April 7-9, 2022 • Hyatt Regency • Lexington, KY
Communication Strategies to Promote Comprehensive Well-being
Communication Strategies to Promote Comprehensive Well-being
Abstract: Type II Diabetic Patient Communicative Experiences in Rural Communities: Understanding the Complexity of Adherence
Diabetes Mellitus Type II (T2D) is a chronic condition affecting the body's capability to produce and/or utilize insulin (CDC, 2017). Estimates suggest that there are 100 million type II diabetics living in the United States. The ability to control T2D depends a great deal on patient self-management and self-care activities and reaching optimal control requires patients to adhere to medical recommendations. Moreover, management of T2D requires patients to engage in multiple self-care behaviors including dietary changes, losing weight, engaging in physical activity, blood glucose monitoring, taking oral and/or insulin medication, and attending clinical appointments. A predictor of patient adherence is communication. In the context of T2D, better communication leads to improved patient adherence, and when patients are adherent, they experience improved health outcomes. However, for patients in rural underserved communities, little is known about their experiences of managing type II diabetes, the impact of patient-provider communication on adherence, and their experiences with their medical providers in the management of T2D. As such, this study explored the experiences of rural patients living with T2D examining how patient-provider communication facilities or hinders patient adherence. For this qualitive descriptive study, thirty (N=30) T2D patients living in rural Illinois, attending a diabetic education class at a critical access hospital were interviewed. In-depth interviews lasted on average 1 hour and 3 minutes. There were 18 females (n = 60%) and 12 males (n = 40%) with ages ranging from 36-76 years old (M = 58.7, SD = 10.5). Participants on average reported having T2D for 6.4 years (SD = 3.63, range 1 to 15 years) and just over half of participants (n = 16) indicated they see two medical providers to help treat their T2D. Data were transcribed verbatim and analyzed based on thematic analysis principles. Findings coalesced around four specific types of behaviors (wellness-related behaviors, screening-related behaviors, medication-related behaviors, and treatment-related behaviors). These different behaviors, for which T2D need to be adherent, were then further examined for emergent sub-themes. Analysis revealed that there were four sub-themes that were consistent across each of the behaviors mentioned above: patient understanding, agreement, trust, and motivation. The analysis also revealed that patients recognize they must be adherent to all categories in order to make significant improvements to their health. These behaviors include appropriate testing, eating “right,” exercising, going to the eye doctor for screenings, and taking medication as directed. As such, responses supported that patients engage in multiple types of behaviors to which they have to be adherent. Differentiating these types of adherences is important in understanding how communication affects adherence thus leads to improved patient health outcomes, as well as how providers talk about and address these types of behaviors (e.g., providers must acknowledge diet and exercise along with taking medication). Finally, patients’ rural location seemingly impacted the consistent communication they receive from their different providers, leading to confusion about their self-care. Overall, this study demonstrated the complexity of communication about adherence, and makes evident that a providers must approach conversations about T2D adherence in nuanced ways.