Child participation during outpatient consultations: a mixed methods study.

Area of Science:

• Pediatric Healthcare
• Clinical Communication
• Patient-Centered Care

Background:

• Child participation in healthcare is desired but often limited.
• Existing data on child involvement in clinical encounters is scarce.
• Verbal child participation ranges from 4-17% and is often confined to social talk or providing basic medical information.

Purpose of the Study:

• To assess the actual level of child participation in Dutch pediatric outpatient clinics.
• To identify factors influencing child engagement during medical consultations.

Main Methods:

• Recorded and transcribed 16 consultations from six pediatricians.
• Included children aged 4-18 years referred by a general practitioner.
• Utilized quantitative (word count, speech turns) and qualitative (conversation analysis) methods.

Main Results:

• Children's speech turns equaled parents' (28% vs. 29%), but their word contribution was significantly lower (11% vs. 23% for parents).
• Older children (teenagers) showed higher participation in both words and turns.
• Children actively initiated conversations and participated during history taking and examinations, but not in decision-making.

Conclusions:

• Despite increased turn-taking, children's verbal contribution in pediatric consultations remains low.
• Encouraging a triadic conversation style among pediatricians, parents, and children throughout the encounter can potentially increase child participation.