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PubMed1999

Communication teaching and assessment in medical education: an international consensus statement. Netherlands Institute of Primary Health Care.

The importance of communication between doctors and patients has been well established, and there is growing acceptance of the need to teach and assess communication skills in medical schools. Faculty meeting at a consensus workshop during the International Conference on Teaching Communication in Medicine (Oxford, July 1996) generated a series of recommendations for developing and implementing teaching and assessment programmes. The points were refined in subsequent discussions with other interested groups, and endorsed in their current form by a workshop of teachers attending the Communication in Health Care Conference organized by NIVEL, the Netherlands Institute of Primary Health Care (Amsterdam, June 1998). While focused on medical schools, the eight recommendations highlighted in this consensus statement are also relevant to both graduate and continuing medical education programmes: (1) teaching and assessment should be based on a broad view of communication in medicine; (2) communication skills teaching and clinical teaching should be consistent and complementary; (3) teaching should define, and help students achieve, patient-centred communication tasks; (4) communication teaching and assessment should foster personal and professional growth; (5) there should be a planned and coherent framework for communication skills teaching; (6) students' ability to achieve communication tasks should be assessed directly; (7) communication skills teaching and assessment programmes should be evaluated; (8) faculty development should be supported and adequately resourced.

Clinical Competence↗
PubMed2001

A typology approach to describing parents as communicators about sexuality.

Teenagers in Grades 8 and 10 and their parents completed a questionnaire examining the frequency of parental communications about sexuality and the communicative style when discussing sexuality and in general. Respondents also assessed parents' competence in communicating about sexual matters. For each set of respondents (teens reporting about mother, teens reporting about father, mothers' self-reports, fathers' self-reports), a cluster analysis yielded four clusters that were similar for each set. Relative to other parents, there was a group of parents that could be labelled as competent communicators and a group that could be labelled as problematic communicators about sexuality, with strong associations between cluster membership and score on the global measure of communicative competence. There were two intermediate categories that reflected more or less competence although the precise nature of these clusters differed as a function of informant group. Overall, fathers were rated as poorer communicators about sexuality than were mothers, at least by their teenage children. Consistent with other studies, mothers were more likely to be perceived as effective communicators by daughters and older teens. It appears that, independent of their level of competence, parents adjust their communication strategies according to the age and sex of their child, at least in the eyes of that child. Effective and problematic communicators among mothers were regarded as such by both sets of informants. This was not the case for fathers. We conclude that it is possible to classify parents usefully on the basis of perceived competence as communicators about sexuality.

Adolescent↗
PubMed2005

Nutrition communication styles of family doctors: results of quantitative research.

OBJECTIVE: To assess the nutrition communication styles of Dutch family doctors and in particular to assess its psychosocial and sociodemographic correlates. DESIGN: A cross-sectional study in which a representative sample of 600 Dutch family doctors completed a questionnaire. SETTING: The survey was conducted in October and November 2004 in the Netherlands. SUBJECTS: A total of 267 family doctors completed the questionnaire (response rate 45%). METHODS: Principal component factor analyses with varimax rotation were performed to construct factors. Cronbach's alpha was used as an index of reliability. Our hypothetical model for nutrition communication style was tested using multiple regression analysis, combining the forward and backward procedures under the condition of the same results. RESULTS: Many family doctors felt at ease with a motivational nutrition communication style. The main predictor for motivational nutrition communication style was task perception of prevention (26%). Some individual and environmental correlates had an additional influence (explained variance 49%). Other styles showed explained variances up to 57%. The motivational style was the best predictor for actual nutrition communication behaviour (35%), while the confrontational style was the best predictor for actual nutrition communication behaviour towards overweight (34%). CONCLUSIONS: In contemporary busy practice, family doctors seem to rely on their predominant nutrition communication style to deal with standard situations efficiently: for the majority, this proved to be the motivational nutrition communication style. Moreover, family doctors used a combination of styles. This study suggests that family doctors behave like chameleons, by adapting their style to the specific circumstances, like context, time and patient. If family doctors communicate about nutrition in general, they select any of the five nutrition communication styles. If they communicate about overweight, they pick either the confrontational or motivational style.

Adult↗
PubMed2000

Correlates of safer sex communication among college students.

Correlates of safer sex communication among college students The purpose of this study was to examine factors that are thought to promote communication about safer sex and HIV among college students in the United States of America and to determine the extent to which communication about safer sex is important in the use of condoms. A better understanding of factors associated with safer sex communication can be helpful in developing HIV and STD prevention programmes for college students. Following approval from the institutional review boards of the six participating colleges and universities, researchers collected data from a random sample of students. The study included participant responses if participants were 18-25 years of age, single and sexually active. For the sample of 1349 participants, the mean age was 20.6 years. Sixty-three per cent of the sample was female, 50.5% white, 42.3% African-American, and the remainder of other ethnic groups. Over 50% of respondents reported frequent condom use, with 28% noting that they used a condom every time and 30.6% reporting condom use almost every time they had sex. Only 9.6% indicated that they never used a condom. The results of hierarchical multiple regression analysis revealed that the perception of quality of general communication with parents, the perception of a partner's attitude towards communication, communication self-efficacy, and communication outcome expectancies, were associated with safer sex communication. However, the association between safer sex communication and condom use was weak, suggesting that other factors excluded from this study are important in determining condom use for this sample of respondents. The findings provide some implications for HIV interventions. Interventions that enhance self-efficacy and positive outcome expectancies related to communication about safer sex are likely to foster discussion with a sexual partner. However, they might not lead to actual condom use.

Adolescent↗
PubMed2003

Can undergraduate education have an effect on the ways in which pre-registration house officers conceptualise communication?

AIMS: In 1994 Manchester Medical School introduced a learner-centred course using problem-based learning (PBL), which emphasises effective communication skills. This study explored how 2 cohorts of graduates conceptualised communication within their role as pre-registration house officer (PRHOs). METHODS: Graduates from the last year of the traditional and first year of the new course were interviewed 3 months after starting work. They were asked how well their courses had prepared them for working as PRHOs and were given a specific question about communication skills. Interviews were tape-recorded, transcribed, coded and analysed. RESULTS: In all, 24 traditional course graduates (TCGs) and 23 new course graduates (NCGs) were interviewed. Traditional course graduates tended to conceptualise communication as informing people rather than as involving negotiation or having therapeutic effects. Most TCGs considered good communicators 'were born that way' and did not think communication skills could be learned. Many NCGs had a richer concept of communication that recognised communication has therapeutic benefits for patients and involved negotiation. They understood it was possible to teach communication skills. However, a minority of NCGs conceptualised communication in a similar way to TCGs. CONCLUSION: Our study suggests that the new course has helped NCGs acquire a more complex concept of communication in their role as PRHOs.

Cohort Studies↗
PubMed2006

A model for communication skills assessment across the undergraduate curriculum.

Physicians' interpersonal and communication skills have a significant impact on patient care and correlate with improved healthcare outcomes. Some studies suggest, however, that communication skills decline during the four years of medical school. Regulatory and other medical organizations, recognizing the importance of interpersonal and communication skills in the practice of medicine, now require competence in communication skills. Two challenges exist: to select a framework of interpersonal and communication skills to teach across undergraduate medical education, and to develop and implement a uniform model for the assessment of these skills. The authors describe a process and model for developing and institutionalizing the assessment of communication skills across the undergraduate curriculum. Consensus was built regarding communication skill competencies by working with course leaders and examination directors, a uniform framework of competencies was selected to both teach and assess communication skills, and the framework was implemented across the Harvard Medical School undergraduate curriculum. The authors adapted an assessment framework based on the Bayer-Fetzer Kalamazoo Consensus Statement adapted a patient and added and satisfaction tool to bring patients' perspectives into the assessment of the learners. The core communication competencies and evaluation instruments were implemented in school-wide courses and assessment exercises including the first-year Patient-Doctor I Clinical Assessment, second-year Objective Structured Clinical Exam (OSCE), third-year Patient-Doctor III Clinical Assessment, fourth-year Comprehensive Clinical Practice Examination and the Core Medicine Clerkships. Faculty were offered workshops and interactive web-based teaching to become familiar with the framework, and students used the framework with repeated opportunities for faculty feedback on these skills. A model is offered for educational leaders and others who are involved in designing assessment in communication skills. By presenting an approach for implementation, the authors hope to provide guidance for the successful integration of communication skills assessment in undergraduate medical education.

Communication↗
PubMed2004

Achieving involvement: process outcomes from a cluster randomized trial of shared decision making skill development and use of risk communication aids in general practice.

BACKGROUND: A consulting method known as 'shared decision making' (SDM) has been described and operationalized in terms of several 'competences'. One of these competences concerns the discussion of the risks and benefits of treatment or care options-'risk communication'. Few data exist on clinicians' ability to acquire skills and implement the competences of SDM or risk communication in consultations with patients. OBJECTIVE: The aims of this study were to evaluate the effects of skill development workshops for SDM and the use of risk communication aids on the process of consultations. METHODS: A cluster randomized trial with crossover was carried out with the participation of 20 recently qualified GPs in urban and rural general practices in Gwent, South Wales. A total of 747 patients with known atrial fibrillation, prostatism, menorrhagia or menopausal symptoms were invited to a consultation to review their condition or treatments. Half the consultations were randomly selected for audio-taping, of which 352 patients attended and were audio-taped successfully. After baseline, participating doctors were randomized to receive training in (i) SDM skills or (ii) the use of simple risk communication aids, using simulated patients. The alternative training was then provided for the final study phase. Patients were allocated randomly to a consultation during baseline or intervention 1 (SDM or risk communication aids) or intervention 2 phases. A randomly selected half of the consultations were audio-taped from each phase. Raters (independent, trained and blinded to study phase) assessed the audio-tapes using a validated scale to assess levels of patient involvement (OPTION: observing patient involvement), and to analyse the nature of risk information discussed. Clinicians completed questionnaires after each consultation, assessing perceived clinician-patient agreement and level of patient involvement in decisions. Multilevel modelling was carried out with the OPTION score as the dependent variable, and rater, consultation and clinician levels of data, standardized by rater within clinician. RESULTS: Following each of the interventions, the clinicians significantly increased their involvement of patients in decision making (OPTION score increased by 10.6 following risk communication training [95% confidence interval (CI) 7.9 -13.3; P < 0.001] and by 12.9 after SDM skill development (95% CI 10 -15.8, P < 0.001), a moderate effect size. The level of involvement achieved by the risk communication aids was significantly increased by the subsequent introduction of the skill development workshops (7.7 increase in OPTION score, 95% CI 3.4-12; P < 0.001). The alternative sequence (skills followed by risk communication aids) did not achieve this effect. The use of most risk information formats increased after the provision of specific risk communication aids (P < 0.001). Clinicians using the risk communication tools perceived significantly higher patient and clinician agreement on treatment (P < 0.001), patient satisfaction with information (P < 0.01), clinician satisfaction with decision (P < 0.01) and general overall satisfaction with the consultation (P < 0.001) than those who were exposed to SDM skill development workshops. CONCLUSIONS: These clinicians were able to acquire the skills to implement SDM competences and to use risk communication aids. Each intervention provided independent effects. Further progress towards greater patient involvement in health care decision making is possible, and skill development in this area should be incorporated into postgraduate professional development programmes.

Adult↗
PubMed2005

Improved communication between doctors and with managers would benefit professional integrity and reduce the occupational medicine workload.

BACKGROUND: Professional expectations for communication skills are explicit. These skills are needed for professional integrity and personal morale. Nevertheless, occupational physicians see doctors as patients for whom communication among between doctors and with their managers are the principal cause of their presenting health problems. AIM: To describe the frameworks of professionalism in medicine and the duty to care for good communication; present issues surrounding competency in communication skills; identify health problems among doctors associated with poor communication; and consider roles of economic appraisal and preventive strategies. METHOD: A literature review identified key publications of professional expectations and requirements of doctors for their communication skills. Health problems among doctors associated with poor communication and presenting at least twice in a National Health Service (NHS) occupational health (OH) department during January-December 2002, were sought by manual retrieval of all doctor-patient records. The categories of communication difficulty were agreed in the focus group discussion of the presenting problems with occupational physicians. RESULTS: Nine categories of communication difficulties among doctors resulting in their presentation in OH departments with health problems were identified. CONCLUSIONS: Personal health problems caused by poor communication involve considerable time and potential litigation costs. Doctors need to be reminded of their responsibilities. Opportunity cost studies would help to strengthen an evidence base for the need of doctors to adhere to the professional requirements of good communication skills.

Communication↗
PubMed1995

Effects of talker familiarity on communication breakdown in conversations with adult cochlear-implant users.

This investigation had three objectives: a) to determine the types of repair strategies that cochlear-implant users implement to rectify communication breakdowns during ongoing conversation when talking to either familiar or unfamiliar communication partners, b) to determine how communication partners respond to particular types of repair strategies, and c) to describe the use of conversational behaviors that might circumvent communication difficulties. In Experiment 1, cochlear-implant subjects were videotaped while talking to familiar and then unfamiliar communication partners. In Experiment 2, a second group of cochlear-implant subjects were videotaped while speaking with an unfamiliar partner for 6.5 minutes. Analysis of the videotapes revealed that the cochlear-implant subjects in the two experiments most commonly asked "what?," "huh," or "pardon?" after not recognizing a spoken message (e.g., following a communication breakdown), regardless of whether the communication partner was familiar or unfamiliar. Communication partners' more common response to this repair strategy was to repeat the original message. When cochlear-implant subjects repeated back the segment of a message that they understood, communication partners most often confirmed or corrected them. When they requested information, communication partners usually provided it. The cochlear-implant subjects were more likely to use controlling conversational behaviors when interacting with unfamiliar than familiar communication partners. We conclude that repair strategy-response adjacency pairs may emerge during spontaneous conversations. Use of both specific and nonspecific repair strategies may indicate cochlear-implant users' adherence to a cooperative principle.

Adult↗
PubMed2006

A theory-based instrument to evaluate team communication in the operating room: balancing measurement authenticity and reliability.

BACKGROUND: Breakdown in communication among members of the healthcare team threatens the effective delivery of health services, and raises the risk of errors and adverse events. AIM: To describe the process of developing an authentic, theory-based evaluation instrument that measures communication among members of the operating room team by documenting communication failures. METHODS: 25 procedures were viewed by 3 observers observing in pairs, and records of events on each communication failure observed were independently completed by each observer. Each record included the type and outcome of the failure (both selected from a checklist of options), as well as the time of occurrence and a description of the event. For each observer, records of events were compiled to create a profile for the procedure. RESULTS: At the level of identifying events in the procedure, mean inter-rater agreement was low (mean agreement across pairs 47.3%). However, inter-rater reliability regarding the total number of communication failures per procedure was reasonable (mean ICC across pairs 0.72). When observers recorded the same event, a strong concordance about the type of communication failure represented by the event was found. DISCUSSION: Reasonable inter-rater reliability was shown by the instrument in assessing the relative rate of communication failures displayed per procedure. The difficulties in identifying and interpreting individual communication events reflect the delicate balance between increased subtlety and increased error. Complex team communication does not readily reduce to mere observation of events; some level of interpretation is required to meaningfully account for communicative exchanges. Although such observer interpretation improves the subtlety and validity of the instrument, it necessarily introduces error, reducing reliability. Although we continue to work towards increasing the instrument's sensitivity at the level of individual categories, this study suggests that the instrument could be used to measure the effect of team communication intervention on overall failure rates at the level of procedure.

Academic Medical Centers↗
PubMed2006

Determinants and impact of generalist-specialist communication about pediatric outpatient referrals.

OBJECTIVE: Effective communication between primary care and specialty physicians is essential for comanagement when children are referred to specialty care. We sought to determine rates of physician-reported communication between primary care physicians and specialists, the clinical impact of communication or its absence, and patient- and practice system-level determinants of communication for a cohort of children referred to specialty care. METHODS: We enrolled 179 patients newly referred from general pediatricians in 30 community practices to 15 pediatric medical specialists in 5 specialties. Primary care physicians and specialists completed questionnaires at the first specialty visit and 6 months later. Questions covered communication received by primary care physicians and specialists, its impact on care provision, system characteristics of practices, and roles of physicians in treatment. We used multivariate logistic regression to determine associations between practice system and patient characteristics and the dependent variable of reported primary care physician-specialist communication. RESULTS: Specialists reported communication from referring primary care physicians for only 50% of initial referrals, whereas primary care physicians reported communication from specialists after 84% of initial consultations. Communication was strongly associated with physicians' reported ability to provide optimal care. System characteristics associated with reported primary care physician-specialist communication were computer access to chart notes and lack of delays in receipt of information. Associated patient characteristics included non-Medicaid insurance, no additional specialists seen, and specialty to which referred. Physicians favored comanagement of referred patients in more than two thirds of the cases. CONCLUSIONS: Although a prerequisite for optimal care, communication from primary care physicians to specialists is frequently absent. Interventions should promote widely accessible clinical information systems and target children with complex needs and public insurance.

Ambulatory Care↗
PubMedDate not supplied

[Analyses of the communicative functions expressed by language therapists and patients of the autistic spectrum].

BACKGROUND: communicative functions used by language therapists and patients. AIM: to analyze the communicative functions used by language therapists and patients of the autistic spectrum. METHOD: the communicative functions expressed by six therapists in interaction with six patients each were analyzed, constituting 36 profiles of communicative functions expressed by the dyad therapist-patient. All therapists were part of a Training Program in Childhood Psychiatric Disorders and the patients were diagnosed within the autistic spectrum. Data were gathered using the transcriptions of a videotaped therapy session and these were analyzed according to the criteria suggested by Fernandes (2000). The communicative functions were divided in two different ways: interpersonal and non-interpersonal, and instrumental, regulatory, interactive, personal, heuristic and imaginative. RESULTS: the comparison between the functions used by the language therapists and the patients indicated a statistically significant difference in use of the following functions: request of social routine, request of information, request of action, comment, recognition of other, exclamation, non-focused, exploratory, exhibition, play and reactive. There was also a statistically significant difference between the use of interpersonal, non-interpersonal, regulatory, interactive, personal and heuristic communicative functions. CONCLUSION: the functional communicative profile of language therapists is different from the one presented by their patients when comparing each communicative function and when the communicative functions are grouped (interpersonal and non-interpersonal, and instrumental, regulatory, interactive, personal, heuristic and imaginative). Therapists use communicative functions to fill in the communicative space and to make requests. This finding agrees with the findings of previous studies.

Adolescent↗
PubMed1985

Inhibited intercellular communication as a mechanistic link between teratogenesis and carcinogenesis.

Teratogenesis and carcinogenesis share many characteristics, leading to the speculation that they may also share pathogenic mechanisms. Direct intercellular communication mediated by membrane junctions is known to occur between a variety of cells and may play an important role in the control of cell growth and differentiation. Inhibition of junctional communication may be a mechanism common to both teratogenesis and carcinogenesis whereby cells and tissues are diverted from their normal differentiation paths. The multistage model of carcinogenesis predicts that the irreversibly initiated cell is at least partially regulated by the surrounding cells of a tissue, and that the initiated cell remains inactive until stimulated to proliferate by a tumor promotor. Tumor promoters may release the initiated cell from control of the surrounding tissue by interrupting intercellular communication, since many tumor promoters have now been shown to interfere with junctional communication in cultured mammalian cells. Furthermore, many tumorigenic cells have compromised junctional communication abilities. Similarly, it has been reasoned that the cells of an embryo must be able to communicate with each other to define tissue specificity and pattern formation, and to coordinate morphogenetic events. Many studies have chronicled alterations in junctional communication that occur coincident with major developmental events and some studies suggest that junctional communication may be modified at boundaries of morphogenetic fields. A recent in vivo study has provided evidence that inhibition of junctional communication may interfere with embryonic development, and several teratogens are known to interrupt junctional communication in mammalian cells in culture. These observations suggest that inhibition of junctional intercellular communication may be a shared mechanism of carcinogenesis and teratogenesis.

Animals↗
PubMed2004

[The development and effects of a comprehensive communication course for nursing students].

PURPOSE: The purposes of this study were to: (a) develop a comprehensive communication course combined with a group program for improving communication skills; and (b) examine the effects of the comprehensive communication course on interpersonal communication, relationship change, self-esteem, and depression in nursing students. METHOD: The experimental group consisted of 82 nursing students, and the control group, 108 nursing students. Both groups each took communication courses from March to June, 2002 and 2003. A group program for improving communication skills was conducted for each 8 subgroups of the experimental group for 90 minutes once a week during the 6 weeks, while the existing communication lecture was conducted for the control group. Both groups were post-tested after the intervention for verifying the difference of variables between the two groups, and the experimental group was also pre-tested for verifying the difference between before and after the treatment. RESULT & CONCLUSION: Interpersonal communication score of the post-test in the experimental group was significantly higher than in the control group and the depression score of the post-test in the experimental group was significantly lower than in the control group. Interpersonal communication, relationship change and self-esteem scores were significantly increased and the depression score was significantly decreased in experimental group after the treatment. In conclusion, the comprehensive communication course that was developed in this study had positive effects on communication skills in nursing students.

Adolescent↗
PubMed2002

Communication loads on clinical staff in the emergency department.

OBJECTIVE: To measure communication loads on clinical staff in an acute clinical setting, and to describe the pattern of informal and formal communication events, Australia. DESIGN: Observational study. SETTING: Two emergency departments, one rural and one urban, in New South Wales hospitals, between June and July 1999. PARTICIPANTS: Twelve clinical staff members, comprising six nurses and six doctors. MAIN OUTCOME MEASURES: Time involved in communication; number of communication events, interruptions, and overlapping communications; choice of communication channel; purpose of communication. RESULTS: 35 hours and 13 minutes were observed, and 1286 distinct communication events were identified, representing 36.5 events per person per hour (95% CI, 34.5-38.5). A third of communication events (30.6%) were classified as interruptions, giving a rate of 11.15 interruptions per hour for all subjects; 10% of communication time involved two or more concurrent conversations; and 12.7% of all events involved formal information sources such as patients' medical records. Face-to-face conversation accounted for 82%. While medical staff asked for information slightly less frequently than nursing staff (25.4% v 30.9%), they received information much less frequently (6.6% v 16.2%). CONCLUSION: Our results support the need for communication training in emergency departments and other similar workplaces. The combination of interruptions and multiple concurrent tasks may produce clinical errors by disrupting memory processes. About 90% of the information transactions observed involved interpersonal exchanges rather than interaction with formal information sources. This may put a low upper limit on the potential for improving information processes by introducing electronic medical records.

Communication↗
PubMed1999

Medical education initiatives in communication skills.

Medical educators at undergraduate, postgraduate and continuing medical education levels acknowledge that communication is a fundamental medical skill. Responding to patient, professional and governmental advocates, as well as to advances in research on patient-physician communication and its teaching, some medical educators are in the process of starting new communication curricula, while others are working at expanding, integrating and further developing already well-established programs. For most people working in this area, the question is no longer whether to teach and assess communication skills and attitudes but, rather, how to do so most efficiently and effectively. In order to enhance the development of communication curricula at all levels, we first provide a brief look at how communication education has become widely encouraged in many parts of the globe, and we set out the underlying assumptions that frame the teaching and learning of communication in medicine. We then summarize critical components common to many established communication curricula and identify a series of specific strategies for teaching communication skills. We include a chart that describes a sample of the wide variety of resources available to assist in the development and teaching of communication curricula in medicine. Finally, we consider gaps in current communication curricula and suggest the next steps and ideas for moving forwards.

Attitude of Health Personnel↗
PubMed1989

[The suicidal approach-/rejection syndrome. The assessment of suicidal risk based on communication pathology].

In the case of attempted suicide, the patient unconsciously and/or consciously manipulates people in his surroundings in communication-intending behaviour, whereas in the case of committed suicide, the patient shows communication-rejecting behaviour. This phenomenological description of suicidal behaviour is explained in a theory of communication in such a way that communication-intending behaviour is shown by the communication-style of aggression, and communication-rejecting behaviour is characterized by the communication-style of rejection. Finally an attempt is made to describe syndromically communication-intending behaviour, characteristic of attempted suicide, or communication-rejecting behaviour, typical for committed suicide, taking into account all essential psycho-biological components. This new instrument for estimating suicidality is used in a representative sample for Salzburg of 185 attempted suicides. It is thereby shown that a syndrome of purely communication-intending behaviour or a typical communication-rejection syndrome only occurs among a small percentage. In the majority of probands both psychodynamic and biological factors are responsible for the attempted suicide.

Adolescent↗
PubMed1988

Maternal communication style with mentally retarded children.

Mothers' style of communicating with 1- to 3-year-old mentally retarded children was related to children's communication. Mother--child communication was coded to characterize maternal communicative functions, the relationship of mother and child communication to the topic of conversation, the modality and meaningfulness of children's communication, and the manner that mothers and children reciprocate to each others' communication. Six maternal style factors were identified: attentiveness, responsiveness, persistent requesting, child-orientation, quality of requests, and quality of information. The regression of communication style factors on children's communication indicated that children were more verbal and communicatively responsive when their mothers were responsive to children's communication and focused on child-oriented topics.

Attention↗