Loughborough University, U416 Brockington Building, Loughborough, Leicestershire, LE11 3TU, UK.
School of Communication and Information, Rutgers, the State University of New Jersey, 4 Huntington Street, New Brunswick(,) NJ, 08901, USA.
Soc Sci Med. 2020 Dec;266:113291. doi: 10.1016/j.socscimed.2020.113291. Epub 2020 Aug 30.
Involving children in their healthcare encounter is a national and international priority. While existing research has examined the ways in which children are recruited to participate in the consultation, no work has examined whether and how children instigate talk, and the extent to which their contributions are successful. This paper presents a conversation analysis of a selection of 10 out of 30 video recordings in which children aged 4-10 years instigate talk during consultations they attend with their parents/carers at a UK pediatric clinic. The analysis reveals for the first time that children do successfully instigate talk without being asked or selected in 22 episodes during their consultation with the doctor. Children most frequently address their parent/carer (16/22). They capitalize on specific contexts within the consultation to instigate talk, for example: history-taking questions about what they ate or how they reacted (10/22); or discussions surrounding the child's feelings or sensations following the skin-prick testing (7/22) - aspects of experience to which they have access. Children's non-solicited talk necessarily occurs when they are not currently active participators and children engage in extra interactional work including various verbal strategies (summons and prosodic variations) and non-verbal resources (tapping and gaze) to break into the interaction. The benefits of their contributions include the opportunity to affirm the child's role as a legitimate contributor, and the potential for additional medically-relevant information to arise which could enrich the clinical process. Our analysis shows that the previously overlooked phenomenon of children instigating talk, although not common, can play a crucial role in the consultation. We suggest that strategies to increase such involvement have the potential to augment the healthcare process. Our findings offer a critical baseline for the introduction of new consultations models, such as digital appointments, which may exclude some children completely.
让儿童参与他们的医疗保健是国家和国际的优先事项。虽然现有研究已经研究了儿童被招募参与咨询的方式，但没有研究探讨儿童是否以及如何发起谈话，以及他们的贡献在多大程度上是成功的。本文对英国儿科诊所的 30 个视频记录中的 10 个进行了会话分析，这些视频记录中的儿童年龄在 4-10 岁之间，他们在与父母/照顾者一起就诊的咨询中发起了谈话。分析首次揭示，在与医生的咨询中，有 22 个场景中，儿童无需被要求或选择，就能成功发起谈话。儿童最常与父母/照顾者（16/22）交流。他们利用咨询中的特定背景发起谈话，例如：关于他们吃了什么或如何反应的病史问题（10/22）；或围绕孩子在皮肤刺痛测试后的感受或感觉展开讨论（7/22）——这些都是他们能够接触到的经验方面。当儿童不是当前的积极参与者时，他们的非请求性谈话就会自然而然地发生，并且儿童会进行额外的互动工作，包括各种言语策略（召唤和韵律变化）和非言语资源（轻敲和凝视），以打破互动。他们的贡献的好处包括有机会肯定孩子作为合法参与者的角色，并且有可能出现更多与医疗相关的信息，从而丰富临床过程。我们的分析表明，尽管儿童发起谈话的现象以前被忽视，但它在咨询中可以起到至关重要的作用。我们认为，增加这种参与的策略有可能增强医疗保健过程。我们的研究结果为引入新的咨询模式提供了一个重要的基准，例如数字预约，这些模式可能会完全排除一些儿童。
