Discussions of diabetes management are challenging for patients and physicians during treatment plan appointments—in large part because “diabetes management” has multiple, competing meanings. Our goal in this study was to examine talk between patients and physicians over multiple visits to: (1) determine the multiple meanings of diabetes management, and (2) determine the specific ways these meanings compete with each other. To accomplish this goal, we gathered data at a family medicine residency clinic in the Midwestern United States, video-recording the interactions of six different patient-physician dyads over multiple visits. Next, we performed in-depth analyses of these interactions using Baxter’s (2011) Relational Dialectics Theory 2.0, which focuses on discourses occurring within interpersonal interactions, rather than on the individuals within interpersonal interactions. Our results reveal meanings associated with two dominant oppositional discourses comprising the meaning of diabetes management: high self-efficacy and low self-efficacy. Additionally, we found that—during conversations between patients and physicians—the central discourse of high self-efficacy competed with the less-central discourse of low self-efficacy. Our results also reveal that both patients and physicians used both discourses. Finally, our results revealed that at times, both patients and physicians mixed these discourses, creating a new “hybrid” meaning for diabetes management: Moderation. Understanding these discourses and how they compete can help physicians focus on the cultural discourses that shape their own and patients’ views of diabetes management and realize the transformational possibilities that can occur in treatment plan discussions through a more moderate discourse.


Patient-Physician Interaction, Diabetes, Video-Recorded Interaction, Discourse Analysis, Relational Dialectics Theory 2.0, High Self-Efficacy, Low Self-Efficacy

Author Bio(s)

Laura L. O’Hara (Ph.D., Ohio University, 1998) is an Associate Professor of Communication Studies at Ball State University. Dr. O’Hara’s research interests include health communication and critical-cultural studies in intercultural communication, education, and gender. She has presented and published research related to low-health literacy, diabetes, and communication; international students’ acculturation in U.S. higher education institutions; how race is discussed during the research process; how alternative groups are discursively constructed by “insider groups;” and alternative pedagogical strategies. Correspondence regarding this article can be addressed directly to: lohara@bsu.edu.

Carolyn K. Shue (Ph.D., Ohio University, 1997) is a Professor of Communication Studies at Ball State University in Muncie, Indiana. Dr. Shue's research focuses on the evaluation of communication processes in the clinical setting and understanding the connection between communication processes and health outcomes. She has presented and published research related to low-health literacy, diabetes, and communication; physician communication skills training and the clinical management of childhood obesity; and family communication processes that occur during the progression of Alzheimer's disease. She has professional experience in the area of medical education and assessment. Correspondence regarding this article can also be addressed directly to: ckshue@bsu.edu.

Publication Date


Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 International License.





To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.