{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T11:09:06Z","timestamp":1788952146993,"version":"build-2803163510"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>WeChat group consultations extend pediatric advice into everyday messaging, but their interactional organization is not well described.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify recurring interactional stages, and clarification practices in asynchronous caregiver-physician exchanges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u202f=\u202f9 vs. 3; M\u202f=\u202f17.91 vs. 3.50; IQR\u202f=\u202f14.75 vs. 3) and clinical data collection (median\u202f=\u202f10 vs. 7; M\u202f=\u202f14.22 vs. 9.29; IQR\u202f=\u202f11 vs. 7). Message-length distributions became more comparable during diagnostic advice (median\u202f=\u202f10 for both; IQR\u202f=\u202f12 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1942110","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:12:08Z","timestamp":1788948728000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Interactional organization of WeChat-based pediatric consultations in China: a mixed-methods study of caregiver-physician exchanges"],"prefix":"10.3389","volume":"14","author":[{"given":"Jijia","family":"Kuang","sequence":"first","affiliation":[{"name":"School of Foreign Languages, Chengdu University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Sun","sequence":"additional","affiliation":[{"name":"School of Humanities and Management Science, Southwest Medical University","place":["Luzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e85456","DOI":"10.2196\/85456","article-title":"Communication strategies to promote patient engagement in telemedicine: systematic review","volume":"28","author":"Hu","year":"2026","journal-title":"J Med Internet Res"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2020\/8830200","article-title":"The recent progress and applications of digital technologies in healthcare: a review","volume":"2020","author":"Senbekov","year":"2020","journal-title":"Int J Telemed 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Univ"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"ooae047","DOI":"10.1093\/jamiaopen\/ooae047","article-title":"Transforming and facilitating health care delivery through social networking platforms: evidences and implications from WeChat","volume":"7","author":"Ye","year":"2024","journal-title":"JAMIA open"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1177\/009365096023001001","article-title":"Computer-mediated communication: impersonal, interpersonal, and hyperpersonal interaction","volume":"23","author":"Walther","year":"1996","journal-title":"Commun Res"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/j.ijmedinf.2008.07.002","article-title":"Doctor, patient and computer\u2014a framework for the new consultation","volume":"78","author":"Pearce","year":"2008","journal-title":"Int J Med Inform"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e49040","DOI":"10.2196\/49040","article-title":"Doctors\u2019 personal preference and adoption of Mobile apps to communicate with patients in China: qualitative study","volume":"12","author":"Chen","year":"2024","journal-title":"JMIR Mhealth Uhealth"},{"key":"ref11","volume-title":"Talk at Work: Interaction in Institutional Settings","author":"Drew","year":"1992"},{"key":"ref12","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9780511607172","volume-title":"Communication in Medical Care: Interaction between Primary Care Physicians and Patients","author":"Heritage","year":"2006"},{"key":"ref13","volume-title":"Doctors Talking to Patients: A Study of the Verbal Behaviour of General Practitioners Consulting in Their Surgeries","author":"Byrne","year":"1976"},{"key":"ref14","first-page":"157","volume-title":"Talk and Social Structure","author":"Fisher","year":"1991"},{"key":"ref15","volume-title":"The Politics of Medical Encounters","author":"Waitzkin","year":"1991"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1016\/S0277-9536(01)00029-6","article-title":"Constructing an account by contrast in counselling for childhood genetic testing","volume":"54","author":"Sarangi","year":"2002","journal-title":"Soc Sci Med"},{"key":"ref17","volume-title":"Handbook of Health Communication","author":"Street","year":"2003"},{"key":"ref18","doi-asserted-by":"crossref","DOI":"10.5040\/9798400641794","volume-title":"Doctors Talking with Patients\/Patients Talking with Doctors: Improving Communication in Medical Visits","author":"Roter","year":"2006"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1012","DOI":"10.1080\/10410236.2023.2201733","article-title":"Comparisons of communication in medical face-to-face and teleconsultations: a systematic review and narrative synthesis","volume":"39","author":"Ford","year":"2024","journal-title":"Health Commun"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1166","DOI":"10.1136\/bmj.328.7449.1166","article-title":"Health related virtual communities and electronic support groups: systematic review of the effects of online peer-to-peer interactions","volume":"328","author":"Eysenbach","year":"2004","journal-title":"BMJ"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1867","DOI":"10.1016\/j.chb.2008.02.004","article-title":"Fostering empowerment in online support groups","volume":"24","author":"Barak","year":"2008","journal-title":"Comput Hum Behav"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.ijmedinf.2005.07.032","article-title":"Influences, usage, and outcomes of internet health information searching","volume":"75","author":"Rice","year":"2006","journal-title":"Int J Med Inform"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1177\/1461444809342738","article-title":"The politics of 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A new method for Visualising doctor-patient communication","volume":"104","author":"Manalastas","year":"2021","journal-title":"Patient Educ Couns"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1016\/j.socscimed.2009.01.011","article-title":"The opening phase of telemedicine consultations: an analysis of interaction","volume":"68","author":"Pappas","year":"2009","journal-title":"Soc Sci Med"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1111\/j.1467-9566.2008.01109.x","article-title":"Beyond \u201cdoctor and patient\u201d: developments in the study of healthcare interactions","volume":"31","author":"Pilnick","year":"2009","journal-title":"Sociol Health Illn"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e60352","DOI":"10.2196\/60352","article-title":"Electronic communication between children\u2019s caregivers and health care teams: scoping review on parental caregiver\u2019s perceptions and experience","volume":"7","author":"Gamper","year":"2024","journal-title":"JMIR Pediatrics Parenting"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1111\/j.1749-818X.2012.00233.x","article-title":"Epistemics in conversation","volume":"6","author":"Heritage","year":"2012","journal-title":"Lang Linguist Compass"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"116964","DOI":"10.1016\/j.socscimed.2024.116964","article-title":"\u201cDoing being a good parent\u201d in the pediatric clinic: parents\u2019 knowledge displays in advice requests on infants\u2019 everyday care","volume":"351","author":"Ranzani","year":"2024","journal-title":"Soc Sci Med"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"108664","DOI":"10.1016\/j.pec.2025.108664","article-title":"The electronic health record as an interactional and epistemic resource: insights from pediatric well-child visits","volume":"134","author":"Ranzani","year":"2025","journal-title":"Patient Educ Couns"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1177\/14614456231184087","article-title":"Polyphony in the pediatric clinic: parents reporting teachers\u2019 talk as a resource for building deontic and epistemic (dis)alliances among caregivers","volume":"27","author":"Caronia","year":"2025","journal-title":"Discourse Stud"},{"key":"ref39","volume-title":"Why Do You Ask?: The Function of Questions in Institutional Discourse","author":"Heritage","year":"2009"},{"key":"ref40","first-page":"257","volume-title":"Questioning and Answering Practices Across Contexts and Cultures. 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