Appeal to emotion, interpersonal relevance important in diabetes risk communication

Communicating the risks of type 2 diabetes (T2D) needs to be done in an emotionally impactful way while also having an interpersonal appeal, according to a recent Singapore study. To improve the uptake of healthy lifestyle practices, shifting from a long-term view of the disease to more short-term, observable benefits may be valuable.

“Lay beliefs and perceptions of T2D risk are contextual, shaped by social representations of the disease conditions and cultural practices relating to T2D prevention,” the researchers said. “Cue to initiate behaviour needs to be emotionally driven in collective contexts while sustaining behaviour is through individual positive feedback from observed short-term benefits.”

Forty-one adults were interviewed to assess the popular beliefs around T2D, the drivers of these perceptions, and their cost-benefit assessments of adopting preventive lifestyle behaviours.

All participants had good awareness of diabetes and its risk factors, including obesity, diet, family history, and a sedentary lifestyle. They also knew its common symptoms, such as frequent urination, weight fluctuation, and “sweet pee.” [BMC Public Health 2022;22:1582]

There was also a good general understanding of how T2D progresses. In general, participants perceived early-stage diabetes as more of an inconvenience due to the need for daily medication and dietary adjustments, though they thought that later T2D stages were “disastrous to quality of life.” Nevertheless, they felt that advanced disease was a distant possibility, and that the slow progression of T2D made it less life-threatening as other chronic conditions.

Of note, while most participants sought out expert advice on T2D, they only did so after a triggering event—that is, someone in their circle had also been recently diagnosed, or a scheduled health screen prompted them to. In particular, many flagged the medical jargon and amount of information as overwhelming.

Food, exercise, and culture

An important theme that emerged during the interviews is the participants’ relationship with food.

Many shared that dietary restrictions, either to prevent or manage T2D, would be of high personal impact in a country like Singapore, where local food culture is tied intimately with the Singaporean identity.

“Our culture is about eating – we have a fusion of food and all kinds of foods from all around the world. Even if healthier, people do not want to meet friends over a fruit platter. They will meet for a Korean barbeque. So, from a cultural perspective, it’s very hard to disconnect from food,” said one participant.

Moreover, healthier food options tend to be more expensive and are more time-consuming to prepare.

In turn, many considered adopting a healthy diet to prevent T2D as a net loss for their lifestyle, as such measures reduced their enjoyment and would make social events and relationships less satisfying for them. Some participants also pointed out that food served as a break from the stress of work or daily life.

Work was also cited as a barrier to physical activity, with many participants saying that while they did want to exercise and understood both its short- and long-term benefits, work and other responsibilities often just have higher priority than exercise.

“In the study, dietary change was generally perceived negatively due to the hedonistic approach to food and its strong association with Singapore food culture and social interactions,” the researchers said. Meanwhile, “[t]ime needed for physical activity can also be overshadowed by competing priorities of work and familial commitments. However, exercise was perceived to have short-term gains related to wellness and physical performance.

“[T]he differential view of loss and gain associated with healthy eating and exercise could influence the varied sustainability of the respective behaviours,” they added.