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Communication and Medicine

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Lifestyle counseling in type 2 diabetes prevention: A case study of a nurse's communication activity to produce change talk

Tarja Kettunen / Marita Poskiparta / Päivi Kiuru / Kirsti Kasila
Published Online: 2006-06-19 | DOI: https://doi.org/10.1515/CAM.2006.002


As a case study, this article describes a nurse's communication activity, focusing on change talk during lifestyle counseling in primary healthcare. All videotaped counseling sessions with a single patient within a period of two years were transcribed verbatim. In the analysis, an emphasis was placed on the nurse's communication activity that produced change talk, how the nurse initiated change talk, and how the patient received it. The observations provide evidence that the dilemma of simultaneously maintaining professional authority and patient perspective leads to sensitivity in lifestyle counseling. Three categories of change talk were identified: rejected, restrictive, and expansive change talk. Producing change talk is a very demanding task for counselors. It is best produced when the nurse stays within the patient's frame of reference with a combination of reflective, change-inducing questions, encouraging assessments and conversational space. On the basis of our results, we suggest that nurses need training to identify and to encourage patients' change talk and to communicate flexibly according to patients' values during lifestyle counseling. In addition, in order to insist on change talk, we need to demonstrate how change talk could be carried out so that nurses could orient to it.

Keywords: type 2 diabetes; lifestyle; counseling; change; nurse; patient

About the article

Tarja Kettunen

Tarja Kettunen is a researcher at the Research Center for Health Promotion at the University of Jyväskylä, Finland. Her work centers on nurse–patient communication in hospital and primary care settings. She has published a range of articles in this area. Her research interests focus on issues of patient participation and empowerment. She has trained a large number of healthcare providers on these issues. She is currently involved in the Program for the Prevention of Type 2 Diabetes.

Marita Poskiparta

Marita Poskiparta is a Docent, a Senior Research Fellow, at the Research Center for Health Promotion at the University of Jyväskylä, Finland. She is also a lecturer of Health Education and Health Promotion at the University of Jyväskylä. She has published widely on health promotion and health counseling and has more than twenty years' experience in researching, teaching, and consulting in healthcare settings. She is currently involved in many projects, for example the Program for the Prevention of Type 2 Diabetes in Finland and Controlling Caries in the Present Conditions.

Päivi Kiuru

Päivi Kiuru is a Research Fellow at the Research Center for Health Promotion at the University of Jyväskylä, Finland. She is currently doing her doctoral work on health counseling and structures of interaction in counseling chains for type 2 diabetes and has published several articles in this area.

Kirsti Kasila

Kirsti Kasila is a Research Fellow at the Research Center for Health Promotion at the University of Jyväskylä, Finland. She is presently doing her doctoral work on interaction processes and methods of health counseling in the organizational culture context of oral health. She has published several articles in this area.

1Address for correspondence: University of Jyväskylä, Department of Health Sciences, Research Center for Health Promotion, P. O. Box 35 (L), FIN-40014 University of Jyväskylä, Finland.

Published Online: 2006-06-19

Published in Print: 2006-05-01

Citation Information: Communication & Medicine, Volume 3, Issue 1, Pages 3–14, ISSN (Online) 1613-3625, ISSN (Print) 1612-1783, DOI: https://doi.org/10.1515/CAM.2006.002.

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