• LedfordChristy J WCJWFrom the Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (CJWL); College of Journalism & Communications, UF Health Cancer Center, UF Health Center for Arts in Medicine, University of F, Carla L Fisher, Lauren A Cafferty, Jeremy T Jackson, Dean A Seehusen, and Paul F Crawford.
• From the Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (CJWL); College of Journalism & Communications, UF Health Cancer Center, UF Health Center for Arts in Medicine, University of Florida, Gainesville, FL (CLF); Henry M. Jackson Foundation, Military Primary Care Research Network, Uniformed Services University of the Health Sciences, Department of Family Medicine, Bethesda, MD (LAC, JTJ); Department of Family Medicine, Augusta University, Augusta, GA (DAS); Department of Family Medicine, Nellis Family Medicine Residency, Mike O'Callaghan Military Medical Center, Las Vegas, NV (PFC).
• J Am Board Fam Med. 2020 Mar 1; 33 (2): 211-219.

IntroductionUnderstanding patients' perspectives about their diabetes and what causes those perspectives to shift is critical to building a treatment strategy with the patient and facilitating patient self-management behavior. Key "turning points" can provide crucial opportunities to enact a change in perspective. The goal of this study is to identify "turning points" that have significance to diabetes-related health.MethodsResearch coordinators interviewed 33 patients aged 25 to 65 diagnosed with type 2 diabetes mellitus or prediabetes at medical centers in Augusta, Georgia, and Las Vegas, Nevada. Retrospective interview technique and turning point analysis was employed to plot health or diabetes management changes from diagnosis up to the present day. The constant comparative method was used to conduct a thematic analysis. Axial coding identified properties characterizing each turning point.ResultsPatients reported 5 interrelated turning points occurring at various times after diagnosis: 1) gaining knowledge, either through patients own research and/or a health care class; 2) making lifestyle changes, including exercising and healthier eating; 3) encountering a life-changing event/transition, including events that derailed healthy behavior, motivated health behavior, and removed barriers to enacting healthy behavior; 4) receiving social support, either through holding patients accountable or encouraging them to enact healthy behavior; and 5) interacting with clinicians, such as medication changes or behavior changes critical to disease management.DiscussionThese turning points provide specific moments throughout diabetes care in which family physicians can effectively partner with patients. By prompting, facilitating, or attending to these turning points, family physicians can partner with patients throughout diabetes care.© Copyright 2020 by the American Board of Family Medicine.

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