Real and Perceived Discordance in Physicians and U.S. Adults’ Beliefs Regarding the Causes and Controllability of Type 2 Diabetes

ABSTRACT

Discordance between physicians and patients’ health beliefs can impede health communication efforts. However, little research considers physicians’ perceptions of patient beliefs, despite the importance of perceptions in shaping communication. In the current work, we examine instances of actual and perceived discordance between physicians and U.S. adults’ beliefs regarding the causes and controllability of type 2 diabetes. 229 family physicians completed an online survey measuring their health beliefs and perceptions of their patients’ beliefs. Physicians’ responses were contrasted against beliefs from a national survey sample of 1,168 U.S. adults. T-tests assessed whether (a) physicians’ beliefs diverged from the national sample’s beliefs (actual discordance), (b) physicians perceived that their health beliefs diverged from their patients’ beliefs (perceived discordance), and (c) physicians’ perceptions of patient beliefs diverged from the national sample’s beliefs (accuracy of perceived discordance). Findings revealed evidence of actual discordance; compared to the national sample, physicians were more likely to attribute type 2 diabetes to genes (versus lifestyle factors) and perceived greater control over developing diabetes. Moreover, although physicians perceived discordance between their own and their patients’ beliefs, data from the national sample suggested that these gaps were less substantial than physicians expected. In particular, findings showed that physicians generally overestimated discordance, expecting that people would be less likely to (1) attribute the development of diabetes to lifestyle factors (versus genes), and (2) perceive control over developing diabetes, than was actually reported. Implications of actual and perceived discordance for effective health communication and patient education are discussed.

KEYWORDS:

• discordance
• doctor-patient communication
• health communication
• health beliefs
• type 2 diabetes
• perceptions
• patient education

Data availability

The data that support the findings of this study are available from the corresponding author upon request.

Disclosure of potential conflict of interest

The authors do not have any disclosures to report.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Notes

1. To address concerns about the time lag in data collection with the physician survey, we conducted a follow-up replication survey using Amazon Mechanical Turk. Additional details about this study are reported in the analytic strategy and online supplement.

2. A sample of 1,201 participants (approximately 400 per racial/ethnic group) were recruited. During data cleaning, 33 participants were dropped from analysis due to ineligibility (diabetic status: n = 4; race/ethnicity status: n = 29).

3. In this paper, non-diabetic adults are defined as individuals who may have diabetes risk factors, but whose HbA1c levels have not reached a clinical threshold of concern. Although our sample included individuals who were pre-diabetic (e.g., individuals who have elevated HbA1c levels that can be managed with lifestyle changes alone), patients who have been diagnosed with diabetes were excluded.

4. Due to a manual error, one item (“In general, is type 2 diabetes due more to a person’s genes or more to their lifestyle and health habits?”) was not included in the MTurk survey. Moreover, to avoid losses in statistical power, survey response scales did not include responses that were volunteered by the national sample (e.g., “Neither Agree nor Disagree”).

Additional information

Funding

This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health under Grant [R0IDK083347] and the National Institute of Diabetes and Digestive and Kidney Diseases under Grant [P30DK092926] (Michigan Center for Diabetes Translational Research). Data for the physician sample was funded internally by Touro University California. The content of this publication is solely the responsibility of the authors and does not necessarily represent the views of our funding sources.