Jijia Kuang, Xue Sun
The findings demonstrate how asynchronous messaging redistributes communicative activities between caregivers and physicians, with clarification as a recurrent mechanism for specifying clinically relevant information. Structured symptom prompts, clearer message threading, and explicit escalation guidance warrant testing in future intervention research. This study provides an empirical basis for understanding the sequential organization of asynchronous pediatric consultations and offers actionable directions for communication design in digital health services.
BACKGROUND: WeChat group consultations extend pediatric advice into everyday messaging, but their interactional organization is not well described.
OBJECTIVE: To identify recurring interactional stages, and clarification practices in asynchronous caregiver-physician exchanges.
METHODS: We analyzed 5,938 messages nested within 347 manually identified complete consultation episodes from one private pediatric WeChat group in Chengdu, China, collected from January to December 2024. A qualitatively led mixed-methods design combined manual sequence segmentation, descriptive analysis of message distribution and length, and targeted qualitative analysis of clarification sequences.
RESULTS: Four recurrent stages were identified: problem initiation, clinical data collection, diagnostic advice, and closure. Opening and illness presentation were combined in 69.45% of episodes (241/347), and diagnosis with treatment recommendation in 85.88% (298/347). Caregivers produced more messages overall than physicians (3,273 vs. 2,665), with substantially longer and more variable messages during problem initiation (median = 9 vs. 3; M = 17.91 vs. 3.50; IQR = 14.75 vs. 3) and clinical data collection (median = 10 vs. 7; M = 14.22 vs. 9.29; IQR = 11 vs. 7). Message-length distributions became more comparable during diagnostic advice (median = 10 for both; IQR = 12 vs. 13). Clarification sequences were identified in both directions: 293 physician-led sequences during clinical data collection and 686 caregiver-initiated sequences during diagnostic advice, progressively transforming underspecified symptom reports into more specified clinical accounts.
CONCLUSION: The findings demonstrate how asynchronous messaging redistributes communicative activities between caregivers and physicians, with clarification as a recurrent mechanism for specifying clinically relevant information. Structured symptom prompts, clearer message threading, and explicit escalation guidance warrant testing in future intervention research. This study provides an empirical basis for understanding the sequential organization of asynchronous pediatric consultations and offers actionable directions for communication design in digital health services.