The power of language: what is the evidence for changing the way we talk about diabetes?

The UK ‘Language Matters Working Group’ has reviewed the research on the importance of using positive language in diabetes care

By Eloise Litterbach

The quality of the relationship between a person and their health professional(s) impacts on their health outcomes and satisfaction with care. The language used by health professionals is one of the most powerful tools to create a positive relationship. When preparing to write their Language Matters position statement (launched in June 2018), the UK ‘Language Matters Working Group’ reviewed the current research on health professionals’ use of language in diabetes care. The review reports that the use of particular language is unhelpful in promoting a positive relationship between a person with diabetes and their healthcare team. For example, when health professionals use terms with negative connotations, such as ‘non-compliance’ and ‘non-adherence’, a person is less likely to connect and engage with their health professional. Research also revealed that these words are still regularly used in academic and clinical publications. Similarly, ‘labelling’ people (e.g. referring to them as ‘diabetic’ rather than as ‘a person with diabetes’) increases experienced and perceived stigma among people with diabetes. Stigma and unhelpful, negative language is detrimental and associated with greater distress and reduced quality of life in people living with diabetes. The review also highlights the need to understand culturally appropriate language and communication barriers so that opportunities to identify diabetes-related distress are not overlooked through miscommunication.

This review has led to a set of guidelines to assist healthcare professionals use appropriate language when talking about diabetes. Some of the recommendations include: adopting an empathic, positive approach when communicating about and to people with diabetes, seeking to be non-authoritarian and non-judgmental, and encouraging positive language among others. This review has also informed the NHS England Position Statement, Language Matters, which professionals can use as a guide. Implementation of these guidelines could be expected to contribute toward a reduction of diabetes distress and help individuals to feel understood, valued and empowered to manage their diabetes optimally.

Changing the conversation around diabetes has also been highlighted in this short video by Mytonomy, launched at the American Association of Diabetes Educators conference (August 2018).

In related news, the UK’s Academy of Medical Royal Colleges has launched ‘Please, write to me’, new guidance on the writing of outpatient clinic letters directly to patients (and a copy sent to their GP, rather than the other way around). The guidance specifically recommends: “Avoid stigmatizing words and comments that may offend some people. For example, ‘you have diabetes’ is more palatable than ‘you are a diabetic’”. In this guidance, launched on 3 September 2018, the AoMRC advises that this practice improves communication and that clinical practice becomes more person-centred. Most importantly, patients find such letters informative, supportive and useful.

Lloyd C, Wilson A, Holt R, Whicher C, Kar P and The Language Matters Group. Language matters: a UK perspective. Diabetic Medicine, 2018. doi: 10.1111/dme.13801

To read more about language matters, check out our previous blogs on this topic.