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.