Exploration of the patient’s voice
Finding deeper meaning in the linguistic cues used by adults living with diabetes
Keywords:adherence, agency, diabetes, multidimensional analysis, non-adherence, self-management
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.
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.1.19184.108.40.206
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
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