Professor Clive Seale, SMD is researching ‘Cinical Encounters in Diabetes Care’ in the East End of London.
(Project team: Moira Kelly, Carol Rivas, Clive Seale)
Our study on clinical encounters in diabetes care aims to increase understanding of how Type 2 diabetes is monitored and managed in consultations between clinicians and patients. The study involves video-recording 60-80 consultations between clinicians and patients (doctors, nurses and dieticians) in diabetes clinics located in primary care practices in east London. We are also undertaking related qualitative interviews with participants (clinicians and patients). We have recorded consultations involving South Asian patients who are fluent in English, other patients who are fluent in English, and South Asian patients who are not fluent in English and for whom the majority or all of the consultation is not conducted in English (either because the clinician speaks their language or because an interpreter is present).
The data will be analysed in various ways, including using conversation analysis (CA), a research approach that has been usefully applied to consultations in healthcare settings, particularly in primary care. CA aims to investigate social action through studying talk, particularly the sequential nature of interaction between two or more participants. Sequential analysis of data is particularly valuable in studying the collaborative nature of communication in clinical settings, allowing for detailed study of the interaction between clinician and patient. For example, by examining sequences of talk it is possible to consider how different types of questioning may produce particular types of responses. This study will therefore examine the structure of the consultation, the type of information that gets discussed, how information is presented and received (by patients and clinicians) and styles of question-asking. Patterns occurring across the data will be identified. The influence of factors such as ethnicity, age and gender of clinician and patient on the process of the consultation will also be described. We expect the study to contribute to current knowledge and practice and to education for clinicians and for patients in five main areas: the influence of ethnicity and fluency in English on the work of the diabetes consultation; discussion of monitoring; discussion of medication; discussion of lifestyle; and discussion of issues related to self-management.
Each video recording will be deposited in a Data Archive with which the study will be associated, if both the clinician and patient taking part give their consent. There is no obligation to do this and it is possible to participate in the main study without opting into the Data Archive. A participant can give consent to one or more recordings being deposited, and others not being deposited. Written transcripts prepared for the analysis will also be stored in the Data Archive. The Archive materials will be made available to other researchers and to educators interested in using them to promote knowledge about diabetes management and we hope to also provide edited excerpts of our study for public education.