Table 2: Sequential analysis of fifteen transcripts (abridged version/selected interactions).

ID**/visit type

Interaction

Style/Pattern

ID 2

Well

The provider addresses the (male) child as he/she enters the room. This child was previously seen for illness, but presents for a well visit at this appointment. The provider thanks the caregivers for participating in the study and begins discussing the child’s growth, developments, and habits.

 

The provider uses the questioning, answering/advising, explanation (QAE) structure when the conversation moves into discussion of diet. The answering/advising and explaining while using simple language continues with recommendation of fluoride use.

 

“Beginning at 6 months old, any baby who’s exclusively breast fed should also be getting fluoride. He’s probably on tri-be-sol, but this is called tri-vi-fluoro. It is the same dose and everything, but its gives him fluoride, which doesn’t go through breast milk very well. Umm, once he’s getting water, fluoridated water in juice, or just drinking water, than you can stop the fluoride water”.

 

Another QAE sequence concerning tooth brushing and toothpaste occurs following the fluoride recommendation. The provider asks questions on frequency and methods about the child’s oral hygiene habits.

 

Another QAE arrangement occurs with age-appropriate tooth brushing instructions.

 

“…by brushing, you’re doing two things, one you’re keeping his teeth clean, and you’re also getting him used to having him in your mouth so teeth brushing becomes second nature.” After this thorough conversation about oral health, the provider performs a screening and explains the application of fluoride varnish. He/she mentions that the practice’s goal is to examine the child’s teeth each time he is here and “If we notice that he has a problem with his teeth at a young age, we’ll send him to a dentist”.

 

The provider discusses the child’s latest developments again as well as screen-time and car seat use. The appointment concludes with a discussion of vaccinations.

Question-Advice-Explanation (QAE)* Simple language

 

 

 

 

 

 

 

 

 

 

 

Question-Advice-Explanation*

 

 

 

 

 

Question-Advice-Explanation*

ID 8

The provider addresses the child directly right away during this interaction. The (male) child is presumably 3 years old because the provider says, “I can’t believe that you’re 3 already!” They discuss vaccinations the child is due for and the provider asks how the child is doing and what he is eating. There is a discussion about solid diet, but none of it relates to oral health. The provider utilizes questioning when talking about liquid diet. He/she determines that the child drinks water “with a little flavor in it”. They talk about brushing, toothpaste and fluoride use. The provider gives advice and presents 2-3 concepts at one time when talking about oral hygiene habits. The caregiver is assertive and reports that the child was “having dental problems last year”.

 

The provider asks what types of problems they had and confirms that the caregiver has established a dental home for the child. He/she provides advice concerning liquid diet and begins a physical exam about halfway through the appointment. The provider tells the caregiver “I can see where he’s had some build up on here” when he/she looks in the child’s mouth. He/she tells them about the fluoride varnish and gives instructions for eating and drinking afterwards. The patient is inquisitive about the fluoride treatment and the provider answers his/her questions.

 

As the provider continues examining the child, he/she gives advice about vaccinations and asks if the care giver has any further questions. The caregiver asks about a skin condition and the provider gives advice on products. The provider exits the appointment by affirming that they do not need to see the child for a year until his next well-child visit and tells them to “keep up the good work”.

Question-Advice*

Inquisitive/Assertive caregiver

2-3 concepts at a time

ID 12

Sick

The provider immediately thanks the caregiver for participating in the study. He/she addresses the (male) child patient directly, asking how he is feeling. The caregiver answers, listing a number of symptoms. The child is very upset and crying. The provider does a physical exam with the child in the caregiver’s lap. The exam includes an oral screening. The provider explains the illness, diagnosis, and treatment. He/she uses questioning and advice discussing oral hygiene habits next, but lacks explanation. The provider does use simple language and only presents 2-3 concepts at a time when providing advice about tooth brushing and toothpaste use as well as liquid diet. The provider explains the treatment for the child’s illness once more before exiting the appointment.

Question-Advice*

Simple language

Presents 2-3 concepts at a time

ID 14

Sick

The provider enters the appointment and promptly begins questioning the caregiver about the (female) child’s symptoms. He/she also addresses the child directly, asking her how she is feeling. The provider begins an exam by first looking in the child’s mouth. He/she makes a diagnosis and recommends treatment.

 

The children switch places and another (male) child is assessed. The provider does a physical exam on this sick child and discusses treatment. He/she does an oral screening “Stick your tongue out. Come over here and I’ll look at your teeth. “Ahh” Mommy’s doing a good job, they look great” and gives some feedback. The provider and caregiver continue conversing about the child’s illness and treatment until the last part of the appointment when the provider inserts oral health information. He/she uses simple language while providing advice and explanations concerning liquid diet, homecare habits and topical fluoride varnish. The provider does not utilize any questioning but presents 2-3 concepts at a time while making oral hygiene recommendations. The oral health interaction is brief, but the provider touches on the important topics. The interaction concludes with confirmation of treatment for the children’s illnesses.

Advice-Explanation*

Presents 2-3 concepts at a time

 

**ID: abbreviation for the de-identified transcripts with their assigned number.