Listening to patients’ voices: Linguistic indicators related to diabetes self-management
Issue: Vol 9 No. 1 (2012)
Journal: Communication & Medicine
A great deal of research in health care has examined a wide range of variables to better understand the degree to which patients follow the advice of medical professionals in managing their health, known as adherence. This paper explains the development of the linguistic systems to describe and evaluate two psychosocial constructs (i.e. control orientation and agency) that have been found to be related to adherence in previous research for subjects with diabetes (Trento et al. 2007; Wangberg 2007; O’Hea et al. 2009). The present data came from 43 semi-structured in-depth interviews of subjects with Type 2 diabetes. One-on-one interviews with open-ended questions elicited subjects’ ‘stories’ about living with diabetes, and the transcribed interviews were analyzed to develop the linguistic systems of control orientation and agency. The resultant systems were applied to the 43 interviews by raters with high inter-rater reliability. The results showed demarcations of clearly identified codings of patient types. The paper presents the linguistic coding systems developed in the study, the results of their application to the patient interview data, and recommendations for improved communication with patients.
Author: Ulla Connor, Marta Antón, Elizabeth Goering, Kathryn Lauten, Paris Roach, Stephanie Balunda, Amir Hayat
Anderson, E. S., Winett, R. A. and Wojcik, J. R. (2000) Social-cognitive determinants of nutrition behavior among supermarket food shoppers: A structural equation analysis. Health Psychology 19 (5): 479–486. http://dx.doi.org/10.1037/0278-6188.8.131.529
Bandura, A. (1977) Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review 84 (2): 191–215. http://dx.doi.org/10.1037/0033-295X.84.2.191
Bandura, A. (1997) Self-efficacy: The Exercise of Control. New York: Freeman.
Biber, D., Johansson, S., Leech, G., Conrad, S. and Finegan, E. (1999) Longman Grammar of Spoken and Written English. Essex, UK: Pearson Education.
Bower, A. B. and Taylor, V. A. (2003) Increasing intention to comply with pharmaceutical product instructions: An exploratory study investigating the roles of frame and plain language. Journal of Health Communication 8 (2): 145–156. http://dx.doi.org/10.1080/10810730305693
Castor, T. and Cooren, F. (2006) Organizations as hybrid forms of life: The implications of the selection of agency in problem formulation. Management Communication Quarterly 19 (4): 570–600. http://dx.doi.org/10.1177/0893318905284764
Centers for Disease Control and Prevention (2011) National Diabetes Fact Sheet: National estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention.
DeWalt, D. A., Davis, T. C., Wallace, A. S., Seligman, H. K., Bryant-Shilliday, B., Arnold, C. L., Freburger, J. and Schillinger, D. (2009) Goal setting in diabetes self-management: Taking the baby steps to success. Patient Education and Counseling 77(2): 218–223. http://dx.doi.org/10.1016/j.pec.2009.03.012
Dunbar, J. (1998) Predictors of patient adherence: Patient characteristics. In S. A. Shumaker, J. K. Ockene, E. B. Schron and W. L. McBee (eds) The Handbook of Health Behavior Change, 348–360. New York: Springer Publications.
Dunbar-Jacob, J. and Schlenk, E. (2001) Patient adherence to treatment regimen. In A. Baum, T. A. Reveson and J. E. Singer (eds) Handbook of Health Psychology 571–580. Mahwah, NJ: Lawrence Erlbaum.
Finegan, E. (2008) Language: Its Structure and Use (5th ed). Boston, MA: Thomson Wadsworth.
Frankel, R. M. and Beckman, H. B. (1989) Conversation and compliance with medical recommendations: An application of micro-analysis in medicine. Rethinking Communication 2 (1): 60–74.
Glasgow, R. E., Toobert, D. J. and Gillette, C. D. (2001) Psychosocial barriers to diabetes self-management and quality of life. Diabetes Spectrum 14 (1): 33–41. http://dx.doi.org/10.2337/diaspect.14.1.33
Hadjistavropoulos, H. and Shymkiw, J. (2007) Predicting readiness to self-manage pain. The Clinical Journal of Pain 23 (3): 259–266. http://dx.doi.org/10.1097/AJP.0b013e31802f67f3
Hagedoorn, M., Keers, J. C., Links, T. P., Bouma, J., Ter Maaten, J. C. and Sanderman, R. (2005) Improving self-management in insulin-treated adults participating in diabetes education: The role of overprotection by the partner. Diabetic Medicine 23 (3): 271–277. http://dx.doi.org/10.1111/j.1464-5491.2006.01794.x
Hamilton, H. E. (2001) Patient’s voices in the medical world: An exploration of accounts of noncompliance. In D. Tannen and J. E. Alatis (eds) Round Table on Languages and Linguistics. Linguistics, Language, and the Real World: Discourse and Beyond, 147–165. Washington, DC: Georgetown University Press.
Kavanagh, D. J., Gooley, S. and Wilson, P. H. (1993) Prediction of adherence and control in diabetes. Journal of Behavioral Medicine 16 (5): 509–522. http://dx.doi.org/10.1007/BF00844820
Kickbusch, I. (2004, October 8) Improving health literacy in the European Union: Towards a Europe of informed and active health citizens. Paper presented at the European Health Forum Gastein 2004. Retrieved January 12, 2006, from http://www.ilonakickbusch.com/en/10-recent-keynotes/health-literacy-gastein.pdf
Klingle, R. S. and Burgoon, M. (1995) Patient compliance and satisfaction with physician influence attempts: A reinforcement expectancy approach to compliance gaining over time. Communication Research 22 (2): 148–187. http://dx.doi.org/10.1177/009365095022002002
Kneckt, M. (2000) Psychological Features Characterizing Oral Health Behavior, Diabetes Self-care Health Status among IDDM Patients. Published Doctoral Dissertation, Oulu University, Finland.
Lakoff, G. and Johnson, M. (1980) Metaphors We Live By. Chicago, IL: Chicago University Press.
Lauten, K., Connor, U., Antón, M., Balunda, S., Goering, E., Hayat, A. and Roach, P. (2010, November) ‘You are what you talk’ – patient-centered interactions.Paper presented at the ICADE Diabetes Conference 2010, Indianapolis, IN.
Lorig, K., Stewart, A., Ritter, P., González, V., Laurent, D. and Lynch, J. (1996) Outcome Measures for Health Education and Other Health Care Interventions. Thousand Oaks, CA: Sage.
Lowery, B. J. and DuCette, J. P. (1976) Disease-related learning and disease control in diabetics as a function of locus of control. Nursing Research 25 (5): 358–362. http://dx.doi.org/10.1097/00006199-197609000-00014
Luszczynska, A. and Schwarzer, R. (2005) Multidimensional health locus of control: Comments on the construct and its measurement. Journal of Health Psychology 10 (5): 633–642. http://dx.doi.org/10.1177/1359105305055307
Maibach, E. and Murphy, D. A. (1995) Self-efficacy in health promotion research and practice: Conceptualization and measurement. Health Education Research 10 (1):37–50. http://dx.doi.org/10.1093/her/10.1.37
McHorney, C. A. (2009) The adherence estimator: A brief, proximal screener for patient propensity to adhere to prescription medications for chronic disease. Current Medical Research and Opinions 25 (1):215–238. http://dx.doi.org/10.1185/03007990802619425
Moisan, J., Gaudet, M., Grégoire, J. and Bouchard, R. (2002) Non-compliance with drug treatment and reading difficulties with regard to prescription labeling among seniors. Gerontology 48 (1): 44–51. http://dx.doi.org/10.1159/000048924
Montague, M. C., Nichols, S. A. and Durra, A. P. (2005) Self-management in African-American women with diabetes. The Diabetes Educator 31 (5): 700–711. http://dx.doi.org/10.1177/0145721705280414
Morris, L. S. and Schulz, R. M. (1992) Patient compliance—An overview. Journal of Clinical Pharmacy and Therapeutics 17 (5):283–295. http://dx.doi.org/10.1111/j.1365-2710.1992.tb01306.x
Morris, L. S. and Schulz, R. M. (1993) Medication compliance: The patient’s perspective. Clinical Therapeutics 15 (3): 593–606.
Murray, M. D., Young, J. M., Morrow, D. G., Weiner, M., Tu, W., Hoke, S. C. and Weinburger, M. (2004) Methodology of an ongoing, randomized, controlled trial to improve drug use for elderly patients with chronic heart failure. The American Journal of Geriatric Pharmacotherapy 2 (1): 53–65. http://dx.doi.org/10.1016/S1543-5946(04)90007-4
O’Hea, E. L. (2003) Adherence to Medical Regimens in Low-income Adults with Type 2 Diabetes: The Influence of Perceived Control Constructs. Doctoral dissertation, Louisiana State University. Retrieved from http://etd.lsu.edu/docs/available/etd-0729103-130157/unrestricted/O%27Hea_dis.pdf
O’Hea, E. L., Grothe, K. B., Bodenlos, J. S., Bourdreaux, E. D., White, M. A. and Brantley, P. J. (2005) Predicting medical regimen adherence: The interactions of health locus of control beliefs. Journal of Health Psychology 10 (5): 705–717. http://dx.doi.org/10.1177/1359105305055330
O’Hea, E. L., Moon, S., Grothe, K. B., Boudreaux, E., Bodenlos, J. S., Wallston, K. and Brantley, P. J. (2009) The interaction of locus of control, self-efficacy, and outcome expectancy in relation to HbA1c in medically underserved individuals with type 2 diabetes. Journal of Behavioral Medicine 32:106–117. http://dx.doi.org/10.1007/s10865-008-9188-x
Pryor, B. and Mengel, M. C. (1987) Communication strategies for improving diabetics’ self care. Journal of Communication 37 (4): 24–35. http://dx.doi.org/10.1111/j.1460-2466.1987.tb01006.x
Rotter, J. B. (1966) Generalized expectancies for internal versus external control of reinforcement. Psychological Monographs: General and Applied 80: 1–28. http://dx.doi.org/10.1037/h0092976
Schwarzer, R. and Jerusalem, M. (1995) Generalized Self-Efficacy scale. In J. Weinman, S. Wright and M. Johnston (eds) Measures in Health Psychology: A User’s Portfolio. Causal and Control Beliefs, 35–37. Windsor, UK: Nfer-Nelson.
Strickland, B. R. (1978) Internal-External expectancies and health-related behaviors. Journal of Consulting and Clinical Psychology 46 (6): 1192–1211. http://dx.doi.org/10.1037/0022-006X.46.6.1192
Trento, M., Tomelini, M., Basile, M., Borgo, E., Passera, P., Miselli, V., Tomalino, M., Cavallot, F. and Porta, M. (2007) The locus of control in patients with type 1 and type 2 diabetes managed by individual and group care. Diabetic Medicine 25 (1): 86–90. http://dx.doi.org/10.1111/j.1464-5491.2007.02319.x
van Dulmen, S., Sluijs, E., van Dijk, L., de Ridder, D., Heerdink, R., Bensing, J. and the International Expert Forum on Patient Adherence (2008) Furthering patient adherence: A position paper of the international expert forum on patient adherence based on an internet forum discussion. BMC Health Services Research 8 (1): 47. http://www.biomedcentral.com/1472-6963/8/47 http://dx.doi.org/10.1186/1472-6963-8-47
Via, P. S. and Salyer, J. (1999) Psychosocial self-efficacy and personal characteristics of veterans attending a diabetes education program. The Diabetes Educator 25(5): 727–737. http://dx.doi.org/10.1177/014572179902500505
Wallston, K. A. (1992) Hocus-pocus, the focus isn’t strictly on locus: Rotter’s social learning theory modified for health. Cognitive Therapy and Research 16 (2): 183–199. http://dx.doi.org/10.1007/BF01173488
Wallston, K. A., Wallston, B. A. and DeVellis, R. (1978) Development of the multidimensional health locus of control (MHLC) scales. Health Education & Behavior 6 (2): 160–170. http://dx.doi.org/10.1177/109019817800600107
Wangberg, S. C. (2007) An internet-based diabetes self-care intervention tailored to self-efficacy. Health Education Research 23 (1): 1–10. http://dx.doi.org/10.1093/her/cym014
World Health Organization (2011, August) Diabetes Fact Sheet (Issue Brief No. 312). Geneva, CH. http://www.who.int/mediacentre/factsheets/fs312/en/