Title: Applying the Verona Coding Definitions of Emotional Sequences (vr-codes) in the Dental Context Involving Patients with Complex Communication Needs: an Exploratory Study Applying the Verona Coding Definitions of Emotional Sequences (vr-codes) in the Dental Context Involving Patients with Compl

Applying the Verona Coding Definitions of Emotional Sequences (VR-CoDES) in the dental context involving patients with complex communication needs: an exploratory study, Patient Education and Counseling This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Abstract Objective: The VR-CoDES has been previously applied in the dental context. However, we know little about how dental patients with intellectual disabilities (ID) and complex communication needs express their emotional distress during dental visits. This is the first study explored the applicability of the VR-CoDES to a dental context involving patients with ID. Methods: Fourteen dental consultations were video recorded and coded using the VR-CoDES, assisted with the additional guidelines for the VR-CoDES in a dental context. Both inter-and intra-coder reliabilities were checked on the seven consultations where cues were observed. Results: Sixteen cues (eight non-verbal) were identified within seven of the 14 consultations. Twenty responses were observed (12 reducing space) with four multiple responses. Cohen's Kappa were 0.76 (inter-coder) and 0.88 (intra-coder). Conclusion: With the additional guidelines, cues and responses were reliably identified. Cue expression was exhibited by non-verbal expression of emotion with people with ID in the literature. Further guidance is needed to improve the coding accuracy on multiple providers' responses and to investigate potential impacts of conflicting responses on patients. Practice implications: The findings provided a useful initial step toward an ongoing exploration of how healthcare providers identify and manage emotional distress of patients with ID.