Competing Discourses of Professional-patient Relationships in Type 2 Diabetes Management

The ecological model of communication in medical encounters: A scoping review

OBJECTIVE

The ecological model of communication in medical encounters (EMCME) could provide a framework for examining issues related to health equity in healthcare interactions. This study seeks to understand how scholarship has engaged with the model and the extent of its use in health equity work.

METHODS

A scoping review of the EMCME was conducted using three major databases: Scopus, Web of Science, and Google Scholar in September 2023. Databases were searched for works citing the article explicating the model.

RESULTS

The search returned 336 unique documents. After inclusion and exclusion criteria were applied, 85 documents remained and were analyzed. Many pieces described the model or used the model to frame their work; far fewer pieces used the model to test empirical relationships. Most works, however, focused on a single context: interpersonal. Twenty-five works directly used the model in relation to health equity.

CONCLUSION

There are several contexts of the model that remain underexplored. More attention to these contexts may not only help to better the clinical encounter but advance health equity.

PRACTICE IMPLICATIONS

Increased use of the full EMCME in all facets - research, practice, and teaching - could provide a framework for framing and organizing work around health equity.

Educational Interventions on Diabetic Foot Self-Care: A Study Protocol for a Pragmatic Randomized Controlled Trial

Diabetic foot is one of the most serious complications of diabetes and foot ulcer recurrence has been associated with poor foot care. Educational programs may work as a vehicle for promoting knowledge and adequate foot self-care behaviors, reducing potential ulcerative complications in the diabetic foot, and promoting a better quality of life. This study protocol will analyze the impact of two different educational strategies - an instructive video (Experimental Group 1) compared to a foot care leaflet with real-time guided reading (Experimental Group 2) and standard care (Control Group) - on adherence and knowledge about diabetic foot care and patients' perception of their foot health. This study is a Pragmatic Randomized Controlled Trial of a non-pharmacological treatment. Participants need to have a diabetic foot diagnosis and attend a Diabetic Foot Multidisciplinary Consultation at two hospitals from the North of Portugal. Participants will be assessed at the first appointment of the diabetic foot consultation (T0), two weeks after (T1), and three months later, at follow-up (T2). Primary outcomes will be adherence and knowledge about diabetic foot care and general foot health. Secondary outcomes will be illness representations regarding diabetic foot. The results of this study will inform educational interventions to decrease diabetic foot ulcers, amputation rates, and the costs associated with both, contributing to foot care adherence and improve patient's quality of life.

Individualized care for older adults with diabetes and its relationship with communication, psychosocial self-efficacy, resources and support for self-management and socio-demographics

AIM

To examine the relationship between patient-provider communication, psychosocial patient self-efficacy, resources and support for self-management and socio-demographics within individualized care of older adults with diabetes.

DESIGN

A quantitative study with a cross-sectional survey design.

METHODS

Data were collected from September 2019 to January 2021 using: Individualized Care Scale, The Communication Assessment Tool, The Diabetes Empowerment Scale and The Resources and Support for Self-Management Scale. Patients with either Type 1 or Type 2 diabetes mellitus that were 65 years old and over (N = 145) participated in the study.

RESULTS

The most positive aspects of patient-provider communication were respect and creating a comfortable environment for the patient. A significant relationship was observed between patients' perceptions and support of individualized care and diabetes-related measures. Effective communication was the main factor associated with support for individualizing care, and together with education level, empowerment and access to resources, explained 23% of the variance.

The Discursive Struggles of the Client–Worker Relationship in the Social Services

This study examines how disability service workers identify the discourses of the client-worker relationships. We studied the clientworker relationship from the perspective of the relational dialectics theory with a focus on relational contradictions and the meanings created within discursive struggles. We analyzed the interview data from 22 social workers using contrapuntal analysis. According to the social workers’ perceptions, two discursive struggles exist in client-worker relationships: i) the struggle of integration, consisting of the contradiction of the ideal and the real and the contradiction of closeness and reservedness and ii) the struggle of certainty, consisting of the contradiction of predictability and novelty and the contradiction of openness and closedness. These struggles and contradictions arranges on the societal and relational frames to fully depict the nature of social work. Overall, our analysis shows that the client-worker relationship is both bound to the norms of a professional and a close interpersonal relationship, making its study particularly interesting.