Peer-reviewed article
Communication Strategies to Improve Child Participation in Triadic Consultations Within Healthcare Settings: A Scoping Review
Maha A. Alharbi, Suzanne Grant, George Cherukara, Siyang Yuan ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This scoping review examines communication strategies used in healthcare consultations involving children, caregivers, and healthcare providers. The review of 37 studies found that children often play passive roles in these conversations, with outcomes depending heavily on how healthcare providers and parents communicate. Healthcare providers who use supportive, child-friendly approaches with open-ended questions tend to encourage more child participation than those using directive, task-focused styles. The review identifies a need for cultural change in how paediatric healthcare is delivered to better support children's right to participate in decisions about their care.
Key points
- Child participation in triadic healthcare consultations is frequently minimal and varies significantly based on communication styles of healthcare providers and caregivers
- Healthcare providers using supportive and facilitative styles that emphasise rapport-building, open-ended questioning, and child-friendly language facilitate greater child engagement compared to directive, task-focused approaches
- Parental roles are classified into three styles: supportive facilitator, dominant and protective, each affecting child participation differently
- Child's age, developmental stage, cultural influences, emotional context, and healthcare environment significantly impact participation levels
- A notable lack of standardised measurement tools limits comparability of findings across studies and future progress evaluation
Limitations
This scoping review maps existing evidence but does not evaluate the effectiveness of specific interventions through experimental design. The review cannot determine which communication strategies are most effective or provide causal evidence of their impact on child health outcomes.
Abstract
INTRODUCTION: Children under 18 are recognised as key stakeholders in healthcare and possess the right to actively participate in decisions regarding their care. Despite this, they are frequently relegated to passive roles during triadic healthcare consultations involving healthcare providers (HCPs), caregivers, and children. Enhancing child participation requires effective communication strategies; however, numerous barriers persist, including healthcare provider dominance and parental interference. This review aims to explore and identify effective communication strategies employed by healthcare providers and caregivers to improve child participation in triadic consultations within healthcare settings. METHOD: A scoping review methodology, based on the Joanna Briggs Institute framework and PRISMA guidelines, was used. A comprehensive search was conducted across four databases-PubMed, PsycINFO, Scopus, and CINAHL using predefined eligibility criteria. Studies focused on children under 18 in triadic healthcare consultations. Qualitative, quantitative, and mixed-methods studies were included to map existing evidence and highlight gaps. RESULTS: A total of 37 out of 41 studies revealed that child participation in triadic consultations is frequently minimal and varies significantly depending on the communication styles of HCPs and caregivers. HCPs exhibit a range of communication styles, with some adopting a directive or task-focused (Dyadic approach) that prioritises medical tasks and often sidelines children in conversations, while others utilise supportive and facilitative styles (Triadic approach) that emphasise rapport-building, open-ended questioning, child-friendly language, and the use of interactive techniques that facilitate engagement. Parental roles in this dynamic were classified into three main styles: supportive facilitator, dominant and protective. Factors such as the child's age and developmental stage, wider cultural influences, the emotional context, and the healthcare environment were also found to significantly impact child participation. A variety of measurement tools were utilised to assess participation levels, including the Roter Interaction Analysis System (RIAS), conversational analysis and context-specific coding schemes. However, the review identified a notable lack of standardised tools, which limits the comparability of findings across different studies. CONCLUSION: This review highlights the need to enhance child participation in healthcare consultations through effective communication. However, improving participation requires more than communication skills training alone. HCPs must work closely alongside parents and caregivers to support children's participation rights and embed these principles in routine practice. Achieving this objective requires engaging both HCPs and parents to drive changes in clinical practice through a fundamental cultural shift in paediatric care delivery. Future research should employ validated measurement tools to evaluate progress and identify effective approaches to enhancing child engagement in healthcare settings. PATIENT AND PUBLIC CONTRIBUTION: The findings have been discussed with Patient and Public Involvement (PPI) members who have children. Their valuable insights contributed to the interpretation of the review findings and informed the next stage of the project, which will include audio observation of triadic consultations in paediatric dental settings.