Promoting Stigma-Free Language in Type 2 Diabetes Care Among Primary Care Clinicians: Randomized Controlled Pilot...

The American Diabetes Association and the Association of Diabetes Care & Education Specialists recommend person-first, strengths-based, and stigma-free language in diabetes care and education. However, interventions to promote stigma-free language among primary care clinicians remain limited.

This mixed methods pilot study aimed to evaluate the acceptability and preliminary effects of a diabetes stigma-reduction training module for primary care clinicians, designed to increase awareness of language used in clinician-patient interactions and explore changes in attitudes and intentions toward avoiding stigmatizing language.

Twenty-one primary care clinicians completed either a stigma-reduction training module (n=12) or an active control condition (n=9). Both conditions included a standardized patient encounter, an educational video, and a guided self-reflection activity. The stigma-reduction training module included diabetes-specific content on stigmatizing language and person-first, strengths-based alternatives. Theory of Planned Behavior domain measures were administered before and immediately after the assigned condition. Attitudes and intentions were assessed precondition and postcondition. Acceptability was evaluated using a postcondition survey and semistructured qualitative interviews. Repeated-measures ANOVA was used to assess between-group changes over time, and a qualitative descriptive approach was used to explore clinicians' perceptions.

Clinicians who received the stigma-reduction training module demonstrated significantly greater improvement in attitudes toward avoiding stigmatizing language compared with clinicians in the active control condition, with mean attitude scores increasing by 1.19 (SD 0.68) points versus 0.21 (SD 0.44) points, respectively. A significant condition × time interaction was observed (F1,19=14.27; P=.001, partial η2=0.43, Cohen d=1.67). The between-group difference in intention change was not statistically significant, with mean intention scores increasing by 0.69 (SD 1.08) points in the stigma-reduction training module condition versus 0.02 (SD 0.90) points in the active control condition (F1,19=2.33; P=.14, partial η2=0.11, Cohen d=0.67). Acceptability ratings were higher for the stigma-reduction training module than for the active control condition for clarity (mean 6.17, SD 0.72 vs mean 4.44, SD 1.74; P=.02), helpfulness (mean 6.08, SD 1.00 vs mean 4.56, SD 1.59; P=.03), and likelihood of recommendation (mean 6.25, SD 0.87 vs mean 4.56, SD 1.67; P=.02). The qualitative findings suggested that clinicians perceived the stigma-reduction training module as actionable, relevant to primary care, and useful for promoting self-reflection about habitual language use. The active control condition was generally perceived as a useful refresher but less novel and impactful.

This pilot study suggests that a brief, theory-informed diabetes stigma-reduction training module is acceptable and associated with improved clinician attitudes toward stigmatizing language in a simulated clinical environment. Changes in intentions were descriptively in the expected direction but did not reach statistical significance. The findings should be interpreted cautiously, given the small sample size and lack of behavioral outcome assessment. Future studies should evaluate the module in larger, more diverse samples and assess whether changes in attitudes translate into sustained changes in clinician language use and patient experiences.