Table 1
Linguistic Categories Used to Characterize Agency in Contraceptive Decision-Making Clinical Encounters.
| LINGUISTIC CATEGORY | POTENTIAL SUBJECTS | TYPE OF AGENCY | EXAMPLE |
|---|---|---|---|
| First-person singular “I” representing the patient | I | Patient as agent | I decided to get an IUD |
| Pronouns and nouns representing the app | it, the app | App as agent | The app suggested the IUD |
| Pronouns and nouns representing the doctor | she, he, the doctor | Physician as agent | The physician recommended the IUD |
| First-person plural “we” representing patient and others (either physician or other women) | We | Joint agency | We decided on the IUD |
Figure 1
A visual representation of subjects represented in interviews with patients following use of a contraceptive decision aid mobile app and an encounter for contraceptive decision-making. Arrows represent connections between subjects that may facilitate shared decisions and the starburst symbol represents physician actions that may hinder shared decisions.
Table 2
The Linguistic Lens on Agency: Recommendations for Providers.
| TYPE OF AGENCY | RECOMMENDATION | TARGET LANGUAGE |
|---|---|---|
| Patient individual agency | Ask open-ended questions and give patient time to express questions, needs, concerns, thoughts | Patient:
|
| External resource agency (e.g., apps, websites) | Identify and make available decision aids (including apps or other resources) that facilitate shared decision making | Provider:
Patient:
|
| Physician agency (supportive) | Ask questions to determine patient knowledge and needs; validate patient decisions; listen actively. | Provider:
|
| Physician agency (hindering) | Do not use directives or make decisions for the patient | Provider—to AVOID:
|
| Joint patient-provider agency | Listen for patient use of “we” but do not initiate it unless used by patient. | Patient:
|
| Distributed agency (across patient, provider and/or other resources) | Consider “three-talk” model to enhance autonomy. Cue and listen for patient values, preferences, and sociocultural context. Avoid directives. | Patient-Provider:
|