The dialogic involvement of the child during the pediatric visit. An analysis of the dialogue in the context of primary care

Background: The promotion of the active involvement of all the patients in health practices, in particular of children, is an important resource for the structuring of services more specifically aimed at responding to their needs. Objective: This paper presents an analysis of dialogues in pediatric primary care practices in order to explore the dialogic involvement of children during the visit. Methods: Transcripts of 44 visits, aimed to children (mean age 7.39 years), were analyzed. Dialogic sequences involving children were extracted from transcripts and the frequencies of the bars relative to them were detected. They were catalogued according to two variables: ‘provenance’, which refers to the person initiating bar, and ‘contents’, which refers to the topic discussed and examined through contingency tables and a correlation analysis. Results: The dialogue initiated by pediatricians seems to focus exclusively on medical matters, whereas children tend to focus on everyday matters. Emotional matters related to health aspects are introduced by parents, through intrusive interventions in the conversation. Conclusions: Dialogues in pediatric primary care seem to be characterized by a clear distinction between medical and daily components; the latter, of specific interest to children, seem to be dismissed as information irrelevant to the clinical pathway. The dialogic involvement of the participants in health practice, especially that of children, seems to be a process in which the combination of medical, emotional and every day aspects appears complex and difficult to implement. It is therefore necessary to support the dialogue between the paediatrician, the parents and the child.