Using video-based observation research methods in primary care health encounters to evaluate complex interactions

Onur Asan, Enid Montague


Objective The purpose of this paper is to describe the use of video-based observation research methods in primary care environment and highlight important methodological considerations and provide practical guidance for primary care and human factors researchers conducting video studies to understand patient–clinician interaction in primary care settings.

Methods We reviewed studies in the literature which used video methods in health care research, and we also used our own experience based on the video studies we conducted in primary care settings.

Results This paper highlighted the benefits of using video techniques, such as multi-channel recording and video coding, and compared “unmanned” video recording with the traditional observation method in primary care research. We proposed a list that can be followed step by step to conduct an effective video study in a primary care setting for a given problem. This paper also described obstacles, researchers should anticipate when using video recording methods in future studies.

Conclusion With the new technological improvements, video-based observation research is becoming a promising method in primary care and HFE research. Video recording has been under-utilised as a data collection tool because of confidentiality and privacy issues. However, it has many benefits as opposed to traditional observations, and recent studies using video recording methods have introduced new research areas and approaches.


observations; primary care research; video recording

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Kohn LT, Corrigan JM and Donaldson MS. To Err is Human: Building a Safer Health System. Atlanta, GA: National Academies Press, 2000.

Reid PP. Building a Better Delivery System: A New Engineering/Health Care Partnership. Atlanta, GA: National Academy Press, 2005.

Dul J, Bruder R, Buckle P, Carayon P, Falzon P, Marras WS et al. A strategy for human factors/ergonomics: developing the discipline and profession. Ergonomics 2012;55(4):377–395. PMid:22332611.

Carayon P. Handbook of Human Factors and Ergonomics in Health Care and Patient Safety, Boca Raton, FL: CRC, 2007.

a. Beasley JW, Hankey TH, Erickson R, Stange KC, Mundt M, Elliott M et al. How many problems do family physicians manage at each encounter? A WReN study. The Annals of Family Medicine 2004;2(5):405–10. PMCid:PMC1466713.

b. Carayon P. Emerging role of human factors and ergonomics in healthcare delivery–A new field of application and influence for the IEA. Work. A Journal of Prevention, Assessment and Rehabilitation 2012;41:5037–40.

Carthey J. The role of structured observational research in health care. Quality and Safety in Health Care 2003;12(suppl 2):ii13–6. PMid:14645890; PMCid:PMC1765776.

Wears RL. Beyond error. Academic Emergency Medicine 2000;7(11):1175–6. PMid:11073460.

Jeffcott SA and Mackenzie CF. Measuring team performance in healthcare: Review of research and implications for patient safety. Journal of Critical Care 2008;23(2):188–96. PMid:18538211.

Kumarapeli P and de Lusignan S. Using the computer in the clinical consultation; setting the stage, reviewing, recording, and taking actions: multi-channel video study. Journal of the American Medical Informatics Association 2013;20(e1):67–e75. PMid:23242763; PMCid:PMC3715353.

Seagull FJ and Guerlain S (Eds). Observation Measure of Team Process and Performance in Health Care, Human Factors and Ergonomics Society, 2003.

Schaeff JH. Videotape: New techniques of observation and analysis in anthropology. Principles of Visual Anthropology 2009:255.

Theadom A, De Lusignan S, Wilson E and Chan T. Using three-channel video to evaluate the impact of the use of the computer on the patient-centredness of the general practice consultation. Informatics in Primary Care 2003;11(3):149–56. PMid:14680538.

Sheeler I, Koczan P, Wallage W and de Lusignan S. Low-cost three-channel video for assessment of the clinical consultation. Informatics in Primary Care 2007;15(1):25–31. PMid:17612472.

Leong A, Koczan P, De Lusignan S and Sheeler I. A framework for comparing video methods used to assess the clinical consultation: a qualitative study. Informatics for Health and Social Care 2006;31(4):255–65. PMid:17135058.

Refsum C, Kumarapeli P, Gunaratne A, Dodds R, Hasan A and De Lusignan S. Measuring the impact of different brands of computer systems on the clinical consultation: a pilot study. Informatics in Primary Care 2008;16(2):119–27. PMid:18713528.

Pilnick A, Hindmarsh J and Gill V. Beyond ‘doctor and patient’: developments in the study of healthcare interactions. Sociology of Health & Illness 2009;31(6):787–802. PMid:19843267.

Frankel R. The laying on of hands: aspects of the organization of gaze, touch, and talk in a medical encounter. The social organization of doctor-patient communication. 1983:19–54.

Bensing JM, Verheul W and van Dulmen AM. Patient anxiety in the medical encounter: a study of verbal and nonverbal communication in general practice. Health Education 2008;108(5):373–83.

Zandbelt L, Smets E, Oort F, Godfried M and de Haes H. Patient participation in the medical specialist encounter: does physicians' patient-centred communication matter? Patient Education and Counseling 2007;65(3):396–406. PMid:17085006.

Bensing J, Tromp F, Van Dulmen S, van den Brink-Muinen A, Verheul W and Schellevis F. Shifts in doctor-patient communication between 1986 and 2002: a study of videotaped general practice consultations with hypertension patients. BMC Family Practice 2006;7(1):62. PMid:17064407; PMCid:PMC1630692.

Pearce C, Kumarpeli P and de Lusignan S. Getting seamless care right from the beginning-integrating computers into the human interaction. Studies in Health Technology and Informatics 2010;155:196. PMid:20543329.

Frankel R, Altschuler A, George S, Kinsman J, Jimison H, Robertson NR et al. Effects of exam-room computing on clinician-patient communication: a longitudinal qualitative study. Journal of General Internal Medicine 2005;20(8):677–82. PMid:16050873; PMCid:PMC1490186.

Pearce C, Dwan K, Arnold M and Phillips C. Analysing the doctor patient computer relationship: the use of video data. Informatics in Primary Care 2006;14(4):221–6. PMid:17504573.

Pflug B, Kumarapeli P, van Vlymen J, Chan T, Ammenwerth E and de Lusignan S (Eds). Measuring the impact of the computer on the consultation: An application to synchronise multi-channel video, automated monitoring, and rating scales, 2008.

De Lusignan S, Kumarapeli P, Chan T, Pflug B, Van Vlymen J, Jones B et al. The ALFA (Activity Log Files Aggregation) toolkit: a method for precise observation of the consultation. Journal of Medical Internet Research 2008;10(4). PMid:18812313; PMCid:PMC2629369.

Asan O and Montague E. Technology-mediated information sharing between patients and clinicians in primary care encounters. Behaviour & Information Technology 2013(Epub ahead of print):1–12.

Asan O and Montague E. Physician interactions with electronic health records in primary care. Health Systems 2012;1(2): 96–103. PMid:24009982; PMCid:PMC3760434.

Montague E and Asan O. Dynamic modeling of patient and physician eye gaze to understand the effects of electronic health records on doctor–patient communication and attention. International Journal of Medical Informatics 2014;83(3):225–34. PMid:24380671.

Kazmi Z. Effects of exam room EHR use on doctor-patient communication: a systematic literature review. Informatics in Primary Care 2014;21(1):30–9. PMid:24629654.

Saba GW, Wong ST, Schillinger D, Fernandez A, Somkin CP, Wilson CC et al. Shared decision making and the experience of partnership in primary care. The Annals of Family Medicine 2006;4(1):54–62. PMid:16449397; PMCid:PMC1466999.

Henry SG, Forman JH, and Fetters MD. ‘How do you know what Aunt Martha looks like?’A video elicitation study exploring tacit clues in doctor–patient interactions. Journal of Evaluation in Clinical Practice 2011;17(5):933–9. PMid:21210905.

Henry SG and Fetters MD. Video elicitation interviews: a qualitative research method for investigating physician-patient interactions. The Annals of Family Medicine 2012;10(2):118–25. PMid:22412003; PMCid:PMC3315127.

Iedema R, Forsyth R, Georgiou A, Braithwaite J and Westbrook J. Video research in health. Qualitative Research Journal 2006; 6(2):15–30.

Menikoff J. Where's the Law-Uncovering the Truth about IRBs and Censorship. Northwestern University Law Review 2007;101:791.

Guerlain S, Turrentine B, Adams R and Calland JF. Using video data for the analysis and training of medical personnel. Cognition, Technology and Work 2004;6(3):131–8.

Broyles L, Tate J and Happ M. Videorecording in clinical research: mapping the ethical terrain. Nursing Research 2008;57(1):59.

Weinger M, Gonzales D, Slagle J and Syeed M. Video capture of clinical care to enhance patient safety. Quality and Safety in Health Care 2004;13(2):136.

Wolf LE, Zandecki J and Lo B. The certificate of confidentiality application: a view from the NIH Institutes. IRB: Ethics and Human Research 2004;26(1):14–8. PMid:15281213.

Coleman T. Using video-recorded consultations for research in primary care: advantages and limitations. Family Practice 2000;17(5):422. PMid:11021903.

Mackenzie C and Xiao Y. Video techniques and data compared with observation in emergency trauma care. Quality and Safety in Health Care 2003;12(suppl 2):ii51. PMid:14645896; PMCid:PMC1765775.

Grimshaw AD. Sound-Image Data Records for Research on Social Interaction. Sociological Methods & Research. Special Issue on Sound-Image Records in social Interaction Research 1982; 11(2): 121–44.

Pearce C, Arnold M, Phillips, C and Dwan K. Methodological considerations of digital video observation: beyond conversation analysis. International Journal of Multiple Research Approaches 2010; 4(2): 90–9.

Pringle M and Stewart-Evans C. Does awareness of being video recorded affect doctors' consultation behaviour? The British Journal of General Practice 1990;40(340):455. PMid:2271278; PMCid:PMC1371415.

Brewer MB. Research design and issues of validity. In Handbook of Research Methods in Social and Personality Psychology. Cambridge: Cambridge University Press, 2000:3–16.

Creswell JW. Qualitative Inquiry & Research Design: Choosing Among Five Approaches. Thousand Oaks, CA: Sage 2007.

Montague E, Xu J, Chen P, Asan O, Barrett BP and Chewning B. Modeling eye gaze patterns in clinician–patient interaction with lag sequential analysis. human factors. The Journal of the Human Factors and Ergonomics Society 2011;53(5):502–16.

Ong L, De Haes J, Hoos A and Lammes F. Doctor-patient communication: a review of the literature. Social Science and Medicine 1995;40(7):903–18.

Blanchard CG, Labrecque MS, Ruckdeschel JC and Blanchard EB. Information and decision-making preferences of hospitalized adult cancer patients. Social Science and Medicine 1988;27(11): 1139–45.

Harrison BL (Ed) Video annotation and multimedia interfaces: from theory to practice. Proceedings of the Human Factors and Ergonomics Society Annual Meeting. Thousand Oaks, CA: Sage, 1991.

De Lusignan S, Kumarapeli P, Debar S, Kushniruk A and Pearce C. Using an open source observational tool to measure the influence of the doctor’s consulting style and the computer system on the outcomes of the clinical consultation. Studies in Health Technology and Informatics 2009;150:1017–21. PMid:19745467.

Cegala DJ, McGee DS and McNeilis KS. Components of patients' and doctors' perceptions of communication competence during a primary care medical interview. Health Communication 1996;8(1):1–27.

Cromarty I. What do patients think about during their consultations? A qualitative study. The British Journal of General Practice 1996;46(410):525. PMid:8917871; PMCid:PMC1239747.

Pearce C, Dwan K, Arnold M, Phillips C and Trumble S. Doctor, patient and computer--a framework for the new consultation. International Journal of Medical Informatics 2009;78(1):32–8. PMid:18752989.

Hermansson GL, Webster AC and McFarland K. Counselor deliberate postural lean and communication of facilitative conditions. Journal of Counseling Psychology 1988;35(2):149–53.

Roter DL. Patient participation in the patient-provider interaction: the effects of patient question asking on the quality of interaction, satisfaction and compliance. Health Education and Behavior 1977;5(4):281.

Connor M, Fletcher I and Salmon P. The analysis of verbal interaction sequences in dyadic clinical communication: A review of methods. Patient Education and Counseling 2009;75(2):169–77. PMid:19097842.

Hall JA, Irish JT, Roter DL, Ehrlich CM and Miller LH. Gender in medical encounters: An analysis of physician and patient communication in a primary care setting. Health Psychology 1994;13(5):384. PMid:7805632.

Burchard KW and Rowland-Morin PA. A new method of assessing the interpersonal skills of surgeons. Academic Medicine 1990;65(4):274–6. PMid:2334511.

Kraan H, Crijnen A, Zuidweg J, Van der Vleuten C and Imbos T. Evaluating Undergraduate Training –A Checklist for Medical Interviewing Skills. In: Communicating With Medical Patients. Newbury Park, CA: Sage, 1989, pp. 167–77.

Duggan P and Parrott L. Physicians' nonverbal rapport building and patients' talk about the subjective component of illness. Human Communication Research 2001;27(2):299–311.

Als AB. The desk-top computer as a magic box: patterns of behaviour connected with the desk-top computer; GPs' and patients' perceptions. Family Practice 1997;14(1):17. PMid:9061339.

Collins L, Schrimmer A, Diamond J and Burke J. Evaluating verbal and non-verbal communication skills, in an ethnogeriatric OSCE. Patient Education and Counseling 2011;83(2):158–62. PMid:20561763.

D'Agostino TA and Bylund CL. The nonverbal accommodation analysis system (NAAS): initial application and evaluation. Patient Education and Counseling. 2011;85(1):33–9. PMid:20851559.

Newman W, Button G and Cairns P. Pauses in doctor–patient conversation during computer use: The design significance of their durations and accompanying topic changes. International Journal of Human–Computer Studies 2010;68(6):398–409.

Pearce C, Trumble S, Arnold M, Dwan K and Phillips C. Computers in the new consultation: Within the first minute. Family Practice 2008;25(3):202–8. PMid:18504254.

Mast MS, Hall JA, Klöckner C and Choi E. Physician gender affects how physician nonverbal behavior is related to patient satisfaction. Medical Care 2008;46(12):1212–8. PMid:19300310.

Cooper JB, Barron D, Blum R, Davison JK, Feinstein D, Halasz J et al. Video teleconferencing with realistic simulation for medical education* 1. Journal of Clinical Anesthesia 2000;12(3):256–61.

Roter D, Frankel R, Hall J and Sluyter D. The expression of emotion through nonverbal behavior in medical visits. Journal of General Internal Medicine 2006;21(S1):S28–34. PMid:16405706; PMCid:PMC1484830.

Carayon P. Human factors of complex sociotechnical systems. Applied Ergonomics 2006;37(4):525–35. PMid:16756937.

Wilson JR. Fundamentals of ergonomics in theory and practice. Applied ergonomics 2000;31(6):557–67.

Lawler EK, Hedge A and Pavlovic-Veselinovic S. Cognitive ergonomics, socio-technical systems, and the impact of healthcare information technologies. International Journal of Industrial Ergonomics. 2011;41(4):336–44.

Berg M. Implementing information systems in health care organizations: myths and challenges. International Journal of Medical Informatics. 2001;64(2–3):143–56.

Ludwick D and Doucette J. Adopting electronic medical records in primary care: lessons learned from health information systems implementation experience in seven countries. International Journal of Medical Informatics 2009;78(1): 22–31. PMid:18644745.



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