Applying dynamic dyadic systems to explore features of relationship-centered care among Spanish and non-Spanish speaking patients

IF 3.1 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Patient Education and Counseling Pub Date : 2025-01-10 DOI:10.1016/j.pec.2025.108650

Marie C. Haverfield , Yuwei Li , Rachyl Pines , Tyler Kyte , Daria Titova , Jennifer A. Theiss

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Abstract

Objective

Relationship-centered care (RCC) positions the exchange between patient and provider as central to patient care. Due to limitations in analytical approach, how the relational exchange develops throughout the clinical visit remains unclear. Dynamic dyadic systems (DDS) perspectives overcome these limitations to reveal interdependencies and evolving patterns in turn-taking sequences within dyads. We applied DDS analyses to examine how features of RCC manifest during clinical visits with Spanish-speaking Latinx and English-speaking non-Latinx patients.

Methods

We analyzed transcripts from 13 primary care visits (5 with Latinx patients, 8 with non-Latinx patients). Interaction turns totaled N = 2394 units of analysis. Dyadic time series plots examined the trajectory of clinical encounters and contributions made by patients and providers. Sequence analysis identified distinct turn patterns—or conversational motifs among dyads.

Results

Conversational motifs reflected four patterns. In our example, motif distribution differed such that with Latinx Spanish-speaking patients, the provider largely engaged in patient-focused probing dialogue, while relational features of communication were underrepresented. In contrast, with non-Latinx English-speaking patients, providers engaged in more instructive exchange.

Conclusion

Results support DDS to analyze patient-provider communication by illustrating interdependencies in reciprocal exchange and inequities in RCC delivery.

Practice implications

Findings demonstrate opportunities for behavioral change to enhance cultural sensitivity in the delivery of care.

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应用动态二元系统探索西班牙语和非西班牙语患者之间以关系为中心的护理特点。

目的：以关系为中心的护理（RCC）将患者和提供者之间的交流定位为患者护理的核心。由于分析方法的限制，在整个临床访问中关系交换如何发展尚不清楚。动态双元系统（DDS）视角克服了这些限制，揭示了双元内轮流序列的相互依赖性和演化模式。我们应用DDS分析来研究讲西班牙语的拉丁裔和讲英语的非拉丁裔患者的临床就诊中RCC的特征是如何表现的。方法：我们分析了13例初级保健就诊记录（5例拉丁裔患者，8例非拉丁裔患者）。交互回合合计N = 2394个分析单元。二元时间序列图检查了临床接触的轨迹和患者和提供者的贡献。序列分析确定了不同的回合模式-或对偶之间的对话母题。结果：会话母题反映了四种模式。在我们的例子中，motif分布不同，对于讲拉丁西班牙语的患者，提供者主要从事以患者为中心的探索性对话，而沟通的关系特征未被充分代表。相比之下，对于非讲拉丁语的患者，医疗服务提供者进行了更多有益的交流。结论：结果支持DDS分析患者与提供者之间的沟通，说明了RCC交付中相互交换的相互依赖性和不公平。实践意义：研究结果表明，行为改变的机会，以提高文化敏感性在提供护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Patient Education and Counseling 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.60

自引率

11.40%

发文量

384

审稿时长

46 days

期刊介绍： Patient Education and Counseling is an interdisciplinary, international journal for patient education and health promotion researchers, managers and clinicians. The journal seeks to explore and elucidate the educational, counseling and communication models in health care. Its aim is to provide a forum for fundamental as well as applied research, and to promote the study of organizational issues involved with the delivery of patient education, counseling, health promotion services and training models in improving communication between providers and patients.