“Those risks, that preventative work, that is the bedrock of family medicine”: A foucauldian discourse analysis of communicating risk for type 2 diabetes among primary care providers
Bibliographic record
Abstract
With estimates suggesting 350 million individuals are at-risk for type 2 diabetes (T2D), there is an urgent need to critically understand the processes of risk communication with primary care providers. Prior research has shown that primary care is the most likely place where initial conversations with a patients about T2D risk occur, but there remains a paucity of research exploring what may govern this communication. The purpose of this study was to critically explore discourses of risk for preventing T2D from the perspective of primary care providers. Semi-structured interviews (n = 14) were conducted with primary care providers including family physicians (n = 4), medical residents (n = 2), nurses (n = 3), dietitians (n = 4), and a pharmacist (n = 1) working in family health team (FHT) clinics in Southwestern, Ontario, Canada. Foucauldian Discourse Analysis through thematic analysis was applied to analyze the data and generate themes detailing how provider communications about risk for T2D are governed through discourse. Themes included: (1) patient-centred practice; (2) diagnosing prediabetes; (3) contextualizing symptoms; (4) time contingent; (5) adapting to patient knowledge; (6) carefully discussing weight; and (7) age as a balancing act. Overall, providers note using discourses of patient-centred practice to guide approaches to communicating about risk for T2D to patients. There are tensions with fulfilling this ideal patient-centred approach from more powerful discourses of prediabetes, assumptions about patient knowledge, and age that may override the ability to be patient-centred with communications about risk for T2D.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".