Starting the conversation: Patient initiation of weight-related behavioral counseling during pregnancy

Katie O. Washington Cole, Debra Roter

Research output: Contribution to journalArticle


Objective: To examine the relationship between patient initiation and weight-related behavioral counseling during pregnancy. Methods: 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. Results: 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 28. s longer (95% CI 0.27-56.0. s) 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. Conclusions: Patient initiation may lead to behavioral counseling that is longer in duration and includes more 5A's strategies, possibly mediated by socioemotional communication. Practice implications: Participatory prenatal care communication may lead to more effective counseling that is responsive to women's concerns.

Original languageEnglish (US)
JournalPatient Education and Counseling
Publication statusAccepted/In press - Dec 22 2015



  • Behavioral counseling
  • Gestational weight gain
  • Interaction analysis
  • Nutrition
  • Patient initiation
  • Patient-provider communication
  • Physical activity
  • Pregnancy

ASJC Scopus subject areas

  • Medicine(all)

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