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Improving intercultural patient-provider communication in the management of diabetes

Oct 29, 2019

Diabetes educators and healthcare providers are increasingly faced with providing care in a multicultural society, requiring them to be mindful of the traditions and customs among cultural and ethnic groups and to recognize socio-economic challenges that may exist.

When diabetes education programs and diabetes care are delivered using culturally appropriate methods, they can result in improved patient health behaviour, knowledge, health status, and self-efficacy.

Ensuring a safe and high-quality healthcare for all patients requires that diabetes educators and healthcare providers understand how each patient’s socio-cultural background affects his or her health beliefs and behaviours. When cultures and languages differs, diabetes educators and healthcare providers may be unable to deliver the care they have been trained to provide, while culturally-competent care depends on resolving systemic and individual cultural differences that can create misunderstandings and lead to negative health consequences.

A key element to overcoming cultural barriers during clinician-patient interactions is therefore the use of effective communication: a communication which is understandable and respectful when it is provided in a manner compatible with the cultural health beliefs, practices and preferred language of the patient.

The ability to communicate cross-culturally is essential to providing not only healthcare, but also education to diverse populations, as it enables the use of proper verbal and non-verbal communication styles across cultures. It also requires addressing contextual and cultural barriers that preclude effective patient-provider communication.

Research has shown that services for minorities can be improved by removing such language and cultural barriers. Patients who feel that their doctors listen to them and act in their best interest are more inclined to seek help from professional providers in times of need.

One framework that can guide diabetes educators and healthcare professionals in providing culturally-sensitive care and diabetes education to people with diabetes is the ESFT model, known by this mnemonic: 

  • Explanatory model of health and illness
  • Social and environmental factors
  • Fears and concerns
  • Therapeutic contracting

Developed by Joseph Betancourt, MD, Alexander Green, MD, and J. Emilio Carrillo, MD, this model provides a series of questions that can uncover factors that affect a patient's self-efficacy to manage treatment — such as motivations, fears about medications, or economic struggles.

Nurses and other healthcare providers have used this model to engage patients in culturally responsive conversations and uncover potential threats to treatment management. Healthcare providers have used this model to improve healthcare outcomes and address health disparities. The ESFT model helps clinicians identify barriers to management and recognize culturally appropriate strategies to help improve outcomes.

This section will present a scenario where patient–provider communication was not effective. Another scenario will follow where the ESFT model will be used to show effective patient–provider communication that addresses cultural differences. It will also highlight ideas to improve patient-provider communication.


In this discussion, members are asked:

  1. As a healthcare provider, do you consider the context of learning experiences already present when developing collaborative efforts with the patient to identify barriers to diabetes care success?
  2. How do you incorporate sensitivity and respect when educating all people irrespective of ethnicity, race, age, and socioeconomic status?
  3. How do you ensure that you are using educational materials and resources appropriate for culture, age, literacy level, and learning readiness?
  4. How you do acknowledge that cultural perceptions of health can be unique for everyone?
Additional readings:
American Association of Diabetes Educators Website (AADE)
AADE Practice Synopsis, Special Considerations in the Management and Education of Older Persons with Diabetes

Information about the discussion leader

Ms. Betsy Rodríguez is a Senior Public Health Advisor. She is also a nurse, diabetes educator, national and international speaker on diabetes-related topics, health communications bi-cultural specialist, and author. She received her Master’s Degree in the Sciences of Nursing from the Pontifical Catholic University in 1990, majoring as a critical care nurse specialist in chronic diseases with a minor in education and administration. She has been working in diabetes education for more than 25 years and in this capacity, she developed all the Spanish diabetes education resources of the National Diabetes Educations Program at CDC. Betsy was also one of the key members of the Federal Group for the establishment of the HHS-OMH Promotores de Salud Initiative. In this group, she co-lead the First H/L Promotores Initiative. Betsy is the author of the CDC Prevent T 2 Spanish curriculum and worked the adaptation into Chinese and Vietnamese versions of the curriculum. Mrs. Rodríguez provides TA and training to state health departments, national and international diabetes-related professional organizations. She is a current the chair of the ADA National Health Disparities Committee; and a member of the Blue Circle Voices of Diabetes from the International Diabetes Federation.

This is the tenth in a series of discussions introducing some of the programme sessions that will be featured at the IDF Congress 2019 in Busan, Korea, 2-6 December 2019.