Studying interactional organisation in remote group clinics: qualitative study using linguistic ethnography

Since the COVID-19 pandemic there has been increased emphasis on remote provision of healthcare, including innovative models such as remote group clinics. These video or hybrid clinics combine clinical review, peer discussion and education, with (most) patients joining collectively via videoconferencing rather than in individual consultations. This study uses linguistic ethnography to examine how interaction is organised within remote group clinics and how different sociomaterial arrangements (including positioning of videoconferencing equipment) co-shape patient participation. Drawing on interactional analysis of video-recorded sessions (group clinics delivered fully online or in hybrid formats) across five English general practices, alongside ethnographic fieldnotes and qualitative interviews, we show that sociomaterial modalities create new possibilities for interaction (e.g. chat, emojis) while also reshaping participation dynamics. Patients and clinicians are required to navigate multiple communicative modalities simultaneously (e.g. video, audio, text; co-located and remote participants) and interpret participation cues accordingly (e.g. distinguishing disengagement from preference for privacy when cameras are off). Yet, healthcare staff and patients often rely on communication strategies suited to co-located interactions, which may not translate effectively to remote settings. Limited attention to the interactional and sociomaterial conditions that enable and constrain equitable co-presence can lead to suboptimal care and disrupted therapeutic relationships. We argue that careful planning and new communicative competencies are needed to support diverse participation needs and consultation goals. The paper concludes with methodological reflections for researchers conducting linguistic ethnography on remote healthcare provision. • This is the first linguistic ethnography of interaction in remote group clinics • We examine interaction as co-shaped through technology in sociomaterial contexts • Remote clinics offer unique affordances that shape (non-)participation • Hybrid clinics require interaction management to support co-located and remote groups • Further work is needed to ensure equity in interaction and participation dynamics