Enacting communication cycles after prediabetes: Mothers’ stories of diabetes risk and seeking support

Background: Diabetes is a family systems experience of multiple intergenerational relationships. Communicating about diabetes as a familial risk helps individuals perceive greater control over preventing diabetes. Aim: The present study investigates how mothers disclose their prediabetes to their family and the precipitating family communication, with the goal to interrupt the multigenerational legacy of diabetes. Method: Data were collected from a Family Medicine outpatient clinic. Semi-structured interviews were conducted to illicit information about mother-child communication about diabetes. Sort and Sift, Think and Shift analysis provided rich descriptions of mothers’ experiences. Results: The sample consisted of 9 women with prediabetes, aged 42-70, who had at least one child. Eight participants described at least 2 generations of family members with a diabetes-related diagnosis (prediabetes, type 2 diabetes mellitus, and gestational diabetes). First, we present two contextual factors that preexisted the prediabetes diagnosis, which influenced the disclosure decision: general health communication approach and personal evaluation of diabetes. Second, we present the communication cycles that supported self-management. Discussion: Continual communication cycles with family and clinicians can support mothers with prediabetes to enact self-management behaviors and delay the onset of type 2 diabetes mellitus. Conclusion: Mothers need family members to respond favorably to complete a positive communication cycle that can generate continuous emotional, social, and instrumental support

Geographic and Race/Ethnicity Differences in Patient Perceptions of Diabetes

Objectives: The present study takes a culture-centered approach to better understand how the experiences of culture affect patient’s perception of type 2 diabetes mellitus (T2DM). This study explores personal models of T2DM and compares personal models across regional and race/ethnicity differences. Methods: In a practice-based research network, a cross-sectional survey was distributed to patients diagnosed with T2DM at medical centers in Nevada and Georgia. In analyses of covariance, controlling for age, health literacy, and patient activation, geographic location, and race/ethnicity were tested onto 5 dimensions of illness representation. Results: Among 685 patients, race/ethnicity was significantly associated with lower reported understanding diabetes ( P < .01) and less perceived longevity of diabetes ( P < .001). Geographic location was significantly associated with seriousness of the disease ( P < .005) and impact of diabetes ( P < .001). Conclusion: Non-Hispanic White Americans report greater understanding and perceive a longer disease course than non-Hispanic Black Americans and Asian Americans. Regionally, patients in Nevada perceive T2DM as more serious and having more impact on their lives than patients living in Georgia. Primary care physicians should elicit patient perceptions of diabetes within the context of the patient’s ethnic and geographic culture group to improve discussions about diabetes self-management. Specifically, primary care physicians should address the seriousness of a diabetes diagnosis and the chronic nature of the disease with patients who belong to communities with a higher prevalence of the disease

Communicating immunization science : the genesis and evolution of the national network for immunization information

For 10 years, the National Network for Immunization Information (NNii) has pursued its goal to provide the public, health professionals, policy makers, and the media with up-to-date, scientifically valid information related to immunizations to help them understand the issues and to make informed decisions. This investigation provides a critical evaluation of the strategic communication planning and implementation of NNii from conception to present day. The study uses a case study methodology, developing a systematic analysis of organizational documents, the media environment, and in-depth interviews by applying Weick's model of organizing as an interpretive framework. Iterative data analysis included open coding, axial coding, and thematic saturation. Themes were compared with phases of strategic communication and present study propositions. Major themes identified included the organization's informative nature, funding credibility, nonbranding, reflective evaluation, collaborative partnerships, and media strategy. NNii meets the requirements of requisite variety, nonsummativity, and organizational flexibility proposed by Weick's model of organizing. However, a lack of systematic evaluation of organization goals prevents it from adapting communication tactics and strategies. In addition, the authors recommend that NNii, while maintaining its informative nature, adopt persuasive strategies to attract and retain the attention of its target audiences.18 page(s

"Practicing medicine" : patient perceptions of physician communication and the process of prescription

Objective: This study explores patient perceptions of physician communication regarding prescription medications and develops a theory of the effects of perceived physician communication on the patient decision-making process of medication taking. Methods: Using a grounded theory approach, this study systematically analyzed patient narratives of communication with physicians regarding prescription medications and the patient's resulting medication taking and adherence behavior. Results: Participants described concern about side effects, lack of perceived need for medications, and healthcare system factors as barriers to medication adherence. Overall, participants seemed to assess the utility of communication about these issues based on their perceptions of their physician as the source of the message. Conclusion: The theory generated here includes patient assessments of their physician's credibility (trustworthiness and expertise) as a critical influence in how chronically-ill patients process information about the need for prescribed therapy. Trial and error to find appropriate medications seemed to deteriorate patients' perceptions of their physicians' credibility. Practice implications: A practical application of this theory is the recommendation for physicians to increase perceived expertise by clearly outlining treatment processes at the outset of treatment, presenting efficacy and timeline expectations for finding appropriate medications.9 page(s

Being Brave

This month’s issue begins with a qualitative study conducted by a team of researchers from the University of Rochester’s Department of Family Medicine. This team, led by Holly Russell, MD, MS, explored barriers and facilitators to reporting and responding to gender discrimination and sexual harassment within their own department. This was brave, and inspiring, and—as it was done extremely well—also lays out an educational roadmap for those moved to replicate this important work. The women editors of Family Medicine collaborated on this editorial, after recognizing the strength of shared narrative highlighted by this study. The italicized quotes that follow are reflections from this team