication between physician and child contributes
to an improved relationship in terms of satisfaction with
care and adherence to treatment, and to better health
outcomes (Pantell et al., 1982; Colland, 1990; Holtzhei-
mer et al., 1998). Furthermore, the development of a
patient-centred approach and increased demand for
shared decision-making, disease prevention and health
promotion have led to a shift in the doctor–patient
relationship from extremely asymmetrical towards more
*Tel.: +31-30-2535526; fax: +31-30-2534733.
E-mail addresses: h.tates@fss.uu.nl (K. Tates); l.meeuwe-
sen@fss.uu.nl (L. Meeuwesen).
0277-9536/01/$ - see front matter #2001 Elsevier Science Ltd. All rights reserved.
PII: S 0277-9536(00)00193-3
egalitarian (Davis & Fallowfield, 1991; Roter & Hall,
1992; Stewart et al., 1995; Borne, 1998). In addition,
parenting has become less repressive and authoritarian
(De Swaan, 1988). Moreover, recent developmental
cognitive studies have shown that children play a far
more active role in the interaction with adults than has
been assumed until now (Elbers et al., 1992; Hoogsteder,
1995). Consequently, the child’s role in the medical
consultation should be as important as the parent’s, and
it is increasingly acknowledged that children themselves
should be involved in decisions about their own health
care (Alderson & Montgomery, 1996; Rylance, 1996;
Hart & Chesson, 1998).
The objective of our study is to evaluate the state of
the art of research into doctor–parent–child commu-
nication, and to explore the role of the child. Before
turning to the specific research questions, we will define
three aspects that we expect to play a key role in doctor–
parent–child communication, namely:
Relational aspects: With regard to the medical inter-
view, two types of patient needs are generally distin-
guished; being the cognitive need to be informed (the
need to know and understand), and the emotional need
to be taken seriously (the need to feel known and
understood) (Engel, 1988). In response, the physician is
assumed to possess two types of relational skills;
instrumental, or task-related behaviour, and affective,
or socio-emotional behaviour. Instrumental behaviour
involves skills such as asking questions and providing
information, while affective communication aims at
reflecting feelings and showing empathy and concern
(Roter, 1989; Bensing, 1991). Effective communication
between doctor and patient is characterized by a balance
between instrumental and affective behaviour, depend-
ing on the specific needs of the patient and the goal of
the interview at the time.
Structural aspects: The issue of asymmetry is one of
the key themes in studies on doctor–patient relations
(Linell & Luckmann, 1991; Ong et al., 1995). In the case
of a child patient, the issue of asymmetry is expected to
play a crucial part, because of the child’s position of
double asymmetry, with the physician embodying both
institutional and adult authority. The asymmetrical
character is reflected in the way the communication is
organized and structured in terms of sequences of
initiatives and responses (Linell & Luckmann, 1991;
Van Dijk, 1996; Drew & Sorjonen, 1997). Turn-taking in
conversation is an important element in defining and
establishing relationships, and presents the opportunity
to explore the degree of asymmetry between participants
(Linell & Luckmann, 1991).
Content of the interaction: Compared with the
relational and structural aspects, little attention has
been paid to the actual content of the participant’s
linguistic behaviour in medical encounters (Ong et al.,
1995). During a consultation, the participants use
medical and psychological terms appropriate in that
context, but it appears that doctor and patient may
assign different meanings to the same term. Health
terminology is moving towards everyday language use,
and the meanings that become ascribed might lead to a
misunderstanding of which the parties involved are
unaware (Ley, 1988; Hadlow & Pitts, 1991). We use the
term ‘interactive frame’ to refer to the participant’s sense
of what activity is being engaged in (Tannen & Wallat,
1983, 1987; Tannen, 1993). Depending on the linguistic
features of the speaker’s contribution, the hearer can
assign a particular interpretative frame to the speaker’s
contribution (e.g. an utterance is understood as a
request or as a joke). Interactive frames are related to
‘knowledge schemas’; structures of knowledge about
situations, actions and actors, simply because such
schemas provide expectations not only about what can
happen, but about how to interpret what is said and
done. In medical communication the participant’s
knowledge schemas may represent conflicting informa-
tion about the ongoing activity. As a result of this
mismatch of knowledge schemas, participants are
oriented towards different frames of reference, which
may result in miscommunication and conflicts (Tannen,
1993).
Our reasons for distinguishing the above-mentioned
three aspects of communication are analytical. In
practice, these aspects may be intertwined, and not
always discernable as such.
Finally, we are interested in methodological issues
regarding the way the studies reviewed dealt with the
consequences of a third participant’s presence. A pivotal
question is whether a choice was made for a dyadic
analysis of the interaction between doctor–parent and
doctor–child, or for a triadic analysis of the contribution
of all three participants.
To summarize, this review seeks to address the
following questions.
1. Which aspects of the interaction between doctor,
parent and child play a prominent part in research on
doctor–parent–child communication?
2. Has any attention been paid to the specific role of the
child in medical encounters, and what are its
characteristics?
3. To what extent are the methodologies used suitable
for analysing triadic medical conversation?
Data collection and analysis
The procedures used for finding eligible studies
included on-line database searches, e.g. PsycLit, Socio-
file and Medline, and searching for references in
scientific papers and books on doctor–patient commu-
nication. The following terms were used: physician/
K. Tates, L. Meeuwesen / Social Science and Medicine 52 (2001) 839–851840
doctor–parent–child communication, physician/doctor–
patient communication, physician/doctor–child commu-
nication, adult–child communication, medical consulta-
tions, child discourse, medical discourse, medical
interviews, language and medicine, pediatric encounters,
triadic encounters. Publications were included if they
met the following criteria.
1. The study was directed at the verbal and/or
nonverbal communication between doctor, parent
and child in a medical setting, with the child being the
patient.
2. The study involved research from the last 30 years,
published in English.
3. The study involved audio or video recordings of
consultations.
These search procedures produced 12 articles published
between 1968 and 1998, which formed the basis of the
current review study. A further eight studies were
restricted to the interaction between doctor and parent
and were excluded from the analysis, although selected
results from these studies, if relevant, will be mentioned
in the discussion section.
The sample characteristics, the design of the study,
and the questions and findings of the 12 studies were
evaluated in turn. The description of the sample profile
provided an overview of the background variables and
included information about the research setting, physi-
cian–parent–child familiarity (first or repeat visit),
characteristics of the physicians (number, gender,
specialization, and experience), characteristics of the
parents (number, gender, education), characteristics of
the children (number, age, gender, and diagnosis) and
the sample size. To answer the methodological question,
the designstudy included defining the nature of the study
(in terms of quantitative versus qualitative research),
comparing the observational strategy (coding from
video, audio tape, direct observation or transcript), the
communication channel (analysis of verbal or nonverbal
communication), the observational instrument, and
whether the communication was analysed as two dyads
(analysing the interaction between doctor–parent and
doctor–child) or as a triad (analysing the interaction
between all three participants). The question of which
aspects of communication had been analysed was
answered in the review of the questions and findingsof
the studies.
Results
Sample characteristics
Table 1 presents a profile of the background variables
of the studies reviewed, in terms of setting, familiarity,
characteristics of the physician, parent and child, and
the sample size.
Most studies on doctor–parent–child communication
were carried out within the setting of a (children’s)
hospital, mostly within pediatrics. The extent of prior
relationship was reported in nine studies. The studies
were most frequently concerned with repeat visits or a
mixture of first and repeat visits; three studies concerned
just only visit consultations (Korsch et al., 1968;
Freemon et al., 1971; Korsch & Negrete, 1972). The
physician’s specialization was stated in every study; most
studies concerned pediatricians, whereas three studies
involved a family physician or a general practitioner
(Pantell et al., 1982; Meeuwesen & Kaptein, 1996;
Meeuwesen et al., 1998). The physician’s gender was
reported in seven studies, the majority being male.
Experience and age of the physician were hardly ever
mentioned. Nine studies reported the parent’s gender
(mainly mothers), whereas only four studies gave the
parent’s educational background (parents with second-
ary or higher education were over-represented). The
sample size (the unit of analysis being the medical
interview) varied from n=1 (Tannen & Wallat, 1983,
1987) to n=800 in the Korsch studies. The age of the
child was reported in all studies; with most research
involving children aged from 5 to 13 years. Three studies
predominantly concerned infants and toddlers (Korsch
studies: 75% under the age of 5 years). Half of the
studies mentioned the gender of the child patient. All
studies reported the primary diagnosis, which ranged
from preventive health care through acute somatic
symptoms, allergies and lung diseases to severe devel-
opmental disabilities.
Design of the studies reviewed
Table 2 presents an overview of the design of the
studies reviewed, in terms of qualitative versus quanti-
tative research, observational strategy, communication
channel, observational instrument, and whether the
observation system was designed for analysing two
dyads (doctor–parent and doctor–child) or a triad
(interaction between all three participants).
Six studies were based on tapes and transcripts, the
other half of the studies reviewed made use of video
recordings (four video studies additionally made use of
transcripts). Most research was restricted to the
participants’ verbal behaviour; only four studies also
took nonverbal communication into account (Tannen &
Wallat, 1983, 1987; Worobey et al., 1987;Van Dulmen,
1998).
Regarding the observational instrument, seven quan-
titative studies applied category systems in order to code
the verbal behaviour of the participants. The most
commonly used methods were Bales’ Interaction Process
Analysis (IPA) (Bales, 1950) (Korsch et al., 1968;
K. Tates, L. Meeuwesen / Social Science and Medicine 52 (2001) 839–851 841
Table 1
Sample characteristics: setting and characteristics of doctor, parent and child
Study Setting and familiarity Characteristics doctor Characteristics parent Characteristics child
Korsch et al. (1968) Pediatric emergency clinic, first
visits
Pediatrician: n=64, 1–5 years’
experience
n=800 interview, n=293,
mainly mothers, different educational levels
n=800, 0–10 years, 75% under
5 years, mainly acute somatic
complaints
Freemon et al. (1971) See Korsch et al. (1968) See Korsch et al. (1968) n=285 from data of Korsch et al.
(1968)
n=285 from data of Korsch et al.
(1968)
Korsch and Negrete
(1972)
See Korsch et al. (1968) See Korsch et al. (1968) See Korsch et al. (1968) See Korsch et al. (1968)
Pantell et al. (1982) Family medical centre, 72% repeat
visits
Family physician: n=49, mean
2.3 consultation (range 1–9)
n=115; educational level: 7% low;
50% medium; 43% high
n=115, 60 girls, 55 boys, age 4–14
years, mean age 8.5 years, health
maintenance+acute illness
Tannen and Wallat
(1983, 1987)
Interdisciplinary clinic/children’s
hospital
Pediatrician: n=1, female n=1, mother n=1, 9 year-old girl, physical and
mental retardation
Worobey et al. (1987) Pediatric consultation Pediatrician: n=4 n=11 n=11, age 4–6 years, lung diseases
Aronsson and
Rundstro
¨m (1988, 1989)
Allergic outpatient clinic, 97%
repeat visits
Pediatrician: n=5, 1 female,
4 male
n=32, 25 mothers, 3 fathers, 4 both
parents
n=32, age 5–15 years, allergy
Meeuwesen and Kaptein
(1996)
General practitioner’s surgery,
repeat visits
General practitioner: n=39,
majority male
n=59, mainly mothers n=95, 49 girls, 46 boys, mean age
7.8 years, comparable acute
complaints
van Dulmen (1998) Outpatient consultations general
hospital, 87% repeat visits
Pediatrician: n=21, 9 female, 12
male, mean 15.5 consultation
n=302 n=302, mean age 5.3 years, 60%
boys, 40% girls, diverse diagnoses
Meeuwesen et al.
(1998)
General practitioner’s surgery,
repeat visits
General practitioner, n=17,
majority male
n=20, 18 mothers, 2 fathers n=20, age 6–13 years, mean age 9
years, 13 girls, 7 boys, comparable
acute complaints
K. Tates, L. Meeuwesen / Social Science and Medicine 52 (2001) 839–851842
Table 2
Design of the studies reviewed
Study and nature Observational strategy Communication channel Observational instrument Two
dyads/
triad
Korsch et al. (1968), quantitative Audio+transcripts+interview Verbal Interaction Process Analysis, Bales, satisfaction ratings Two
dyads
Freemon et al. (1971), quantitative Audio+transcripts+interview Verbal Interaction Process Analysis, Bales, satisfaction ratings Two
dyads
Korsch and Negrete (1972), quantitative Audio+transcripts+interview Verbal Interaction Process Analysis, Bales, satisfaction ratings Two
dyads
Pantell et al. (1982), quantitative Video Verbal Interaction Process Analysis, Bales Two
dyads
Tannen and Wallat (1983, 1987), qualitative Video+transcripts Verbal+nonverbal Micro-analysis Two
dyads
Worobey et al. (1987), quantitative Audio+transcripts Verbal+nonverbal Schenkein Two
dyads
Aronsson and Rundstro
¨m (1988), quantitative Audio+transcripts Verbal Child Allocated Turns system Triad
Aronsson and Rundstro
¨m (1989), qualitative Audio+transcripts Verbal Politeness Theory, Brown and Levinson (1987) Two
dyads
Meeuwesen and Kaptein (1996), quantitative Video+transcripts Verbal Turn Allocation System Triad
Van Dulmen (1998), quantitative Video Verbal+nonverbal Roter Interaction Analysis System Two
dyads
Meeuwesen et al. (1998), quantitative Video+transcripts Verbal Turn Allocation System, Roter Interaction Analysis System Triad
K. Tates, L. Meeuwesen / Social Science and Medicine 52 (2001) 839–851 843
Freemon et al., 1971; Korsch & Negrete, 1972; Pantell et
al., 1982), and derived systems such as the Roter
Interaction Analysis System (RIAS) (Roter, 1989)
(Van Dulmen, 1998; Meeuwesen et al., 1998). The RIAS
is a modification of the Bales system adapted for doctor–
patient communication. This system distinguishes be-
tween instrumental and affective utterances by doctors
and patients. Instrumental clusters refer to problem-
solving (giving information, asking questions and
counselling); affective clusters refer to aspects for
establishing a good relationship (such as giving comfort,
reassurance and showing empathy). A comparable
classification method was used by Worobey et al.
(1987), who focused on form and content of the
pediatrician’s utterances, by analysing intonation, sen-
tence type, and the person addressed.
In three quantitative studies, investigators employed a
turn-taking system designed for triadic medical commu-
nication; Aronsson and Rundstro
¨m (1988) made use of
the Child Allocated Turns System (CAT), while
Meeuwesen and Kaptein (1996) and Meeuwesen et al.
(1998) applied a modified version of the CAT, the Turn
Allocation System (TAS). The CAT focused on the
child-allocated turns of the doctor, whereas the TAS
explicitly aimed at describing the turn-taking patterns of
all three participants, by analysing all turns in terms of
initiative, allocation and response.
Two qualitative studies made use of conversation-
analytical micro-analyses (Tannen & Wallat, 1983,
1987). Another qualitative study applied Brown and
Levinson’s Politeness Theory (1987) (Aronsson &
Rundstro
¨m, 1989), which focuses on the field of tension
between the need for clarity on the one hand, and the
need for politeness on the other. Brown and Levinson
discuss ‘politeness’ in terms of respect behaviour and
solidarity behaviour. Positive politeness strategies, such
as expressions of solidarity and familiarity, appeal to the
other’s need for solidarity, whereas negative politeness
strategies, such as expressions of restraint and distan-
cing, appeal to the other’s need to be respected.
Sociological variables such as ‘social distance’ and
‘power’ predict the way participants phrase their
utterances in terms of politeness. Where there is a large
power difference between speaker and the person
addressed, the speaker will phrase his message in an
indirect and respectful way, whereas smaller power
differences are associated with directness and clarity.
For a critical overview of the strengths and limitations
of recent methods of analysis, see Charon et al. (1994),
and Boon and Stewart (1998).
Although all 12 studies claimed to analyse the
interaction between doctor, parent and child, only three
studies (Aronsson & Rundstro
¨m, 1988; Meeuwesen &
Kaptein, 1996; Meeuwesen et al., 1998) explicitly
focused on the communication between all three
participants (doctor–parent, doctor–child and child-
parent). The remaining 10 studies restricted their
analysis to the doctor–parent and doctor–child dyads.
Questions and findings of the studies reviewed
Table 3 presents an overview of the research questions
and the findings of the 12 studies reviewed, as well as the
aspects of communication focused on.
Six of the seven studies focusing on the relational
aspects of the communication between doctor, parent
and child yielded information on the conversational
contribution of the participants. The studies reviewed
proved tolerably consistent in their findings on the
conversational contribution of the physician (about
60%). However, they differed substantially in the
reported contribution of the parent and the child
(parent: 26–39%; child: 2–14%) (Freemon et al., 1971;
Pantell et al., 1982; Aronsson & Rundstro
¨m, 1988;
Meeuwesen & Kaptein, 1996; Van Dulmen, 1998;
Meeuwesen et al., 1998). Although there is some
variation, the conversational contribution of the child
is very small or even absent; Van Dulmen (1998)
reported that in 36% of the pediatric consultations the
child did not participate at all verbally. Two studies
reported differences in the child’s conversational con-
tribution in terms of an increase with age (Pantell et al.,
1982; Van Dulmen, 1998). Meeuwesen et al. (1998)
described an increase of the conversational contribution
of the child between the 1970s and the 1980s. When
focusing on the doctor–child (including child–doctor)
interaction, there was a considerable variance in the
results reported; ranging from 12% (Freemon et al.,
1971) to 45% (Pantell et al., 1982) and even 63%
(Worobey et al., 1987).
With respect to the distinction between affective and
instrumental behaviour, there seemed to be remarkable
differences in the doctor’s role depending on who was
addressed. In interaction with the parent, the doctor
showed the commonly described physician role profile,
characterized by a good deal of instrumental behaviour:
the doctor provided information and instruction and
asked for information, while the parent gave informa-
tion and asked a few questions (Freemon et al., 1971;
Korsch & Negrete, 1972; Pantell et al., 1982). On the
other hand, the doctor’s role profile in interaction with
the child was by and large restricted to affective
behaviour, such as social behaviour and joking (Free-
mon et al., 1971; Pantell et al., 1982; Van Dulmen,
1998). Freemon et al. (1971) even found 50% of the
doctor’s behaviour to be affective, while another 25%
consisted of instructions. Although doctors relied on the
child for obtaining information (Worobey et al., 1987
even found that doctors questioned the child more than
they questioned the parent), the greater part of medical
information was directed at the parent (Pantell et al.,
1982; Worobey et al., 1987; Van Dulmen, 1998).
K. Tates, L. Meeuwesen / Social Science and Medicine 52 (2001) 839–851844
Table 3
Questions and findings of the studies reviewed
Study and aspect Research question Findings
Korsch et al. (1968), Relationship nature communication doctor and
parental satisfaction+compliance
* Positive relationship affective behaviour doctor
and parental satisfaction
relation * 76% of parents were satisfied
* 24% of main worries were mentioned
* A fifth of parents did not receive clear
information
* Doctor should pay attention to parent’s need for
reassurance and explanation
* Use of medical jargon does not always lead to
miscommunication
Freemon et al. (1971), Relationship attributes to doctor–parent
interaction and parental satisfaction+
compliance
* Conversational contribution: doctor 59%, parent
39%, child 2%
relation * Communication: doctor–parent
a
88%, doctor–
child 12%
* Role profile doctor–parent: doctor asks for
information, gives instruction/mother gives
information and expresses tension
* Role profile doctor–child: doctor 50% affective
behaviour, 25% instructions/child answers
questions and follows instructions
Korsch and Negrete (1972), Relationship attributes to doctor–parent
interaction and parental satisfaction+
compliance
* Content analysis supports findings Korsch et al.
(1968): doctor’s attention to worries correlates with
high parental satisfaction
relation * Affective behaviour doctor towards child only
slightly influences parental satisfaction
* In more than 50% of the cases the doctor uses
medical jargon
Pantell et al. (1982), Relationship nature communication and
characteristics children+parents
* Conversational contribution: doctor 60%, parent
26%, child 14%
relation * Communication: doctor–parent 50%, doctor–
child 45%, parent–child 5%
* Role profile doctor: relies on the child for
obtaining information+shows affective behaviour,
whereas the doctor provides the parent with
medical information
Tannen and Wallat (1983,
1987), content
How does a doctor cope with conflicting
demands during consultation?
* The doctor addresses each audience from a
different frame: towards child, motherese frame;
towards mother, consultative frame; towards video
audience, reporting frame
* Conflicting frames may lead to
miscommunication
Worobey et al. (1987), How does a doctor accommodate form and
content to addressee?
* Conversational contribution: the doctor
addresses the child more than he does the parent
(63% versus 37%)
relation+content * Doctor directs most questions towards child
* Doctor uses three different styles of conversation:
towards child, friendly talk (50%), gentle,
authoritative talk (13%); towards the parent,
consultative talk (37%)
Aronsson and Rundstro
¨m
(1988),
Who controls the child’s contribution in a
pediatric consultation?
* Conversational contribution: doctor 58%, parent
34%, child 8%
structure * Parents are responsible for excluding the child
from conversation: parental interference in 52% of
the turns allocated to the child by the doctor
* Parents differ in type and degree of control
K. Tates, L. Meeuwesen / Social Science and Medicine 52 (2001) 839–851 845
Two relational studies reported the effects of commu-
nication on outcome variables such as satisfaction and
adherence to treatment (compliance). Parents who had
not been given the opportunity to express their concern
about their child or who did not receive the information
they expected, were less satisfied and showed less
compliance (Korsch et al., 1968; Korsch & Negrete,
1972). The Korsch studies showed that only 24% of the
parents indeed made their worries explicit and stressed
the positive relationship between affective behaviour of
the doctor towards the parent and parental satisfaction.
Affective behaviour of the doctor towards the child only
slightly influenced the satisfaction of the parents
(Korsch & Negrete, 1972). None of the studies reviewed
addressed the effects of relational aspects of the
communication on outcome variables from the perspec-
tive of the child.
The three studies that paid attention to the structural
aspects of doctor–parent–child communication revealed
that in terms of turn-taking, it was mainly the parent
who was responsible for excluding the child from
medical conversation by interfering in 52% of the turns
the doctor directed to the child. The extent of the
doctor’s control, however, was almost constant
Table 3 (continued)
Study and aspect Research question Findings
Aronsson and Rundstro
¨m
(1989), content
In what way does the presence of a third party
affect the doctor’s facework?
* Doctors operate within different politeness
strategies: the parent is approached with
indirectness and respect behaviour, whereas the
child is approached with directness and solidarity
behaviour
* Doctors criticize the parent through the child
(strategic exploitation of a third-party presence)
* Doctors tend to soften the direct approach of the
child by using a joking mode
Meeuwesen and Kaptein
(1996),
Description and comparison of doctor–parent–
child communication over a period of 15 years
* Conversational contribution: doctor 52%/50%,
parent 41%/39%, child 7%/11%
structure * Communication: doctor–parent 75.6%/65.8%;
doctor–child 12.4%/19.9%; parent–child 7%/7.2%
* The conversational contribution of the child has
increased over the years as the result of the child
taking more initiatives and the GP addressing the
child more frequently
Van Dulmen (1998), What is the extent and nature of children’s
contributions to pediatric outpatient
consultations?
* Conversational contribution: doctor 59%, parent
37%, child 4%
relation * One out of four doctor’s statements was directed
to the child
* Role profile: although doctors ask the child a lot
of questions (26%), only a small part of the
medical information is directed to the child (13%)
* The amount of doctor–child communication
increased with the child’s age (whereas the
proportion of affective behaviour remained
constant)
Meeuwesen et al. (1998),
relation+structure
Description and comparison of conversational
patterns in doctor–parent–child
communication over a period of 15 years
* Conversational contribution: doctor 55%/50%,
parent 40%/36%, child 5%/14%
* Communication: doctor–parent 68.6%/54.2%,
doctor–child 22.7%/27.8%, parent–child 4.7%/
9.9%
* The conversational contribution of the child has
increased over the years as a result of the child
taking more initiatives
* The child gave more information, while the GP’s
instrumental behaviour and parental affective
behaviour diminished
a
The notation ‘communication doctor–patient’ and ‘communiction doctor– child’ implies reciprocity
K. Tates, L. Meeuwesen / Social Science and Medicine 52 (2001) 839–851846
(Aronsson & Rundstro
¨m, 1988). In the course of time
there was an increase in the conversational contribution
of the child, mainly attributable to an increase in the
number of initiatives on the part of the child itself
(Meeuwesen & Kaptein, 1996; Meeuwesen et al., 1998),
and to the doctor addressing the child more directly
(Meeuwesen & Kaptein, 1996).
The relational studies of Korsch et al. (1968) and
Korsch and Negrete (1972) revealed that in more than
50% of the cases the physician made use of medical
jargon towards the parent. Research into the content of
the communication aimed at describing the potential
discrepancies between this medical jargon and everyday
language, and patterns of mutual influence in terms of
accommodation of conversational style. Accommoda-
tion of conversational style was studied in terms of
frames of reference by Tannen and Wallat (1983, 1987).
They reported how the doctor found a balance between
such conflicting demands as consulting the mother,
examining the child and reporting to the video audience,
by switching frames, depending on the person addressed.
In interaction with parents the doctor mainly used a
consultation frame, in which task-related instrumental
behaviour dominated the conversation. When talking to
the child, the physician switched to a ‘motherese’ frame,
which was characterized by an affective, teasing
conversational style. This dichotomy is consistent with
the findings of Worobey et al. (1987), where the doctor
mainly used an affective conversational style towards the
child, whereas the mother was addressed in a consulta-
tion frame. Aronsson and Rundstro
¨m (1989) ap-
proached the same problem in another way, by
focusing on the field of tension between the doctor’s
need for clarity on the one hand, and the need for
politeness on the other. They analysed the physician’s
questioning in terms of directness/indirectness and the
person addressed, and found that the parent was
addressed indirectly or respectfully, whereas the child
was addressed rather directly. Their findings also
demonstrated how the doctor used the child as a third
party in order to formulate his criticism towards the
parent in a mitigated way. The doctor’s direct approach
was compensated for by an excess of affective behaviour
towards the child (joking relationship). Pantell et al.
(1982) showed that accommodation to the person
addressed in terms of instrumental versus affective
behaviour also included the topic of conversation.
Discussion
The aim of this review study was to evaluate the state
of the art of research into doctor–parent–child commu-
nication, and to explore the role of the child in medical
interaction. We are led to the conclusion that doctor–
parent–child communication is a subject that has been
insufficiently studied; most of the studies reviewed
ignored the consequences of the child’s presence in
medical communication as well as the need for triadic
analyses. The communication in the doctor–parent–
child triad possesses distinguishing features that differ
fundamentally from dyadic doctor–patient interactions,
and therefore must be studied as a unique subset of the
medical encounter. We will elaborate on this conclusions
by returning to the research questions.
Aspects of doctor–parent–child communication
The first question concerns the different aspects of
doctor–parent–child communication which have been
highlighted in the studies reviewed. Obviously, studies
on the relational aspects of the interaction are dominant
in this field of research. By drawing attention to the gap
in doctor–patient communication (in terms of affective
and instrumental behaviour), the Korsch studies have
set the trend for a long-lasting tradition focusing on this
aspect of medical interaction. In the first place, this type
of quantitative research yields information on the
conversational contribution of the participants. The
studies reviewed reported the physician’s contribution to
the consultation at about 60%. This is consistent with
general studies on doctor–patient communication, with
patients contributing 40% to the conversation (Roter et
al., 1988), and in accordance with Arntson and Philips-
born (1982) in their description of doctor–parent
communication. The child’s participation obviously
seems to occur at the expense of the parental contribu-
tion to the conversation. The most important conclu-
sion, however, is that the conversational contribution of
the child is very slight. The variance in the restricted
child participation (2–14%) can be explained by
regarding the background variables. The studies of the
Korsch group mainly examined infants and toddlers,
1
whereas the mean age in the other studies ranged from 5
to 10 years. The plausibility of this explanation is
sustained by the findings of Pantell et al. (1982) and Van
Dulmen (1998), who stress the positive correlation
between the child’s age and conversational contribution.
A second possible explanation is that the Korsch
research was carried out in the late 1960s, a period in
which children did not have much of a say. The
presupposition that the child’s contribution has in-
creased over the years is supported by Meeuwesen and
Kaptein (1996) and Meeuwesen et al. (1998). A third
factor might be a difference in doctor–parent–child
familiarity; in the Korsch studies participants met for
the first time, whereas other studies mainly involved
repeat visits.
1
This puts the Korsch quotation in the introduction into
perspective.
K. Tates, L. Meeuwesen / Social Science and Medicine 52 (2001) 839–851 847
Secondly, relational research draws attention to
differences in the physician’s role profile, depending on
the person addressed. Whereas, in interaction with the
parent the doctor mainly shows instrumental behaviour,
the communication between doctor and child seems to
be restricted to the affective domain. In this respect the
interaction between physician and child can indeed be
typified as a ‘joking relationship’ (Aronsson & Rund-
stro
¨m, 1989). Although doctors rely on the child for
obtaining information, diagnostic and treatment infor-
mation are primarily directed to the parent. In terms of
the various goals of the medical consultation, the
physician largely restricts the medical interaction with
the child to the creation of a good interpersonal
relationship. However, restricting doctor–child interac-
tion to the affective domain precludes two other
important goals of medical communication, namely
exchanging information and medical decision-making
(Ong et al., 1995).
Finally, this field of research stresses the positive
relationship between the affective behaviour of the
doctor and parental satisfaction and compliance. This
is in line with studies on doctor–parent communication
that reveal a higher correlation between parental
satisfaction and the physician’s affective behaviour for
worried parents, and a higher correlation between
satisfaction and the physician’s informativeness for
repeat visits (Street, 1991, 1992). Surprisingly, the issue
of the child’s satisfaction and compliance in relation to
the process of medical communication is not a topic of
interest. One might expect, however, that the way the
physician interacts with the child will influence the
outcome of the consultation in terms of satisfaction,
adherence, recall and understanding (and probably
health outcomes).
By focusing on the structural aspects of doctor–
parent–child interaction, linguistic-oriented research
extends and specifies the findings of relational studies.
Whereas the latter pictures the small conversational
contribution of the child, structural research illustrates
how the child by and large is excluded from medical
communication by a controlling parent. On the other
hand, the child itself can potentially exert influence on
the organization of the communication. The increase of
the child’s contribution in the course of time seems to be
the result of an increase in the number of initiatives by
the child itself (Meeuwesen & Kaptein, 1996; Meeuwe-
sen et al., 1998), as well as the doctor giving more room
to the child (Meeuwesen & Kaptein, 1996). Information
on the dynamics of communication can become manifest
only by investigating the sequential patterns of turn-
taking in this triad.
The four studies addressing the content of doctor–
parent–child interaction strongly support the difference
in the physician’s behaviour in terms of affective versus
instrumental behaviour depending on the person ad-
dressed. This dichotomy in the doctor’s verbal beha-
viour applies both to the topic of discussion (Pantell et
al., 1982), and to accommodation in terms of frames or
politeness strategies applied (Tannen & Wallat, 1983,
1987; Worobey et al., 1987; Aronsson & Rundstro
¨m,
1988, 1989). These studies easily demonstrate how the
presence of a child influences the physician’s verbal
behaviour. In this context Stiles (1989) stresses the error
of the presupposition that process variables on patients
are constant. Stiles criticizes the fact that the patient’s
demands and the doctor’s responsiveness are often
ignored in studies on doctor–patient interactions.
This is consistent with the comments of Tannen and
Wallat (1981) and Street (1992), who point out the
importance of research on interactional influences in
medical consultations. Research on the content of
medical conversation is vital for exposing such pro-
cesses, and, in the case of a doctor–parent–child
triad, this type of interactional research underlines
the difference between a triadic and a dyadic conversa-
tion.
To summarize, we have to conclude that researchers
have focused on diverse aspects of doctor–parent–child
interaction, with the result that knowledge on the
different aspects of communication is highly fragmented
and poorly integrated. We would like to draw attention
to the complementary nature of the various aspects of
medical doctor–parent–child communication, and the
need to study all these aspects of the interaction in
relation with each other.
The childs role in medical communication
This study supports the assumption that the role of
the child in medical communication is a subject that has
been insufficiently studied. Even when the patient is a
child, the focus of research is usually doctor–parent
interaction, rather than the communication between
doctor and child, and little attention is given to the
specific role of the child. In so far as the studies reviewed
deal with the specific contribution of the child, they
picture the stereotype of child participation being
restricted to the provision of medical information and
to the maintenance of a ‘joking relationship’ with the
physician. In addition, the studies reveal that the child’s
control in medical conversation is rather limited. We
have to conclude that, as far as the doctor is concerned,
it is a matter of quantitative control (in terms of
conversational contribution), turn-taking control (in
terms of allocation) and semantic control (in terms of
topic control) (Linell & Luckman, 1991). The strategic
control of the parent appears from the fact that the
parent claims a lot of the child’s turns in speaking. This
is consistent with Pantell and Lewis (1993), who stress
that although physicians direct a considerable amount
of speech towards the child, they seldom discuss
K. Tates, L. Meeuwesen / Social Science and Medicine 52 (2001) 839–851848
management issues with the children, not even with
older children or adolescents.
This negation of the child as an active participant does
not seem to be consistent with the development of the
patient-centred approach and the increased demand for
shared decision-making and informed consent (Stewart
et al., 1995; Borne, 1998). As we stated in the
introduction, it is increasingly being acknowledged that
children too should be involved in decisions about their
own health care. From the perspective of patient-centred
care, the child’s role in the consultation should be as
important as the parent’s.
On the other hand, the findings of this review study
demonstrate that the child can potentially exert influence
on both relational and structural characteristics of the
communication, as well as on the content of the
interaction. However, there is still a lack of extensive
data on this subject. One possible explanation for this
gap between the expectations concerning the child’s role
in medical communication and the results of this review
study could lie in the methodologies used in the studies
we reviewed.
Design of the studies reviewed
The majority of research methodologies used are
based on analysing dyads. Although all studies claim to
examine the interaction between doctor, parent and
child, most studies have not dealt with the implications
of a third participant’s presence. A consequence of this
prevailing dyadic approach is that valuable information
on the interactional dynamics of triadic communication,
in terms of influences and role attributions, remains
underexposed. By restricting the focus of research to the
dyadic interaction doctor–parent and doctor–child, a
phenomenon such as parental control (the parent taking
over the turns the doctor directed to the child) would not
have been revealed. It is not surprising that, especially in
studies focusing on the structural aspects of commu-
nication, the necessity of adapting the coding schemas to
include all participants in the analysis is rather strong. In
these sequential analyses, one is forced to take into
account the implications of a third participant’s
presence, e.g. by including a category such as allocation
of turns, because of the impossibility of regarding the
utterances of participant B as a direct consequence of
the verbal behaviour of participant A.
As stated above, research into the content of
interaction supports the need for triadic analyses by
revealing the interactional influences of communication
in the doctor–parent–child triad in terms of accommo-
dation of conversation style. So far, however, this type
of research has been restricted to doctor–parent and
doctor–child communication, and therefore cannot be
typified as triadic by nature. The prevailing doctor
perspective in this type of research is probably
responsible for the parent–child interaction being over-
looked.
We have to conclude that because the interactional
dynamics of a triad differ fundamentally from those of a
dyad, triadic analyses are a prerequisite for a full
account of the communication in the doctor–parent–
child triad.
Recommendations
As we have shown that triadic analyses are indis-
pensable for exposing the dynamics of triadic medical
communication, future research should focus on the
implications of a third participant’s presence on the
methodology used, and should attempt to develop a
conceptual framework for analysing triadic medical
communication such as the doctor–parent–child triad.
In order to conduct triadic analyses, researchers
should develop adaptive coding schemes to take into
account a third participant’s presence by including the
allocation of utterances (who the speaker is addressing),
and by analysing the communication between all three
interlocutors. In addition, research methodologies
should employ a developmental perspective, because
children’s communication skills and their understanding
of diseases may change with age (Hart & Chesson,
1998), and with type of illness. As the samples of the
studies reviewed reflect a dissimilarity of practice
settings, different age limits, and a broad diversity of
complaints, there should be more consistency in future
research with respect to sample and method of analysis.
Samples should be more balanced in terms of back-
ground variables such as setting, sample size, type of
illness, the child’s age and gender, socio-economic
characteristics, and cultural background.
In view of the emphasis in this review study on the
complementary nature of research focusing on various
aspects of medical doctor–parent–child communication,
future studies should further explore a number of
underexposed characteristics. A deeper understanding
of the relationship between interactional style and
outcome variables, such as satisfaction and adherence,
could have considerable potential for health education
with respect to children developing a sense of respon-
sibility for their own health care. Future research should
explore the influences on the turn-taking patterns in this
triad, e.g. the child’s age, the type of complaint, and the
segment of consultation. Triadic analyses on the content
of interaction would reveal whether accommodation of
conversational style also applies to the parent and the
child. In addition, content analysis may yield valuable
information in terms of topic initiations, topic shifts and
topic avoidance in this triad.
We would like to stress that, for a full account of the
communication, all aspects of the interaction should be
K. Tates, L. Meeuwesen / Social Science and Medicine 52 (2001) 839–851 849
studied in relation with each other. This case for a
combined approach is equally applicable to the combi-
nation of quantitative and qualitative research.
Although most research on doctor–patient communica-
tion is quantitative by nature, qualitative research is
vital for exposing processes of responsiveness and
accommodation of conversational style. The argument
in favour of a combined approach is consistent with
Wasserman and Inui (1983), Roter et al. (1988), Wait-
zkin (1990), Roter and Frankel 1992), and Charon et al.
(1994), who stress the complementary nature of quali-
tative and quantitative research and the rich potential
for cross-method collaboration. Finally, it is strongly
recommended that future research focus on nonverbal
behaviour during medical consultations involving a
child patient. Although several researchers have ac-
knowledged the importance of nonverbal behaviour
(Roter et al., 1988; Ong et al., 1995; Boon & Stewart,
1998), this is still an underdeveloped area in research
into doctor–parent–child communication.
The physician’s perspective was dominant in the studies
reviewed, and thereby most research implicitly aims at
improving the physician’s behaviour. From the perspec-
tive of patient education and counselling, of both child
and parent, future research should not be restricted to the
doctor’s perspective. Only by using a plural perspective,
i.e. by dealing with the perspective of all three partici-
pants, can the processes of mutual influence of the
interactants be fully examined (Stiles, 1989; Street, 1992).
By using a plural perspective, future research should
aim at gaining knowledge on the implicit and explicit
role attributions of all three participants. The role of the
child in medical communication is particularly deserving
of more attention. The child itself has to be taken
seriously and should be considered as an intelligent,
capable and cooperative participant, with its own
cognitive and emotional needs. The question of when a
child can be considered a full participant in medical
communication has to be answered in relation to the
child’s age, the type of complaint, and the parent–child
relationship. Children may become more or less
empowered by different discursive practices of both
parent and doctor. Therefore, future research should
also focus on the various roles of the parent in medical
interaction, e.g. representative, mediator, or activator.
This type of research could shed light on the back-
grounds of parental control; e.g. in terms of parental
responsibility and concern or the child’s lack of
familiarity with the medical setting. Finally, the role of
the doctor deserves further attention; it is the physician
who has to deal with two interlocutors with potentially
different needs and goals. In the case of the doctor–
parent–child triad the development towards patient-
centred medicine may be more problematic than
hitherto assumed. On the one hand, the doctor should
teach the child to cope with questions on health and
illness, while on the other hand the physician has to be
sensitive to the account of events and questions of the
parent. Physicians ultimately have to cope with this ‘pas
de trois’:
Pediatric visits are particularly challenging in requir-
ing that the physician engage in a dance with not one
but at least two partners }parent and child }and
that the physician be able to lead at times and follow
at others. (Pantell & Lewis, 1993: p. 7).
Acknowledgements
This study was conducted as part of a larger ongoing
project entitled Physician–child communication over the
years: an interactional analysis (Utrecht University,
Department of General Social Sciences). We wish to
thank Jozien Bensing, Ed Elbers, and the anonymous
reviewers of Social Science and Medicine for their critical
comments on earlier drafts of this paper.
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Este estudo tem por objetivo descrever a elaboração e aceitabilidade de um material lúdico específico, utilizado como recurso mediador do atendimento infantil em um hemocentro durante a pandemia de COVID-19. Considerando o perfil das crianças atendidas no serviço, predominantemente com doença falciforme, investiu-se na produção de representações de hemácias (HbA e HbS), de glóbulos brancos, da medula óssea e do vírus SARS-CoV-2. Os modelos foram inspirados em versões existentes, à exceção da medula óssea, e optou-se pela confecção em crochê e pela adição de aspectos humanos, como boca e olho, para melhor aceitação e assimilação do material pelas crianças. Os elementos do sangue foram utilizados nos atendimentos de casos novos e já em andamento, inseridos na intervenção psicológica. O modelo estilizado do vírus foi empregado para produção de vídeos educativos, sobre prevenção e cuidados durante a pandemia, que foram enviados para os familiares das crianças em seguimento e divulgados em redes sociais. Os resultados indicaram a viabilidade e boa receptividade do material lúdico por parte de pacientes, pais e equipe multiprofissional, e reforçaram a importância de disponibilizar recursos criativos como suporte para o tratamento e manejo de doenças crônicas em crianças.
... A historic review of the literature shows that the role of children in medical communication interactions has been underexplored, with the medical research community frequently undervaluing the contributions children can make to their medical care 6 . Thankfully, this historic perspective in pediatric medical research has begun to change, particularly in the field of medical informatics. ...
Article
Telehealth has increased dramatically with COVID-19. However, current telehealth systems are designed for able-bodied adults, rather than for pediatric populations or for people with disabilities. Using a design scenario of a child with a communication disability who needs to access telehealth services, we explore children's ideas of the future of telehealth technology. We analyzed designs generated by six children and found three provocative over-arching design themes. The designs highlight how improving accessibility, accommodating communication preferences, and incorporating home based sensor technologies have the potential to improve telehealth for both pediatric patients and their physicians. We discuss how these themes can be incorporated into practical telehealth designs to serve a variety of patient populations-including adults, children, and people with disabilities.
... Ils citent une étude de Van Dulmen, datant de 1998, qui établissait que dans 36% des consultations, l'enfant ne participait pas du tout verbalement. La contribution de l'enfant à la conversation varie de 4 à 15 % selon les études (Tates, Meeuwesen, 2001). ...
Thesis
Généralisée à partir des années 1980, la politique d’ouverture des services pédiatriques a permis l’affirmation progressive d’un « droit de visite » des parents à l’hôpital. Après avoir étudié les fondements historiques de cette politique et mis en lumière l’importance des savoirs psychologiques dans son élaboration, ses conséquences sur le fonctionnement des services hospitaliers et la dynamique familiale ont été appréhendées. L’enquête par observation directe dans deux services, l’un de pédiatrie générale, l’autre spécialisé dans les greffes de foie, visait à proposer une analyse « par le bas » de l’institution hospitalière, en se situant au plus près des interactions entre parents, enfants et soignants. Il s’agissait ainsi de proposer un abord microsociologique des relations entre sphère privée et sphère publique, en éclairant la place du segment pédiatrique dans la régulation de la famille contemporaine. L’enquête de terrain a permis d’identifier, deux régimes de présence parentale, un régime de visites et un régime de présence continue, le « devoir de présence » des parents à l’hôpital ayant eu pour effet de renforcer la prééminence maternelle dans les soins à l’enfant. Elle met en évidence la manière dont les parents viennent s’inscrire dans la division du travail hospitalier, selon une double logique de délégation et de réappropriation des soins. « Cheville ouvrière » des politiques d’humanisation et facteur d’accélération de la trajectoire hospitalière de l’enfant, les parents ne se contentent pas cependant d’être des auxiliaires des soignants. Le contrôle qu’ils exercent sur les soins peut devenir une source de tensions dans leurs relations avec le personnel hospitalier qui exerce en retour un contrôle sur les pratiques parentales et s’autorise à intervenir lorsque les parents s’éloignent des normes contemporaines qui encadrent l’exercice de la parentalité.
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In dealing with recent migration-related phenomena, inclusion has become an increasingly common normative ethical imperative in socio-political discourse. Considering inclusion as a situated interactive accomplishment, this article reports findings from a study on medical visits, each one involving a physician, an unaccompanied foreign minor (UFM) and a professional educator. Adopting a Conversation Analysis-informed approach to a corpus of video-recorded visits, we analyze (a) the physician’s shifts in addressivity, which either foster or hinder UFM’s inclusion during the history-taking phase, and b) when and how these shifts occur. We contend that, by shifting addressivity, the physician navigates the locally incompatible goals of gaining reliable information on UFM patients and fostering their active participation. We contend that the micro-practice of shifting addressivity is consistent with the management of cultural-linguistic diversity proposed by the intercultural dialogue perspective.
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The study examines how alternative health information affects the professional authority of doctors. Drawing on in-depth interviews with mothers in Hong Kong and focusing on child-rearing practices, we find that mothers glean expert knowledge from doctors and experiential knowledge from online resources, social networks, and direct observations. Despite the prevalence of information online and traditional Chinese remedies, mothers do not use experiential knowledge to challenge doctors. Instead, they self-interpret medical advice and set self-determined courses of action based on their own practical situations. Generally, they dichotomize child-rearing and caring issues into medical versus non-medical domains to which they apply expert and experiential knowledge, respectively. How a condition is categorized depends on whether their individualized experiential knowledge is adequate to allow them to manage the health of their child. This study concludes that mothers with alternative health information still respect professional authorities in clinical interactions, which accords with previous sociological studies, but mothers often consider expert knowledge overly generic, so they take initiative to translate generic health-related knowledge into individualized knowledge for their child and determine their own course of action. Our theoretical contribution is to bring situational concerns into the debate of professional authority by revealing how the accumulation of experiential knowledge informs situated action.
Thesis
La thèse interroge la configuration des relations de soin au sein de l’hôpital et de la famille, à partir du cas d’enfants de 6 à 14 ans atteints d’un diabète de type 1. Ce travail s’attache à étudier, par une approche qualitative – fondée sur des entretiens semi-directifs et sur l’observation ethnographique –, la forme que prennent ces relations telles que co-construites avec les enfants, leur diversité et leur possibilité d’évolution dans le temps. Les relations de soin donnent à voir des rapports sociaux plus larges et parfois inégaux, notamment d’âges et de générations. En investiguant le rôle et l’action des divers acteurs impliqués dans ces deux arènes d’action, l’enquête vise à saisir plus finement les manières dont ces asymétries sont reproduites, « mises en pratique » dans les soins ou modifiées. En plaçant au centre de l’analyse l’agentivité des enfants, elle étudie les manières dont ceux-ci se saisissent de ces asymétries, les interprètent, y participent ou les subvertissent en se réappropriant leur corps et la maladie, en négociant en situation et avec une pluralité d’acteurs leur place dans les soins et les liens qu’ils entretiennent aux autres.
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This study focussed on identifying the key concerns and information needs of young people with Adolescent Idiopathic Scoliosis (AIS) and their parents and examined what resources might help improve young people’s ‘participativeness’ and health literacy during clinic consultations. A qualitative participatory design underpinned the study. Workshops involving multiple methods were used to engage with young people with AIS and their parents, who were recruited through a regional children’s hospital. The study design was informed by patient and public consultation with eight young people and two parents. 10 young people (aged 14–16 years) and 11 of their parents participated in the study. Young people and their parents reported uncertainty and anxiety before coming to clinic and faced issues participating in the consultation, being involved in decision-making and understanding the information and language. These challenges resulted in unmet information needs. Young people’s health literacy relating to an AIS diagnosis and treatment is facilitated by them being prepared and informed before coming to clinic and be actively supported to be involved during the consultation. We collaboratively developed the ‘Coming to Spinal Clinic’ resource to help young people with AIS and parents prepare for and get the most out of their visit.
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Healthcare professionals have a great job in communicating with the patients. Especially in communication with pediatric patients, it is necessary to be more careful and sensitive than adult patients. Because these patients are more open to various behavioral patterns and communication styles according to age groups. In addition, there may be a danger that the child patient is not given the right to speak because it takes time to communicate with these patients or because the family does not give the child the right to speak to the child culturally. The treatment process in which the child patient is not given the right to speak and is not made to feel like an individual will be incomplete. Communication in the family-child-healthcare worker triangle is very important in the treatment of pediatric patients who require special attention in the provision of healthcare services. Parents whose children are sick feel anxious, sometimes they may enter into complex emotions such as nervousness, sadness, self-blame, and therefore may need support. Likewise, children may develop negative feelings and thoughts such as fear of hospital, feeling that their body will be harmed, and rush to separate from their parents. Correct communication should be established in order to reduce these negative feelings on both sides, support the patient and their family with sufficient and correct information, and communication styles should be preferred according to the age groups of children. Health institutions (especially units that provide care for children) should be planned in a way to meet the needs of pediatric patients in terms of both system and design.
Conference Paper
Asthma self-management programmes have been shown to increase children's knowledge about asthma and improve their management practices and health status. However, existing programmes have rarely addressed the unique learning needs of very young children. This study aimed to develop and assess the effectiveness of a video tape and picture book designed to teach children about the prevention and management of acute episodes of asthma. The information content of the educational resources was determined by analysis of relevant medical information and asthma management skills. Social Learning Theory and consideration of the developmental stage of the target population informed the format and style of presentation of the resources. Eighty children aged between 2 and 5 years who had been diagnosed with asthma by their medical practitioner and who required daily asthma medication participated in a controlled experimental study. The study evaluated the impact of the asthma education resources on children's knowledge about asthma, compliance with medication regimens and health status. Children were randomly allocated to one of three experimental groups. Children in these groups were exposed to either the video tape alone, the book alone or both the video tape and book, or to a control group who viewed materials unrelated to asthma. The results for the three experimental groups were compared with the control group who did not receive exposure to any of the asthma education resources, The results showed that children in each experimental group had significantly greater gains in asthma-related knowledge than children in the control group and children exposed to both resources showed the greatest increases In knowledge. Children In each of the three experimental groups also had better compliance rand health than children in the control group, These findings indicate that carefully designed asthma education resources are useful for providing even the youngest children with information about asthma and its management.
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Communication can be seen as the main ingredient in medical care. In reviewing doctor-patient communication, the following topics are addressed: (1) different purposes of medical communication; (2) analysis of doctor-patient communication; (3) specific communicative behaviors; (4) the influence of communicative behaviors on patient outcomes; and (5) concluding remarks. Three different purposes of communication are identified, namely: (a) creating a good inter-personal relationship; (b) exchanging information; and (c) making treatment-related decisions. Communication during medical encounters can be analyzed by using different interaction analysis systems (IAS). These systems differ with regard to their clinical relevance, observational strategy, reliability/validity and channels of communicative behavior. Several communicative behaviors that occur in consultations are discussed: instrumental (cure oriented) vs affective (care oriented) behavior, verbal vs non-verbal behavior, privacy behavior, high vs low controlling behavior, and medical vs everyday language vocabularies. Consequences of specific physician behaviors on certain patient outcomes, namely: satisfaction, compliance/adherence to treatment, recall and understanding of information, and health status/psychiatric morbidity are described. Finally, a framework relating background, process and outcome variables is presented.