Communicating with older diabetes patients: Self-management and social comparison☆
Introduction
Quote A: “……… my diabetes is under such excellent control because I know my friends; they eat such horrible things…” (Interview 16)
Quote B: “…. my aunt never drank,… never smoked, … never kept late hours…… ate well….and it's paying off for her….she's in excellent health for her age….and I mostly want to be independent (like her)….” (Interview 14)
The above quotes illustrate the ways in which patients invoke social comparison processes in the self-management of type 2 diabetes. In the first, the patient attributes her excellent diabetes control to her better eating habits compared to those of her friends. In contrast, in the second, the patient compares herself with a family member doing better than her at self-managing—a goal the patient aspires to.
Medical providers know that self-management is a critical factor for achieving and maintaining optimal blood glucose levels [1]. And since more than 95% of diabetes care needs to be performed by the patient [2], educating the patient is paramount for diabetes self-management [3], [4]. Over the years diabetes education material has begun to acknowledge priorities, goals, resources, culture and lifestyles of individual patients when developing self-management plans [5], [6], [7], [8], [9], [10]. A recent position statement by the American Association of Diabetes Educators (AADE) emphasizes: “The effectiveness of information (given patients) increases when it evolves from and is related to the participants’ experiences, beliefs and priorities” [11]. Since the health status and life experiences of older diabetes patients may be highly heterogeneous, seeking their perspectives is particularly germane for providers in efforts to develop effective self-management plans for them.
Our earlier research explored older diabetes patients’ healthcare goals, motivations shaping their goals, and actual self-care practices [12], [13]. The main findings of the study [12] were: (1) older patients express their healthcare goals in a social and functional language, and (2) healthcare goals are shaped by providers as well as by social comparison with peers/family members.
Social comparison is defined as behavior through which individuals assess themselves, and is generally invoked when “reality” cannot be measured by conventional physical devices, and thus needs to be socially defined [14]. Two underlying conditions are: (1) when “objective” means are not available, individuals evaluate their opinions and abilities through comparisons with those of others [15], [16] and (2) they are more likely to compare their attitudes with others similar on socio-demographic attributes rather than with those widely discrepant from themselves [17]. Social comparison has been shown to have a significant role in chronic pain and chronic diseases [18], and in Latino patients with diabetes [19]. However, its role in self-management in older diabetes patients has yet to be explored.
The specific goals of this paper are to examine: (1) how patients use social comparisons with peers/family members to construct their healthcare goals and self-management routines, (2) what functions are served by these comparisons and (3) develop a conceptual model to delineate how social comparison influences older diabetes patients’ self-management.
Section snippets
Sample and design
The present study is a secondary data analysis [20] of the sample detailed in a prior publication [12] and only a brief summary is delineated here. The sample of 28 older patients with diabetes was drawn from the general internal medicine, geriatrics and endocrinology clinics of The University of Chicago. IRB approval was obtained before patient recruitment.
This is an exploratory study using in-depth, one-on-one, semi-structured interviews with older type 2 diabetes patients (65 and over). A
Patient characteristics
The average age of patients was 74.3 (range: 66–87 years). They had lived with diabetes for an average of 9.1 years (range: 0.33–40 years). The sample was predominantly African-American (79%) and female (57%). The mean Charlson Comorbidity Index Score was 3.9 [12].
Stressful life-changing event and healthcare goals
Quote C: “….you go through your life, you retire, and then everything in your body breaks down, and you get hit with something like….you are diabetic….and now your entire life is about to change, and not for the better …. It's.
Discussion and conclusion
Older patients perceive the diagnosis of type 2 diabetes and consequent self-management recommendations as stressful life-changing events (Quote C). Also, they express their healthcare goals in functional terms, and it is conceivable that these might serve as precursors to making comparisons with others. While many factors (including media) may influence a patient's self-care practices, social comparison with peers/family members and education and counseling by healthcare providers emerged as
Conflict of interest statement
This is to certify that all three of the above named authors do not have any actual or potential conflict of interest including any financial, personal or other relationships with other people or organizations within three (3) years of beginning the submitted work that could inappropriately influence, or be perceived to influence their work.
Acknowledgements
The research reported in this paper was supported by The Section of Geriatrics (RGB), a Hartford Center of Excellence Pilot Grant (ESH), a National Institute on Aging Geriatric Academic Program Award (K12 AG000488 ESH), a National Institute on Aging Career Development Award (K23 AG021963 ESH), a National Institute of Diabetes and Digestive and Kidney Diseases Diabetes Research and Training Center (P60 DK20595—RGB, ESH and MHC) and a Mid-Career Investigator Award in Patient-Oriented Research
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2011, Clinical Psychology ReviewCitation Excerpt :Downward Social Comparison Theory (Wills, 1987) proposes that threatened people are more likely to compare themselves with others that are in a less favorable situation and that such downward comparisons are functional in boosting subjective well-being. These downward social comparisons reduce emotional discomfort (Gibbons & Gerrard, 1991; Jensen, Turner, Romano, & Karoly, 1991; Taylor, Wood, & Lichtman, 1983) and improve self-management of symptoms, for example in diabetes (e.g., Gorawara-Bhat, Huang, & Chin, 2008). A study using variations of the Implicit Association Test, a test of implicit attitudes based on reaction times, found that downward social comparison was changing the negative affective evaluation of asthma compared to when no explicit standard or a standard on a similar level was presented (Petersen & Ritz, 2010).
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An earlier version of this research was presented at the 2007 International Conference on Communication in Healthcare, Charleston, South Carolina, USA.