• Geoffrey Meshack Likata Ungaya School Of Communication and Development Studies Jomo Kenyatta University of Agriculture and Technology
  • Professor Hellen K. Mberia School Of Communication and Development Studies Jomo Kenyatta University of Agriculture and Technology
  • Dr. Kyalo Wa Ngula School of Communication Chuka University
  • Dr. William Kiprono Sigilai Senior Medical Specialist Diabetes and Endocrinology Unit Kenyatta National Hospital
  • Dr. Saira Sokwalla Head of Department Diabetes Care Center MP Shah Hospital



Healthcare provider patient communication, Verbal Language Use, Diabetes Mellitus, Management Practices, Patients, Healthcare providers


Purpose: To establish the effect of healthcare provider patient verbal language use on diabetes mellitus management practices in selected hospital in Kenya.

Methodology: This was a causal comparative research study design with application of quantitative and qualitative methodology. The study was carried out at the outpatient diabetic clinics of Kenyatta National Hospital and MP Shah Hospital. 400 patient participants were involved in the study and comprised of 313 patients at Kenyatta National Hospital (KNH) and 87 patients at MP Shah respectively studied between the months of February 2019 and November 2019. A researcher administered questionnaire was used to collect data. The results were summarized using percentages and means or medians for categorical and continuous data respectively. Comparisons were done using chi square test of association of categorical variables and independent t-test for comparison of means. Linear regression and ANOVA were used to test for associations and hypothesis between healthcare provider patient verbal language use (VLU) and diabetes mellitus management practices (DMMPs).

Results: Patients at MP Shah Hospital rated the verbal language use significantly higher than the patients at KNH (p< 0.001). However, linear regression analysis showed that verbal language use was not statistically significant overall in Kenya [β=0.04, (95% CI -0.09, 0.17), p=0.552], at KNH [β=0.05, (95% CI -0.10, 0.19), p=0.513] and MP Shah Hospital [β=0.09, (95% CI -0.21, 0.39), p=0.552]; (P > 0.05), hence the failure to reject the null hypothesis. Therefore, there was no significant effect of verbal language use by the healthcare provider and the patient on diabetes mellitus management practices in selected hospitals Kenya.

Unique contribution to theory, practice and policy: Verbal language use though important in healthcare provider patient interactions was not responsible for improvement in the diabetes mellitus management practices among the patients. Therefore, verbal language use by the healthcare providers in their communication interaction with patients need to be reinforced in healthcare practice to ensure improved DMMPs. Strategies should be developed to enhance verbal language use through educational curriculum development and implementation at the medical training institutions.


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Author Biographies

Geoffrey Meshack Likata Ungaya, School Of Communication and Development Studies Jomo Kenyatta University of Agriculture and Technology

Post Graduate Student

Professor Hellen K. Mberia, School Of Communication and Development Studies Jomo Kenyatta University of Agriculture and Technology


Dr. Kyalo Wa Ngula, School of Communication Chuka University



Abdulhadi, N., Al Shafaee, A., Freudenthal, S., Östenson, C and Wahlström, R. (2007). Patient provider interaction from the perspectives of type 2 diabetes patients in Muscat, Oman: a qualitative study. BMC Health Services Research, 7:162 doi: 10.1186/1472-6963-7-162

Abdulhadi, N., Al-Shafaee, M.A., Östenson, C., Vernby, A., and Rolf Wahlström, R. (2006). Quality of interaction between primary health-care providers and patients with type 2 diabetes in Muscat, Oman: an observational study. .BMC Family Practice, 7:72 doi: 10.1186/1471-2296-7-72

Abdulhadi, N.M.N., Al-Shafaee, M.A., Wahlström, R., and Hjelm, K. (2013). Doctors’ and nurses’ views on patient care for type 2 diabetes: an interview study in primary health care in Oman. Prim Health Care Res Dev, 14(3): 258–269.

doi: 10.1017/S146342361200062X PMCID: PMC3682753

Adhikary. G., Shawon .M.S.R., Ali. M.W., Shamsuzzaman.M., Ahmed. S., Shackelford. K.A, Woldeab. A., Alam. N., Lim.S.S., Levine. A., Gakidou. E., Uddin. J. (2018). Factors influencing patients’ satisfaction at different levels of health facilities in Bangladesh: Results from patient exit interviews. PLoS ONE, 13(5): e0196643. doi:10.1371/journal.pone.0196643

Alhodaib, H. (2014). Information technology in DM [internet]. Diapedia, 81040851628 rev. no. 7. Available from:

Alzaid, A. (2014). There Is A Missing Ingredient In Diabetes Care Today. Diabetes Technology & Therapeutics, 16(8), 542-544. Doi:10.1089/dia.2014.0076 PMCID: PMC4129926

Azevedo.M., and Alla.S. (2008). Diabetes in Sub-Saharan Africa: Kenya, Mali, Mozambique, Nigeria, South Africa and Zambia. Int J Diabetes Dev Ctries, 28(4): 101–108. doi: 10.4103/0973-3930.45268 PMCID: PMC2822152

Babbie, E.R (2010). The Practice of Social Research. 12th ed. Belmont, CA: Wadsworth; London : Cengage.

Baltaci.D., Eroz.R., Ankarali.H., Erdem.O., Celer.A., Korkut.Y (2013). Association between Patients' Sociodemographic Characteristics and their Satisfaction with Primary Health Care Services in Turkey. Kuwait Medical Journal; 45 (4): 291 - 299

Berger, C. R. (1986). Uncertainty outcome values in predicted relationships: uncertainty reduction theory then and now. Human Communication Research, (13)34-38.

Berger, C.R., & Calabrese, R.J. (1975). Some explorations in initial interaction and beyond: Toward a developmental theory of interpersonal communication. Human Communication Research, 1(2), 99-112. pg.99

Bylund.C.L.B., Peterson, E.B & Cameron, K.A. (2012). A practitioner’s guide to interpersonal communication theory: An overview and exploration of selected theories. Patient Educ Couns, 87(3): 261–267. doi: 10.1016/j.pec.2011.10.006. PMCID: PMC3297682 NIHMSID: NIHMS340567

Campos.C. (2006). Narrowing the Cultural Divide in Diabetes Mellitus Care: A Focus on Improving Cultural Competency to Better Serve Hispanic/Latino Populations. Insulin, 1(2), 70–76

Cohen.L., Manion.L & Morrison.K(2007). Research Methods in Education. Routledge, 270 Madison Avenue, New York, NY 10016 USA

Cooper.L.A & Roter.D.L (2003). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care: Patient-Provider Communication: The Effect of Race and Ethnicity on Process and Outcomes of Healthcare. The National Academies Press, 500 Fifth St., NW | Washington, DC 20001

Cornett, S. (2009). "Assessing and Addressing Health Literacy". The Online Journal of Issues in Nursing, 14(3), Manuscript 2 DOI: 10.3912/OJIN.Vol14No03Man02

Damasceno.M.M.C., Zanetti.M.L., Carvalho.E.C., Teixeira.C.R.S., Araújo.M.F.M., Alencar.A.M.P.G. (2012). Therapeutic communication between health workers and patients concerning diabetes mellitus care.Rev. Latino-Am. Enfermagem, 20 (4).

Dulmen, A.M., van, Verhaak, P.F.M., Bilo, H.J.G. (1997). Shifts in doctor-patient communication during a series of outpatient consultations in non-insulin-dependent diabetes mellitus. Patient Education and Counseling, 30(3), 227-237

Fong Ha, J, and Longnecker, N. (2010). Doctor-Patient Communication: A Review. Ochsner J. Spring; 10(1): 38–43. PMCID: PMC3096184

Forbes, D., A. Sidhu, and J. Singh. (2011). “Coupling of indigenous-patient-friendly cultural communications with clinical care guidelines for type 2 diabetes mellitus.” In Health Informatics and Knowledge Management in conjunction with Australasian Computer Science Week (ACSW 2011), Perth, Australia: Australia Computer Society.

Funnell.M.M., Anderson.R.M.(2004). Empowerment and Self-Management of Diabetes. Clinical Diabetes; 22(3): 123-127. doi: 10.2337/diaclin.22.3.123

Gregory, S.W, Jr. & Webster, S. (1996). A Nonverbal Signal in Voices of Interview Partners Effectively Predicts Communication Accommodation and Social Status Perceptions. Journal of Personality and Social Psychology, 70(6), 1231-1240. 0022-3514/96/$3.00

Hacker K, Choi YS, Trebino L, Hicks L, Friedman E, Blanchfield B, et al. (2012). Exploring the Impact of Language Services on Utilization and Clinical Outcomes for Diabetics. PLoS ONE 7(6): e38507. doi:10.1371/journal.pone.0038507

Hacker, K., Choi, Y.S., Trebino, L., Hicks, L., Friedman, E., Blanchfield, B., Gazelle, G.S., (2012). Exploring the Impact of Language Services on Utilization and Clinical Outcomes for Diabetics. PLoS ONE, 7(6): e38507. doi:10.1371/journal.pone.0038507

Haidet, P. (2007). Jazz and the ‘Art’ of Medicine: Improvisation in the Medical Encounter. Ann Fam Med, 5(2), 164–169. doi: 10.1370/afm.624 PMCID: PMC1838697

Hapunda, G., Abubakar, A.A., van de Vijver, F., and Pouwer, F. (2015). Living with type 1 diabetes is challenging for Zambian adolescents: qualitative data on stress, coping with stress and quality of care and life. BMC Endocrine Disorders, 15:20

doi: 10.1186/s12902-015-0013-6

Heisler.M., Bouknight.R.R., Hayward.R.A., Smith.D.M. Kerr.E.A (2002). The Relative Importance of Physician Communication, Participatory Decision Making, and Patient Understanding in Diabetes Self-management. J Gen Intern Med.; 17(4): 243–252.

doi: 10.1046/j.1525-1497.2002.10905.x PMCID: PMC1495033

Hehl, J & McDonald, D.D. (2014). Older Adults' Pain Communication During Ambulatory Medical Visits: An Exploration of Communication Accommodation Theory. Pain Manag Nurs, 15(2), 466-473

Hudelson.P., Dao.M.D., Perron.N.J. & Bischoff.A (2013). Interpreter-mediated diabetes consultations: a qualitative analysis of physician communication practices. BMC Family Practice, 14:163. doi:10.1186/1471-2296-14-163

Kadirvelu, A., Sadasivan,S & Hui Ng, S. (2012). Social support in type II diabetes care: a case of too little, too late. Diabetes Metab Syndr Obes, 5: 407–417.

doi: 10.2147/DMSO.S37183 PMCID: PMC3514066

Karter, A.J. (2006). The Role of Self-monitoring of Blood Glucose in Glycemic Control. Endocr Pract. Endocr Pract, 12(0 1): 110–117. doi: 10.4158/EP.12.S1.110


Kettunen.T., Poskiparta.M and Liimatainen.L. (2001). Empowering counseling—a case study: nurse–patient encounter in a hospital. Health Educ. Res. 16 (2): 227-238. doi: 10.1093/her/16.2.227

Kourkouta, L and Papathanasiou, I.V. (2014). Communication in Nursing Practice. Mater Sociomed, 26(1), 65–67. doi: 10.5455/msm.2014.26.65-67 PMCID: PMC3990376

Kruse.R.L., Olsberg.J.E., Shigaki.C.L., Oliver.D.R.P., Vetter-Smith.M.J., Tamara M. Day.T.M., LeMaster.J.W(2013). Communication during Patient- Provider Encounters Regarding Diabetes Self-Management. Family Medicine, Vol. 45, No. 7

Larsson, I.E., Sahlsten, M.J.M., Segesten, K., and Plos, K.A.E. (2011). Patients' Perceptions of Nurses' Behaviour That Influence Patient Participation in Nursing Care: A Critical Incident Study. Nursing Research and Practice; Article ID 534060, 8 pages

Lord.H.G (1973). Ex Post Facto Studies as a Research Method. Special Report No. 7320. Syracuse City School District, N.Y.

Mickel, J.T., McGuire, S & Gross-Gray, S. (2013). Grey’s Anatomy and Communication Accommodation: Exploring Aspects of Nonverbal Interactions Portrayed in Media. Interpersonal, 7(1), doi:10.5964/ijpr.v7i1.95

Mugenda.O., & Mugenda.A (1999). Research Methods: Quantitative and Qualitative Approaches. Acts press, Nairobi, Kenya.

Muijs, D (2010). Doing quantitative research in education with SPSS. 2nd edition, London, GB, SAGE Publications.

Mulder, B.C., Lokhorst, A.M.,. Rutten, G.E.H.M & van Woerkum, C.M.J. (2014). Effective Nurse Communication With Type 2 Diabetes Patients: A Review. West J Nurs, Res published online 22. DOI: 10.1177/0193945914531077

Nam, S.,Chesla,C.A., Stotts ,N.A., Kroon ,L.,Janson,S.(2011). Barriers to diabetes management: Patient and provider factors. Diabetes research and clinical practice (Impact Factor: 2.54); 93(1):1-9. DOI: 10.1016/j.diabres.2011.02.002

National Academies of Sciences, Engineering, and Medicine (2018). "Factors That Affect Health-Care Utilization." Health-Care Utilization as a Proxy in Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/24969National diabetes Data Group, Report of an Expert Committee, Bethesda, National institute of Health, 1985(administrative document)

Ngo-Metzger,Q., Telfair,J., Sorkin,D.H., Weidmer,B., Weech-Maldonado,R., Hurtado,M., Hays,R.D. (2006). Cultural Competency and Quality of Care: Obtaining the Patient’s Perspective. Commonwealth Fund pub. no. 963.

Obirikorang.Y., Obirikorang.C., Anto.E.O., Acheampong.E., Batu.E.N., Stella.A.D., Constance.O., and Brenya.P.K (2016). Knowledge of complications of diabetes mellitus among patients visiting the diabetes clinic at Sampa Government Hospital, Ghana: a descriptive study. BMC Public Health, 16: 637. doi: 10.1186/s12889-016-3311-7. PMID: 27457072; PMCID: PMC4960830.

Parsons. J.A., Baker, N.A., Smith-Gorvie.T., Hudak. P.L. (2014). To 'Get by' or 'get help'? A qualitative study of physicians' challenges and dilemmas when patients have limited English proficiency. BMJ Open. 2014;4 (6):e004613. doi: 10.1136/bmjopen-2013-004613. PubMed PMID:24902724 PubMed Central PMC4054645

Partida.Y. (February 2012). Language and Health Care. Diabetes Spectrum, 25(1), 19-22.

doi: 10.2337/diaspect.25.1.19

Ryder, P. & Garagounis, T. (2014). I have lost my reputation: Power, Communication, and Complaints against Medical Practitioners (University of New South Wales) Southern. Semiotic Review, 4, (2)

Salkind.N.J (2010). Causal Comparative Design In: Encyclopedia of Research Design, Vol 1. SAGE Publications Inc, California, USA.

Scheppersa, E.,van Dongenb, E., Dekkerc, J., Geertzend, J and Dekkere, J. (2006). Potential barriers to the use of health services among ethnic minorities: a review. Family Practice, 23 (3), 325-348. doi: 10.1093/fampra/cmi113

Soysal.A & Yağar.F (2017). Evaluation of Quality and Cost in Public and Private Health Care Institutions: A Case Study in Turkey. International Journal of Business and Social Science, Vol. 8, No. 2.

Stellefson,M., Dipnarine,K., Stopka,C. (2013) The Chronic Care Model and Diabetes Management in US Primary Care Settings: A Systematic Review. Prev Chronic Dis; 10:120180. DOI:

Tarasova,V.D., Caballero, J.A., Turner, P., Inzucchi,S.E. (2014). Speaking to Patients About Diabetes Risk: Is Terminology Important? Clinical Diabetes, 32(2), 90-95.

doi: 10.2337/diaclin.32.2.90

Torres, H.C; Pereira, F.R.L; Alexandre, R. (2011). Evaluation of the educational practices in promoting self-management in type 2 diabetes mellitus. Rev. esc. enferm., 45(5) São Paulo,..http://dx.

Tripp-Reimer, T., Choi,E., Kelley, L.S., and Enslein, J.C. (2001). Cultural Barriers to Care: Inverting the Problem. Diabetes Spectrum, 14(1), 13-22. doi: 10.2337/diaspect.14.1.13

Wachira.J., Middlestadt.S., Reece.M., Peng.C.J., Braitstein.P (2014). Physician communication behaviors from the perspective of adult HIV patients in Kenya. International Journal for Quality in Health Care, 26(2), 190 – 197

DOI: 190-197

Weir, K. (2012). Improving patient-physician communication. American Psychological Association ion, 43(10), 36

Young, J.S. (2013). Resources for Middle Eastern Patients: Online Resources for Culturally and Linguistically Appropriate Services in Home Healthcare and Hospice. Home Healthcare, 31 (1), 18 – 26.

Zolnierek, K.B.H and DiMatteo, M.R. (2009). Physician Communication and Patient Adherence to Treatment: A Meta-analysis. Med Care, 47(8): 826–834. doi: 10.1097/MLR.0b013e31819a5acc PMCID: PMC2728700




How to Cite

Ungaya, G., Mberia, H. ., Wa Ngula, K. ., Sigilai, W. ., & Sokwalla, S. (2021). HEALTHCARE PROVIDER PATIENT VERBAL LANGUAGE USE ON DIABETES MELLITUS MANAGEMENT PRACTICES IN SELECTED HOSPITALS IN KENYA. Journal of Health, Medicine and Nursing, 7(2), 61 – 98.