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Bibiliography and Abstracts of RIAS Studies 2011

Following are abstracts of RIAS studies, listed in alphabetical order by first author. Just click on a letter below to view the abstracts by the author's last name. Monographs and doctoral theses have their own page.

A B C D E F G H I J K L M N O P Q R S

T U V W X Y Z Monographs & Theses

Caris-Verhallen WM, de Gruijter IM, Kerkstra A, Bensing JM. Factors related to nurse communication with elderly people. J Adv Nurs 1999 Nov;30(5):1106-17.
(Nursing, Netherlands)
This study explores variables that might influence nurses' communication with elderly patients. Three groups of variables arise from the literature that seem to affect the quality or quantity of nurse-patient communication: variables related to nurses, to patients, and to the setting in which nursing care takes place. The study was conducted in two different care settings: a home for elderly people and a home care organization. In a sample of 181 video-taped nursing encounters, involving 47 nurses and 109 patients a study was made of nurse-patient communication. In addition, relevant data related to patients, nurses and situation were gathered by questionnaires and were combined with the results of observations of videotaped nurse-patient interactions. It was found that the educational level of nurses was related most strongly to the way nurses communicate with their elderly patients. Patient characteristics such as age, gender and subjective state of health appeared to play a minor role in the way nurses communicate.

Caris-Verhallen WM, Kerkstra A, Bensing JM. Non-verbal behaviour in nurse-elderly patient communication. J Adv Nurs. 1999 Apr;29(4):808-18.
(Nursing, Netherlands)
This study explores the occurrence of non-verbal communication in nurse-elderly patient interaction in two different care settings: home nursing and a home for the elderly. In a sample of 181 nursing encounters involving 47 nurses a study was made of videotaped nurse-patient communication. Six non-verbal behaviours were observed: patient-directed eye gaze, affirmative head nodding, smiling, forward leaning, affective touch and instrumental touch. With the exception of instrumental touch these non-verbal behaviours are important in establishing a good relationship with the patient. To study the relationship between non-verbal and verbal communication, verbal communication was observed using an adapted version of Roter's Interaction Analysis System, which distinguishes socio-emotional and task-related communication. Data were analysed in hierarchical linear models. The results demonstrated that nurses use mainly eye gaze, head nodding and smiling to establish a good relation with their patients. The use of affective touch is mainly attributable to nurses' personal style. Compared to nurses in the community, nurses in the home for the elderly more often display non-verbal behaviours such as patient-directed gaze and affective touch.

Caris-Verhallen WM, Kerkstra A, Bensing JM, Grypdonck MH. Effects of video interaction analysis training on nurse-patient communication in the care of the elderly. Patient Educ Couns. 2000 Jan;39(1):91-103.
(Nursing , Netherlands)
This paper describes an empirical evaluation of communication skills training for nurses in elderly care. The training programme was based on Video Interaction Analysis and aimed to improve nurses' communication skills such that they pay attention to patients' physical, social and emotional needs and support self care in elderly people. The effects of the training course were measured in an experimental and control group. They were rated by independent observers, by comparing videotapes of nursing encounters before and after training. Forty nurses participated in 316 videotaped nursing encounters. Multi-level analysis was used to take into account similarity among same nurse encounters. It was found that nurses who followed the training programme, provided the patients with more information about nursing and health topics. They also used more open-ended questions. In addition, they were rated as more involved, warmer and less patronizing. Due to limitations in the study design, it could not be demonstrated that these findings can entirely be ascribed to the training course. Further research, incorporating a randomized controlled design and larger sample sizes, is recommended to determine whether the results can be attributed to this specific type of training.

Caris-Verhallen WM, Kerkstra A, van der Heijden PG, Bensing JM. Nurse-elderly patient communication in home care and institutional care: an explorative study. Int J Nurs Stud. 1998 Feb-Apr;35(1-2):95-108.
(Nursing , Netherlands)
This study explores communication patterns between nurses and elderly patients in two different care settings. In a sample of 181 video-taped nursing encounters, involving 47 nurses and 109 patients, a study was made of nurse-patient communication. The video recordings were observed using an adapted version of Roter's Interaction Analysis System, which yields frequencies of 23 types of verbal behaviours. These data were analyzed using correspondence analysis, to reduce them to a smaller number of verbal categories, in which two socio-emotional categories and three categories with task-related communication, could be distinguished. For each encounter five summary statistics corresponding to these categories were calculated. Using analysis of variance, it was shown that the amount of socio-emotional interaction in both settings appeared to be higher than was reported in previous studies into nurse-patient communication. Compared with the home for the elderly, communication was more task-related in home care.

Caris-Verhallen W, Timmermans L, van Dulmen S. Observation of nurse-patient interaction in oncology: review of assessment instruments. Patient Educ Couns. 2004 Sep;54(3):307-20.
(Oncology, Nursing, Netherlands)
The aim of this review is to identify assessment instruments that can be used for analyzing sequences and can be applied to research into nurse-patient communication in cancer care. A systematic search of the literature revealed a variety of methods and instruments applicable to studies recording nurse-patient interaction. The studies that were qualitative in nature offered valuable information on observational research in general, on procedures relating to informed consent and observational arrangements in nursing practice. The quantitative studies provided an insight into the content and structure of the interaction by describing communication concepts or by frequency counts of previously determined behaviours. Systematic research into interaction sequences was not found. However, some of the quantitative instruments identified could be adapted for this purpose. The complexity and time-consuming nature of observational research highlight the need for efficiency. For instance a combination of quantitative and qualitative instruments could be considered. Copyright 2004 Elsevier Ireland Ltd.

Carter WB, Inui TS, Kukull WA, Haigh VH. Outcome-based doctor-patient interaction analysis: II.Identifying effective provider and patient behavior. Med Care 1982 Jun;20(6):550-66.
(Patient Recall or Satisfaction, Primary Care, United States)
Three interactional analysis (IA) systems (Bales', Roter’s modified Bales, and Stiles' "Verbal response modes") were used to characterize behavioral elements of provider-patient dialogues of 101 new-patient visits in a general medical clinic. In a previous article, the explanatory power of these IA systems was compared. In this article, specific provider and patient behaviors within segments of the encounter (introduction-history, physical examination and conclusion), which were shown to be related to encounter outcomes of knowledge, compliance and satisfaction, were examined. Review of interactional behaviors entering regression analysis with a significant F-to-enter (p less than or equal to 0.05) and supplementary contextual analyses suggested the importance of several categories of physician and patient behavior. Behaviors manifesting tension bear important and complex relationships to encounter outcomes. For example, patient and physician expressions of tension generally bear strong negative relationships to patient satisfaction, while patient expressions interpreted as tension release are positively related to both satisfaction and compliance. The timing of other behaviors appears to be critical to subsequent outcomes. If patient requests for medication occur early in the encounter, this behavior is positively related to subsequent patient satisfaction. However, if they occur in the concluding segment, a negative relationship results. Finally, several relationships taken together indicate that physician teaching in the concluding segment may be important. While useful observations may emerge from application of currently available IA techniques, the resulting information is best characterized as hypothesis-generating. These IA systems have many limitations, and research is needed to derived more clinically oriented systems that may permit more consistent demonstrations of critical process-outcome relationships.

Cavaco AM, Romano J. Exploring pharmacists' communication with customers through screening services. Patient Educ Couns. 2010 Sep;80(3):377-83. Epub 2010 Jul 27.
(Communication Skills, Pharmacy, Portugal)
OBJECTIVE: To describe pharmacist-customer communication, during blood pressure and capillary cholesterol services, in a community pharmacy setting. METHODS: Participants were purposively selected and data collected by audio-recording. The encounters' verbal content was transcribed verbatim, utterances identified, time stamped, and classified according to a coding scheme of 15 categories. Four dialogue structures were analyzed: speaker turn, interactivity, turn density and turn duration. RESULTS: Eighty-three episodes were registered (51 blood pressure, 32 cholesterol). The average blood pressure episode lasted 5:35 min, with 81.2 utterances (55.3% customers), and an interactivity rate of 7 turns/min. The average cholesterol episode took 7:05 min, with 135.3 utterances (52.7% pharmacists), and an interactivity rate of 13.3 turns/min. In both cases, pharmacists asked more questions (mainly closed ones), while customers gave more information. An increased number of speaker turns and closed questions were associated to higher systolic pressure. No correlations were identified with cholesterol values. CONCLUSION: It would seem that pharmacists tend to control the exchange and its content through closed questioning. Although talk dominance is balanced, hypertensive episodes induce a higher information search. PRACTICE IMPLICATIONS: Educational interventions, focusing on pharmacists' communication competencies, should be available to favor interaction skills resulting in a customer's augment of proactive information seeking behavior.

Cavaco A, Roter D. Pharmaceutical consultations in community pharmacies: utility of the Roter Interaction Analysis System to study pharmacist-patient communication. Int J Pharm Pract. 2010 Jun;18(3):141-8.
(Communication Skills, Pharmacy, Portugal)
Communication is a key issue in the delivery of healthcare services. In the pharmacy context, pharmacist-patient communication may vary from brief counselling episodes to extensive pharmaceutical care consultations. Many community pharmacies have developed practices to facilitate the effective delivery of pharmacy care, in particular to chronic patients, although the nature and extent of the services differ widely from country to country. Diabetes-focused pharmaceutical care is an example highlighting both the opportunities and challenges associated with an expansion of pharmacy services from product dispensing to pharmaceutical consultations. An area of particular challenge of such an expansion of pharmaceutical services is the development of expertise in the delivery of patient-centred pharmaceutical consultations. Although well known to medicine and nursing, patient-centredness has not been routinely incorporated into the training of pharmacists, evaluation of pharmacy practice or conduct of pharmacy-related research. There are few studies of the communication process based on analysis of an objective record such as an audio or video recording and the common perspective is largely a one-way information flow from pharmacist to patient. This has hampered the field's ability to link pharmacy communication to outcomes, including patient adherence and satisfaction with services. An extensive body of communication research on physician-patient interaction, employing the Roter Interaction Analysis System (RIAS), exists and the system presents a potentially useful tool in the pharmacy context. The purpose of this essay is to explore the utility of the RIAS for analysis of pharmacist-patient interaction and its implication for improving patient care and optimizing pharmacy-specific outcomes.

Cené CW, Roter D, Carson KA, Miller ER 3rd, Cooper LA. The effect of patient race and blood pressure control on patient-physician communication. J Gen Intern Med. 2009 Sep;24(9):1057-64. Epub 2009 Jul 3.
(Primary Care, Racial Disparities, United States)
BACKGROUND: Racial disparities in hypertension control contribute to higher rates of cardiovascular mortality among blacks. Patient-physician communication quality is associated with better health outcomes, including blood pressure (BP) control. Both race/ethnicity and BP control may adversely affect communication. OBJECTIVE: To determine whether being black and having poor BP control interact to adversely affect patient-physician communication more than either condition alone, a situation referred to as "double jeopardy." DESIGN, SETTINGS, AND PATIENTS: Cross-sectional study of enrollment data from a randomized controlled trial of interventions to enhance patient adherence to therapy for hypertension. Participants included 226 hypertensive patients and 39 physicians from 15 primary care practices in Baltimore, MD. MEASUREMENTS: Communication behaviors and visit length from coding of audiotapes. RESULTS: After controlling for patient and physician characteristics, blacks with uncontrolled BP have shorter visits (B = -3.9 min, p < 0.01) with less biomedical (B = -24.0, p = 0.05), psychosocial (B = -19.4, p < 0.01), and rapport-building (B = -19.5, p = 0.01) statements than whites with controlled BP. Of all communication outcomes, blacks with uncontrolled BP are only in "double jeopardy" for a patient positive affect-coders give them lower ratings than all other patients. Blacks with controlled BP also experience shorter visits and less communication with physicians than whites with controlled BP. There are no significant communication differences between the visits of whites with uncontrolled versus controlled BP. CONCLUSIONS: This study reveals that patient race is associated with the quality of patient-physician communication to a greater extent than BP control. Interventions that improve patient-physician communication should be tested as a strategy to reduce racial disparities in hypertension care and outcomes.

Claramita M, Dalen JV, Van Der Vleuten CP. Doctors in a Southeast Asian country communicate sub-optimally regardless of patients' educational background. Patient Educ Couns. 2011 Mar 18.
(Primary Care, Indonesia)
OBJECTIVE: To explore the relationship between the style of doctor-patient communication and patients' educational background in a Southeast Asian teaching hospital setting using the Roter Interaction Analysis System (RIAS). METHODS: We analyzed a total of 245 audio-taped consultations involving 30 internal medicine residents with 7-10 patients each in the internal medicine outpatient clinics. The patients were categorized into a group with a high and a group with a low educational level. We ranked the data into 41 RIAS utterances and RIAS-based composite categories in order of observed frequency during consultations. RESULTS: The residents invariantly used a paternalistic style irrespective of patients' educational background. The RIAS utterances and the composite categories show no significant relationship between communication style and patients' educational level. CONCLUSION: Doctors in a Southeast Asian country use a paternalistic communication style during consultations, regardless of patients' educational background. PRACTICE IMPLICATION: To approach a more partnership doctor-patient communication, culture and clinical environment concern of Southeast Asian should be further investigated.

Clayman ML, Roter D, Wissow LS, Bandeen-Roche K. Autonomy-related behaviors of patient companions and their effect on decision-making activity in geriatric primary care visits. Soc Sci Med. 2005 Apr;60(7):1583-91.
(Companions, Geriatrics, United States)
The objective of this study, undertaken in the USA, was to investigate the consequences of autonomy-related companion behaviors on patient decision-making activity during geriatric primary care visits. Videotapes were analyzed to characterize patient and companion decision-making activity and related companion behaviors. These behaviors were coded throughout the visit using an autonomy-based framework that included both autonomy enhancing (i.e. facilitating patient understanding, patient involvement, and doctor understanding) and detracting behaviors, (i.e. controlling the patient and building alliances with the physician). Patients (N = 93) in this cross-sectional sample range in age from 65 to 95 years and are mostly white (n = 73, 79%) and female (n = 67, 72%). Companions are spouses (n = 42, 46%), adult children (n = 33, 36%), or other relatives and friends (n = 15, 16%) of patients. Companions are active participants in medical visits and engage in more autonomy enhancing than detracting behaviors. Companions of sicker (compared with less sick) patients were more likely to facilitate patient understanding, p < .05; doctor understanding, p < .01; and patient involvement, p = .06, in care. Patients whose companions facilitated their involvement in the medical visit by asking the patient questions, prompting the patient to talk, and asking for the patient's opinion were more than four times as likely to be active in decision-making as patients whose companions did not assist in this manner (unadjusted OR 3.5, CI 1.4-8.7, p < .01; adjusted OR 4.5, CI 1.6-12.4, p < .01). Companions can play an important role in the visits of geriatric patients by facilitating communication throughout the visit as well as patient activity in decision-making.

Coe JB, Adams CL, Bonnett BN. Prevalence and nature of cost discussions during clinical appointments in companion animal practice. J Am Vet Med Assoc. 2009 Jun 1;234(11):1418-24.
(Veterinary Medicine, Canada)
OBJECTIVE: To determine prevalence and nature of cost discussions between veterinarians and pet owners during clinical appointments in companion animal practice. DESIGN: Cross-sectional descriptive study. SAMPLE POPULATION: 20 veterinarians in companion animal practice in eastern Ontario and 350 clients and their pets. PROCEDURES: 200 veterinarian-client-patient interactions were randomly selected from all videotaped interactions and analyzed with the Roter interaction analysis system. Additional proficiency codes and blocking functions were developed to capture the prevalence, nature, and context of cost discussions. RESULTS: 58 of the 200 (29%) appointments that were analyzed included a discussion of cost. During 38 of these 58 (66%) appointments, the discussion involved costs associated with the veterinarian's time or with services provided by the veterinarian. Overall, reference to a written estimate was made during only 28 of the 200 (14%) appointments. Cost discussions were most common during appointments in which a decision related to diagnostic testing or dentistry was made. Appointments were significantly longer when a cost discussion was included than when it was not. CONCLUSIONS AND CLINICAL RELEVANCE: Results of the present study suggested that discussions related to cost were relatively uncommon during clinical appointments in companion animal practice and that written estimates were infrequently used to aid these discussions. When discussions of cost did occur, veterinarians appeared to focus on explaining costs in terms of the veterinarian's time or services provided by the veterinarian, rather than on the medical information that could be obtained or the benefits to the future health or function of the pet.

Cooper LA, Ford DE, Ghods BK, Roter DL, Primm AB, Larson SM, Gill JM, Noronha GJ, Shaya EK, Wang NY. A cluster randomized trial of standard quality improvement versus patient-centered interventions to enhance depression care for African Americans in the primary care setting: study protocol NCT00243425. Implement Sci. 2010 Feb 23;5:
(Racial Disparities, Primary Care, Depression, United States)
BACKGROUND: Several studies document disparities in access to care and quality of care for depression for African Americans. Research suggests that patient attitudes and clinician communication behaviors may contribute to these disparities. Evidence links patient-centered care to improvements in mental health outcomes; therefore, quality improvement interventions that enhance this dimension of care are promising strategies to improve treatment and outcomes of depression among African Americans. This paper describes the design of the BRIDGE (Blacks Receiving Interventions for Depression and Gaining Empowerment) Study. The goal of the study is to compare the effectiveness of two interventions for African-American patients with depression--a standard quality improvement program and a patient-centered quality improvement program. The main hypothesis is that patients in the patient-centered group will have a greater reduction in their depression symptoms, higher rates of depression remission, and greater improvements in mental health functioning at six, twelve, and eighteen months than patients in the standard group. The study also examines patient ratings of care and receipt of guideline-concordant treatment for depression. METHODS/DESIGN: A total of 36 primary care clinicians and 132 of their African-American patients with major depressive disorder were recruited into a cluster randomized trial. The study uses intent-to-treat analyses to compare the effectiveness of standard quality improvement interventions (academic detailing about depression guidelines for clinicians and disease-oriented care management for their patients) and patient-centered quality improvement interventions (communication skills training to enhance participatory decision-making for clinicians and care management focused on explanatory models, socio-cultural barriers, and treatment preferences for their patients) for improving outcomes over 12 months of follow-up. DISCUSSION: The BRIDGE Study includes clinicians and African-American patients in under-resourced community-based practices who have not been well-represented in clinical trials to improve depression care. The patient-centered and culturally targeted approach to depression care is a relatively new one that has not been tested in most previous studies. The study will provide evidence about whether patient-centered accommodations improve quality of care and outcomes to a greater extent than standard quality improvement strategies for African Americans with depression.

Cooper LA, Roter DL, Bone LR, Larson SM, Miller ER 3rd, Barr MS, Carson KA, Levine DM. A randomized controlled trial of interventions to enhance patient-physician partnership, patient adherence and high blood pressure control among ethnic minorities and poor persons: study protocol NCT00123045. Implement Sci. 2009 Feb 19;4:7.
(Primary Care, Racial Disparities, United States)
ABSTRACT: BACKGROUND: Disparities in health and healthcare are extensively documented across clinical conditions, settings, and dimensions of healthcare quality. In particular, studies show that ethnic minorities and persons with low socioeconomic status receive poorer quality of interpersonal or patient-centered care than whites and persons with higher socioeconomic status. Strong evidence links patient-centered care to improvements in patient adherence and health outcomes; therefore, interventions that enhance this dimension of care are promising strategies to improve adherence and overcome disparities in outcomes for ethnic minorities and poor persons. OBJECTIVE: This paper describes the design of the Patient-Physician Partnership (Triple P) Study. The goal of the study is to compare the relative effectiveness of the patient and physician intensive interventions, separately, and in combination with one another, with the effectiveness of minimal interventions. The main hypothesis is that patients in the intensive intervention groups will have better adherence to appointments, medication, and lifestyle recommendations at three and twelve months than patients in minimal intervention groups. The study also examines other process and outcome measures, including patient-physician communication behaviors, patient ratings of care, health service utilization, and blood pressure control. METHODS: A total of 50 primary care physicians and 279 of their ethnic minority or poor patients with hypertension were recruited into a randomized controlled trial with a two by two factorial design. The study used a patient-centered, culturally tailored, education and activation intervention for patients with active follow-up delivered by a community health worker in the clinic. It also included a computerized, self-study communication skills training program for physicians, delivered via an interactive CD-ROM, with tailored feedback to address their individual communication skills needs. CONCLUSION: The Triple P study will provide new knowledge about how to improve patient adherence, quality of care, and cardiovascular outcomes, as well as how to reduce disparities in care and outcomes of ethnic minority and poor persons with hypertension.

Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003 Dec 2;139(11):907-15.
(Primary Care, Race-Concordance, Patient Satisfaction, United States)
BACKGROUND: African-American patients who visit physicians of the same race rate their medical visits as more satisfying and participatory than do those who see physicians of other races. Little research has investigated the communication process in race-concordant and race-discordant medical visits. Objectives: To compare patient-physician communication in race-concordant and race-discordant visits and examine whether communication behaviors explain differences in patient ratings of satisfaction and participatory decision making. DESIGN: Cohort study with follow-up using previsit and postvisit surveys and audiotape analysis. SETTING: 16 urban primary care practices. PATIENTS: 252 adults (142 African-American patients and 110 white patients) receiving care from 31 physicians (of whom 18 were African-American and 13 were white). MEASUREMENTS: Audiotape measures of patient-centeredness, patient ratings of physicians' participatory decision-making styles, and overall satisfaction. RESULTS: Race-concordant visits were longer (2.15 minutes [95% CI, 0.60 to 3.71]) and had higher ratings of patient positive affect (0.55 point, [95% CI, 0.04 to 1.05]) compared with race-discordant visits. Patients in race-concordant visits were more satisfied and rated their physicians as more participatory (8.42 points [95% CI, 3.23 to 13.60]). Audiotape measures of patient-centered communication behaviors did not explain differences in participatory decision making or satisfaction between race-concordant and race-discordant visits. CONCLUSIONS: Race-concordant visits are longer and characterized by more patient positive affect. Previous studies link similar communication findings to continuity of care. The association between race concordance and higher patient ratings of care is independent of patient-centered communication, suggesting that other factors, such as patient and physician attitudes, may mediate the relationship. Until more evidence is available regarding the mechanisms of this relationship and the effectiveness of intercultural communication skills programs, increasing ethnic diversity among physicians may be the most direct strategy to improve health care experiences for members of ethnic minority groups.

Cox ED, Smith MA, Brown RL, Fitzpatrick MA. Learning to participate: effect of child age and parental education on participation in pediatric visits. Health Commun. 2009 Apr;24(3):249-58.
(Pediatrics, United States)
Children's participation in health care improves outcomes, yet little is known about factors that affect participation. We examine how child age and parental education affect participation. Visit videotapes were coded to reflect key visit tasks: information giving, information gathering, and relationship building. Multivariable models were used to analyze how participation was associated with child age and parental education. For each year of child age, physicians did 3% more information gathering, incidence rate ratio (IRR) = 1.03, 95% confidence interval (95% CI) = 1.01-1.06, but reduced relationship building by 4%, IRR = 0.96, 95% CI = 0.94-0.97. Children of college-graduate parents spoke twice as much information-giving talk, IRR = 2.11, 95% CI = 1.07-4.17, and nearly 5 times as much relationship-building talk, IRR = 4.74, 95% CI = 1.45-15.52, as children with less educated parents. Results suggest physicians might attend to relationship building with older children and work to improve participation of children of less educated parents.

Cox ED, Smith MA, Brown RL, Fitzpatrick MA. Assessment of the physician-caregiver relationship scales (PCRS). Patient Educ Couns. 2008 Jan;70(1):69-78.
(Pediatrics, United States)
OBJECTIVE: The physician-caregiver relationship affects patients' health outcomes, but measures of this important relationship are lacking. We develop and validate the physician-caregiver relationship scales (PCRS), incorporating three relationship domains (liking, understanding, dominance). METHODS: Videotapes of 100 children's visits were coded for verbal and nonverbal communication. Roter interaction analysis system utterance categories (personal remarks, laughter, agreements, approvals, concerns, reassurances, back channels and empathy) and summary measures (physician proportion of total talk and of number of questions) along with nonverbal measures (touch initiations, upright postures and leaning toward a participant) were used as indicators. Model fit was evaluated with confirmatory factor analysis (CFA). Validity was evaluated by associations of the PCRS with visit characteristics and global affect ratings. RESULTS: PCRS domains incorporating verbal and nonverbal indicators demonstrated good model fit (RMSEA<0.05; SRMR<0.12; TLI and CFI>0.95). Construct and predictive validity were demonstrated with PCRS domains relating to visit characteristics and affect ratings as predicted. CONCLUSIONS: CFA supported the multi-dimensional PCRS with three domains-liking, understanding and dominance. Such measures are valuable tools for investigations of physician-caregiver relationships. PRACTICE IMPLICATIONS: Models suggest specific indicators of the physician-caregiver relationship and inform.

Cox ED, Smith MA, Brown RL, Fitzpatrick MA. Effect of gender and visit length on participation in pediatric visits. Patient Educ Couns. 2007 Mar;65(3):320-8.
(Pediatrics, United States)
OBJECTIVE: To examine the effect of child, physician and parent genders as well as visit length on participation. METHODS: We analyzed videotapes and sociodemographics from 100 pediatric visits. Using the Roter Interaction Analysis System, coded utterances were aggregated to reflect key visit tasks: information giving, information gathering and relationship building. Negative binomial models were used to analyze how participation was associated with participants' genders and visit length. RESULTS: After adjustment, girls did twice as much relationship building as boys (incidence rate ratio = 2.33, 95% confidence interval = 1.01-5.36) and their physicians did 34% more information gathering (1.34, 1.16-1.55). Female physicians did 29% less information giving (0.71, 0.54-0.94). Having the father accompany the child reduced child relationship building 76% (0.24, 0.08-0.69) and reduced physician information giving 14% (0.86, 0.75-0.995), compared to having mother accompany. After adjusting for participants' genders, longer visits were associated with more participation for all participants. CONCLUSION: Child participation was impacted by child gender and by the accompanying parent's gender as well as the visit length. PRACTICE IMPLICATIONS: Because gender-based patterns of participation are evident in childhood, interventions to facilitate participation might begin early in life. To improve participation, interventions might include advocating for policies to support longer visit lengths.