Provider-patient communication and metabolic control.

OBJECTIVE: To determine whether nurses' and NIDDM patients' communication styles during consultations are related to subsequent metabolic control and to examine factors influencing patterns of communication in these consultations. RESEARCH DESIGN AND METHODS: A total of 47 NIDDM patients participated in the study and completed the following procedures: 1) assessment of baseline HbA1, 2) attended 3.5 days of diabetes education, 3) returned in 1 mo for a follow-up consultation with a nurse, and (4) returned in 9-12 wk for a follow-up HbA1 assessment. The communication variables coded from the consultations were the frequency with which nurses produced controlling, informative, and patient-centered utterances and the frequency with which patients sought information, engaged in decision making, and expressed negative affect. RESULTS: The results were as follows: 1) patients experienced poorer metabolic control after interacting with nurses who were more controlling and directive in their communication with patients (r = 0.39, P < 0.01); 2) the nurses' use of patient-centered responses was directly related to the degree to which patients expressed feelings (r = 0.34, P < 0.01) and exhibited decision-making behavior (r = 0.62, P < 0.01); and 3) several of the nurses' and patients' communicative behaviors were related to patient characteristics such as age, sex, education, and baseline HbA1 levels. CONCLUSIONS: The results suggest that providers' attempts to exert considerable control during consultations with NIDDM patients may be counterproductive and contribute to poorer outcomes. The findings also indicate that patient-centered behaviors (e.g., encouraging the patient's involvement, respecting the patient's opinion, and offering support) facilitate the patient's ability to be an active participant in the consultation.

Efficacy of diabetes education: classroom versus individualized instruction.

A pilot study was conducted using the concerns based adoption model (CBAM) developed at the University of Texas-Austin. This model uses two diagnostic dimensions: stages of concern (SC) and levels of use (LU). Movement in these dimensions is an important determinant of self-motivated disease management. It is postulated that this self-motivation is the basis of long-term adherence to the patient's therapeutic regimen and results in the decreased use of medical services. Twenty patients who attended a series of formal diabetes education classes were compared with 20 patients who received individualized instruction. Classroom education was significantly more effective in increasing the SC about diabetes management. However, the increase in LU (technical skills) was not significantly different in either setting. At 2- to 3-month follow-up evaluation, results indicated that retention of skills and motivation are excellent and that SC and LU continued to improve. In summary, this study demonstrated that classroom education is technically equivalent, more cost-effective, and may be more conducive to learning than individualized instruction.