Table 4.

Participant quotes that illustrate the facilitating factors to patient‐centered communication in type 2 diabetes

	Patients	Providers
F1 Patient‐provider relationship
Seeing patients as persons	[F1a] I agree with that doctor of a certain age that could be my grandfather, he listened to me like a priest in confessional and told me: ‘You have to look after yourself and do more or less what you feel is right’ [feeling heard]. (FG4)	[F1b] The approach to diabetes is not the approach to diabetes or the diabetic. It is the approach of a human being in front of us that will probably have information. (FG7)
Patients playing a more active role/increasing partnership in decision making	[F1c] I had squabbles with doctors before, it is not that they showed me disrespect but: ‘You don't know. Are you the doctor?’ and I reply: ‘In fact I am not a doctor, not even close, but I am my own man, and being my own man, I know my resolution to get better’… My suggestion is… to look the doctor in the eye and say: ‘Doctor, what is wrong with me?’ (FG4)	[F1d] Doctor and patient, side by side, both deciding, agreeing… (FG7)
Trustworthy relationships	[F1e] The trust between the ‘patient‐doctor’ is fundamental because […] a person that doesn't have trust… it's complicated. (FG5)
Psychosocial support	[F1f] I immediately started to cry. […] And the nurse says: ‘Don't worry because your finger is not lost, when you came in it was much redder, it had an infection but now is looking better.’ (FG4)
F2 Disease and treatment‐related behavior
Wake‐up call	[F2a] I was supposed to take drugs for hypertension, diabetes, triglycerides, and cholesterol. (…) And I did not take them, so I ended up here [at the hospital] with a heart attack. Now, of course… after the warning, I started to take the medications, the insulin… (FG5)	[F2b] [When dealing with patients harder to motivate towards behavior change] I really think that only the wake‐up call or the fact of having, for example, a brother with type 2 diabetes that had a heart attack and was at death's door. Only a family wake‐up call, an emotional wake‐up call makes them change. (FG6)
Providing tailored practical information	[F2c] We needed to know exactly how we should and shouldn't do it [follow recommendations]. (FG3) [F2d] People [patients] should also be able to change doctors anytime they don't get along with them. Patient 2: But I don't know what the argument is and how to do it. (FG5) [F2e] Many meetings like this one [focus group]. (…) It may not look like it, but we learn a great deal with one another. (FG2)	[F2f] We have to be very practical, very practical in what we say, very practical in the education we provide and think: ‘How is your day?’ ‘It is this, this and this.’ Then, we will work through their day with that person. (FG7) [F2g] We sometimes tell people to walk, exercise, but you got to know the person well. If it's someone with foot pain, he or she will never walk. It's no good. (FG6)
Increasing patients’ responsibility		[F2h] Actually he [the patient] doesn't need very precise knowledge early on and you have to hold people accountable and provide knowledge for that and all that. (FG6)
Aggressive attitude/positive communication approach		[F2i] I am usually not gentle. Because I get them [patients] at a stage when either we can save their leg or we have to amputate. So I just say it all and they are very shocked. (FG6) [F2j] Maybe we should talk more about the benefits, talk more about the positive side of the therapeutic management. (FG6)
Investing in diabetes educators		[F2k] There has to be well‐trained educators … because otherwise, we are wasting trained professionals [physicians’ time and knowledge] that have to do other things, right? (FG7)
Family support		[F2l] 15 days ago, he [the patient] came by my office and weighed 80Kg. (…) ‘I need to congratulate you!’ (…) And I asked what happened? His daughter had entered the picture and removed the mother [his wife] from the kitchen, had started cooking and clearly squeezed the old man. (…) So, the family entered the picture. (FG6)
Macro‐level interventions		[F2m] Maybe they [the fast‐food and the candy] should be more expensive (…) and overtaxed. (FG6) [F2n] I think children have a… very important role. Maybe in schools if they talked about the disease and explained [healthy behaviors]… (FG6) [F2o] Some things [boardwalks] have contributed to that [patients having access to structures to support behavior change advice from providers]. (FG6)
F3 Gathering and providing information
Plain language	[F3a] I wish they [the physicians] would speak small‐town Portuguese: ‘You are being treated for this, you need to do this and that!’ And you learn. Now, speaking in medical terms you wonder. I do! (FG4)	[F3b] Both the family doctor and the nurse (…) know exactly what educational limitations they [their patients] have, the difficulties understanding… They [providers] adjust the language. (FG7)
Appropriate analogies	[F3c] [Describing how another doctor explained that previous doctors had prescribed medication that caused him to feel very sick from very low blood sugar] ‘My colleagues did the job at 80%. Because they started giving you airplane fuel when your car should have regular fuel.’ (FG4)
Increased consistency among providers and improving their communication skills		[F3d] There is another important aspect, which is for the entire team to use the same language because if everybody uses the same language they reinforce each other and that gives the patient a lot of confidence. (FG7) [F3e] I think there needs to be training of the professionals in ways to communicate [with patients]. (FG7)
Having more time		[F3f] Because we categorize people by their attire, their gaze, the way they talk… and we believe the person is understanding everything but only if you take a little longer will you go the extra mile. (FG6)
Repeating information		[F3g] No, at that moment [the diagnosis] very little will be taken in. Moments need to be repeated. (FG7)