title: Starting the conversation: Patient initiation of weight-related behavioral counseling during pregnancy.
abstract: To examine the relationship between patient initiation and weight-related behavioral counseling during pregnancy.
  
  
  
  We examined audio recordings of prenatal visits between 22 obstetricians and 120 patients for behavioral counseling using the Roter Interaction Analysis System and the 5A's behavioral counseling framework. We used multivariate regression models to examine the relationship between patient initiation and communication outcomes.
  
  
  
  Overall, 55% of prenatal visits included any behavioral counseling. Patients initiated counseling episodes 45.5% of these visits. Patients were less verbally dominated by their clinicians in prenatal visits with patient-initiated behavioral counseling episodes (difference in clinician verbal dominance ratio=0.73, 95% CI=0.16-1.30). Patient-initiated counseling episodes included more socioemotional communication relative to those initiated by clinicians (p=0.02). The total duration of counseling was 28s longer (95% CI 0.27-56.0s) and clinicians were more likely to use two or more 5A's strategies (OR=3.61, 95% CI=1.01-12.88) when patients initiated discussions.
  
  
  
  Patient initiation may lead to behavioral counseling that is longer in duration and includes more 5A's strategies, possibly mediated by socioemotional communication.
  
  
  
  Participatory prenatal care communication may lead to more effective counseling that is responsive to women's concerns.
authors.affiliation: Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Room 750, Baltimore, MD 21205, USA. Electronic address: katiewashington@jhu.edu.
authors.forename: Katie O
authors.initials: KO
authors.lastname: Washington Cole
authors.affiliation: Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Room 750, Baltimore, MD 21205, USA.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Roter
mesh_terms: D000328:Adult; D001835:Body Weight; D003142:Communication; D003376:Counseling; D003430:Cross-Sectional Studies; D004032:Diet; D005260:Female; D006801:Humans; D009043:Motor Activity; D015999:Multivariate Analysis; D009765:Obesity / Q000517:prevention & control; D009774:Obstetrics; D010353:Patient Education as Topic; D010358:Patient Participation; D010817:Physician-Patient Relations; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control; D037841:Pregnant People / Q000523:psychology*; D011295:Prenatal Care; D012044:Regression Analysis; D013637:Tape Recording; D015430:Weight Gain
keywords: Behavioral counseling; Gestational weight gain; Interaction analysis; Nutrition; Patient initiation; Patient-provider communication; Physical activity; Pregnancy