Parent-Provider Communication Dynamics at 2- to 24-Month English and Spanish Well-Child Care Visits

Well-child care visits are critical, but time is limited, so we sought to better understand preventive care topic coverage and communication dynamics between parents and clinicians during early childhood well-child care visits.

We audio-recorded 104 well-visits in English and Spanish for children aged 2 to 24 months. Recordings were coded for content (eg, feeding and sleep) and communication dynamics (eg, provider question asking). Following qualitative analysis, the number of codes for visit content and communication dynamics was calculated for further quantitative analysis. To assess general communication patterns between parents and clinicians, Mann-Whitney U tests were used to determine if the number of communication dynamic episodes differed significantly by parent language, visit length, and content discussed during the visit (eg, development and behavior).

Exactly 39% of visits were conducted in Spanish. Topics most often discussed related to physical health, nutrition, and growth. Instances of clinician and parent information giving happened significantly (P < .001) more often in English compared to Spanish visits. Longer well-child care visits have significantly (P < .01) more instances of positive rapport building; visits with positive rapport building are more likely to include discussions related to developmental milestones (P < .04), as well as parenting experience (P < .03).

Parent-provider communication dynamics were enhanced when visits lasted over 15 minutes, and when positive rapport building was more frequent. Our findings highlight the importance of adequate time and rapport building during visits to facilitate engagement of parents in meaningful discussions.