Contributor: Deborah Greenwood, PhD, RN, CDE, BC-ADM, FAADE
In partnership with
When we talk about the language we use in healthcare, it’s more than just the words we say. It’s our way of thinking. It’s communication in all aspects, including body language and physical expressions, but it is also, and most importantly, the thinking and mental processing that is going on during a conversation.
Many of you experience your healthcare in the traditional, problem-focused model, where the person living with the condition is often viewed as “not following directions” or “non-compliant” or that their blood glucose is “out of control.” But there are more productive ways of having conversations about health and wellness.
DiabetesSisters recently shared a presentation with their board of directors, reviewing the use of person-first, strength-based, empowering language. The position paper, The Use of Language in Diabetes Care and Education, published in 2017 jointly by the American Diabetes Association and the American Association of Diabetes Educators, describes how language can improve health communication as well as health outcomes.
The overarching tenants are:
- Chronic conditions are complex, involving many factors and variables
- Every member of the healthcare team can serve people with chronic conditions more effectively through a respectful, inclusive, and person-centered approach
- Stigma that has historically been attached to many conditions, especially diabetes, can contribute to stress and feeling of shame and judgement
- Person-first, strengths-based, empowering language can improve communication and enhance motivation, health, and well-being.
We know that people with diabetes live more than 99% of their lives outside of the healthcare system, self-managing diabetes. You’re not “patients” at home…..that’s where person-first language starts. Focusing on the person, not on their condition or being “sick”…..just living every day.
I love sharing this diagram that shows the “work” associated with chronic conditions. If a person does “everything” the guidelines ask them to do, the tasks of diabetes, they would spend about 2.5 hours/day…..So when we speak with people who don’t understand or know chronic disease, we ask them….”what would you give up or stop doing to find the 2.5 hours a day you needed.” AND those 2.5 hours don’t consider the nuances of the impact on life, and factors that make living with chronic conditions challenging, like work, travel, family implications, and lack of income, to name just a few.
You might ask, how does this relate to language?
When you understand the complexity of living with a chronic condition, it can help build compassion and recognize the reality of day to day life, and how it is impacting everything else. It’s frustrating to go to a medical appointment and talk with a healthcare team that only focuses on what’s wrong, what’s not happened, what could have been better.
When a care team has a more accepting mindset, the language will follow
The key is that we’re not just replacing the words in the conversation….it’s not being “politically correct”, being “nice” or the “word police”…… it’s the message behind the words. Because the way we communicate impacts health outcomes. When we use a strengths-based, person-first approach, you inherently stop the shame, blame, and guilt often associated with living with a chronic condition. When we use a person-first approach, we stop applying labels that lead to bias and stigma. Labels like “uncontrolled”, ““noncompliant”, “nonadherent” are stigmatizing terms associated with being “lazy”, “unmotivated”, “unwilling”, or “don’t care.” Instead, we will improve communication and enhance motivation, health, and well-being.
The #LanguageMatters movement has many similarities to the concepts of a “solution-focused approach” to behavioral health. Tami Ross (dietitian and diabetes educator) and I have been writing a blog for the past year at AFreshPOVforYou.com to share this approach. In a solution-focused approach, we emphasize what people know and what they can do, focusing on their strengths and the times when things are going well (we call these times exceptions). You can read more about language and diabetes on our blog here.
We can “preach” the #LanguageMatters mantra all we want, but the myths and misconceptions are continually bombarding us. Just this past month, there were multiple Twitter storms on the use of “letter grades” for A1C values and a famous UK diabetes show calling a desert “diabetes on a plate.” Each time you hear a misconception, it’s an opportunity to educate and change the way someone thinks.
In summary, we want to use language that……
- Is neutral, nonjudgmental, and based on facts, actions, or physiology/biology
- Is free from stigma
- Is strengths-based, respectful, inclusive, and imparts hope
- Fosters collaboration between patients and providers
- Is person-centered
We want the care team to recognize the hard work being done every day when people live with diabetes. We want to encourage them to be positive and focus on what is going well, and then try to build upon that. You can help spread this movement by using person-first, strength-based language when you talk about diabetes too. Try to move away from words like “blood glucose control” and choose “in-range” or “out-of-range” instead. When someone isn’t taking their medication because they can’t afford it or are having side effects, talk about the choices they are making instead of being “non-compliant” or “non-adherent.” Use "person with diabetes" instead of “diabetic” so you can put the person first. Language is a habit just like anything else, and we need to practice over time to change our behavior.
Last year the diabetes community came together to co-design a video to spread the #LanguageMatters movement and create a call to action. You can watch it here. Please share on your own social media networks, and with friends and colleagues. Help us show the world that #LanguageMatters!
Deborah Greenwood, PhD, RN, CDE, BC-ADM, FAADE, is President of Deborah Greenwood Consulting in Sacramento, CA, specializing in innovative models of education and support with a focus on technology. She has published and lectured on technology-enabled models of care, digital health, e-Patient engagement, and social media for self-management support. She is also a co-founder of A Fresh POV for You, guiding people with diabetes and diabetes care and education specialists to focus on principles of a solutions-focused approach to diabetes care and education. Deborah is an Adjunct, Assistant Professor at the University of Texas Health, San Antonio, and Arizona State University. She was the president of AADE in 2015 and now serves on board of directors for DiabetesSisters. She is passionate about using strengths-based, person-first language in health care.