The manner, tone and words we use to communicate as health-care professionals (HCPs) can significantly impact the lives of people with diabetes. Words are powerful and can positively or negatively influence the way people view themselves as well as affect self-management, emotional well-being and provider relationships. A task force consisting of representatives from the American Association of Diabetes Educators (AADE) and the American Diabetes Association (ADA) developed practical guidelines to assist HCPs, family members/significant others and the community at large to help better serve and support people with diabetes.
The four guiding principles for communication with and about people living with diabetes are as follows:
- 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.
The power of words
According to Jane K. Dickinson, RN, PHD, CDE (and language guideline co-author), “The words we use and the messages we send are part of the context created for people with diabetes. When they hear messages that are judgmental or impart blame, shame or guilt, they are less likely to trust us and more likely to feel discouraged.”
Dickinson, who has been living with Type 1 diabetes for over 40 years, believes in language that is empowering, and focuses on the entire person and their goals, needs and individualized care. “When we focus on what’s important to the person and acknowledge their whole story, people with diabetes are more likely to partner with health-care providers in managing their diabetes”, says Dickinson. Daily diabetes care is stressful, and emotional stress may elevate blood glucose levels. As health-care providers, it’s important to focus on lessening diabetes distress in all ways, and using empowering language is an excellent step towards improving diabetes management.
“When we focus on what’s important to the person and acknowledge their whole story, people with diabetes are more likely to partner with health-care providers in managing their diabetes.”
Tools you can use
As health-care professionals, the words we choose may influence whether or not an individual will follow up with their self-care and determine the success and effectiveness of future relationships with the health-care team. Think about words that may be commonly used during appointments, classes or virtual sessions. Instead of using judgmental words such as “control,” “compliance” or “adherence,” Dickinson suggests using language that focuses on the person and improves engagement. For example, if a person with diabetes is interested in working on blood glucose management, center the discussion around that specific issue. For example, specifically discuss time in range, or HbA1c or glycemic response, rather than the negative and undefinable term “control.” Using the term “control” isn’t a useful measurement, and can cause an individual to feel discouraged, as if they are somehow failing themselves and their diabetes care.
Begin with simple swaps. Instead of labeling a person as “diabetic”, say “a person with diabetes.” Rather than ask someone to “test” blood glucose (which denotes pass or fail), suggest “check” blood glucose. The AADE has developed helpful language resources for health-care professionals as well as the community at large, and for the media to learn more about language and diabetes. These resources can be accessed free of charge at www.diabeteseducator.org
Neutral, non-judgmental and action-oriented
According to the information provided by the task force, as health-care professionals, it’s important for us to use language that is neutral, non-judgmental and based on specific actions and facts. Dickinson is encouraged to see health-care professionals starting to use this person-centered approach around language. According to Dickinson “the hardest thing is how ingrained the negative words are in the diabetes and health-care communities. We say what we know and hear and read every day. In fact, many people living with diabetes still refer to themselves using words we are trying to eliminate. We are asking health-care professionals to lead by example, stop using judgmental language and start using empowering language. For so long the emotional side of diabetes has not been recognized, which has led to the negative, judgmental and shaming language we are so used to. Many providers don’t even hear themselves using it. The first step is to become aware of the problem. Listen for these words and then work toward changing them.”
Access additional resources and practical information to enhance the care and treatment of your diabetes patients.
About our expert
Susan Weiner, MS RDN CDE FAADE
Owner, Susan Weiner Nutrition, PLLC
2015 AADE Diabetes Educator of the Year