Diabetes and the Motivated Patient: Understanding Perlocutionary Effect in Health Communication

Abstract

Health care providers (HCP) understand the importance of keeping patients motivated but may be unaware how their words may have unintended negative effects upon their patient’s lives. People with diabetes report being told by their HCP that they are “cured” or that they are praised for strides made in weight loss and/or lowered blood glucose, and interpret these messages in unexpected ways. For this paper, we focus upon one case to illustrate the depth and nuance of the patient–provider communication as it emerged within a larger interview-based ethnographic study. Audio-recorded interviews and transcriptions were analyzed discursively. Discourse analysis reveals the ways ideology affects how the patient responds to HCP’s utterances and how this affects diabetes self-care. Findings indicate significant perlocutionary effects upon health outcomes, varying both positively and/or negatively. This study points to the importance of carefully considering the power of words and whenever possible knowing the patient’s ideological orientation to their world. HCPs should be explicit and deliberate with their communication. Sensitization to the various ways patients hear and react to messages in a clinical setting may lead to improved health outcomes, especially for those with chronic health conditions such as diabetes mellitus.

Acknowledgments

The authors are particularly grateful to Keith and the other participants who provided their insights. In addition to the listed authors, we wish to thank the anonymous reviewers, Susan Goldman, Ashanté Reese, Charlene Quinn, and Robert Rubinstein for their contributions.

The term health care professional (HCP) refers to any member of the health care team.

Participants for this study were recruited by the Healthy Aging in Neighborhoods of Diversity across the Life Span Study (HANDLS), a study performed by the Intramural Research Program in the National Institute on Aging. The authors sincerely thank Michele K. Evans (HANDLS Principal Investigator), Alan B. Zonderman (HANDLS Lead Associate Investigator), Jennifer Norbeck, and Monique Brown, along with all of the HANDLS team, for their support of this project. We wish to express particular gratitude to Monique Brown for all of her help in the recruitment of eligible participants.

Funding

This research was supported by a National Institute on Aging grant to the University of Maryland, Baltimore County Center of Aging Studies. Principal Investigator: J. Kevin Eckert, RO1AG041709.

Additional information

Funding

This research was supported by a National Institute on Aging grant to the University of Maryland, Baltimore County Center of Aging Studies. Principal Investigator: J. Kevin Eckert, RO1AG041709.