Involved, interrupted or ignored? Triadic communication in children's non-urgent X-ray procedures

Introduction
X-rays are among the most common healthcare procedure carried out on children1. Despite most X-ray procedures being non-invasive, some children report feeling anxious, fearful, unprepared and excluded from communication between radiographers and their parents. This study explored the triadic communication, that occurred between children, parents and radiographers, during children's non-urgent X-ray procedures.

Methods
A qualitative constructivist Grounded Theory approach was used. Non-participant observations were conducted during 45 non-urgent X-ray procedures conducted at one hospital in the UK involving children aged 4–11 years. Semi-structured interviews were conducted after the procedure with children (n = 17) and their parents (n = 9). Data were analysed using constant comparison techniques.

Results
Three non-hierarchical categories of triadic communication were identified: Involved (children's voices were actively sought and listened to); Interrupted (adult voices overshadowed children's); and Ignored (children's voices were not sought or were overlooked).

Conclusion
Triadic communication in children's X-ray procedures is complex and influences how children experience their procedure. Children can express preferences for how, when and with whom they communicate. When communication is authentic, individually tailored, child-led and focusses on developing rapport, children feel more confident and involved. In contrast, heavily scripted and adult-led instructional communication can leave children marginalised and feeling ignored within their procedure. These findings emphasise the need for individualised communication practices in radiography settings.

Implications for practice
Radiographers should prioritise child-centred, flexible communication based on children's preferences for participation over the use of overly scripted or adult-dominated instructional talk.