A conversation analytic study examining how general practitioners tailor lifestyle advice in primary care consultations

Abstract

Background: Tailoring of health care is increasingly referred to in both health research and practice guidelines. Health care professionals can employ a range of strategies to individualize health care to their patients’, which has been found to improve treatment adherence. However, little is known about how health professionals should, and already do, tailor health care interactionally. The study aimed to identify the specific interactional features involved in the design and structure of tailoring lifestyle advice. Methods: Ethics approval of the study was granted by the Health Research Authority, UK. An observational design was used to conduct a secondary analysis of n=86 video and audio recordings of primary care consultations from the ‘One in a Million’ archive. Data were transcribed according to the conventions used in conversation analysis. The conversation analytic method was employed to examine both; spoken language and non-verbal actions. Findings: Analysis of lifestyle advice sequences revealed ways in which general practitioners tailor lifestyle advice to the particular health needs of the patient. Doctors topicalise the patients’ health problem as the framework within which the ensuing/prior advice is offered and should be understood - thereby enacting a process of ‘personalization’ or ‘individualization’. This serves to demonstrate to the patient 'evidence' that the doctor is orienting closely to the patient's particular health problem. Conclusions: Tailoring advice may present one ‘strategy’ for clinicians to make their interactions more patient-centered. It allows them to demonstrate (lexically) a strong orientation to the particulars of the patient’s needs by shaping the advice being given.