Table 4.

Major Transcription and Coding Challenges and Solutions for Part II (Verbal behaviors)

Transcription Challenges	Solutions	No. of videos with the issue
1. Personal identifiers are mentioned in the video	Personal identifiers (i.e., person’s real name, name of NH) usually expose who someone is or where he/she lives or works. These identifiers are replaced with the staff or resident participant’s ID or the study site ID that was created for the study.	20
2. Wrong transcription format	Each transcription is one full sentence with a period (.) or question mark (?), taking up one line in the coding screen in the Noldus software, and is assigned with one code. Sometimes transcription of multiple sentences was put in one line. In this case, the transcription needs to be split into separate lines following the rule above, in order to have a separate code for each full sentence.	18
3. Transcription starting point and ending point	Verbal utterances of the whole video from the beginning to the end of the video footage should be transcribed.	5
4. Could not hear clearly what the subject was saying	Transcribe as “unsure” literally.	4
Coding Challenges
1. Clarification between “giving choices” vs. “assessing comfort/condition”	For a question-related verbal utterance to be coded as “giving choices”, a specific item such as a bite of certain food, a sip of certain liquid, or other meal-related items (e.g., utensils, napkins) must be involved. Additionally, giving the resident multiple options to choose from is also coded as “giving choices”. When the staff repeated the resident’s request for clarification purpose, code as “assessing comfort/condition”.	37
2. Distinguishin g between codes for meal-related and non-meal-related verbal utterances	Both meal-related and non-meal-related verbal utterances should be coded following the coding scheme. It is possible that general conversation that is non-meal-related are mostly coded as “showing interest” (e.g., laughter, small-talk), when other codes are not appropriate. In many cases, conversations contain specific item or substance that make the verbal utterances qualified for other more descriptive codes. It is recommended to always attempt to find the most descriptive code for a verbal utterance.	31
3. Clarification between “showing approval/agreement “ vs. “showing interest”.	The verbal utterance is coded as “showing approval/agreement” if the subject is encouraging, praising, or agreeing with the person he/she is conversing with. Often there is a friendly general utterance that keeps the conversation going back and forth, but does not warrant a “showing approval/agreement” code, code as “showing interest” in this case.	27
4. Clarification between “asking for help/cooperation”	The first distinction is often made upon whether there is a question mark at the end of the transcription or not (whether the verbal utterance is a question or a statement). If the verbal vs. “assessing for comfort/condition” vs. “showing interest” utterance is a question, attempting to elicit an action, code as “asking for help/cooperation”, rather than “assessing for comfort/condition”. If the verbal utterance is a question, attempting to check on the subject’s status, code as “assessing for comfort/condition”. A few exceptions existed. If the verbal utterance is a question, but the subject is asking for help to understand something or to solicit more information related to something or someone, code as “showing interest”.	25
5. The use of “unsure” codes	The codes “unsure - positive” and “unsure - negative” are mostly used when it is unclear what the subject is saying, with few exceptions. Meaningful verbal utterances are usually assigned to more descriptive codes if possible, with the two “unsure” codes being the least descriptive options.	20
6. Clarification between “orientation/giving instructions” vs. “controlling voice” vs. “verbal refusal”	When giving instructions, if the staff uses a voice that clearly sounds harsh or negative, code as “controlling voice”, rather than “orientation/giving instructions” based on tone of voice. However, the staff or resident participant can disagree or speak with a strong and loud tone throughout a conversation without warranting the coding of “verbal refusal” or “controlling voice”.	18