{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T21:33:32Z","timestamp":1786484012557,"version":"build-2736575974"},"reference-count":38,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Diabetes"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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\u2019 perceptions.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n 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 \u00d7 time interaction was observed (\n F<\/jats:italic>\n 1,19<\/jats:sub>\n =14.27;\n P<\/jats:italic>\n =.001, partial \u03b7\n 2<\/jats:sup>\n =0.43, Cohen\n d<\/jats:italic>\n =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 (\n F<\/jats:italic>\n 1,19<\/jats:sub>\n =2.33;\n P<\/jats:italic>\n =.14, partial \u03b7\n 2<\/jats:sup>\n =0.11, Cohen\n d<\/jats:italic>\n =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;\n P<\/jats:italic>\n =.02), helpfulness (mean 6.08, SD 1.00 vs mean 4.56, SD 1.59;\n P<\/jats:italic>\n =.03), and likelihood of recommendation (mean 6.25, SD 0.87 vs mean 4.56, SD 1.67;\n P<\/jats:italic>\n =.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.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/95805","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T21:12:46Z","timestamp":1786482766000},"page":"e95805-e95805","source":"Crossref","is-referenced-by-count":0,"title":["Promoting Stigma-Free Language in Type 2 Diabetes Care Among Primary Care Clinicians: Randomized Controlled Pilot Trial"],"prefix":"10.2196","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8356-2222","authenticated-orcid":false,"given":"Kevin L","family":"Joiner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1243-6249","authenticated-orcid":false,"given":"Alexandra","family":"Agapiou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6181-8058","authenticated-orcid":false,"given":"Alicia","family":"Carmichael","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5893-4469","authenticated-orcid":false,"given":"Brandon P","family":"Labbree","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1626-4470","authenticated-orcid":false,"given":"Donna","family":"Walter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8622-0790","authenticated-orcid":false,"given":"Houda","family":"Tarraf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5165-6951","authenticated-orcid":false,"given":"Medha","family":"Raju","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4628-6976","authenticated-orcid":false,"given":"Boluwatife","family":"Dogari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3933-8917","authenticated-orcid":false,"given":"Nao","family":"Hagiwara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4453-0490","authenticated-orcid":false,"given":"Sophia","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6334-0430","authenticated-orcid":false,"given":"Richard","family":"Gonzalez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"R1","unstructured":"National diabetes statistics report. Centers for Disease Control and Prevention (CDC). URL: https:\/\/www.cdc.gov\/diabetes\/php\/data-research\/index.html [Accessed 09-01-2026]"},{"issue":"2","key":"R2","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1111\/dom.13088","article-title":"Therapeutic inertia in the treatment of hyperglycaemia in patients with type 2 diabetes: a systematic review","volume":"20","author":"Khunti","journal-title":"Diabetes Obes Metab"},{"issue":"1","key":"R3","doi-asserted-by":"publisher","first-page":"258","DOI":"10.2337\/dci20-0053","article-title":"Social determinants of health and diabetes: a scientific review","volume":"44","author":"Hill-Briggs","journal-title":"Diabetes Care"},{"issue":"11","key":"R4","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-003384","article-title":"'I call it the blame and shame disease': a qualitative study about perceptions of social stigma surrounding type 2 diabetes","volume":"3","author":"Browne","journal-title":"BMJ Open"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2021.108655","article-title":"Our language matters: improving communication with and about people with diabetes. A position statement by Diabetes Australia","volume":"173","author":"Speight","journal-title":"Diabetes Res Clin Pract"},{"issue":"1","key":"R6","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1146\/annurev.soc.27.1.363","article-title":"Conceptualizing Stigma","volume":"27","author":"Link","journal-title":"Annu Rev Sociol"},{"issue":"1","key":"R7","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/S2213-8587(23)00347-9","article-title":"Bringing an end to diabetes stigma and discrimination: an international consensus statement on evidence and recommendations","volume":"12","author":"Speight","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"5","key":"R8","doi-asserted-by":"publisher","first-page":"658","DOI":"10.1111\/dme.13598","article-title":"Diabetes stigma is associated with negative treatment appraisals among adults with insulin-treated type 2 diabetes: results from the second Diabetes MILES - Australia (MILES-2) survey","volume":"35","author":"Holmes-Truscott","journal-title":"Diabet Med"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2020.108387","article-title":"Weight stigma and diabetes stigma in U.S. adults with type 2 diabetes: associations with diabetes self-care behaviors and perceptions of health care","volume":"168","author":"Puhl","journal-title":"Diabetes Res Clin Pract"},{"issue":"11","key":"R10","doi-asserted-by":"publisher","first-page":"2137","DOI":"10.1007\/s13300-025-01795-8","article-title":"Examining the relationship between weight stigma, diabetes stigma, and HbA1c in adults with type 2 diabetes","volume":"16","author":"Sims","journal-title":"Diabetes Ther"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1111\/dme.70311","article-title":"From language matters to stigma-free communication in diabetes: evolution, challenges, and next steps","author":"Holmes-Truscott","journal-title":"Diabet Med"},{"key":"R12","unstructured":"NIMHD research framework. National Institute on Minority Health and Health Disparities (NIMHD). 2025. URL: https:\/\/www.nimhd.nih.gov\/resources\/nimhd-research-framework [Accessed 09-01-2026]"},{"issue":"1 Suppl 1","key":"R13","doi-asserted-by":"publisher","first-page":"S27","DOI":"10.2337\/dc25-S002","article-title":"2. Diagnosis and classification of diabetes: standards of care in diabetes-2025","volume":"48","author":"American Diabetes Association Professional Practice Committee","journal-title":"Diabetes Care"},{"issue":"12","key":"R14","doi-asserted-by":"publisher","first-page":"2186","DOI":"10.1016\/j.pec.2018.08.021","article-title":"Communicating with diverse patients: how patient and clinician factors affect disparities","volume":"101","author":"P\u00e9rez-Stable","journal-title":"Patient Educ Couns"},{"issue":"Supplement_1","key":"R15","doi-asserted-by":"publisher","first-page":"S89","DOI":"10.2337\/dc26-S005","article-title":"5. Facilitating positive health behaviors and well-being to improve health outcomes: standards of care in diabetes-2026","volume":"49","author":"American Diabetes Association Professional Practice Committee for Diabetes","journal-title":"Diabetes Care"},{"issue":"6","key":"R16","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1370\/afm.3175","article-title":"Diabetes management: a case study to drive national policy change in primary care settings","volume":"22","author":"Bannuru","journal-title":"Ann Fam Med"},{"issue":"12","key":"R17","doi-asserted-by":"publisher","first-page":"1790","DOI":"10.2337\/dci17-0041","article-title":"The use of language in diabetes care and education","volume":"40","author":"Dickinson","journal-title":"Diabetes Care"},{"issue":"2","key":"R18","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/0749-5978(91)90020-T","article-title":"The theory of planned behavior","volume":"50","author":"Ajzen","journal-title":"Organ Behav Hum Decis Process"},{"issue":"1","key":"R19","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-019-1256-2","article-title":"Stigma in health facilities: why it matters and how we can change it","volume":"17","author":"Nyblade","journal-title":"BMC Med"},{"issue":"1","key":"R20","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-019-1271-3","article-title":"The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas","volume":"17","author":"Stangl","journal-title":"BMC Med"},{"issue":"10","key":"R21","doi-asserted-by":"publisher","DOI":"10.1111\/obr.13494","article-title":"Effective strategies in ending weight stigma in healthcare","volume":"23","author":"Talumaa","journal-title":"Obes Rev"},{"key":"R22","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2024-081123","article-title":"CONSORT 2025 statement: updated guideline for reporting randomised trials","volume":"389","author":"Hopewell","journal-title":"BMJ"},{"key":"R23","unstructured":"Health Research University of Michigan. URL: https:\/\/umhealthresearch.org\/ [Accessed 09-01-2026]"},{"key":"R24","unstructured":"University of Michigan HomeLab Core Facility (RRID:SCR_026753). RRID Portal. URL: https:\/\/rrid.site\/data\/record\/nlx_144509-1\/SCR_026753\/resolver [Accessed 19-06-2026]"},{"key":"R25","doi-asserted-by":"publisher","DOI":"10.1017\/S1463423625100728","article-title":"An educational video to promote the use of stigma-free language by primary care clinicians in interactions with adults with type 2 diabetes: a qualitative study","volume":"27","author":"Joiner","journal-title":"Prim Health Care Res Dev"},{"key":"R26","unstructured":"Communication skills: a patient-centered approach. wmumed YouTube page. Jul 9, 2015. URL: https:\/\/www.youtube.com\/watch?v=S4wWClQhZaA [Accessed 09-01-2026]"},{"key":"R27","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-14-101","article-title":"Getting under the skin of the primary care consultation using video stimulated recall: a systematic review","volume":"14","author":"Paskins","journal-title":"BMC Med Res Methodol"},{"issue":"1","key":"R28","doi-asserted-by":"publisher","DOI":"10.1177\/1609406917719623","article-title":"Exploring the added value of video-stimulated recall in researching the primary care doctor\u2013patient consultation","volume":"16","author":"Paskins","journal-title":"Int J Qual Methods"},{"issue":"1","key":"R29","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1080\/09515070600589719","article-title":"The self-confrontation method: theory, research, and practical utility","volume":"19","author":"Lyddon","journal-title":"Couns Psychol Q"},{"key":"R30","unstructured":"Ajzen I . Constructing a theory of planned behavior questionnaire. University of Massachusetts Amherst; 2006. URL: https:\/\/people.umass.edu\/aizen\/pdf\/tpb.measurement.pdf [Accessed 09-01-2026]"},{"issue":"10","key":"R31","doi-asserted-by":"publisher","first-page":"1076","DOI":"10.1001\/archinte.167.10.1076","article-title":"Helping patients with type 2 diabetes mellitus make treatment decisions: statin choice randomized trial","volume":"167","author":"Weymiller","journal-title":"Arch Intern Med"},{"issue":"4","key":"R32","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1002\/1098-240x(200008)23:4<334::aid-nur9>3.0.co;2-g","article-title":"Whatever happened to qualitative description?","volume":"23","author":"Sandelowski","journal-title":"Res Nurs Health"},{"issue":"2","key":"R33","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1093\/clipsy.8.2.133","article-title":"A stage model of behavioral therapies research: getting started and moving on from stage I","volume":"8","author":"Rounsaville","journal-title":"Clin Psychol Sci Pract"},{"issue":"Suppl 2","key":"R34","doi-asserted-by":"publisher","first-page":"S57","DOI":"10.5014\/ajot.2014.685S03","article-title":"Use of simulated patients and reflective video analysis to assess occupational therapy students\u2019 preparedness for fieldwork","volume":"68 Suppl 2","author":"Giles","journal-title":"Am J Occup Ther"},{"issue":"10234","key":"R35","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.1016\/S0140-6736(20)30846-1","article-title":"A call for grounding implicit bias training in clinical and translational frameworks","volume":"395","author":"Hagiwara","journal-title":"Lancet"},{"issue":"6","key":"R36","doi-asserted-by":"publisher","first-page":"1267","DOI":"10.1016\/j.jesp.2012.06.003","article-title":"Long-term reduction in implicit race bias: a prejudice habit-breaking intervention","volume":"48","author":"Devine","journal-title":"J Exp Soc Psychol"},{"key":"R37","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-10-109","article-title":"Barriers and facilitators to recruitment of physicians and practices for primary care health services research at one centre","volume":"10","author":"Johnston","journal-title":"BMC Med Res Methodol"},{"issue":"8","key":"R38","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1046\/j.1525-1497.2000.02329.x","article-title":"Problems in recruiting community-based physicians for health services research","volume":"15","author":"Asch","journal-title":"J Gen Intern Med"}],"container-title":["JMIR Diabetes"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T21:12:48Z","timestamp":1786482768000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetes.jmir.org\/2026\/1\/e95805"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,11]]},"references-count":38,"URL":"https:\/\/doi.org\/10.2196\/95805","relation":{},"ISSN":["2371-4379"],"issn-type":[{"value":"2371-4379","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,11]]},"article-number":"v11i2e95805"}}