APPENDIX

Coding Scheme

Communication-Behavior DescriptionCodesExamples
1. Who initiates vaccine topic generally, in any way?1 = PediatricianSee 3a and 4a below
2 = Guardian“So what about vaccines?”
2. Who initiates vaccine recommendation or plan specifically?1 = Pediatrician
2 = Guardian in a way that allows or provides doctor to initiate the recommendation/plan“We know he’s getting shots today.”
3 = Guardian proposes a plan that complies with or endorses recommended plan; if 3, go to 5a and 4a–c = 99“We’re going on vacation so I think I would like to get all the vaccines today.”
4 = Guardian proposes a plan that resists vaccines or resists recommended plan; if 4, go to 5a and 4a–c = 99“So we wanted to wait on Hep B and the polio and just do the other ones.”
99 = No verbal recommendation or plan
3a. Does the pediatrician lead with a prevaccine discussion move?0 = No
• This must be an initiating action like a question that demands a response, not the beginning of an initiation.1 = Yes“It’s time for shots” or “How did he do with the vaccines last time?” or “Do you have questions about the vaccines?”
99 = N/A due to guardian initiation (see code 2 above)
3b. What type of response does the guardian give to the prevaccine move?1 = Unmitigated go-aheadGo-ahead = “Fine,” “No”
2 = Raises question regarding “fact” of immunization“What are the vaccines he has to have?”
3 = Raises issue of “concern” regarding immunization“It’s 3 at once—all today?”
4 = Raises opinion/plan regarding immunization (go to 5a)“We do want to be vaccinated against whooping cough.”
5 = Raises multiple issues (1–4 above)
99 = N/A due to no pre-move
4a. Initiation: How does the pediatrician initiate the vaccine recommendation (key)? Must be an initiating action (T1). Note: sometimes doctors do this over the course of multiple sequences of talk because the recommendation has multiple parts; code on overall recommendation, especially at its end. However, if resistance comes earlier, code at that point.1 = Presuppositional (in favor of shots)“Well we have to do some shots”; “The vaccines we would give today can cause fever”
2 = Presuppositional + tag (in favor of shots) or strongly rising questioning intonation“So we'll do 3 shots and the drink. Is that okay?”
Rule: code on most recent/proximate action3 = Polar interrogative“Are we going to do the shots today?” or “Here is option X: Do you want to do that?”; “Are we gonna do some immunizations today?”
4 = Open interrogative“How do you feel about the immunizations?” or “What do you want to do about shots?”
5 = Initiation designed against immunization (note that parent acceptance/agreement with this will be coded as resistance in 4b)“You’re still declining shots”; “And you’re choosing right now not to?”
99 = N/A due to code 3 in 2 or code 4 in 3b; or no verbal recommendation or plan at all
4b. Response: How does the guardian respond to the pediatrician’s initial initiation move? (T2)0 = Resistance: go to 4c below (note that acceptance of code 5 in 4a is resistance)
1 = Unmarked “response” (eg, continuer, simple acknowledgment of speaking)“Mm hm,” (if not a response to a question); “Oh”; “Uh huh”
2 = Accepts verbally or implicitly accepts by virtue of moving on in next turn”Yes” or “Yeah” (if response to question or proposal); “Okay”; “Right”; “Good”; “That’s fine”; “If he gets a fever, can I give him Tylenol?”; or just remaining silent/nonverbally acquiescing
3 = Responds to polar or open interrogative by providing a vaccine plan (go to 5a)Provider: “Are we gonna do some vaccines today?” Parent: “Yes, the Rota … and the Pentacel”
99 = N/A due to no 4a or no recommendation or plan at all
4c. Resistant response: If 4b = 0, what is the nature of the resistance in the guardian’s response to the pediatrician’s initial initiation move?1 = Explicit rejection of some/all of proposal“I don't want him vaccinated today”; “I want to go slow and just do the MMR”
2 = Demurral“I haven't really thought about it”; “I don’t know”
3 = Cites contingency“We're flying tomorrow.”
4 = Raises questions or concerns, brief“Well, where would he get Hep B?” or “What are the side effects?”
5 = Raises concern, extended (3 or more)3 or more concerns
99 = N/A due to no code 0 in 4b
5a. Pursuit #1: How does the pediatrician respond to or pursue the guardian’s response to the initial initiation move? (T3)1 = Pursues initial bid (ie, does not back down); resists completely (code 1 if 2b = 3 and doctor resists in any way)“He really needs these shots”; “If he was my child I would definitely go ahead”
2 = Pursues mitigated version of initial bid, but still more than what parent is going for; resists partially (note: code this when doctors ask parents if they can answer any questions/concerns to get them to change mind)“We could do them when you come back in 2 months”; “We could split them up”
3 = Accepts verbally or implicitly accepts by virtue of moving on in next turn“Okay”; “Let’s check him over” (new activity)
99 = No recommendation or plan at all
5b. Response to pursuit #1: If pediatrician’s pursuit involves another “bid,” how does the guardian respond to the pediatrician’s pursuit? (T4)0 = Resistance: go to 5b1 below
1 = Unmarked “response” (eg, continuer, simple acknowledgment of speaking)“Mm hm”; “Yeah”
2 = Accept“Yes” (if response to question), “Okay”; “Right” ; “Good”
3 = Accept presupposed in next turn“If he gets a fever, can I give him Tylenol?”
99 = N/A due to no pursuit (ie, 5a = 3)
5c. Resistant response to pursuit #1: If pediatrician’s pursuit involves another “bid,” what is the nature of the resistance in the guardian’s response?1 = Explicit rejection of some/all of proposalI don't want him vaccinated today”; “I want to go slow and just do the MMR”
2 = Demurral“I haven't really thought about it”; “I don’t know”
3 = Cites contingencyWe're flying tomorrow”
4 = Raises questions or concerns, brief“That's a lot of shots” or “pained” reaction
5 = Raises concern, extended (3 or more)
99 = N/A (no code 0 in 5b)
6. Pediatrician's final move: How does the pediatrician respond to or pursue the guardian’s response to the subsequent move? (T5)1 = Pursues previous bid (ie, does not back down); resists completely“He really needs these shots”; “If he was my child I would definitely go ahead”
2 = Pursues mitigated version of previous bid, but still more than what parent is going for; resists partially“We could them when you come back in 2 months”; “We could spilt them up”
3 = Accepts verbally or implicitly accepts by virtue of moving on in next turn“Let’s check him over” (new activity)
99 = N/A due to no pursuit (ie, 5a = 3)
7a. Global: Number of guardians’ vaccine-related questions asked before acceptance of vaccinationCode frequency (0–X); ratio-level dataNote that, by “question,” we mean any move that solicits information about vaccines, directly or indirectly.
7b. Global: Number of guardians’ vaccine-related questions asked after acceptance of vaccinationCode frequency (0–X); ratio-level data
8. Global: Does doctor explicitly solicit some/any questions/concerns?0 = No
1 = YesSee 3a: “Do you have questions about the vaccines?”
9. Global: Does pediatrician give rationale for immunization?0 = No
1 = Yes“Haemophilus is a bacteria that lives in our noses and throats and when I was a kid growing up it was the number 1 cause of meningitis in babies”
10. Global: Does pediatrician discuss side effects?0 = No1 = Yes“We've got the Tylenol and Motrin dosing back here so if she does seem to have any fussiness or fever or soreness after today's shots go ahead and do that.”
  • Hep B, hepatitis B; MMR, measles-mumps-rubella; N/A, not applicable; T1, 1st turn of talk; T2, 2nd turn of talk; T3, 3rd turn of talk; T4, 4th turn of talk; T5, 5th turn of talk.