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Nally LM, Blanchette JE. Integrated Strategies to Support Diabetes Technology in Pregnancy. Obstet Gynecol 2024:00006250-990000000-01139. [PMID: 39208437 DOI: 10.1097/aog.0000000000005710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 07/25/2024] [Indexed: 09/04/2024]
Abstract
Managing diabetes in pregnancy can be overwhelming, with numerous dramatic physiologic changes taking place that require constant diligence and attention. Advances in diabetes technology have improved glycemic outcomes, well-being, and quality of life for people with type 1 diabetes of all ages. However, regulatory approval and access to diabetes technology in pregnancy has lagged behind these advancements, leaving many pregnant individuals without tools that could dramatically improve diabetes care before, during, and after gestation. Here, we review the benefits of continuous glucose monitors and automated insulin-delivery systems in pregnancy and highlight specific scientific and structural supports to help implement diabetes technology safely, effectively, and equitably in pregnancy.
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Affiliation(s)
- Laura M Nally
- Yale University School of Medicine, New Haven, Connecticut; and the School of Medicine, Case Western Reserve University, Cleveland, Ohio
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2
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Litterbach E, Holmes-Truscott E, Gray S, Halliday J, Scibilia R, Skinner T, Speight J. "I feel like I'm being talked to like an equal": Diabetes language matters to adults with diabetes, a mixed-methods study. Diabet Med 2024:e15424. [PMID: 39150048 DOI: 10.1111/dme.15424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/28/2024] [Accepted: 07/29/2024] [Indexed: 08/17/2024]
Abstract
AIM To explore reactions to and preferences for words/phrases used in communications about diabetes among adults with diabetes and parents of children with diabetes. METHODS Eligible adults (aged 18+ years) living with diabetes, or parenting a child with diabetes, were recruited via social media to complete an online cross-sectional, mixed-methods survey. Study-specific items were used to examine 22 commonly used diabetes words/phrases in terms of participants' cognitive perceptions ('helpful', 'respectful', 'accurate', 'harmful', 'judgmental' and 'inaccurate') and emotional reactions ('optimistic', 'motivated', 'supported', 'understood', 'offended', 'blamed', 'distressed' and 'angry'). Open-ended questions invited further feedback on (non-)preferred language and its impact(s). Data were analysed using descriptive statistics and inductive thematic analysis. RESULTS Participants (N = 865) included adults with diabetes (type 1: n = 519; type 2: n = 180, other types: n = 48) and parents of children with diabetes (n = 118). Words/phrases most commonly associated with negative perceptions/emotional responses were 'non-compliant' (60% judgmental; 47% felt blamed) and '…good/bad' (54% judgmental; 43% blamed). Positive perceptions were reported for 'managing diabetes' (73% helpful, 47% felt understood), 'person with diabetes' (72% respectful; 49% understood), '…within/outside target range' (60% helpful, 44% understood), and 'condition' (58% respectful; 43% understood). Participants' qualitative responses illuminated perceptions, experiences and impacts across five themes: (1) accuracy and simplicity; (2) identity; (3) blame, judgement and stigma; (4) respect and trust and; (5) support, hope and feeling understood. Themes were consistent across diabetes types. CONCLUSIONS These findings provide novel evidence into (non-)preferred, and potential (negative and positive) impacts of, commonly used diabetes words/phrases, supporting the international #LanguageMatters movement.
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Affiliation(s)
- Eloise Litterbach
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Carlton, Victoria, Australia
- Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Carlton, Victoria, Australia
- Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Australian Centre for Accelerating Diabetes Innovations, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Shikha Gray
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Carlton, Victoria, Australia
| | - Jennifer Halliday
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Carlton, Victoria, Australia
- Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | | | - Timothy Skinner
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Carlton, Victoria, Australia
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Carlton, Victoria, Australia
- Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
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3
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Hughes AS. Diabetes, Insulin & Politics: 28 Years of Stigma, Innovation, and Ableism. HEALTH COMMUNICATION 2024:1-4. [PMID: 38982620 DOI: 10.1080/10410236.2024.2375145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Nearly 3 decades after my type 1 diabetes diagnosis, I wrote this essay to document my journey. Through childhood and teen years where I experienced emotional abuse in clinic and felt the deepest of fears. Then in college, when I realized my voice mattered and I could elevate the voices of others with diabetes. During grad school, I began meeting with legislators and understanding how health policy works. I am now a health psychologist focused on improving health equity for people with diabetes and disabilities. Importantly, my research findings highlight how the U.S. medical system is not equipped to support people with diabetes. In this essay I also highlight key people in the diabetes and disability community who have served as lighthouses on my journey and continue to shine light across my path.
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Affiliation(s)
- Allyson S Hughes
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine
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4
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George S, Kim MY, Naik AR, Lewis BE. Examining Inclusive Language in Clinical Narratives in Medical Biochemistry Textbooks to Model Equitable Patient-Centered Care in Preclinical Undergraduate Medical Education. MEDICAL SCIENCE EDUCATOR 2024; 34:581-587. [PMID: 38887417 PMCID: PMC11180134 DOI: 10.1007/s40670-024-02015-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 06/20/2024]
Abstract
Purpose When healthcare professionals use biased or stigmatizing language to describe people or conditions, it can impact the quality of care or erode the patient-physician relationship. It is not clear where healthcare professionals acquire biased and stigmatizing language in practice. This study focuses on examining language in educational materials used in training of medical students. Specifically, medical biochemistry textbooks were examined as they are often a first exposure to clinical narratives and communication standards. The aim of this project is to investigate whether medical biochemistry textbooks, widely recommended in preclinical UME, model inclusive language communication in clinical narratives. Methods To determine if educational materials follow inclusive writing guidelines, we conducted a modified document analysis on a sample of medical biochemistry textbooks when clinical scenarios were described. Three independent researchers separately reviewed the textbooks, coded the language using NVivo, and generated themes. Results Our results show that medical biochemistry textbooks contain language which is not in alignment with the best practices for inclusive language. Our analysis mapped codes to two primary themes of language misalignment. The first theme, "clinical language" (n = 92), included the following codes: difficult patient, general negative descriptive language, patient as failure, and questioning patient credibility. The second primary theme, "identity-first labeling" (n = 251), included 21 codes. Conclusion This study provides early evidence that the language used in medical biochemistry textbooks to describe people and conditions is not in alignment with inclusive language recommendations. This can reinforce the way future healthcare professionals speak to and about their patients.
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Affiliation(s)
- Sarah George
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI 48309 USA
| | - Min Young Kim
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI 48309 USA
| | - Akshata R. Naik
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI 48309 USA
| | - Brianne E. Lewis
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI 48309 USA
- Department of Foundational Sciences, Central Michigan University College of Medicine, Mount Pleasant, MI 48859 USA
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5
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Parisi CE, Varas-Rodriguez E, Algarin AB, Richards V, Li W, Cruz Carrillo L, Ibañez GE. A Content Analysis of HIV-Related Stigmatizing Language in the Scientific Literature, From 2010-2020: Findings and Recommendations for Editorial Policy. HEALTH COMMUNICATION 2024; 39:1209-1217. [PMID: 37161354 PMCID: PMC10636239 DOI: 10.1080/10410236.2023.2207289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Despite negative effects of HIV-related stigma on people with HIV, some scientific literature continues to use stigmatizing terms. Our study aimed to explore the use of HIV-related stigmatizing language in the scientific literature between 2010 and 2020 based on 2015 UNAIDS terminology guidelines. We searched for articles with the stigmatizing term "HIV/AIDS-infected" or any variations that were peer-reviewed, published between 2010 and 2020, and in English or with an English translation. Our search yielded 26,476 articles that used the stigmatizing term of interest. Frequencies on the variables of interest (journal, year, and country) were run. The use of these terms increased from 2010 to 2017 and decreased from 2018 to 2020. Most journals using the terms were HIV/AIDS specific or on infectious diseases, but the journal with the greatest frequency of use was on general science and medicine. Thirty-six percent of the articles emanated from the United States. To reduce the use of stigmatizing language in the HIV literature, action should be taken by authors, reviewers, editors,educators, and publishers should create formal policies promoting use of non-stigmatizing language.
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Affiliation(s)
- Christina E Parisi
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida
| | - Emil Varas-Rodriguez
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University
| | - Angel B Algarin
- Edson College of Nursing and Health Innovation, Arizona State University
| | - Veronica Richards
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University
| | - Wei Li
- Department of Psychiatry, Yale School of Medicine, Yale University
| | - Liset Cruz Carrillo
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University
| | - Gladys E Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University
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6
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Dickinson JK, Posesorski RE, Djiovanis SG, Brady VJ. Impact of Negative or Stigmatizing Messages on Diabetes Outcomes: An Integrative Review. Sci Diabetes Self Manag Care 2024; 50:167-178. [PMID: 38454649 DOI: 10.1177/26350106241232644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
PURPOSE The purpose was to determine if negative or stigmatizing language and messaging have an impact on diabetes distress, outcomes, or care behaviors in people with diabetes. Since 2012, when the first language position statement was published, the way health care professionals talk to people with diabetes has been an ongoing topic of discussion. However, there have been no recent literature reviews evaluating the impact of problem language on outcomes among people with type 1 and type 2 diabetes. METHODS An integrative review was conducted using 4 electronic databases: CINAHL, Embase, Web of Science, and Medline (Ovid). Studies reporting on diabetes, language, stigma, diabetes distress, glycemic outcomes, and self-care behaviors were included. RESULTS The review included 9 studies, all of which were of high quality. The impact of negative or stigmatizing language on self-care behaviors was the most commonly addressed outcome. Whereas some studies revealed no change, others reported a decrease in self-care behaviors by people with diabetes who had negative perceptions of provider messages. Actual or perceived use of negative or stigmatizing language is linked to higher A1C. Four studies reported an association between messages and diabetes distress. CONCLUSIONS Negative/stigmatizing language has both an immediate and long-term effect on people with diabetes. The inconsistent approaches to studying language in diabetes makes it challenging to compare outcomes and identify themes. Future research is needed to identify effective interventions to change the messages in diabetes.
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Alvarez A, Monteiro S, Chen R, Cohen K, Fofana M, Powell C, Tago A, Martin L. Re-THINK: Use of narratives to explore social justice in clinical practice and education. J Eval Clin Pract 2024; 30:349-354. [PMID: 38062679 DOI: 10.1111/jep.13946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 04/18/2024]
Affiliation(s)
- Al'ai Alvarez
- Department of Emergency Medicine, Stanford University, Stanford, California, USA
| | - Sandra Monteiro
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ruth Chen
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Karen Cohen
- LCSW-R, Licensed Clinical Social Worker in New York and Florida, New York, New York, USA
| | - Mariame Fofana
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Carmin Powell
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Achieng Tago
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Leslie Martin
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Werner P, Ulitsa N, Alpinar-Sencan Z, Shefet D, Schicktanz S. Identifying Stigmatizing Language Used by Israelis and Germans With a Mild Neurocognitive Disorder, Their Relatives, and Caregivers of People With Alzheimer's Disease. Alzheimer Dis Assoc Disord 2024; 38:42-50. [PMID: 38194484 DOI: 10.1097/wad.0000000000000596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 12/11/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES The purpose of the study was to examine and compare the dementia-related discourse and language used by people with mild neurocognitive disorder (MND), their family members, and family caregivers of people with Alzheimer's disease in Israel and Germany. DESIGN This secondary qualitative analysis included focus groups and semistructured interviews. Thematic analysis was used to reveal the main discourses and stigmatic language used regarding dementia and people with dementia. SETTING Israeli and German stakeholders. PARTICIPANTS Forty-four Israeli and 44 German participants: 28 people with MND, 20 family members of people with MND, and 40 family caregivers of people with Alzheimer's disease. RESULTS Two main discourses were identified: the tragedy and the biomedical discourse. The tragedy discourse included several subthemes: "Dementia as the worst-case scenario," "Nothing can be done about dementia," and "People with dementia are not human." The biomedical discourse stressed pathologic aspects of the condition. Similarities and differences were found between Israeli and German participants. CONCLUSIONS The study indicates that, despite culture and language differences, the use of stigmatic discourse and stigmatizing language is common among people with close exposure to dementia in Israel and Germany. Efforts should be increased to develop a person-centered and dementia-friendly language.
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Affiliation(s)
- Perla Werner
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa
| | - Natalie Ulitsa
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa
| | - Zümrüt Alpinar-Sencan
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Daphna Shefet
- The Division of Geriatric Psychiatry, Shalvata Mental Health Center, Hod Hasharon
- Faculty of Medicine, Tel Aviv University
| | - Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany
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Kirk BO, Khan R, Davidov D, Sambamoorthi U, Misra R. Exploring facilitators and barriers to patient-provider communication regarding diabetes self-management. PEC INNOVATION 2023; 3:100188. [PMID: 37457669 PMCID: PMC10339241 DOI: 10.1016/j.pecinn.2023.100188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
Objective Long-term type 2 diabetes management requires open communication between a patient and their provider for self-care adherence. This study explored facilitators and barriers to diabetes-specific communication in West Virginia, a medically underserved state with the highest prevalence of diabetes (16.2%) in the U.S. Methods A secondary qualitative analysis was conducted using data from semi-structured interviews (n = 34) and 4 focus groups (n = 23) with participants of a diabetes education program. Transcripts were analyzed using thematic analysis. Results Three facilitators to patient-provider communication emerged: "Patient-Provider Partnership", "Provider Accessibility", and "Empowerment Through Education". Partnership with providers, especially those who were accessible outside of scheduled appointments, and empowerment obtained through diabetes education facilitated diabetes-specific patient-provider communication. However, barriers included "Providers' Focus on 'Numbers' Rather than Patient Concerns", "Patient Lack of Preparation for Appointments", and "Providers 'Talking Down to' Patients". Conclusion The findings highlight patient- and provider-related factors that impact diabetes-specific communication. Innovation Previous interventions have trained providers in communication skills. Despite some success, challenges in implementation remain considering providers' limited time and overwhelming demands. This study suggests that diabetes education programs incorporating communication and self-advocacy skills could be a promising alternative as they can empower patients to communicate their diabetes-specific needs/preferences with providers.
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Affiliation(s)
- Brenna O. Kirk
- Department of Social and Behavioral Sciences, West Virginia University School of Public Health, 64 Medical Center Dr., Morgantown, WV 26506-9190, United States of America
| | - Raihan Khan
- Department of Health Sciences, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA 22807, United States of America
| | - Danielle Davidov
- Department of Social and Behavioral Sciences, West Virginia University School of Public Health, 64 Medical Center Dr., Morgantown, WV 26506-9190, United States of America
| | - Usha Sambamoorthi
- College of Pharmacy, University of North Texas Health Science System, Fort Worth, TX, United States of America
| | - Ranjita Misra
- Department of Social and Behavioral Sciences, West Virginia University School of Public Health, 64 Medical Center Dr., Morgantown, WV 26506-9190, United States of America
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10
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Dickinson JK, Guzman SJ, Wooldridge JS. The Emotional Impact of Negative Language in People With Diabetes: A Descriptive Study Using a Semantic Differential Scale. Sci Diabetes Self Manag Care 2023; 49:193-205. [PMID: 37052352 DOI: 10.1177/26350106231168326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
PURPOSE Explore the emotional experience of people with diabetes as they encounter words and phrases that have been previously identified as problematic and evaluate potential differences in their emotional impact based on type of diabetes and demographic characteristics. METHODS A cross-sectional descriptive study employing an online survey of 107 adults with type 1 diabetes and 110 adults with type 2 diabetes. A semantic differential scale was used to examine feeling states associated with negative diabetes language. Descriptive statistics including means, standard deviations, and frequencies were calculated for all study variables. For each target word, frequencies of participants who endorsed a positive, neutral, or negative affective response on the sematic differential scale are reported. RESULTS People with diabetes reported feeling blamed, misunderstood, hopeless, judged, not motivated, and not trusting in response to "noncompliant," "unmotivated," "in denial," "preventable," "failed," "should," "uncontrolled," "what did you do wrong," and "you could end up blind or on dialysis." Participants who have type 1 diabetes and are female, White, more educated, and younger reported more negative feelings about the target words. CONCLUSION People with diabetes experience highly negative affective responses when they read and hear previously identified words and phrases considered to be judgmental and unhelpful.
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Affiliation(s)
- Jane K Dickinson
- Department of Health & Behavior Studies, Teachers College Columbia University, Steamboat Springs, Colorado
| | | | - Jennalee S Wooldridge
- Mental Health Service, VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California San Diego, California
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Araújo MM, Pizato N, Rodrigues LS, de Andrade LS, de Moraes VD, de Carvalho KMB, Dutra ES, Botelho PB, Gonçalves VSS. Development and Validation of Protocol Based on Brazilian Dietary Guidelines for Adults with Diabetes Mellitus Who Attended Primary Health Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105784. [PMID: 37239513 DOI: 10.3390/ijerph20105784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/28/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND To date, there is no protocol providing dietary guidelines to assist health care professionals in counseling Brazilian individuals with Diabetes Mellitus (DM) assisted in primary health care (PHC) according to the Dietary Guidelines for the Brazilian Population (DGBP). Therefore, this study aimed to develop and validate a protocol based on the DGBP for health care, non-nutritionist professionals in counseling adults with DM in PHC. METHODS We systematized the recommendations published in the DGBP, the Diabetes Brazilian Society guidelines, and the scientific literature regarding food and nutrition needs of adults with DM. The clarity and relevance were validated by an expert panel (n = 19) and the understanding and applicability were validated by PHC professionals (n = 12). The degree of agreement of the experts was assessed using a Content Validity Index (CVI). Items receiving CVI > 0.8 were considered appropriate. RESULTS The protocol consisted of six dietary recommendations that encouraged the daily consumption of beans, vegetables, and fruits, advised the avoidance of sugar-sweetened beverages and ultra-processed foods, stimulated eating in appropriate environments, and gave additional guidance addressed to the particularities of DM. The protocol clarity, relevance, and applicability were successfully validated. CONCLUSION The protocol supports health care, non-nutritionist professionals in the guidance of dietary recommendations and promoting adequate and healthy eating habits for adults with DM in PHC.
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Affiliation(s)
- Maísa Miranda Araújo
- Graduate Program in Human Nutrition, Department of Nutrition, University of Brasilia, Campus Darcy Ribeiro, Brasília 70910-900, Brazil
| | - Nathalia Pizato
- Graduate Program in Human Nutrition, Department of Nutrition, University of Brasilia, Campus Darcy Ribeiro, Brasília 70910-900, Brazil
| | - Lorrany Santos Rodrigues
- Graduate Program in Public Health, Department of Nutrition, University of Brasilia, Campus Darcy Ribeiro, Brasília 70910-900, Brazil
| | - Laila Santos de Andrade
- Nutrition and Health Research Group-PENSA, Department of Nutrition, University of Brasilia, Campus Darcy Ribeiro, Brasília 70910-900, Brazil
| | - Verena Duarte de Moraes
- Oswaldo Cruz Foundation, Laboratory of Regional Endemic Situations, Rio de Janeiro 21045-900, Brazil
| | - Kênia Mara Baiocchi de Carvalho
- Graduate Program in Human Nutrition, Department of Nutrition, University of Brasilia, Campus Darcy Ribeiro, Brasília 70910-900, Brazil
- Graduate Program in Public Health, Department of Nutrition, University of Brasilia, Campus Darcy Ribeiro, Brasília 70910-900, Brazil
| | - Eliane Said Dutra
- Graduate Program in Human Nutrition, Department of Nutrition, University of Brasilia, Campus Darcy Ribeiro, Brasília 70910-900, Brazil
| | - Patrícia Borges Botelho
- Graduate Program in Human Nutrition, Department of Nutrition, University of Brasilia, Campus Darcy Ribeiro, Brasília 70910-900, Brazil
| | - Vivian Siqueira Santos Gonçalves
- Graduate Program in Public Health, Department of Nutrition, University of Brasilia, Campus Darcy Ribeiro, Brasília 70910-900, Brazil
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Patel T, Umeh K, Poole H, Vaja I, Ramtoola S, Newson L. Health professionals interface with cultural conflict in the delivery of type 2 diabetes care. Psychol Health 2023; 38:230-248. [PMID: 34351821 DOI: 10.1080/08870446.2021.1960346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study explored the knowledge and experiences of health professionals (HPs) caring for South Asian patients with type 2 diabetes (T2D). DESIGN Fourteen HPs, who supported patients with T2D, were interviewed. The recruitment strategy employed purposeful and theoretical sampling methods to recruit HPs who worked across primary and secondary care settings. MAIN OUTCOME MEASURES Grounded Theory (GT) methodology and analysis generated a theoretical framework that explored HP's perceptions and experiences of providing diabetes care for South Asian patients. RESULTS A GT, presenting a core category of Cultural Conflict in T2D care, explores the influences of HP's interactions and delivery of care for South Asian patients. This analysis is informed by four categories: (1) Patient Comparisons: South Asian vs White; (2) Recognising the Heterogeneous Nature of South Asian Patients; (3) Language and Communication; (4) HPs' Training and Experience. CONCLUSIONS The findings consider how the role of social comparison, social norms, and diminished responsibility in patient self-management behaviours influence HPs' perceptions, implicit and explicit bias towards the delivery of care for South Asian patients. There was a clear call for further support and training to help HPs recognise the cultural-ethnic needs of their patients.
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Affiliation(s)
- Tasneem Patel
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Kanayo Umeh
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Helen Poole
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Ishfaq Vaja
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK.,Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Shenaz Ramtoola
- Endocrinology and Metabolic Medicine, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
| | - Lisa Newson
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
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Acuff LM, Wolfe GG, Bowler-Hill S. The Language of Type 1 Diabetes: Why It Matters in Online Patient Education. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2023. [DOI: 10.1080/15398285.2023.2167424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Affiliation(s)
- Lisa M. Acuff
- University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Gwen Geiger Wolfe
- University of Kansas Libraries, University of Kansas, Lawrence, Kansas, USA
| | - Sally Bowler-Hill
- University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, New Mexico, USA
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Abstract
Caitríona Cox and Zoë Fritz argue that outdated medical language that casts doubt, belittles, or blames patients jeopardises the therapeutic relationship and is overdue for change
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Affiliation(s)
- Caitríona Cox
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
| | - Zoë Fritz
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
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15
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Beverly EA, Hughes AS, Saunders A. Examination of Health Care Providers' Use of Language in Diabetes Care: A Secondary Qualitative Data Analysis. Clin Diabetes 2022; 40:434-441. [PMID: 36385976 PMCID: PMC9606549 DOI: 10.2337/cd21-0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this secondary qualitative data analysis was to assess the frequency and context of stigmatizing language used by health care providers (HCPs). The authors conducted content and thematic analysis of in-depth face-to-face and telephone interviews with HCPs in southeastern Ohio. Participants frequently used labeling language, such as "diabetic" and "noncompliant," as well as language with negative connotations, such as "control," "testing," and "regimen." These findings offer a real-world glimpse of how HCPs communicate about people with diabetes in this region of the country.
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Affiliation(s)
- Elizabeth A. Beverly
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH
- Ohio University Diabetes Institute, Athens, OH
| | - Allyson S. Hughes
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH
- Ohio University Diabetes Institute, Athens, OH
| | - Amy Saunders
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH
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16
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Cunningham AT, Arefi P, Gentsch AT, Mills GD, LaNoue MD, Doty AM, Carr BG, Hollander JE, Rising KL. Patient Markers of Successful Diabetes Management. Diabetes Spectr 2021; 34:275-282. [PMID: 34511854 PMCID: PMC8387618 DOI: 10.2337/ds20-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE For individuals with diabetes, diabetes health status may not align with A1C targets. Patients may use nonclinical targets when assessing their diabetes management success. Identifying these targets is important in developing patient-centered management plans. The purpose of this study was to identify patient markers of successful diabetes management among patients in an urban academic health system. METHODS A secondary analysis of semistructured interviews was completed with 89 adults with type 1 or type 2 diabetes. Participants had a recent diabetes-related emergency department (ED) visits or hospitalization or were primary care patients with an A1C >7.5%. Interviews were conducted to saturation. Demographic data were collected via self-report and electronic medical records. Interviews were analyzed using conventional content analysis. This analysis focused on patient perceptions of successful management coded to "measuring management success." RESULTS Although most participants cited A1C or blood glucose as a marker of successful diabetes management, they had varied understanding of these metrics. Most used a combination of targets from the following categories: 1) A1C, blood glucose, and numbers; 2) engagement in medical care; 3) taking medication and medication types; 4) symptoms; 5) diet, exercise, and weight; and 6) stress management and social support. CONCLUSION Individuals not meeting glycemic goals and/or with recent diabetes-related ED visits or hospitalizations had varied understanding of A1C and blood glucose targets. They use multiple additional markers of successful management and had a desire for management discussions that incorporate these markers. These measures should be incorporated into their care plans along with clinical targets.
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Affiliation(s)
- Amy T. Cunningham
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
- Corresponding author: Amy T. Cunningham,
| | - Pouya Arefi
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Alexzandra T. Gentsch
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Geoffrey D. Mills
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Marianna D. LaNoue
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Amanda M.B. Doty
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Brendan G. Carr
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Judd E. Hollander
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Kristin L. Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
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17
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J S, T C S, T D, T B, G K, C L, R S, G J. Our language matters: Improving communication with and about people with diabetes. A position statement by Diabetes Australia. Diabetes Res Clin Pract 2021; 173:108655. [PMID: 33422586 DOI: 10.1016/j.diabres.2021.108655] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/04/2021] [Indexed: 11/22/2022]
Abstract
The words used about diabetes affect the physical and emotional health of people living with diabetes. They also affect how individuals and society view people living with, or at risk of, diabetes. People with diabetes, their families, and people at risk of diabetes, need and deserve communications that are clear and accurate, respectful and inclusive, and free from judgement and bias. The aim of this position statement is to help bring about positive change in the language used about diabetes. It is based on 30+ years of research into the experiences of people with diabetes. Changing thelanguage of diabetes can make a powerful and positive difference to the emotional well-being, self-care and health outcomes of people affected by diabetes. It also affects community and government support for funding diabetes care, prevention and research. Diabetes Australia encourages everyone communicating about diabetes, or about people affected by diabetes, to choose and use their words carefully to support all people affected by diabetes. This position statement is intended as a guide for people working in healthcare, the media, government and policy, academia, industry, as well as employers and the community. It may also be helpful for the family and friends of people with diabetes.
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Affiliation(s)
- Speight J
- Deakin University, School of Psychology, Geelong, Victoria, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia.
| | - Skinner T C
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia; La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia; University of Copenhagen, Psychology, Copenhagen, Denmark
| | - Dunning T
- Deakin University, School of Nursing, Geelong, Victoria, Australia
| | - Black T
- Diabetes Australia, Canberra, ACT, Australia
| | - Kilov G
- University of Melbourne, Parkville, Victoria, Australia; Launceston Diabetes Clinic, Launceston, Tasmania, Australia
| | - Lee C
- Diabetes Australia, Canberra, ACT, Australia
| | - Scibilia R
- Diabetes Australia, Canberra, ACT, Australia
| | - Johnson G
- Diabetes Australia, Canberra, ACT, Australia
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18
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Joiner KL, DeJonckheere M, Whittemore R, Grey M. Perceptions and experiences of living with type 1 diabetes among Latino adolescents and parents with limited English proficiency. Res Nurs Health 2020; 43:263-273. [PMID: 32281136 DOI: 10.1002/nur.22019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/12/2020] [Accepted: 03/28/2020] [Indexed: 11/07/2022]
Abstract
We explored perceptions and experiences of living with type 1 diabetes mellitus (T1DM) among U.S. Latino adolescents (age 12-19 years) with T1DM and parents with limited English proficiency. We used a qualitative descriptive approach with semi-structured interviews of adolescents together with their parents. Interview data were reviewed, coded, and combined into themes about participant experiences with T1DM. Twenty-four adolescents (mean age: 15.4 years) and 23 parents participated. Analysis resulted in three themes: (a) Understanding and adapting to T1DM (i.e., initial fear and misunderstandings of T1DM; adolescents' reflections on living with a chronic health condition); (b) Coming to terms with social and environmental influences on T1DM self-management (i.e., T1DM as disruptive to school and social activities; dealing with stigma and judgments related to diabetes); and, (c) Integrating T1DM self-management expectations with components of Latino cultures (i.e., orientation toward family well-being; parent concerns about cultural preferences that influence food choices, positive influence of spirituality and religiousness; parental views of their current health care in comparison to that available in their place of birth). Adolescents and their parents reported experiences that are universal to adolescents with T1DM in addition to challenges that are unique to Latinos. Efforts aimed at improving T1DM self-management during adolescence with this population need to be tailored to meet the unique social and cultural contexts and delivered in a culturally and linguistically congruent manner.
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Affiliation(s)
- Kevin L Joiner
- School of Nursing, University of Michigan, Ann Arbor, Michigan
| | | | | | - Margaret Grey
- School of Nursing, Yale University, Orange, Connecticut
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19
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Abstract
Diabetes educators can be challenged by therapeutic inertia, as has been documented with other health care providers. There are many contributing factors related to the educators themselves, their patients, and the health care system in which they operate. To address this potentially significant barrier to quality patient care, diabetes educators can adopt numerous strategies to maximize their impact and address the factors contributing to therapeutic inertia in their practices.
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Affiliation(s)
- Carla Cox
- Mountain Vista Medicine, South Jordan, UT
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20
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Guzman SJ. A Behavioral Perspective of Therapeutic Inertia: A Look at the Transition to Insulin Therapy. Diabetes Spectr 2020; 33:38-43. [PMID: 32116452 PMCID: PMC7026761 DOI: 10.2337/ds19-0024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
From a behavioral perspective, therapeutic inertia can happen when obstacles to changing a diabetes treatment plan outweigh perceived benefits. There is a complex interaction of important treatment-related obstacles for people with diabetes (PWD), their treating health care professional (HCP), and the clinical setting in which they interact. Tipping the scales toward more effective action involve strategies that increase perceptions of the benefits of treatment intensification while addressing important obstacles so that treatment changes are seen by both PWD and HCPs as worthwhile and achievable.
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21
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Abstract
Nurses can make a difference by carefully considering the language they use to talk to or about patients with diabetes. This article discusses the importance of words and messages in healthcare, particularly in diabetes education.
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Affiliation(s)
- Jane K Dickinson
- Jane K. Dickinson is the diabetes education and management program director and lecturer at Teachers College, Columbia University in New York, N.Y. Martha M. Funnell is an emeritus research scientist with the department of learning health sciences at the University of Michigan Medical School in Ann Arbor, Mich., and a member of the Nursing2019 editorial board
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22
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Abstract
Pharmacy data reveal that 70% of patients were missing one or more days worth of drops out of five. Adopting approaches to behavior change and management skills used for people with diabetes may provide insight to improve self-management of glaucoma. Every person who is diagnosed with a chronic health condition such as glaucoma has unique life circumstances that may present barriers to behavior change. An accurate diagnosis and a treatment plan are useless if patients do not use their prescribed eye drops. Active listening and effective communication can result in persons who are more engaged in their self-care behaviors. Collaborative communication using person-centered and strengths-based messages could help eye care providers identify challenges and concerns for people with glaucoma who are experiencing inconsistencies with their eye drops. In an atmosphere where patients can discuss their challenges with treatment recommendations without judgment or fear, they are more likely to trust their provider and therefore share their situation openly and honestly. This is accomplished by choosing language that communicates mutually-agreed-upon self-management goals and addresses and strengthens individual and clinical outcomes. The eye care professional is then seen by the patient as a resource who can empathize when setbacks occur and reinforce the patient's self-management goals. Open-ended questions and tell-ask-tell approaches for identifying barriers to care are keys to more effective communication and trusting relationships. This includes recognizing that glaucoma is associated with increased rates of anxiety or depression that may be an overlooked barrier to self-management. By adopting language recommendations from diabetes care and education, eye care practitioners may be better equipped to help people with glaucoma improve their self-care.
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Beeney LJ, Fynes-Clinton EJ. The Language of Diabetes Complications: Communication and Framing of Risk Messages in North American and Australasian Diabetes-Specific Media. Clin Diabetes 2019; 37:116-123. [PMID: 31057217 PMCID: PMC6468819 DOI: 10.2337/cd18-0024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
IN BRIEF Reducing the risk of diabetes complications requires the delivery of accurate and constructive information for people with diabetes to make informed self-management choices. This article reports on a study assessing the language and framing of risk messages about long-term complications featured in publications produced by North American and Australasian diabetes organizations. Findings highlight problems with the language, content, and framing of messages about risk of long-term diabetes complications presented by diabetes-specific media. These poorly communicated messages may be contributing to distorted perceptions of complications risk and diabetes distress and may interfere with optimal self-management.
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Affiliation(s)
- Linda J. Beeney
- Sydney Medical School, The University of Sydney, Sydney, Australia
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24
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Dickinson JK, Guzman SJ, Maryniuk MD, O'Brian CA, Kadohiro JK, Jackson RA, D'Hondt N, Montgomery B, Close KL, Funnell MM. The Use of Language in Diabetes Care and Education. Diabetes Care 2017; 40:1790-1799. [PMID: 29042412 DOI: 10.2337/dci17-0041] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Language is powerful and can have a strong impact on perceptions as well as behavior. A task force, consisting of representatives from the American Association of Diabetes Educators (AADE) and the American Diabetes Association (ADA), convened to discuss language in diabetes care and education. This document represents the expert opinion of the task force. The literature supports the need for a language movement in diabetes care and education. There are effective ways of communicating about diabetes. This article provides recommendations for language used by health care professionals and others when discussing diabetes through spoken or written words-whether directed to people with diabetes, colleagues, or the general public, as well as research questions related to language and diabetes.
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Affiliation(s)
- Jane K Dickinson
- Department of Health & Behavior Studies, Teachers College, Columbia University, New York, NY
| | - Susan J Guzman
- Clinical/Educational Services, Behavioral Diabetes Institute, San Diego, CA
| | | | - Catherine A O'Brian
- Department of Science and Practice, American Association of Diabetes Educators, Chicago, IL
| | - Jane K Kadohiro
- Diabetes Education and Support Consulting Services, Reno, NV
| | | | | | | | - Kelly L Close
- Close Concerns and The diaTribe Foundation, San Francisco, CA
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