Communicating with older diabetes patients: Self-management and social comparison

Objective: The health status and life experiences of older diabetes patients may be highly heterogeneous, thus making their perspectives particularly relevant for developing individualized self-management plans for this population. Our earlier research showed older diabetes patients' healthcare goals and self-management behaviors are frequently shaped through social comparisons with peers/family members. The present paper explores this role of social comparison in their self-management practices and develops a conceptual model depicting the process. Methods: Data were collected using open-ended, semi-structured interviews to elicit 28 older, type 2 diabetes patients' healthcare goals and self-management practices. Qualitative techniques were used to extract salient themes. Results: Social comparison plays a salient role in routinizing older patients' self-management practices. Almost all patients assess their self-management by making downward comparisons with individuals doing worse than them; upward comparisons are rarely invoked. Occasionally patients' social comparisons lead them to adopt normalizing behaviors resulting in deviations from medically recommended self-care. Conclusion: The findings formed the basis for developing a conceptual model delineating the role of social comparison in self-management that can be beneficial for providers in tailoring educational interventions for self-management. Practice implications: Fostering these comparisons can help providers enhance communication on initiating and sustaining self-management practices. (C) 2008 Elsevier Ireland Ltd. All rights reserved.