Discourses of prevention for veterans with chronic disease in primary care: Cues for health promotion planning

Health promotion program planning in public health rarely focuses on primary care settings and the communication needs of older people with chronic disease. The communication practices that older people with chronic disease receive and use with primary care providers regarding health promotion, prevention and wellness have been under-examined in relation to public health needs. Macro-level public health communication interventions neglect the baseline communication and health literacy practices involved in communicating health information with older adults and omit the role of primary care providers, who can produce contradictory messaging. As part of a larger study of racial variations in communication, decision making and diabetes outcomes in the Veterans Affairs (VA) health system, this qualitative study uses discourse analysis to define and examine discourses of health promotion and prevention involved in 40 provider-patient primary care discussions about diabetes, as a model for chronic disease public health-oriented micro-analysis. A sample of 20 Black and 20 White patients who had the highest and lowest A1c values, the test associated with glycemic control, were selected from a larger sample of 200 Veterans with diabetes. Contrasting patterns of communication practices emerge that can be used in intervention mapping to shape public health-primary care collaboration and potential interventions. Specific examples include gaps in primary and secondary prevention, cultural metaphors that go ignored, personal agency and context cues responsive to health promotion messages, and message details signaling differing health literacy needs. The application of qualitative methodology provides hypothesis generation and intervention components for potential health promotion program planning.