Speaking of Health Assessing Health Communication Strategies for Diverse Populations (2002) / Chapter Skim
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154 5 The Diabetes Exemplar INTRODUCTION Although a number of useful studies have been conducted on clinical interventions for Type 2 diabetes (e.g., Diabetes Prevention Program, 1997-2002; United Kingdom Perspective Diabetes Study, 1987-2001) , the literature is disappointingly sparse on communication interventions to change behavior related to the prevention and treatment of diabetes in diverse populations.
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The Diabetes Exemplar 155 sequelae in the general population and in ethnic minority populations; and present factors to be considered in developing effective and testable communication interventions for the prevention and control of diabetes in the future.
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156 SPEAKING OF HEALTH time frame for its prevention and the control of its adverse consequences differ for medical practitioners who embrace a biomedical perspective on diabetes, patients who hold to cultural and experience-based common-sense beliefs of the disease, and family members and friends whose perspective on diabetes and its control is shaped by cultural knowledge and observation of diabetic persons. Understanding the various perspectives on diabetes and how they may affect one another is essential to creating communication programs that are effective in changing patterns of behavior to improve diabetes control.
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The Diabetes Exemplar 157 DIABETES AND DIVERSE POPULATIONS Three sets of concepts and data comprise the "bedrock" for the development of messages and programs for diabetes control from the framework of the biomedical model: (1) physiological concepts and data describing the underlying disease process, (2)
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158 SPEAKING OF HEALTH lin, resulting in the failure of transport of sugars across cell membranes; the net result is elevated blood sugar levels (American Diabetes Association, 2000; Centers for Disease Control and Prevention, 2000a)
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The Diabetes Exemplar 159 more likely to develop diabetes than age-matched non-Hispanic whites (Bonham and Brock, 1985; Carter, Pugh, and Monterrosa, 1996; Harris, 1991; O'Brien et al., 1989; Wetterhall et al., 1992)
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160 SPEAKING OF HEALTH et al., 1989; Stahn, Gohdes, and Valway, 1993; Hendricks and Haas, 1991; Johnson and Strauss, 1993; Martinez and Strauss, 1993; Muneta et al., 1993; Murphy et al., 1992; Rith-Najarian, Valway, and Gohdes, 1993; Schraer et al., 1988; Sugarman and Percy, 1989; Valway, Linkins, and Gohdes, 1993)
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The Diabetes Exemplar 161 An estimated 97 million adults in the United States are either overweight or obese, and approximately 75 percent engage in no or only minimal physical activity on a regular basis (National Institutes of Health, 1998; U.S. Department of Health and Human Services, 1996)
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162 SPEAKING OF HEALTH Social and Cultural Disparities in Medical Consequences of Diabetes Not only is diabetes more prevalent among diverse populations, but its consequences are more serious. Moreover, the costs are not evenly distributed: They are borne more heavily by ethnic minorities.
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The Diabetes Exemplar 163 bidity and Mortality Weekly Report, 2000; Nelson and Bennett, 1989; Quiggins and Farrell, 1993; Stahn, Gohdes, and Valway, 1993)
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164 SPEAKING OF HEALTH shaped by multiple sources of information (as noted in the discussion of behavioral theory in Chapter 2)
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The Diabetes Exemplar 165 among diabetic individuals in all communities. Differences appear, however, in the prevalence and precise meaning of the factors within each domain.
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166 SPEAKING OF HEALTH to relatively uncontrollable factors will lead to low community efficacy, with adverse effects on personal efficacy. Problems controlling diet were pronounced and common to all groups.
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The Diabetes Exemplar 167 these can create a sense of unease and hesitation to adopt and adhere to weight reduction programs. Another example concerns the role of symptoms and feeling states as motivators and deterrents to diabetes-healthy diets.
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168 SPEAKING OF HEALTH exercise by the former (Summerson, Konen, and Dignan, 1992)
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The Diabetes Exemplar 169 such as auto accidents and prior illnesses (Hunt, Valenzuela, and Pugh, 1998)
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170 SPEAKING OF HEALTH fined, both mass media and interpersonal communication of various types (e.g., doctor and investigator with participants, participants with family members and friends) , is involved in all three types of studies.
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The Diabetes Exemplar 171 over a long time period with a median followup of 11 years. More than 60 research papers have published findings from this program.
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172 SPEAKING OF HEALTH followup, the percentage that had maintained these goals over time was 38 percent and 58 percent, respectively. Behaviors such as dieting and exercise for weight loss define two of the complex, difficult-to-change behaviors important for both primary and secondary prevention: Dieting requires regulating an appetitive response, while exercise requires the introduction of a time-consuming change in lifestyle that can be physically distressing.
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The Diabetes Exemplar 173 exercise and other health behaviors is distressingly small (Leventhal et al., 2001)
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174 SPEAKING OF HEALTH controllable causes, may undermine self-efficacy motivation, resulting in failure to sustain behavioral change. An Education Program to Influence Behavior The National Diabetes Education Program (2002)
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The Diabetes Exemplar 175 tural barriers)
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176 SPEAKING OF HEALTH ences are specified, however, this assumption remains little more than an empty truism. The hypothesis, that behavioral theory has a critical role to play in assuring success, has a similar empty status until theory is translated into specific communication content and structure, and delivered in appropriate channels.
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The Diabetes Exemplar 177 1. Does the behavior make sense given the model of the disease held by the recipient audience?
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178 SPEAKING OF HEALTH he or she has failed to change behavior if the criteria for evaluating success are inappropriate. For example, if expectations for weight loss are unrealistic, such as 5-pound changes in a week, appropriate changes of 1 to 2 pounds a week may be read as failures, leading to nonadherence and rejection of prior and future health messages.
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