Jane K. Dickinson
Health care providers should employ neutral, nonjudgmental language that puts a patient with diabetes before the disease to remove pervasive, negative labeling and, potentially, boost outcomes, according to a consensus statement released by the American Diabetes Association and the American Association of Diabetes Educators.
“While information exists on how to interact more effectively with people living with diabetes, there is very little discussion about the language we use in these encounters,” Jane K. Dickinson, PhD, RN, CDE, program director for the Master of Science in Diabetes Education and Management at Teachers College, Columbia University, and colleagues wrote. “People experience both diabetes and the language of diabetes in context. Language is the principal vehicle for the sharing of knowledge and understanding. Words are immediately shaped into meanings when people hear or read them, and those meanings can affect how a person views him or herself.”
In preparing the consensus statement, the ADA and AADE convened a task force to discuss language in diabetes care and education, reviewing literature regarding language used in the delivery of care and making recommendations designed to enhance the communication process.
The task force members defined and adopted four guiding principles for communication with and about people living with diabetes:
- Diabetes is a complex and challenging disease involving many factors and variables.
- Stigma that has historically been attached to a diagnosis of diabetes can contribute to stress and feelings of shame and judgement.
- Every member of the health care team can serve people with diabetes more effectively through a respectful, inclusive and person-centered approach.
- Person-first, strengths-based, empowering language can improve communication and enhance the motivation, health and well-being of people with diabetes.
Using those principles as a guideline, the researchers recommended that health care providers use language that is “neutral, nonjudgmental and based on the facts, actions or physiology/biology.” Use of the word “control,” for example, in relation to blood glucose levels (such as “poor diabetes control”) can elicit feelings of shame or failure in a patient, who may struggle to manage his or her disease. Researchers recommended replacement language like the word “manage,” or factual statements like, “She is checking blood glucose levels a few times per week.”
Researchers also recommended providers use language that is free from stigma — using the word “noncompliant” as one example — and employ language that will focus on a patient’s strengths and facts, instead using words like “engagement,” “participation,” “involvement” and “medication taking.”
Additionally, researchers recommended that providers use language that is strengths-based, respectful, inclusive and “imparts hope,” focusing on what is wrong rather than on what is missing or abnormal, and to use language that fosters collaboration between patients and providers.
“People’s sense of identity may get disrupted when they have a disease such as diabetes,” the researchers wrote. “A person’s experience of diabetes can influence their self-talk, for example, someone might say, ‘I’m a bad diabetic, because I don’t eat how I’m supposed to.’ This ‘dialogue with the self’ is influenced by the words used by health care professionals, who are seen as knowledgeable and powerful.”
The researchers also noted that there is a paucity of research that directly addresses questions about language in diabetes care and education, and several important questions, including the relationship between language and stigma in diabetes, deserve further study.
“The paradigm of diabetes care and education is moving past an approach that views the health care provider as the expert who tells people with diabetes what to do,” the researchers wrote. “It is moving toward an approach where people with diabetes are the central members of their care teams, experts on their experiences and integral in the management of their disease. Diabetes professionals are working toward person-centered care that is based on respectful, inclusive and empowering interactions.” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.