Exploration of the patient’s voice

Finding deeper meaning in the linguistic cues used by adults living with diabetes

Authors

  • Phillip Cox Wake Forest University
  • Shannon L Mihalko Wake Forest University
  • Suzanne C Danhauer Wake Forest School of Medicine
  • Julienne K Kirk Wake Forest School of Medicine
  • Mollie Rose Canzona Wake Forest University
  • Heather L Black Merck Sharp & Dohme Corp.
  • Sally A Shumaker Wake Forest School of Medicine

DOI:

https://doi.org/10.1558/cam.18160

Keywords:

adherence, agency, diabetes, multidimensional analysis, non-adherence, self-management

Abstract

Diabetes self-management is a complex process in which individuals are asked to modify established health behaviors. Healthcare providers are instrumental in enhancing individual self-management and are encouraged to consider the patient perspective, often expressed indirectly. Using multidimensional analysis, this study analyzed talk to compare linguistic features used by adherent and non-adherent individuals with diabetes. In-depth telephone interviews were conducted with 108 individuals. Recruitment was stratified by sex, race and glycated hemoglobin (A1C) score. Interviewer contributions were removed from the transcripts, leaving only the participants’ contributions. Using A1C score (<7%, >7%) the texts were divided into adherent and non-adherent datasets. Based on computer-assisted, quantitative analysis, ten linguistic features had a significant difference in frequency of use between the two groups. The participants in the adherent group used a greater frequency of linguistic features related to personal stance than the non-adherent group, and these expressions of personal stance were considered in relation to the participant’s sense of agency. A better understanding of the way in which different subsets of individuals talk about diabetes self-management would facilitate greater healthcare provider understanding of the patient’s perspective during clinical encounters to improve adherence.

Author Biographies

Phillip Cox, Wake Forest University

Phillip Cox, MS, MBA, is a Research Assistant in the Health and Exercise Science Department at Wake Forest University. His research interests include health psychology and psychosocial determinants of health.

Shannon L Mihalko, Wake Forest University

Shannon L. Mihalko, PhD, is a Professor in the Health and Exercise Science Department at Wake Forest University. Her research focuses on adherence and quality of life in adults with chronic disease. Specifically, her work examines determinants and consequences of behavior change and adherence, with a specific focus on building self-efficacy. She holds a joint appointment in the Department of Social Sciences and Health Policy within the Division of Public Health Sciences at Wake Forest University School of Medicine.

Suzanne C Danhauer, Wake Forest School of Medicine

Suzanne C. Danhauer, PhD, is a tenured Professor in the Department of Social Science and Health Policy in the Division of Public Health Sciences at Wake Forest School of Medicine. She also holds a joint appointment in the Department of Internal Medicine, Section on Hematology and Oncology. She is a clinical health psychologist whose work has investigated potential benefits of behavioral and mind-body modalities, with an emphasis on symptom management, for cancer survivors and adults with other chronic illnesses.

Julienne K Kirk, Wake Forest School of Medicine

Julienne K. Kirk, PharmD, CDE, is a Professor in the Department of Family and Community Medicine at Wake Forest Baptist Health. She is a Certified Diabetes Care and Education Specialist in the Department of Endocrinology. She has worked as a clinician, researcher and educator for the past 35 years. Her research focus includes patient adherence, minority health and chronic disease management. 

Mollie Rose Canzona, Wake Forest University

Mollie Rose Canzona, PhD, uses a lifespan developmental lens to examine how patient–provider communication and family relationships are tied to health behavior and outcomes. She conducts interdisciplinary, narrative-based, mixed-method research to inform behavioral interventions in a cancer prevention and control context. Her current research examines sexual and reproductive health, end of life care, health disparities and cancer caregiving. She is an Assistant Professor and Zachary T. Smith Faculty Fellow in the Department of Communication at Wake Forest University.

Heather L Black, Merck Sharp & Dohme Corp.

Heather L. Black, PhD, is the Director of Healthcare Quality Research within the Center for Observational Real-World Evidence (CORE) at Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. She studies human behavior in the context of the quality of healthcare delivery, medication adherence, navigating systems of care, health technology assessment and the impact of healthcare policies.

Sally A Shumaker, Wake Forest School of Medicine

Sally A. Shumaker, PhD, is a nationally and internationally recognized expert in clinical research. She is a tenured Professor in the Department of Social Sciences and Health Policy. Her primary areas of expertise include women’s health, behavioral science, health-related quality of life and the conducting of multicenter clinical trials.

References

American Diabetes Association (2019a). Glycemic targets: Standards of medical care in diabetes-2019. Diabetes Care 42 (Suppl. 1): S61–S70. https://doi.org/10.2337/dc19-S006

American Diabetes Association (2019b) Standards of medical care in diabetes – 2019. Diabetes Care 42 (Suppl. 1): S1–S2. https://doi.org/10.2337/dc19-Sint01

Anthony, Laurence (2019) AntConc (Version 3.5.8). Tokyo: Waseda University. Online: https://www.laurenceanthony.net/software

Bandura, Albert (2006) Toward a psychology of human agency. Perspectives on Psychological Science 1 (2): 164–180. https://doi.org/10.1111/j.1745-6916.2006.00011.x

Biber, Douglas (1988) Variation Across Speech and Writing. New York: Cambridge University Press. https://doi.org/10.1017/CBO9780511621024

Biber, Douglas (1999) Longman Grammar of Spoken and Written English. Harlow, UK: Pearson Education.

Biber, Douglas and Edward Finegan (1989) Styles of stance in English: Lexical and grammatical marking of evidentiality and affect. Text 9 (1): 93–124. https://doi.org/10.1515/text.1.1989.9.1.93

Borrell-Carrió, Francesc, Anthony L. Suchman and Ronald M. Epstein (2004) The biopsychosocial model 25 years later: Principles, practice, and scientific inquiry. Annals of Family Medicine 2 (6): 576–582. https://doi.org/10.1370/afm.245

Brezina, Vaclav and Miriam Meyerhoff (2014) Significant or random? International Journal of Corpus Linguistics 19 (1): 1–28. https://doi.org/10.1075/ijcl.19.1.01bre

Broom, Dorothy and Andrea Whittaker (2004) Controlling diabetes, controlling diabetics: Moral language in the management of diabetes type 2. Social Science & Medicine 58 (11): 2371–2382. https://doi.org/10.1016/j.socscimed.2003.09.002

Charon, Rita (2007) What to do with stories: The sciences of narrative medicine. Canadian Family Physician / Medecin de Famille Canadien 53 (8): 1265–1267.

Connor, Ulla M., Marta Anton, Elizabeth Goering, Kathryn Lauten, Amir Hayat, Paris Roach and Stephanie Balunda (2012) Listening to patients’ voices: Linguistic indicators related to diabetes self-management. Communication & Medicine 9 (1): 1–12. https://doi.org/10.1558/cam.v9i1.1

Cortes, Viviana (2015) Using corpus-based analytical methods to study patient talk. In Martha Antón and Elizabeth M. Goering (eds.) Understanding Patients’ Voices: A Multi-Method Approach to Health Discourse, 51–65. Amsterdam: John Benjamins. https://doi.org/10.1075/pbns.257.04cor

Crawford, Paul, Brian Brown, Svenja Adolphs, Paul Bissell, Opinder Sahota and Ronald Carter (2018) Compliance, concordance and corpus linguistics: Towards a new paradigm in the study of clinical encounters. Health Language Research Group. Online: http://www.brown.uk.com/teaching/city/compliance.pdf

Greenhalgh, Trisha and Brian Hurwitz (1999) Narrative based medicine: Why study narrative? BMJ (Clinical Research Ed.) 318 (7175): 48–50. https://doi.org/10.1136/bmj.318.7175.48

Hamilton, Heidi E. (2003) Patients’ voices in the medical world: An exploration of accounts of noncompliance. In Deborah Tannen and James E. Alatis (eds) Georgetown University Round Table on Languages and Linguistics 2001: Linguistics, Language, and the Real World: Discourse and Beyond, 147–165. Washington, DC: Georgetown University Press.

Inzucchi, Silvio E., Richard M. Bergenstal, John B. Buse, Michaela Diamant, Ele Ferrannini, Michael Nauck, Anne L. Peters, Apostolos Tsapas et al. (2012) Management of hyperglycaemia in type 2 diabetes: A patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 55 (6): 1577–1596. https://doi.org/10.1007/s00125-012-2534-0

Jaworska, Sylvia and Kath Ryan (2018) Gender and the language of pain in chronic and terminal illness: A corpus-based discourse analysis of patients’ narratives. Social Science and Medi­cine 215: 107–114. https://doi.org/10.1016/j.socscimed.2018.09.002

Kirk, Julienne K., Jaimie C. Hunter, Shannon L. Mihalko, Suzanne C. Danhauer and Sally A. Shumaker (2019) Perspectives of pain in patients with type 2 diabetes. Expert Review of Endocrinology & Metabolism 14 (3): 215–219. https://doi.org/10.1080/17446651.2019.1592674

Kirk, Julienne K., Beverly J. Levine, Shannon L. Mihalko, Suzanne C. Danhauer, Heather L. Black and Sally A. Shumaker (2021) A method­ology to elicit values and strategies in diabetes management. Current Research in Diabetes & Obesity Journal 14 (2): Article 555885. https://doi.org/10.19080/CRDOJ.2020.14.555855

Konopasky, Abigail W. and Kimberly M. Sheridan (2016) Towards a diagnostic toolkit for the language of agency. Mind, Culture, and Activity 23 (2): 108–123. https://doi.org/10.1080/10749039.2015.1128952

Levinson, Wendy, Rita Gorawara-Bhat and Jennifer Lamb (2000) A study of patient clues and physician responses in primary care and surgical settings. Journal of the American Medical Association 284 (8): 1021–1027. https://doi.org/10.1001/jama.284.8.1021

Lu, Yan, Jiayun Xu, Weigang Zhao and Hae-Ra Han (2016) Measuring self-care in persons with type 2 diabetes: A systematic review. Evaluation & the Health Professions 39 (2): 131–184. https://doi.org/10.1177/0163278715588927

Nini, Andrea (2014) Multidimensional Analysis Tagger 1.2 – Manual. Online: https://sites.google.com/site/multidimensionaltagger

Reynolds, Rebecca, Sarah Dennis, Iqbal Hasan, Jan Slewa, Winnie Chen, David Tian, Sangeetha Bobba and Nicholas Zwar (2018) A systematic review of chronic disease management interventions in primary care. BMC Family Practice 19 (1): Article 11. https://doi.org/10.1186/s12875-017-0692-3

Reynolds, Thomas J. and Jonathan Gutman (1988) Laddering theory, method, analysis, and interpretation. Journal of Advertising Research 28 (1): 11–31.

SAS Institute (2020) SAS/STAT (Version 9.4 and above). Cary, NC: SAS Institute.

Scholl, Isabelle, Jördis M. Zill, Martin Härter and Jörg Dirmaier (2014) An integrative model of patient-centeredness – a systematic review and concept analysis. PloS ONE 9 (9): Article e107828. https://doi.org/10.1371/journal.pone.0107828

Staples, Shelley (2016) Identifying linguistic features of medical interactions: A register analysis. In Lucy Pickering, Eric Friginal and Shelly Staples (eds) Talking at Work: Corpus-Based Explorations of Workplace Discourse, 179–208. London: Palgrave Macmillan. https://doi.org/10.1057/978-1-137-49616-4_8

Staples, Shelley, Maria K. Venetis, Jeffrey D. Robinson and Rachel Dultz (2020) Understanding the multi-dimensional nature of informational language in health care interactions. Register Studies 2 (2): 241–274. https://doi.org/10.1075/rs.19009.sta

Stellefson, Michael, Krishna Dipnarine and Christine Stopka (2013) The chronic care model and diabetes management in US primary care settings: A systematic review. Preventing Chronic Disease 10 (1): Article E26. https://doi.org/10.5888/pcd10.120180

Travaline, John M., Robert Ruchinskas and Gilbert E. D’Alonzo (2005) Patient-physician com­munication: Why and how. Journal of the American Osteopathic Association 105 (1): 13–18.

Young-Hyman, Deborah, Mary de Groot, Felicia Hill-Briggs, Jeffrey S. Gonzalez, Korey Hood and Mark Peyrot (2016) Psychosocial care for people with diabetes: A position statement of the American Diabetes Association. Diabetes Care 39 (12): 2126–2140. https://doi.org/10.2337/dc16-2053

Zimmermann, Christa, Lidia Del Piccolo and Arnstein Finset (2007) Cues and concerns by patients in medical consultations: A literature review. Psychological Bulletin 133 (3): 438–463. https://doi.org/10.1037/0033-2909.133.3.438

Published

2022-05-04

How to Cite

Cox, P., Mihalko, S. L., Danhauer, S. C., Kirk, J. K., Canzona, M. R., Black, H. L. ., & Shumaker, S. A. (2022). Exploration of the patient’s voice: Finding deeper meaning in the linguistic cues used by adults living with diabetes. Communication and Medicine, 17(3), 215–229. https://doi.org/10.1558/cam.18160

Issue

Section

Articles