Most research about augmentative and alternative communication (AAC) has focused on improving use of and access to speech generating devices (SGDs). However, many adults with significant physical and developmental disabilities express a preference for unaided, embodied forms of communication. This study used conversation analysis (CA) techniques to analyze the forms and functions of embodied communication that occurred during interactions between a young man who used unaided, embodied communication and an SGD to communicate with a familiar communication partner. Close analysis revealed that embodied resources were required for both unaided and aided forms of communication. Furthermore, both participants used their bodies to establish interactional spaces with different focal points during interaction, which placed different demands on the aided speaker. Unfortunately, when the SGD was the focal point, problematic demands were placed on the aided speaker, which in turn resulted in increased embodied effort on his part. The forms and functions of the body, differences in the participants\' interactions when communication did and did not involve the SGD, and implications for research and practice are all reported and discussed.

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UNASSIGNED: This study examines the interactional management of hearing difficulties and hearing aids (HAs) in real-life, video-recorded social interactions with adults with hearing loss (HL) and their families/friends.
UNASSIGNED: 32 video-recordings in various social settings were analysed using Conversation Analysis.
UNASSIGNED: 20 adults with HL and their families/friends.
UNASSIGNED: HL and/or HAs did not typically become explicit in conversation. When adults with HL\' hearing difficulties did become explicit in the conversation, they were typically accompanied by laughter/humour. Sometimes the humour/laughter was initiated by the person with HL themselves (i.e. self-directed joking) but more frequently it was initiated by someone else within the conversation (i.e. a tease).
UNASSIGNED: The findings display the management of the \"to tell or not to tell\" dilemma in practice, and how humour was often used to lighten the tension when \"telling\" about HL and/or HAs. The findings also highlight that not all humour is equal: there are different outcomes for adults with HL depending on who initiated the humour/laughter within the context of the interaction. This study highlights stigma-in-action - how stigma related to HL and/or HAs is occasioned and managed within real-life social interactions.

This article investigates how domestic violence and abuse (DVA), its underreporting and its links with alcohol consumption, manifest in and impact the outcome of help-seeking telephone calls to U.K.-based police services. Conversation analysis of call-takers\' questions about alcohol found that they either (a) focused only on the perpetrator\'s drinking, and occurred after informing callers that help was being dispatched, or (b) targeted both victims\' and perpetrators\' drinking and complicated the decisions to dispatch police assistance. The article helps specify the communicative practices that may constitute victims\' negative experiences of disclosing DVA to the police.

The text reconstructs the concepts of practice and practicality used in ethnomethodology and conversation analysis and examines their internal similarities and differences as well as similarities and differences to other practice theories. After a description of the characteristics of practice theories, the ethnomethodological perspective on practice and practicality is presented. Then, the use of the terms in conversation analysis is examined. Ethnomethodology uses the notions of \"practice\" and \"practicality\" to outline a non-metaphysical theory of social order in which the sharedness of rules or meanings is not presupposed. \"Practical\" here means that social action, and social order more generally, are practically grounded as well as temporally and situationally constrained. The fact that practical action is fundamentally situated and can only be understood \"from within\" establishes an essentially indexical character of practical action. In conversation analysis, \"practices\" are viewed as \"context-free\" but \"context-sensitive\" components that constitute action and as such become the objects of investigation. While some have diagnosed a departure of conversation analysis from its ethnomethodological roots, I argue that \"context-freeness\" and \"context-sensitivity\" should be complemented by \"context-productivity\" by reference to Garfinkel\'s interpretation of Aron Gurwitsch\'s gestalt phenomenology in order to formulate a more encompassing concept of practice.

Video recordings of oncology interviews reveal how doctors rely on worry to establish medical expertise, facilitate treatment decision-making, and construct worry parameters to help patients understand whether there is a reasonable need for worry or not. Doctors express worry as frequently as cancer patients during oncology interviews, but they face a dilemma: how to provide care for cancer patients without directly stating they are worried about them? Plausible explanations are offered for why doctors do not state personal worries. Conversation analytic methods were employed to identify how doctors rely on worry to achieve distinct social actions. Four worry formulations are examined: (1) variations of \"we worry\" (and at times, non-specific and second person \"you\"), (2) hypothetical worry scenarios, (3) dismissing worry and offering assurance, and (4) doctors claiming they are not worried, bothered, or alarmed. Doctors align with and speak for the professionals and institutions they represent, expressing collective worries and claiming the legitimate right to worry (or not). Doctors also avoid abandoning patients to their own decision-making, yet do not formulate worry to coerce deference or dictate patients\' choices. In all cases patients agreed and displayed minimal resistance to doctors\' worry formulations. These findings contribute to ongoing work across institutional settings where participants have been shown to construct objective, legitimate claims meriting worries about diverse problems. Work is underway to examine when and how patients explicitly raise and doctors respond to cancer worries. Clinical implications are raised for how doctors can use worry to legitimize best treatment options, help patients minimize their worries, rely on hypothetical scenarios allowing patients to compare how other patients managed their cancer, and not dismiss the importance of minimizing the need to worry as a resource for offering reassurance.

During psychiatric diagnostic interviews, the clinician\'s question usually targets specific symptom descriptions based on diagnostic categories for ICD-10/DSM-5 (2, 3). While some patients merely answer questions, others go beyond to describe their subjective experiences in a manner that highlights the intensity and urgency of those experiences. By adopting conversation analysis as a method, this study examines diagnostic interviews conducted in an outpatient clinic in South Finland and identifies sequences that divulge patients\' subjective experiences. From 10 audio-recorded diagnostic interviews, 40 segments were selected where patients replied to medically or factually oriented questions with their self-disclosures. The research focus was on the clinicians\' responses to these disclosures. We present five sequential trajectories that the clinicians offered third-position utterances in response to their patients\' self-disclosure of subjective experiences. These trajectories include the following: 1) the clinician transfers the topic to a new agenda question concerning a medical or factual theme; 2) the clinician presents a follow-up question that selects a topic from the patient\'s self-disclosure of a subjective experience that may orient either towards the medical/factual side or the experiential side of the patient\'s telling; 3) the clinician provides an expert interpretation of the patient\'s self-disclosure of his or her subjective experience from the clinician\'s expert perspective; 4) the clinician gives advice that orients mainly to a treatment recommendation or to another activity; and 5) the clinician presents a formulation that focusses on the core of their patient\'s self-disclosure of his or her subjective experience from the patient\'s perspective. In addition, we present what these responsive practices invoke from the patient in the next turn. We argue that an awareness of these strategies facilitates both the diagnosis and an appropriate therapeutic relationship during the psychiatric assessment interview. Finally, we discuss the clinical significance of our results regarding the patient\'s agency and the clinician\'s more conscious patient-centred orientation in the psychiatric assessment procedure.

OBJECTIVE: To identify factors influencing patient responses in potentially sensitive situations that might lead to embarrassment (defined by politeness theory (PT) as positive face-threatening acts [FTAs]) or a sense of imposition (defined by PT as negative FTAs) during Objective Structured Clinical Examinations (OSCEs) and to assess the participant\'s ability to mitigate such situations.
METHODS: Nineteen OSCE video recordings of 10 pharmacy trainees interacting with mock patients were examined using the PT framework. All relevant participants\' speech acts were coded and quantified into type of FTAs and the mitigation strategies used. Patient (assessor) responses were classified then quantified into preferred responses (ie, quick response) vs dispreferred (ie, delayed or hesitant responses) using conversation analysis. The chi-square test was used to identify any association between relevant variables according to predefined hypotheses using SPSS version 27.
RESULTS: A total of 848 FTAs were analyzed. Participants failed to meet patient face needs in 32.4% of positive FTAs, in 11.5% of negative FTAs, and 44.4% of positive and negative FTAs. Although patients disclosing information about any inappropriate lifestyle behavior (as per OSCE scripts) expressed these via dispreferred mannerisms, participants were less likely to provide patients with reassurance when patient face needs were challenged in this way (68.2% of these dispreferred responses were not given reassuring feedback) than when they were maintained.
CONCLUSIONS: Improving educational programs to include the context of patient face needs and conversational strategies for properly dealing with highly sensitive situations was suggested as a way to equip trainees with the skills to effectively build rapport with patients.

Research on justifications has shown their significance in advice-giving, decision-making and children disputes. However, the majority of studies gloss over practical functions of justifications in patient-physician interactions as they are often expected and pursued by patients and in turn, are adopted by physicians to support their stance and authority. This study, through conversation analysis (CA), aims to explore a) what are pragmatic functions of justifications in patient-physician interaction? b) how and when do physicians unfold their justifications for treatment recommendations? c) how do physicians deal with different responses based on their epistemic and deontic domains?. A total of 32 video-recordings between postpartum women and physicians are collected and studied. Four pragmatic functions of justifications drawn upon by physicians are explored: justifications as face-saving, reassurance, risk discussion and clarification-seeking. Despite physicians\' attempts to justify their positions as less challenged by patients, this is not the entire picture as they demonstrate their desire to resolve patients\' concerns and coordinate their viewpoints to achieve the best practice that facilitates patients\' well-being.

Doctor-patient communication is pivotal for the delivery of effective health care, patient satisfaction and retention, and the development of patient loyalty to the provider. However, the interactional dynamics of loyalty in real-life communication are left underexplored. In this regard, this study aims to examine and analyze loyalty in naturally occurring routine chronic encounters. Based on audio-recordings collected in a state-run tier-three hospital in China, the study uses conversation analysis to examine the sequential placement of loyalty display and its interactional functions in different environments. The findings report two sequential environments where loyalty display emerges: the opening and closing phases. The findings also show that loyalty is mainly produced by the patient to display affiliation and commitment, indicate their preferred treatment options, and rekindle a disconnected relationship. This work contributes to a more nuanced understanding of loyalty display in service and institutional encounters.