We propose to test a communication intervention designed to promote active, competent communication between physicians and children in an office setting. We hypothesize that the proposed intervention will increase children's participation in medical encounters and increase the extent and cognitive appropriateness of physicians' communication to children in substantive areas. Further, we hypothesize that the proposed intervention will increase children's knowledge and active participation in their health care, improve parents' utilization of medical services and improve physician satisfaction. In subsamples of asthmatic children we expect the intervention to improve children's management skills and reduce parents' utilization of medical services. Our educational intervention targets all three participants in the pediatric medical encounter: physician, child and parent. The intervention is contained in videotapes and written materials. The major components of our communication model are: (1) Physicians should increase their direct communication with children in substantive content areas; (2) Information should be provided to children at a cognitively appropriate level; (3) Children should actively participate in the medical interview and express their concerns; (4) Parents should be encouraged to express their concerns in the form of a clear agenda. One hundred and eighty patients ages 7-14, their accompanying parents, and 62 physicians will be studied. A subsample of 80 children will be chronic asthmatics. Half the physicians will be randomly assigned to an experimental group; half will be assigned to a control group. Assignment of patients and parents will be determined by the assignment of their physicians. Three types of outcomes will be studied: interview process; post-encounter outcomes for patient, parent and physician; and cost effectiveness of the intervention. Data will be analyzed using analysis of variance and multiple regression. The long term objectives of this project are: 1) to demonstrate the effectiveness of an exportable educational intervention in enhancing the process of the medical interview; and 2) to demonstrate the causal relationship between the communication process and medical outcomes including children's ability to manage their own health and illness and parents' effectiveness in utilizing medical care.
