don’t have any problems, do you’ when recording in fieldnotes leads ‘You respectful non-awkward communication to loss of detail. seen as important’ Qs re qualitative (e.g. knowledge Only providers interviewed; regime/motivation for treatment) rather than authors attempt to explain quantitative (how many pills taken) communication mainly adherence aspects seen as less awkward. through factors related to Routines to take/remembering medicine providers. asked about but only when adherence seen as v important and discussion seen as Insight into how strategies awkward. Clients agreed to talk more freely such as de-shaming’ can be in response. implemented and how they are responded to need to be 4. Responding on believability –depends acquired through more 1. Good adh, high believability: acknowledgement, detailed studies. perhaps with praise , or ref to possible consequences not adh/side effects In discussion, authors point to 2. Good adh low believability: potential impact of question a. Okaying- if adh not seen that important or discussion style (affects believability), awkward. indicating that details of b. circumventing dialogue-continue discussion but not communication matter. drawing attention to potential lie- e.g. repeat question/ask re qual instead of quant aspects. Study begins to provide c. Confronting signals of doubt--explicit request –subtle insight into what kinds of honesty. Sometimes shaming pt /anger voice, –raised questions which 'seem' to flushed skin facilitate 'free' discussion of practical probs and sollutions. 3. Poor adherence: explore underlying reasons, CA would give more insight behavioural advice or strengthen motivation – provision/ condemnation Physician perception of degree and importance adherence Most saw adherence important , some not. Awkwardness discussion of adh given as reason for limited discussion adh, together with this discussion being not needed reasons awkwardness: good adherence reported previous visit/no objective signs non-adh/other pressing issues to be discussed/relationship seen as fragile/worry to create guilt, positivity of seen as trusting
‘You don’t have any problems, do you’ when respectful non-awkward communication seen as important’ Qs re qualitative (e.g. knowledge regime/motivation for treatment) rather than quantitative (how many pills taken) adherence aspects seen as less awkward. Routines to take/remembering medicine asked about but only when adherence seen as v important and discussion seen as awkward. Clients agreed to talk more freely in response. 4. Responding –depends on believability 1. Good adh, high believability: acknowledgement, perhaps with praise , or ref to possible consequences not adh/side effects 2. Good adh low believability: a. Okaying- if adh not seen that important or discussion awkward. b. circumventing dialogue-continue discussion but not drawing attention to potential lie- e.g. repeat question/ask re qual instead of quant aspects. c. Confronting –subtle signals of doubt--explicit request honesty. Sometimes shaming pt /anger –raised voice, flushed skin 3. Poor adherence: explore underlying reasons, behavioural advice or strengthen motivation provision/ condemnation Physician perception of degree and importance adherence Most saw adherence important , some not. Awkwardness discussion of adh given as reason for limited discussion adh, together with this discussion being not needed reasons awkwardness: good adherence reported previous visit/no objective signs non-adh/other pressing issues to be discussed/relationship seen as fragile/worry to create guilt, positivity of seen as trusting recording in fieldnotes leads to loss of detail. Only providers interviewed; authors attempt to explain communication mainly through factors related to providers. Insight into how strategies such as de-shaming’ can be implemented and how they are responded to need to be acquired through more detailed studies. In discussion, authors point to potential impact of question style (affects believability), indicating that details of communication matter. Study begins to provide insight into what kinds of questions which 'seem' to facilitate 'free' discussion of practical probs and sollutions. CA would give more insight –