Diabetes – interaction between patients can help

Friday, 29 November, 2013

For many years, researchers have studied the causes of diabetes. These researchers are trying to find the best treatments. Why? The number of people with diabetes worldwide has increased from 153 million in 1980 to 347 million in 2008 [1]. With this in mind, the WHO aims to provide scientific guidelines for diabetes prevention, develop norms and standards for diabetes diagnosis and care, and build awareness on the global epidemic of diabetes [1]. World Diabetes Day is marked every year in November (the 14th) – so let’s focus on behavioral research conducted in this research field.

Child and adolescent behavior in Shared Medical Appointments

Janneke Noordman and Sandra van Dulmen [2] examined behavior during Shared Medical Appointments (SMAs) where children and adolescents with Type 1 Diabetes Mellitus (T1DM) interacted with parents and care providers. There are different types of diabetes. Type 1 diabetes is characterized by deficient insulin production and requires daily administration of insulin. Thus, it can lay a heavy burden on daily routines [1]. Noordman and van Dulmen analyzed informational and emotional cues and subsequent responses during SMAs in order to gain insight into the feelings of children and adolescents during these consultations. Since SMAs are aimed at enhancing the interaction between patients, it is very interesting to evaluate the communication process during an appointment. Would this approach work with children and adolescents?

An observational study

The researchers examined 10 SMAs in different hospitals. An adapted version of the Medical Interview Aural Rating Scale (MIARS) was used to code emotional cues of children and adolescents, their parents, and responses of health care providers at these cues, during SMAs. They used The Observer XT to code the behaviors directly from video. Emotional cues and responses - non-verbal utterances that indicate a level of emotion – and informational cues such as verbal information seeking utterances, including direct questions and indirect statements were analyzed. By using video, the researchers were able to code behavior in great detail. When observing multiple people in one scene, live observation is often not feasible.

Enhanced interaction by patients helping patients

This study showed that patients with T1DM and their parents expressed more informational cues than emotional cues during SMAs. This is comparable with behavior shown in individual consultations, the researchers explain. So where does an SMA enhance the interaction? An SMA, enhances the interaction because overall healthcare professionals show more (appropriate) response behavior during SMAs than found in other studies during individual consultation. Interestingly, cues not followed by healthcare professionals were picked up by other patients. The healthcare professional stimulated the interaction between two patients by acting as mediator. Noordman and van Dulmen’s advice: Professionals could more explicitly invite all participants to interact with each other, and enable them to have their share in the communication process.

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  1. WHO Media centre – Diabetes
  2. Noordman, J.; van Dulmen, S. (2013). Shared medical appointments marginally enhance interaction between patients: an observational study on children and adolescents with type 1 diabetes. Patient Education and Counseling92, 418-425.