Health Sciences

School of Public Health

Higher Degree Research Students/Alumni Profiles

Dr Belinda Garth

PhD Thesis, completed in 2005

Emergent Triadic Partnering: A Theory of the Doctor-Parent-Child Partnership in Managing a Child's Disability

An increasing number of Australian and international studies have advocated physician-patient partnerships (as opposed to more paternalistic styles of care) as a way of empowering patients and leading to better patient health outcomes. When a child is the patient, research has focused on the dyadic nature of the physician-parent partnership. There is currently not enough empirical research that investigates the child's role in a potential triadic physician-parent-child partnership (particularly when the child has a disability). Hence, this study used grounded theory methodology to develop a substantive theory on the processes involved in establishing an effective physician-parent-child partnership. A paediatric disability setting was chosen to investigate this given the triadic nature of the physician-parent-child relationship.In-depth interviews were conducted until theoretical saturation was reached, and this occurred after 33 interviews (with 14 parents, 10 children with cerebral palsy, and 9 paediatricians). The data from these interviews were subject to constant comparisons and coded substantively and theoretically. The theory of emergent triadic partnering was generated from the data which postulates a two-part process that includes strategies used by families and paediatricians to continually resolve their main concerns (which were identified as managing the child's disability, dealing with fragmented care, and accessing the required resources). The first part involves the two-way dialogue which focuses on interaction between the parent and the paediatrician and explains how parents draw on the paediatrician for resources and support, and in turn, the paediatrician responds to and monitors the child's needs. The second part of the process is doing partnership which involves four main elements: working together; continuity of care; transparency; and positioning the child. The fewer elements present, the less likely participants were to perceive a partnership. This study is the first to identify important elements of a triadic partnership when a child is the patient.

Belinda Garth PhD, obtained a BHSc (First Class Hons) at La Trobe University, and worked with children who have disabilities in various capacities (as a respite carer, as a volunteer at recreational programs, and as a program assistant in a specialist school). She also worked as a sessional lecturer and tutor in undergraduate research methods while undertaking her PhD. Belinda's doctoral research centred around the development of a grounded theory on the management of disability in the paediatric-disability setting. This conceptual theory explains how families and paediatricians work together to manage the child's disability, and provides indications as to the usefulness of such increasingly-popular concepts as 'partnership' to describe the doctor-family relationship. Belinda interviewed children with cerebral palsy, their parents, and paediatricians, and in January 2004 she presented a poster-paper on emerging categories at the Advances in Qualitative Methods Conference in Edmonton, Canada. Belinda obtained her PhD in 2005.