Development of patient-centric linguistically tailored psychoeducational messages to support nutrition and medication self-management in type 2 diabetes: a feasibility study

Figures & data

Table 1 Linguistic and theoretical construct features for message development

	Control orientation		Agency		Emotions
	Internal	External	High	Low	Positive	Negative
Linguistic and construct oriented style features	Acknowledge the other persons desires or interests. Emphasizing “you” as in the patient, emphasizing patient control.	Reference to outside source of expertise or control of self- management (physician, research) or first person singular “I” if the person conveying message is an expert.	Incorporate “try” *(moderate agency),^Citation52 emphasizing problem-solving skills and what is already going well.	Incorporate “try” with emphasis on one specific, easily achievable change strategy. Acknowledge fears or factors that might hold the person back from trying.	Positive words, “good,” “great”.	Show empathy, “I understand this is tough.” Acknowledge the difficulty in self- management and then provide suggestions to help support the patient’s self-management.
Healthy eating	Learning about foods with high fiber might help you. You should find out which high fiber foods, especially vegetables, work for you and help make you feel full longer.	For a lot of people, eating more vegetables helps them feel full longer. I want you to add high fiber vegetables to your diet and see if they help.	Let’s try adding more high-fiber vegetables to your meals to see if they make you feel full longer. That will help with all the other things you are already doing.	If you are afraid of feeling hungry, eating more high-fiber vegetables can help you feel fuller longer. Try adding just one more serving of a high-fiber vegetable to your one meal each day.	Here’s something that will help keep you feeling good. Include more vegetables with meals, especially the high fiber vegetables. You’ll feel full longer.	I know changing how you eat can be hard, but here’s something I’m sure you can do. Include more vegetables in your meals, especially the high fiber vegetables. They’ll help you feel full longer.
Taking medications	I know you want to take the medicine to get the most effect. Let’s talk about how you can fit the way this medicine has been prescribed into your daily routine.	According to a lot of research, taking medicine correctly gives increased health benefits. So, you should take your medicines in the way the doctor prescribed them.	I know you can do well taking your medicine in the way the doctor prescribed it. It really does help. Keep up the good work.	Let’s try focusing on just one thing: taking your medicine in the way your doctor prescribed it. I’m sure if you focus on that, you can do it, and it will help avoid the negative effects of your diabetes.	It’s great that you came to your appointment today. Another thing you can do is to take your medicine in the way the doctor prescribed it. This will help keep you on top of things.	I understand that taking the medicine correctly is tough, but I’m sure you can do it. Taking your medicines in the way your doctor prescribed them will help.

Notes:

* Segmentation is based on high agency; however, the scenario the tailored message was built upon indicated that patients were having trouble feeling full.

Figure 1 Distribution of segment clusters for all patients segmented (n=20).

Note: *Balanced affect refers to individuals who scored equally on positive and negative affect (n=4) on the Descriptor or who could not be segmented (n=1).

Figure 2 Study subset construct segments (n=7).

Note: *Balanced affect refers to individuals who scored equally on positive and negative affect items on the Descriptor. For analysis, these individuals were classified as negative affect.

Figure 3 Diabetes’ participant feedback on message preferences.

Figure 4 Participants’ preferences for the messages by construct.

ConnorULautenKA multi-method analysis of diabetes patients’ health beliefs and actionsHamiltonHChouWSHandbook of language and health communicationNew YorkRoutledge2014

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