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Combining patient talk about internet use during primary care consultations with retrospective accounts. A qualitative analysis of interactional and interview data

Combining patient talk about internet use during primary care consultations with retrospective accounts. A qualitative analysis of interactional and interview data
Combining patient talk about internet use during primary care consultations with retrospective accounts. A qualitative analysis of interactional and interview data

Despite widespread acknowledgement of internet use for information about health, patients report not disclosing use of online health information in consultations. This paper compares patients' reported use of the internet with matched video recordings of consultations. The concepts of doctorability and epistemics are employed to consider similarities and differences between patients’ reports in interviews and actions in the consultation. Data are drawn from the Harnessing Resources from the Internet study conducted in the UK. The data set consists of 281 video-recorded general practice consultations, with pre-consultation questionnaires completed by all patients, interviews with all 10 participating doctors and 28 selected patients. We focus on the 28 patient interviews and associated consultation recordings. A conversation analytic (CA) approach is used to systematically inspect both the interview and consultation data. In interviews patients presented use of the internet as associated with appropriate self-management and help-seeking. In consultations patients skilfully translated what they had found on the internet in order to provide grounds for the actions they sought. We conclude that patients translate and utilise what they have found on the internet to assert the doctorability of their presenting problems. Furthermore, patients design their talk in both interviews and consultations to accord with their understanding of the epistemic rights of both doctors and patients. Patients search the internet so they are informed about their medical problem, however they carefully manage disclosure of information to avoid disrupting the smooth running of medical interactions.

Conversation analysis, Doctor-patient interaction, Internet, Interviews, Primary care, Qualitative analysis, UK, Video-recorded consultations
0277-9536
Stevenson, Fiona A.
68366278-ef64-41e6-a7b2-099f1971ba8e
Seguin, Maureen
51582489-e9d0-4e32-a72c-b0fa6a0bd4f8
Leydon-Hudson, Geraldine
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Barnes, Rebecca
5f2ab8e7-129c-4ca2-8022-dc371e740597
Ziebland, Sue
9a00bdc5-7b90-4dae-a503-1799f5e80b17
Pope, Catherine
21ae1290-0838-4245-adcf-6f901a0d4607
Murray, Elizabeth
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Atherton, Helen
bf8e3878-c8f2-487c-96c4-a6fc90ba95bb
Stevenson, Fiona A.
68366278-ef64-41e6-a7b2-099f1971ba8e
Seguin, Maureen
51582489-e9d0-4e32-a72c-b0fa6a0bd4f8
Leydon-Hudson, Geraldine
c5cdaff5-0fa1-4d38-b575-b97c2892ec40
Barnes, Rebecca
5f2ab8e7-129c-4ca2-8022-dc371e740597
Ziebland, Sue
9a00bdc5-7b90-4dae-a503-1799f5e80b17
Pope, Catherine
21ae1290-0838-4245-adcf-6f901a0d4607
Murray, Elizabeth
cb300780-9041-44af-9ae5-e13531eb23b8
Atherton, Helen
bf8e3878-c8f2-487c-96c4-a6fc90ba95bb

Stevenson, Fiona A., Seguin, Maureen, Leydon-Hudson, Geraldine, Barnes, Rebecca, Ziebland, Sue, Pope, Catherine, Murray, Elizabeth and Atherton, Helen (2021) Combining patient talk about internet use during primary care consultations with retrospective accounts. A qualitative analysis of interactional and interview data. Social Science and Medicine, 272, [113703]. (doi:10.1016/j.socscimed.2021.113703).

Record type: Article

Abstract

Despite widespread acknowledgement of internet use for information about health, patients report not disclosing use of online health information in consultations. This paper compares patients' reported use of the internet with matched video recordings of consultations. The concepts of doctorability and epistemics are employed to consider similarities and differences between patients’ reports in interviews and actions in the consultation. Data are drawn from the Harnessing Resources from the Internet study conducted in the UK. The data set consists of 281 video-recorded general practice consultations, with pre-consultation questionnaires completed by all patients, interviews with all 10 participating doctors and 28 selected patients. We focus on the 28 patient interviews and associated consultation recordings. A conversation analytic (CA) approach is used to systematically inspect both the interview and consultation data. In interviews patients presented use of the internet as associated with appropriate self-management and help-seeking. In consultations patients skilfully translated what they had found on the internet in order to provide grounds for the actions they sought. We conclude that patients translate and utilise what they have found on the internet to assert the doctorability of their presenting problems. Furthermore, patients design their talk in both interviews and consultations to accord with their understanding of the epistemic rights of both doctors and patients. Patients search the internet so they are informed about their medical problem, however they carefully manage disclosure of information to avoid disrupting the smooth running of medical interactions.

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Accepted/In Press date: 11 January 2021
e-pub ahead of print date: 23 January 2021
Published date: March 2021
Additional Information: Funding Information: The authors would like to acknowledge the patients, GPs and practice staff who supported data collection. Laura Hall who was a researcher on the project, Professor Trish Greenhalgh who was a co-applicant on the original grant, the patient and public involvement representatives, Jon Benford and Charles Prince, as well as the helpful comments of the reviewers. The Harnessing Resources from the Internet (HaRI) project was funded by the National Institute for Health Research School of Primary Care Research - Grant number 284. The views expressed are those of the authors and not necessarily those of the NIHR, the NHS or the Department of Health. NHS costs are covered via the Local Clinical Research Network. CP was part funded by NIHR CLAHRC Wessex. The analysis for this paper was conducted while the first author was a visiting scholar at University of California Los Angeles. FS would like to acknowledge the helpful comments from staff and PhD students that helped to shape the analysis, with particular thanks to Tanya Stivers for her support and incisive comments. Funding Information: The authors would like to acknowledge the patients, GPs and practice staff who supported data collection. Laura Hall who was a researcher on the project, Professor Trish Greenhalgh who was a co-applicant on the original grant, the patient and public involvement representatives, Jon Benford and Charles Prince, as well as the helpful comments of the reviewers. The Harnessing Resources from the Internet (HaRI) project was funded by the National Institute for Health Research School of Primary Care Research - Grant number 284 . The views expressed are those of the authors and not necessarily those of the NIHR, the NHS or the Department of Health. NHS costs are covered via the Local Clinical Research Network. CP was part funded by NIHR CLAHRC Wessex . Publisher Copyright: © 2021 The Author(s) Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: Conversation analysis, Doctor-patient interaction, Internet, Interviews, Primary care, Qualitative analysis, UK, Video-recorded consultations

Identifiers

Local EPrints ID: 450420
URI: http://eprints.soton.ac.uk/id/eprint/450420
ISSN: 0277-9536
PURE UUID: 9a96d5cd-13ee-4905-a0cc-bfd4f7461d45
ORCID for Geraldine Leydon-Hudson: ORCID iD orcid.org/0000-0001-5986-3300
ORCID for Catherine Pope: ORCID iD orcid.org/0000-0002-8935-6702

Catalogue record

Date deposited: 27 Jul 2021 17:26
Last modified: 28 Apr 2022 01:55

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Contributors

Author: Fiona A. Stevenson
Author: Maureen Seguin
Author: Rebecca Barnes
Author: Sue Ziebland
Author: Catherine Pope ORCID iD
Author: Elizabeth Murray
Author: Helen Atherton

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