taboo research topics

Things to Think About When Researching a Taboo Topic

Your PhD research is unique, that’s the whole point of PhD research. Your job as a PhD researcher is to contribute new information to your field. However, your research may be a bit more unique than average if you decide to research a taboo topic.

Taboo topics can elicit strong emotions both from yourself and others, which can put an added mental and emotional strain on your research. A PhD can be a rough, but rewarding journey, but researching a taboo topic can add an additional layer of challenge to doing a PhD (for more on the PhD journey see this post ). This post will address some of the challenges and general things to be aware of if you decide to research a taboo topic for your PhD.

This post is not meant in anyway to discourage potential researchers from doing the very important and necessary work needed on taboo topics. Rather it is meant to prepare and help you handle some of the unique challenges that come with researching and likely publishing on taboo topics, such as the emotional response of yourself and others, public pressure, and the measure of societal influence that you may gain from your research. Taboo topics need researchers, but you should be prepared for what you are undertaking. (For more on common PhD problems check out this post .)

This post was written by a recent PhD graduate  (it is anonymous to keep the discussion frank) on behalf of Dave Maslach. This is part of the R3ciprocity project (Check out the YouTube Channel or the writing feedback software). R3ciprocity helps students, faculty, and research folk by providing a real and authentic look into doing research. It provides solutions and hope to researchers around the world. For more on this topic and to see what Dave has to say about researching taboo topics:

What is a taboo topic?

A taboo topic is one that elicits an emotional or polarizing response from people. Taboo topics are topics that people can sometimes get very heated up about discussing and just bringing up the topic can set off an emotional response in people. Taboo topics can often be uncomfortable for people to talk about, and because of this do not get a lot of exposure or discussion in general society. Researchers in the Social Sciences and Humanities are much more likely to encounter these types of topics as their research deals more directly with societal topics. Some examples of taboo topics include gun control, immigration, politics, religion, and gender and sexuality, among many many others. There are some research areas of the hard sciences that are taboo ( think stem cell research or certain medical procedures ), but taboo topics are much more commonly found in Social Science and Humanities research.

Taboo topics are often topics that people are uncomfortable speaking about, or that cause very charged emotional response. I have seen this personally as one of my research focuses is medieval gender and sexuality. Just the mere mention of the topic sometimes had people shying away from the conversation, as even the sex lives of people 700 years dead made them uncomfortable since they were generally uncomfortable speaking about sex and sexuality. I have also gotten very emotional responses from people who don’t think that sexuality and gender have any bearing on history and that I should “just stick to the facts.” When discussing your research on a taboo topic you can get a wider gambit of response ranging from people very interested in your work to people angry that you are working on that topic at all, hence the taboo part.

Things to consider when researching taboo topics

Again, this list is in no way meant to discourage you from pursuing your chosen taboo topic. It is just meant to help you prepare for your own response to your research and the response of others.

Your taboo research is very important

If something is taboo, by definition we don’t talk about it much, and therefore often don’t understand it very well on a wider societal level. Because of those feelings of taboo and discomfort, few people go into research on taboo topics. This sense of secrecy or prohibition on the topic makes your research all the more important. All research is of course important, but research on a taboo topic takes a different sort of role in society. Your research has the potential to very directly impact society. For instance, feminist researchers in the 1960s and 1970s shaped the Women’s Rights Movement and its direction. Feminist researchers at universities set the directions of the movement, by identifying problems of gender inequality and solutions and therefore had a very real impact on the message and effectiveness of the Women’s Rights Movement (other people outside of academia were of course important too, but the contribution of Feminist researchers was hugely influential).

This larger societal impact factor is something that you should be aware of as a taboo topic researcher. All researchers of course want their research to reach a wide audience and have an impact, but researchers on taboo topics have a unique opportunity to bring understanding of a topic to a wide audience and even reshape the discourse around it.

That being said, it is important to remember to take care with what your research says. This is not to say that you should hide unpleasant results or to falsify data to make a bigger impact, but rather to be aware that what you find can have very real societal impact, for both good and ill. Do be careful with how you approach your results when you are disseminating them and presenting them. Be sure to present your findings clearly and say what you want to say about your topic. There will always be a chance that people will twist your words to suite their own needs, but you can limit that with extra precaution in your presentations and publications.  

Identity as a researcher

Think back to when you were a college student. Did you have a professor that everyone considered the “cool” professor because their research and the classes they taught were edgy, unusual, and a bit taboo? As an undergraduate, I had a Gender Studies professor whose classes on sexuality were in high demand because they were frank and open discussions about sex and sexuality in our society. As this was over 10 years ago, this was unusual in a wider societal context. Most students considered this professor super cool and little mysterious as she was so open and honest about sex and sexuality. Her classes were a safe space to explore all these questions that we weren’t really free to in normal society. Among the students at the university she was known as the “sex professor,” her taboo research was appended to her identity as a person and professional.

This persona or identity with your taboo research is something that you should be aware of when researching a taboo topic. People will identify you with your topic because it is unusual. You should be prepared for it to be part of your life and your image, both personally and professionally. If you publish on your taboo topic other academics will associate you with that topic, even after your have moved on to other research projects. Your other research, while important, will not be as instantly memorable as your taboo research. People find taboo topics fascinating and so they will associate your own personal and professional identity with your topic because it is unusual and easy to remember.

Emotional response

As a taboo topic researcher, you will get an emotional response from other people when you talk about your research, but you should also be aware that you will have to deal with your own emotional response to your research particularly if you deal with a more troublesome or wearing topic such as child abuse or sex crimes. This is an added burden that you will face as a researcher that someone researching a more mainstream topic such as plate tectonics or ocean currents will not have to face. You will have to develop some strategies for dealing with the emotional fallout of your research.

In terms of discussing your research with other people, this will be more about learning to approach the topic in a diplomatic and careful way. I have learned over the years that straight up launching into my research on how medieval gender relations were power relations tends to make people angry (they don’t like to think of gender like that). By being a bit more indirect and gauging their level of interest and ability to have an open and frank discussion on gender and power I can lessen the emotional burden on myself and that other person. Something you will find after a while particularly if you have a really hot button topic is that it is just wearing to try to have an open conversation with someone that doesn’t want to hear your side, and so talking around it is just easier, but gradually easing into a conversation with someone who is open can be very enlightening.

In terms of your own emotional health, it is important to remember that while your research is very important and potentially society changing you should not let it beat you down mentally or emotionally. You will need to take breaks from it and develop some emotional care routines. The best one I can suggest here is talking to a professional like a therapist to help you deal with some of the issues that will come with this type of research. Be aware that while you may be very passionate about your research topic, it can have detrimental effects on your mental health, and you should take care of yourself. Being prepared to take emotional care of yourself will save you from becoming overwhelmed and also improve your research.

Outside Pressure

Because your research is unique, interesting, and taboo you may find that you receive outside pressure to shape your research in a certain way. You may find that a special interest group, a politician, or a society takes notice of your research and puts pressure on you to have your research in some way fit their agenda. How you want to handle this is up to you. If their needs and your research go hand in hand, have at it, but if they want you to prove something contrary to your results don’t be afraid to take a stance. This is after all your research and your results, not theirs.

In association with this, your taboo research may afford you the opportunity to provide some leadership in a movement or society set on promoting a better understanding and acceptance of your topic. Your research and publications have the very real ability here to shape societal discourse and awareness of your topic. Don’t be afraid to take a stance. You have a real opportunity to make a positive impact on society with your taboo research, so don’t be afraid to take that stance. (As a side note, you can take a stance to simple be an unbiased researcher and not let others pressure or influence your research, that is also an acceptable stance).

People are going to ask you questions (a lot of questions!)

Taboo topics are by nature not often discussed openly, but people are deeply fascinated by them (although sometimes they don’t want to admit it). Anytime I go to a large international conference, the sessions that are best attended are sessions on taboo topics like sex, crime, and grisly legends. People don’t often get to discuss or hear about these topics, so they flock to these sessions hoping to have their curiosity slaked and maybe ask a burning question they have always wanted an expert to answer.

It is the same out in the rest of the world. People might be interested in medieval sex lives and sexuality or more than likely simply curious, but they don’t know where to find the answers or even begin to know how to talk about it. So when you come along and start openly talking about a taboo topic, many people will take it as a great opening to ask questions about the topic, engage you in discussion if they know something about it, or even argue with you about your stance on the topic. This is something you should be aware of and be prepared for, you are going to be asked a lot of questions, and people are going to have a lot of opinions on what you research (I have even had people suggest that I shouldn’t research my topic because of the taboo!). The questions will also run from simple curiosity to outright hostility again because of the emotional response elicited by taboo topics.

Talking about your topic with other people can be a lot of fun, but it can also be wearing (See this post on conferences ). This is again one of those places where you should put your best mental and emotional health practices into effect and tell people you are not up for a discussion at that time if your topic is currently an emotional burden.

Overall, the thing to be most aware of when researching a taboo topic is the emotional aspect of it. Your research can be personally emotionally wearing in just its subject matter, but taboo topics will also bring a lot of interest from other people. The questions, pressure, and sometimes hostility of others can be draining, so be prepared for this added strain during your PhD and develop some ways to handle it to preserve your own mental and emotional health.     

R3ciprocity_Team

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Today’s Taboos

We launched a brand new piece of groundbreaking research on today's hidden subjects on 2nd October at The Conduit London, where over 100 people joined us in a lively conversation discussing all things taboo.

We launched our new report on 2nd October at The Conduit where Florence Nolan (Development at Talking Taboos) hosted a fascinating conversation unveiling the stigmatised subjects of 2023. We heard from Katherine Jennings (Director of Talking Taboos), Hannah Marcus (Trustee of Talking Taboos) and Sema Gornall (CEO of The Vavengers ).

Find the link to download the report here: Today's Taboos Report

The report highlights the four taboo areas of 2023:

- Unmentionable Mental Health: Whilst making progress with conversations around mental health conditions like depression and anxiety, people with psychosis related symptoms such as schizophrenia, bi-polar disorder and BPD, continue to face harmful stereotypes and stigmatisation.

- Shameful Sex: STIs are still considered embarrassing and shameful, as well as an indicator of socially unacceptable sexual behaviour. This silencing makes it harder to educate around prevention and treatments.

- Unruly Bowels: Despite online aestheticication of and booming business in ‘gut health’, more ‘real’ conversations around poo and bowel movements are still ignored and deemed shameful to talk about, making it harder for people with Crohn’s, Colitis & IBS to talk about their experiences.

- Daily Disgusts: There is a suggestion that for those who identify as women or have vulvas, normal bodily functions and odours are ‘unclean’, leading to use of unsafe products and impacting everyday experiences like menstruation, which are treated as unclean despite being common, normal and natural.

Why did we choose to do this work? Our mission at Talking Taboos is simple; to shine a light on topics which are ignored or hidden from public view, whose unspoken nature prevents people from seeking, or finding, the help they need.

We want to give voice and space to the taboo experiences people are bravely raising on social media, and highlight how their taboo nature is stopping these topics from receiving the coverage and attention they deserve.

In collaboration with discover.ai , we curated a dataset of UK based online and social data in 2022 across Twitter, news, media, blogs and forums, and used AI tools to analyse this data, looking for emerging themes which are creating resonant conversations or outside impacts. Social and online media is a rich space for exploring taboo subjects since the combination of anonymity and community makes people willing to share experiences they might not in other contexts.

Self-censorship, controversy and taboo in psychological science

Emma Young digests the research.

08 August 2024

Taboo topics exist in most academic fields, but in psychology, they can be particularly powerful. Fears of speaking up, sharing findings that challenge the status quo, or publishing findings that may harm particular demographics, can mean researchers don't necessarily know what their peers think about these topics.

These academics do know what some leading journals think about this, though. In 2022, a Nature Human Behavior editorial , for example, indicated that a paper could be rejected if it could potentially cause harm to a specific group [see also Alon Zivony's article in our June issue]. 'Advancing knowledge and understanding is a fundamental public good,' the editorial read. 'In some cases, however, potential harms to the populations studied may outweigh the benefit of publication.'

University ethics boards have long protected participants from harm, but 'these new policies seek to protect society from putative harms that may attend the dissemination of science,' write the authors of a recent paper in Psychological Science . At the same time, note Cory J. Clark at the University of Pennsylvania and a long list of colleagues at mostly American universities, some scholars have raised a different concern: about a threat to academic freedom stemming from a fear of causing harm to vulnerable groups.

So how do psychology researchers actually feel about taboo topics? Do they self-censor their beliefs? And what should happen to scholars who communicate research that might fit the bill of being 'potentially harmful' to a disadvantaged group?

To explore these questions, the team emailed a survey to 4,603 psychology professors at the top 100 psychology graduate programmes in the U.S. These professors were assured that their responses would be kept anonymous. Despite this, most didn't reply, but 470 (who were still demographically representative of the larger group) answered at least some of the questions.

After reading 10 taboo statements, which Clark and her colleagues had identified during a pilot study, the participants were asked to rate how true or false they felt each was; how reluctant they would feel about openly sharing their beliefs on this topic if it came up in a professional setting, such as a conference; and to what extent they believed scholars should be discouraged from testing its veracity.

Here's the list of taboo statements that were rated by the US-based participants:

• 'The tendency to engage in sexually coercive behaviour likely evolved because it conferred some evolutionary advantages on men who engaged in such behaviour.'
• 'Gender biases are not the most important drivers of the under-representation of women in STEM fields.'
• 'Academia discriminates against Black people (eg. in hiring, promotion, grants, invitations to participate in colloquia/symposia).'
• 'Biological sex is binary for the vast majority of people.'
• 'The social sciences (in the U.S.) discriminate against conservatives (eg. in hiring, promotion, grants, invitations to participate in colloquia/symposia).'
• 'Racial biases are not the most important drivers of higher crime rates among Black Americans relative to White Americans.'
• 'Men and women have different psychological characteristics because of evolution.'
• 'Genetic differences explain non-trivial (10 per cent or more) variance in race differences in intelligence test scores.'
• 'Transgender identity is sometimes the product of social influence.'
• 'Demographic diversity (race, gender) in the workplace often leads to worse performance.'

Clark and her team found that for every conclusion, at least some of the professors were 100 per cent certain it was true, while others were 100 per cent certain it was false. For six of the conclusions – on evolved psychological sex differences, binary biological sex, genetic contribution to IQ differences, demographic diversity, and workplace performance – the average level of belief hovered around the midpoint, but there was lots of disagreement about every given statement.

'These findings seem to indicate little to no scientific consensus on these conclusions, despite high levels of confidence among some scholars (and in both directions),' the team notes. Whether or not the academics rating these statements had in-depth, up-to-date knowledge of each topic, however, is impossible to know; some of these ratings, therefore, may be more based in opinion than scientific rigour.

When it came to the results on self-censorship, again there were big differences in the responses. While many professors reported no reluctance to share their views, others said they would be extremely reluctant to share them.

Most felt that research on these topics should not be discouraged, however. Of the ten statements, the greatest levels of discouragement were for research into a potential genetic contribution to IQ differences – but there was still plenty of disagreement about this.

When the team considered the professors' demographic data alongside their responses, they found some divides. For example, the male professors self-censored more than the females. They also believed more strongly in the truth of every single taboo conclusion, with two exceptions: the women and men were more aligned on the idea that there is a political bias in social science, and the women believed more strongly that academia discriminates against Black people.

The results also revealed that the male professors were quite confident that men and women evolved different psychological characteristics, whereas the females were on the fence about this. For other statements, though, the reverse was true. This led the researchers to write: 'Future research should explore whether male and female psychology professors present to their students different evidence and arguments regarding the veracity of taboo conclusions.'

After these initial three questions came others that delved into the professors' personal fears and attitudes towards their peers.

The results revealed that they were quite concerned about being attacked on social media, being ostracised by peers, and being stigmatised if they openly shared their beliefs on these ten topics. As the researchers note, they acknowledged their beliefs to be 'socially costly'. Many also agreed with the idea that some empirically supported conclusions are 'taboo'.

The participants also tended to feel that moral concerns that a conclusion could harm vulnerable groups were not a legitimate reason for a paper to be retracted. The vast majority also felt that only 'compelling evidence' of harm could justify the suppression of controversial research. Neither, overall, did they feel that concerns about the risks of extremists misconstruing or weaponising taboo results were a reason for a paper to be retracted, though women endorsed this more than men.

Another striking finding was that these professors were, overall, 'very contemptuous' of peers who participated in campaigns to get a paper retracted on moral grounds. 'This raises the question of whether scholars may be contemptuous of journal editors who retract papers for these reasons,' the researchers write.

The responses also revealed that only a narrow majority (52.3 per cent) felt that scholars should be completely free to pursue research questions without fear of institutional punishment for their conclusions, while 1.6 per cent said they should not be free to do this, and 40.6 per cent went for the response option: 'it's complicated.'

When it came to how scholars who published or taught taboo conclusions should be handled, there was very strong support for normal scientific criticism such as journal commentaries, little support for disinviting these academics from talks, and very little support for refusing to publish their work, or for shaming them on social media.

Returning to that demographic perspective, the team reports finding that female, more left-leaning, and younger faculty were generally more opposed to controversial scholarship.

Clark and colleagues do acknowledge a number of limitations to this work. One, clearly, is that it concerns the views of only US-based professors. Also, despite assurances of anonymity, the respondents may not have felt able to disclose their true attitudes. 

Indeed, the researchers regard this work as a starting point for important work into how scholars feel about taboo research. Certainly, their work suggests a lot of division. 'These data cannot resolve the identified conflicts,' the team writes, 'but they may contribute to a shared understanding of the diversity and distribution of perspectives among psychological scientists.'

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Teaching Philosophy

Volume 40, issue 1, march 2017.

Teaching Taboo Topics Why It Matters and How to Pull it Off

In this paper, I offer justifications and strategies for teaching taboo, unpopular, or rarely contested views in undergraduate ethics courses. Teaching taboo topics, while challenging, forcefully demonstrates the commitment that few topics in ethics have obvious answers, and that the study of ethics is more than just debating right and wrong. Drawing from my experience teaching on the topic of bestiality, I articulate the importance of motivating topics that may appear remote and irrelevant to students. Inspired by Kathy Rudy’s queer theory approach to the question of bestiality, I propose that we broaden and reframe taboo issues when teaching undergraduates. Instead of introducing these issues with the typical “Is it right or wrong to do X,” I recommend that we examine the essential political, metaphysical, and epistemological presumptions that inform and shape our moral judgments.

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Sexuality as taboo: using interpretative phenomenological analysis and a Foucauldian lens to explore fathers’ practices in talking to their children about puberty, relationships and reproduction

Fathers can play an important role in their children’s learning about relationships and sexuality but we know very little about the father’s lived experience in this regard.

To explore eight fathers’ perceptions and experiences of discussing puberty, relationships and reproduction with their 10-year-old children.

The paper commences with a genealogical analysis of the history of sex education in England from the Public Health Act of 1848 to the present day. Interpretative phenomenological analysis (IPA) was used as both a methodology and a method. Face-to-face interviews were conducted with each father and results were analysed ideographically, followed by analysis across the group. Interpretations were developed using a Foucauldian lens of governmentality and biopower.

The paper explores how synthesis of IPA with a Foucauldian lens revealed significant tensions between the fathers’ cognitions, accounts and behaviours, which were underpinned by an enduring perception of sexuality as taboo.

By providing a contextualised understanding of the fathers’ practices, this study demonstrates that a more informed approach to health promotion strategy can be achieved and the implications for nursing are explored.

Introduction

Internationally, young people’s vulnerability to compromised sexual health is well documented with prevalence estimates suggesting that 15–24 year-olds acquire over half of all new sexually transmitted infections (STIs) internationally (Centers for Disease Control and Prevention (CDC), 2017; European Centre for Disease Prevention and Control ( ECDC), 2015 ). Such statistics are highly significant at the micro, meso and macro levels since STIs are associated with infertility and severe morbidities ( Shepherd et al., 2010 ) as well as negative psychosocial consequences ( Nack, 2008 ; Royer and Cerf, 2009 ).

In the UK 16–24-year-olds experience higher rates of STIs and unintended pregnancy than any other age range ( Family Planning Association (FPA), 2016 ; Public Health England 2017 ; Public Health Wales, 2017 ), and it is feared that this could be compounded by the current ‘perfect storm’ in sexual and reproductive health in the UK since fragmented commissioning of services is leading to a reduction in specialist services and there is insufficient funding for comprehensive prescribing of contraception ( British Association for Sexual Health and HIV, 2017 ; Local Government Association, 2017 ; Royal College of General Practitioners, 2017 ). Sexual health promotion, particularly for young people has arguably never been more important.

Current approaches to relationships and sex education (RSE) aim to enable young people to develop their confidence and resilience in relation to sexual health decision making (Association for Young People’s Health (AYPH), 2016; Department of Health, 2013 ). One such approach is through parent–child sexuality communication, since open communication has been demonstrated to reduce young people’s sexual risk taking ( Flores and Barroso, 2017 ; Widman et al., 2006 , 2016 ). However, such communication is frequently perceived to be problematic by parents ( Frankham, 2006 ; Stone et al., 2013 , 2015a , 2015b , 2017 ), with a lack of quality communication characterising much of the provision. It would also appear that gender differences exist in this relationship since the impact appears more significant in mother–child sexuality communication than father–child communication ( Widman et al., 2016 ). However, a paucity of studies that have specifically explored the father’s role in this regard makes this relationship difficult to understand. We know that fathers can play an important role in this aspect of their children’s development ( DiIorio et al., 2003 ; Wilson et al., 2010 ; Wyckoff et al., 2008 ), but we know very little about the father’s lived experience in this regard. This study, therefore, aimed to contribute to addressing this deficit by exploring the following research question:

What are the perceptions and practices of fathers in educating their children about puberty, reproduction and relationships?

Genealogical analysis

Instead of a traditional literature review, this study commenced by analysing the socio-historical context of RSE in England, in order to place the men’s stories in context. A genealogical analysis was carried out through documentary analysis commencing with the Public Health Act of 1848. The analysis revealed four themes.

Absence beyond crises

Threats to public and moral health in England, such as the increased prevalence of STIs during the two world wars, the fear surrounding HIV in the late 1980s and the increased STI rates amongst young people since the 1990s, have galvanised government intervention with regards to RSE. However, beyond times of ‘moral crisis’, sex education messages from central government have been equivocal. As Pilcher (2005 ) argues in her analysis of the official guidance manuals concerning the teaching of health education in schools, 1928–1939: ‘given that virtually every other bodily system, function and process, from the frequency of bowel movements to the proper way to breathe, are specified, the human sexual and reproductive body is conspicuous by its absence’ (p. 156). By avoiding the topic of reproduction, the implication was that sex should not be discussed in schools.

Scientific truths privileged over lived truths

In 1943, the Board of Education advised that older adolescents should receive ‘instruction and advice directed to the understanding and control of sexual impulse and emotion, leading on to the establishment of mutual understanding and respect between the sexes, and … to an adequate preparation for marriage’ ( Board of Education, 1943 : 3–4). The aim of RSE was to channel the ‘sexual instinct’ into the socially acceptable contexts of heterosexuality, marriage and parenthood. The dominant construction of the ‘sexual impulse’ was a negative one, with sexuality being aligned with ‘moral and social problems’. Thus, the scientific truths of sex were privileged over the lived truths of sexual pleasure ( Pryce, 2001 ).

Such discourses continued through to the 1970s, with RSE becoming less concerned with physiology and more with morality to ‘protect boys and girls from hazards to health created by their own behaviour’ ( Department of Education and Science, 1977 : 28). Thus, the emphasis moved from restraint to an acceptance that young people may engage in sexual activities, but that they had a responsibility to ensure that the interaction minimised risk. By the mid-1980s RSE had become ‘firmly integrated into the curriculum as a whole’ ( Allen, 1987 : 193), but concern grew from the political right that RSE encouraged not only a ‘precocious and promiscuous’ heterosexuality but also homosexuality as an acceptable form of sexuality ( Durham, 1991 : 111). Consequently, a national, prescriptive statutory framework for RSE was developed.

The 1986 Education Act along with Section 28 of the 1988 Local Government Act, which stated that councils should not promote homosexuality in schools, ‘frightened off’ ( Pilcher 2005 : 166) teachers from addressing sex education issues. By the mid-1990s children’s rights to sex education were very limited; they faced restrictions regarding the particular ‘moral framework’ of sex education that would be presented to them by their schools, they had no right to receive sex education if their parents decided to withdraw them from these lessons and they had no right to confidentiality if they disclosed their sexual activities to teachers. Although Section 28 was repealed in 2003, RSE in the current millennium has been characterised by a lack of clarity and investment, with the Office for Standards in Education, Children's Services and Skills ( OFSTED, 2013 ) identifying that RSE required improvement in over a third of schools in England, culminating in the decision by the Conservative Government in 2017 to make sex education compulsory in all secondary schools and relationship education to be introduced for all school pupils from the age of 4.

The rise of experts and demise of parents

With the increasing governmentality of RSE in England, the role of the parent as sexuality educator has been gradually replaced by a cadre of ‘experts’ such as politicians, clergy, the medical profession, public health professionals, educators and, in more recent times, the media, with a gradual erosion of the role of the parent in this domain. In 1943, it was suggested that although responsibility for RSE lay primarily with parents, RSE should take place in school ( Board of Education, 1943 ). Throughout the 1950s the position was maintained that RSE was ‘by general agreement’ best given by parents. but the position of schools as sexuality educators was significantly strengthened (Ministry of Education, 1958: 189). In 1968 the Handbook of Health Education ( Department of Education and Science, 1968 ) made reference to contraception and sexually transmitted diseases for the first time, and whilst the need for parental support and cooperation was noted, the need for schools to provide sex education was emphasised. Thus, the regulation of sexuality amongst young people created new roles for experts and expert knowledge in the government of young people and children and the regulation of their personal identities. As Mort (1987: 208) asserts, ‘sex education firmly reinstated normalising hierarchies of knowledge, which set teachers above parent …’.

Methodology

A Foucauldian lens of governmentality ( Foucault, 1979 ) was employed throughout the study. Governmentality is characterised by pervasive surveillance and disciplining of the individual and the population ‘in relation to a whole series of power networks that invest in the body, sexuality, the family, kinship, knowledge, technology and so forth’ ( Foucault 1980 : 122). Policy decisions such as those that relate to RSE are, intentionally or otherwise, an example of a technology of power that can shape the conduct of the population. Thus, in the context of RSE the concept of governmentality can help to make a connection between macro-level public health policy and the lived experiences of children and young people at the micro level.

The research employed interpretative phenomenological analysis (IPA) ( Smith et al., 2009 ) as both a methodology and a method. IPA is concerned with social cognition by facilitating the researcher in ‘unravelling the relationship between what people think (cognition), say (account) and do (behaviour)’ ( Smith and Eatough, 2012 : 442), which this study sought to achieve. IPA’s focus on phenomenology as dynamic and the emphasis that is placed on interpretation, subjectivity, nuance, variation and the particular ( Smith et al., 2009 ) aligned the approach with the philosophical position of the study.

The aim of the study was to explore the fathers’ perceptions and practices in educating their children about physical maturation, reproduction and relationships. Eight fathers of four 10-year-old girls and four 10-year-old boys respectively were recruited through advertisements placed with schools, scouting groups, football clubs, cricket clubs, rugby clubs, community groups and social networking sites. All of the fathers lived full time with the child or children who were being discussed in the study and with the mothers of their children. The sample was homogenous, a quality that is advocated for IPA studies ( Smith et al., 2009 ); the fathers were all White professionals, aged 42–46 years old and educated to Masters’ level or equivalent. All fathers participated in individual semi-structured face-to-face interviews which lasted between 30 and 72 minutes. Throughout the interviews the double hermeneutic ( Smith et al., 2009 ) was employed in making sense of the fathers’ experiences. The interviews were recorded and transcribed verbatim. Data analysis was carried out as per Smith et al.’s (2009) guidelines. Thus, analysis was an iterative and inductive process with each interview analysed separately initially. Each transcript was analysed line by line and initial descriptive notes were made, followed by observations of the language used and semantic content, and finally, conceptual comments were recorded which, in due course, became themes. The process was cyclical in that emerging themes were tested against earlier data and themes were, on occasion, changed to become subordinate or superordinate. Finally, a cross-group comparison was made to identify areas of convergence and divergence between the fathers. To facilitate this process Smith et al.’s (2009) guidance concerning the use of abstraction, subsumption, polarisation, contextualisation, numeration and function was used in order to establish a deeper understanding of the data. In keeping with Heidegger’s (2010 : 195) assertion that ‘priority should be given to the new object rather than to one’s preconceptions’ and Gadamer’s contention that pre-understandings or ‘prejudices’ will be present and changing throughout the interpretative process (Moran, 2000), emphasis was given to reflexivity throughout the data analysis phase of the study and interpretations were discussed in detail with the second author to ensure that they remained true to the men’s words. Reflexivity was of particular importance in this study since the first author was an insider, in that she too was a parent of a 10-year-old child, and the risk of bias and preconceived assumptions was a significant risk to the rigour of the study.

All of the fathers recognised that they needed to talk to their children about their changing bodies, relationships and reproduction as they felt that it would be protective for their children. Indeed, they asserted that it is a parental responsibility but acknowledged that they struggled in this domain, with all but one of the fathers continuing the silence that characterised their own learning about sexuality as children. For the purposes of this paper one superordinate theme that emerged across the group will be focused upon –‘Sexuality: An Enduring Taboo’, since it is of particular relevance to the nurse’s role (International Council of Nurses ( ICN), 2018 ). The other two themes which emerged, ‘Childhood Innocence’ and ‘Fatherhood: Aspirations and Realities’, have been reported elsewhere ( Bennett et al., 2017a , 2017b ). The subordinate themes that informed the development of the superordinate theme ‘Sexuality: An Enduring Taboo’ were ‘discomfort’, ‘avoidance’ and ‘s/he knows something, but I don’t know how much’. These are presented below; pseudonyms have been used throughout.

Discomfort was a feature of all of the fathers’ transcripts. For example, one father, James, used language that suggested a lack of ease in discussing puberty, sex and relationships with his son: ‘I sort of tease around the edge with Rich …’. In addition, his use of euphemism in referring to his son’s genitals as ‘private parts’ suggested a degree of awkwardness. Similarly, Michael’s use of euphemism, hesitation and partial response suggested embarrassment in directly responding to a question from his son: ‘A long time ago he asked me sort of about the difference between girls and boys, sort of downstairs, and so I told him bits, the basic bits there but not [tails off]’.

Equally, the fathers demonstrated discomfort in discussing sexuality with their daughters; for example Angus stated: ‘my gender does have an impact … I’m a bloke; I am not going to understand about feelings in relation to periods and that sort of thing. That isn’t going to happen’. Angus appeared to absolve responsibility for this role with his daughter because of his gender: ‘it’s very much been my wife taking the lead’. His language suggested a divide between the ‘personal self’ and the ‘professional self’ since Angus worked with young people and would regularly engage in RSE with both genders, but there was a dissonance between his professional beliefs and personal behaviours. Similarly, another father, Steve, oversaw RSE in the professional environment for both boys and girls, but in relation to discussing menstruation with his own daughter he stated: ‘I think that would be very tricky, very difficult … I really need to go home tonight and see if my wife’s spoken to her at all about that …’. Steve’s dialogue suggested gendered assumptions; menarche was the domain of women and it was his wife’s job to have this discussion with his daughter: ‘I think that’s maybe my wife’s thing, not mine.’

With the exception of one father, Neil, all of the fathers avoided discussing sexuality-related issues with their children. Michael outlined employing distraction techniques when scenes of a sexual nature came on the television, and James described avoiding intimate conversations because ‘I don’t want to embarrass him by asking and say come on let’s sit down and have a chat’. Another father, Colin, used partial answers as an avoidance strategy such as ‘He’s asked questions like what’s that on the toilet, it’s a bit of blood and I have said “it happens to mum sometimes”’. Andy used referral to other people and resources: ‘we’ve always said to her if you don’t want to talk to us, there are friends who have got children, you can always ask them and your older friends’, and ‘[we] said to her “you can read that if you want to”’. Nigel, however, rationalised his avoidance by infantilising his children:

They put ‘naughty girl’ into Google, they … got an image of a man with an erect penis and a woman licking it … They were quite happy that it was a woman licking a man’s penis, they didn’t sexualise it. It didn’t seem the horrific image we might think. It may have been brushed under the carpet or we just moved on as tomorrow is another day.

The metaphors ‘brushed under the carpet’ and ‘moved on’, with their dynamic nature, suggest that there was a wish to physically distance himself from the conversation, thus avoiding the factual conversation that this situation invited.

‘S/he knows something, but I don’t know how much’

The discomfort and avoidance outlined above appeared to lead to uncertainty amongst the fathers regarding their children’s level of understanding concerning puberty, relationships and reproduction. Michael and James guessed that their sons would have picked up some knowledge about sex from their peers, and Angus, Steve and Andy stated that they did not know whether their daughters knew about reproduction or menstruation. Until a month before his interview Nigel had believed that his son knew nothing about sex, but when he had started to broach the subject

Jo came out with this Collin’s book on how to do everything and said ‘Dad you should read through this as there is a bit on how to talk to your children about sex’. And I thought ‘Oh My God’, and he’d read it. He already knew.

It appeared that the fathers required a catalyst to prompt a discussion with their children. Neil referred to his daughter’s physical development as a potential reason, and Nigel referred to a professional situation where he had encountered a boy of a similar age to his son who had commenced puberty: ‘it was a complete shock to me, he’d gone through puberty … I came home that night and said “we need to talk to Jo about this”’. Colin had started to broach the issue because ‘We wanted to tell him before someone in the playground or class told him, so he got all the facts right’, and Andy and Angus described feeling that they ‘ought to’ talk to their girls in response to notification of RSE by their daughters’ respective schools.

Foucault (1980) argued that sexuality is historically and discursively constructed, and no essence exists that requires repression or liberation. Through his understanding of power as productive, Foucault (p. 105) asserted that:

Sexuality must not be thought of as a natural given which power tries to hold in check, or as an obscure domain which knowledge tries gradually to uncover. It is the name that can be given to a historical construct.

Indeed, the fathers’ perceptions of sexuality as taboo may have reflected their personal experiences of learning about sexuality since they grew up in an era where tension characterised beliefs about sexuality, in that constructionist perspectives were gaining popularity, yet their own parents’ beliefs were likely to have been underpinned by essentialist beliefs.

Each of the fathers described sexuality-related conversations as removed from other aspects of day-to-day parenting, regardless of the gender of their child. This echoes the persuasive messages of the state through which normalising judgements about appropriate paternal behaviours are communicated and reinforced with a ‘specialness’ attached to sexuality which sets it apart from the mundane and the routine ( Jackson and Scott, 2010 ). A paradox existed between the men’s perceptions of how openly they communicated with their sons and daughters and the virtual silence that defined their communication about sexuality with both their girls and boys. This finding is consistent with Kirkman et al.’s (2005) study ‘Being open with your mouth shut: the meaning of “openness” in family communication about sexuality’, which identified a range of meanings encompassed by openness and highlighted a mismatch between parents’ perceptions of their relationships with their children and their children’s perceptions.

Societies globally are reluctant to openly discuss issues of sexuality ( Byers, 2011 ; Flores and Barroso, 2017 ). Although the quotations regarding the fathers’ discomfort at discussing menstruation with their daughters suggested gendered divisions of labour, in reality the fathers were equally uncomfortable in discussing these issues with their sons, which led to avoidance behaviours. As Walker (2004) posits, sex education can be very challenging for parents since it demands cognitive, affective and conative processes. As Foucault (1980: 104) highlighted in drawing attention to the ‘pedagogization of children’s sex’, children’s sexuality education is frequently perceived as being fraught with danger: ‘parents, families, educators … would have to take charge … of this precious and perilous, dangerous and endangered sexual potential’. Indeed, the fathers who participated in this study were exposed to the neoliberal economic policies and moral conservatism of the 1980s that saw the implementation of Section 28 of the Local Government Act 1988 , which prohibited local authorities from ‘promoting’ homosexuality and ‘pretended family relationships’ (Local Government Act, 2008). Their experiences of the discourses around RSE at that time may, therefore, have enhanced their perception of the ‘perilous’ nature of sexuality communication with children.

Downing et al. (2011) , Feldman and Rosenthal (2000 ) and Levin and Currie (2010) argue that for parents to become better sex educators, their general communication skills require improvement. Turnbull et al.’s (2008 ) review of the literature identified that receptive parents who spend time with their children are more likely to be able to communicate openly with their adolescents about sensitive issues such as sexuality. Levin and Currie’s (2010) findings also support this assertion. Whilst it is acknowledged that there is a paucity of research that has examined this relationship in the pre-adolescent period, it is likely that the findings can be applied to younger children’s relationships with their parents and the subsequent quality of communication in this domain ( Stone et al., 2013 ). However, the findings of the current study also suggest that communication could have been enhanced if the fathers had had a broader understanding of sexuality. Puberty, relationships and reproduction were subsumed as relating to heterosexual relationships by several of the participants. For example, Michael proposed that since his son was not yet interested in girls he was not yet ready to discuss any of these issues. Goldman (2008) and Goldman and Goldman (1982) also found in their research that terms such as sex, sexual and sexuality were frequently associated with coitus. Similarly, Stone et al. (2013) identified a tendency towards a biologically orientated approach to sexuality amongst parents, with issues such as body comfort, gender perceptions and self-confidence frequently being overlooked.

Foucault (1977) asserted that the modern family, or the biopolitical family cell, is a panoptic, normalising entity and parents act as the instruments of doctors, therapists and biopolitical state interests. Parent–child relationships are characterised for Foucault by parental monitoring of children’s sexuality and the maintenance of ‘a sexually aseptic family space’ ( 2004 : 245). This power, Foucault argues, ‘must model its forms, criteria, interventions and decisions on medical reasons and knowledge’ and parents must therefore be ‘diagnosticians, therapists and agents of health’ ( Foucault, 2004 : 249–250). However, the fathers’ discourses appeared to reject such notions and were free of any suggestion of governmentality. The fathers made no reference to guidance for parents regarding their role in providing comprehensive sexuality education for their children, which mirrored the lack of support that continues to be available to parents in the UK.

The fathers in this study appeared to be disengaged from their children in relation to their physicality and they appeared to find it difficult to acknowledge the needs of their children in this regard. Butler (1990 : 130) argues that for Foucault, ‘cultural values emerge as a result of an inscription on the body’, with the body understood as a blank page, ‘a materiality prior to signification and form’. Butler suggests that the body is made up of a set of flexible ‘boundaries, individual and social, politically maintained and signified’ (1990: 33) and that Foucault could have radicalised his theory further by a ‘critical inquiry that traces the regulatory practices within which bodily contours are constructed’ (p. 133) to provide a critical genealogy of how bodies are ‘made’. The fathers’ perceptions of their children’s asexuality appeared to be supported by a lack of reference to their children’s corporealities. Indeed, several of those, particularly the fathers who had boys, appeared to be unaware that their children were likely to be peri-pubertal. Equally though, when fathers did acknowledge physical changes in their children, they did not appear to align their observations with the reality of their child’s physical, psychological and social stage of development. Whilst the children were seen as gendered and potentially sexual, all but one of the fathers perceived their children as asexual in the same way that parents of younger children frequently describe their children ( Egan and Hawkes, 2010 ). It appeared that the fathers saw their children as social constructions and discursive representations rather than a biological entity.

Original contribution to nursing

Open parent–child sexuality communication can be protective for young people in relation to their sexual assertiveness and decision making, and it can reduce risk-taking behaviours ( Flores and Barroso, 2017 ; Widman et al., 2006, 2016). However, the use of IPA with a Foucauldian lens has shed light on the difficulties fathers may have in overcoming the taboo associated with sexuality and the impact that this may have on their communication regarding sexuality with their children. As Jackson and Scott (2010) argue, by looking at an issue from one particular perspective, another can be obscured; by interpreting the findings of this study from multiple perspectives, a deeper, more informed perspective has been secured. In addition, by specifically focusing on the lived experiences of fathers of 10-year-old children living in England, a novel contribution to the field has been made since up until now there has been a complete absence of research pertaining to this population in relation to father–child sexuality communication.

As highlighted in the International Council of Nurses’ ( 2018 ) response to The Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030), sexual health is frequently neglected as it occurs in a private sphere, but the intimate nature of nurses’ relationship with patients and their families allows them to enter this area of health. Nurses are therefore well-positioned to provide families with the knowledge and resources needed to ensure that fathers are equipped to engage in sexuality communication with their children. Whilst this is largely unchartered territory, the success of family-centred nursing initiatives such as the Family Nurse Partnership (2018) demonstrates that nurse-led family-centred interventions can significantly impact upon parental health behaviours and health outcomes for children.

Furthermore, at the meso and macro levels, nurses are also well placed to influence the design of policies and programmes that are family centred and support fathers in fulfilling this aspect of their parental role. This is of particular relevance to the UK at the current time since changes to the legislation that governs school-based RSE are currently on going.

Limitations

The conclusions that can be drawn from this study are limited by the small sample size employed and the nature of the sample, in that cultural, religious, class and sexual diversity as factors that may influence masculine identities, and fatherhood practices could not be explored. In addition, there is a risk that the language used by participants may be a construction, rather than a description, of the fathers’ lived realities. Throughout the process, presuppositions and judgements were suspended through a process of reflexivity, the aim of which was to focus on what was present in the data rather than what was assumed to be present ( Shaw, 2010 ). However, as Smith et al. (2009) acknowledge, in IPA the researcher significantly shapes the research process and co-constructs the findings of the research; subjectivity is therefore a central feature of this study.

Historically there have been repeated shifts between the school and the home, the teachers and the parents, as the responsible extensions and transformations of the state to shape the sexual conduct of children and young people. Father–child sexuality communication is one potential mediating factor that may help young people to develop greater resilience in reducing their exposure to sexual risk. However, the findings of this study suggest that this opportunity is currently under-exploited. By examining the fathers’ reports through a Foucauldian lens, the strength of the enduring taboo that surrounds sexuality for fathers, and its silencing effect, have been illuminated. Nurses are in a key position to support fathers in overcoming this silence through direct interventions with families as well as influencing health and social policy.

Key points for policy, practice and/or research

• A silence characterises father–child sexuality communication, which can be understood when placed in context socially and historically.
• However, such silence renders children vulnerable both in childhood and later as young people and adults.
• Nurses working with families, children, young people and schools, as well as those working in public health, are in a position to normalise open sexuality communication and to support fathers in undertaking this role.
• There is a need for further research to deepen our understanding of the structural barriers that fathers may face in this aspect of parenting.

Clare Bennett is a lecturer in adult nursing at Cardiff University. She was a Clinical Nurse Specialist in immunology and has also nursed in the fields of HIV and sexual health. Clare is a Doctor of Nursing and teaches research methods, leadership, quality improvement and sexual health promotion at Bachelor, Master’s and Doctoral level. Clare’s research interests are primarily focused on sexual health promotion. Her doctorate explored the role of fathers as sexuality educators for their children, and she has since gone on to become a Winston Churchill Fellow and has undertaken research in the Netherlands regarding parent–child sexuality communication.

Jane Harden is a senior lecturer at Cardiff University. Her research and teaching interests are in the areas of evidence synthesis and implementation with a particular focus on dementia care in acute hospitals. She also teaches patient safety issues and research methods and design. She is currently working on two National Institute for Health Research–funded studies which are looking at ways to improve outcomes for patients with cognitive impairment following admission via medical assessment units. Her PhD was a Foucauldian examination of nurse education and the experiences of mature women who undergo a programme of training leading to Registered Nurse status.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The School of Healthcare Sciences Research Ethics Committee at Cardiff University granted approval for this study.

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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How Decentralized Trials Can Maximize Recruitment and Engagement for “Taboo” Research Topics

DCTs offer an effective avenue for studying what are sometimes considered “taboo” therapeutic areas while respecting participants’ discretion.

Decentralized clinical trials (DCTs) offer an effective avenue for studying what are sometimes considered “taboo” therapeutic areas (those that involve highly personal or sensitive medical areas) while respecting participants’ preference for discretion and generating meaningful outcomes. ObvioHealth has conducted multiple trials on taboo topics, providing helpful insights and best practices to maximize participant recruitment and engagement and enrollment and onboarding for decentralized research .

How do taboo topics affect prospective clinical trial participants?

It’s important to note that taboo medical conditions aren’t innately shameful. But patients who internalize negative cultural attitudes may hold back from talking openly about their symptoms, which can fuel misconceptions and perpetuate stigmas.

“Coming from a clinical background, we think talking about these issues is normal, but a lot of people don’t,” ObvioHealth director of clinical operations Joshua Lowndes notes. “Some issues are harder to talk about, even with a medical professional. You might feel this person is judging you. These concerns can make someone feel reluctant to join a clinical trial.”

Numerous studies show how inhibition around taboo topics impacts the patient experience well-being:

·      Women’s health: British researchers found that some women attribute urinary tract infection to personal weakness, such as poor cleanliness, and that these women “might be particularly vulnerable to feelings of not being taken seriously by their doctors.”

·      Urology and men’s health: “Due to stereotypical perceptions of masculinity, men are often hesitant to visit health care providers,” according to research published in the WorldJournal of Men’s Health . Meanwhile, urologists function as an access point for men to seek medical care. With that in mind, clinical research and therapeutic development for men’s health conditions may improve overall healthcare delivery.

·      Mental health: Sociologist Erwin Goffman lamented in 1963 : “There is no country, society or culture where people with mental illness have the same societal value as people without a mental illness.” Fortunately, acceptance of mental health support and intervention has increased dramatically. But stigma still remains. Clinical research can address this stigma resistance, which is linked with better psychiatric and psychosocial outcomes.

·      Gastrointestinal health: According to a column in The Lancet , “Stigma around irritable bowel syndrome is prevalent among the general public, health-care professionals, and co-workers, and is often related to poor understanding of the condition.” Stigma is linked with “unsatisfactory outcomes” for IBS patients, “including increased health-care use, psychological distress, and impaired quality of life.”

Researchers in the Journal of Science Communication note several factors, such as “medical uncertainty, complex jargon, and patients’ misunderstanding of the human anatomy,” that exacerbate taboos and limit a patient’s ability to participate in shared decision-making.

How do DCTs support clinical research on taboo topics?

When studying taboo topics, DCTs offer several advantages for sponsors and clinical research organizations (CROs).

Recruitment for taboo topics

Recruiting participants for research on sensitive topics can be challenging because prospects may be reluctant to discuss these conditions explicitly. Digital ad campaigns offer an efficient recruitment pipeline to bypass these hesitations and enroll participants.

Social media and search engine ads allow motivated prospects to find relevant studies that may be a fit. When prospects go online to look for answers about a medical condition affecting them or a loved one, these campaigns direct them to clinical trials relevant to their intent.

Importantly, virtual clinical trials don’t require in-person enrollment, which:

·       Shortens the window of time for prospects to second-guess themselves, increasing the likelihood of enrollment.

·       Allows prospects to remain relatively anonymous, offering a sense of privacy.

·       Can strengthen the participant pool by expanding access for people with conditions that limit their ability to travel.

Sponsors and clinical research organizations need to understand cultural and participant attitudes around taboo topics to appropriately define and target the study population. These insights will help to develop more successful patient recruitment campaigns and can also inform the product’s regulatory submission and go-to-market strategy.

Best practices for DCT recruitment:

‍ “In digital recruitment, we use patient-centric messaging that retains clinical integrity, so participants can understand for themselves whether this study is right for them,” ObvioHealth director of clinical operations Joshua Lowndes says. “Research teams should translate advanced clinical terms into language laypeople can understand.”

For instance, ObvioHealth was commissioned to assess the efficacy of an FDA-approved Class II medical device compared to standard exercises to treat stress urinary incontinence and stress-predominant mixed urinary incontinence in women. When recruiting for this study, researchers needed to describe “vaginal prolapse” in a more participant-friendly way.

Maintaining engagement and compliance in DCTs about taboo topics

After participants enroll, maintaining engagement and compliance is key—and this is where DCTs offer another advantage. Talking about symptoms face-to-face can make participants feel overly exposed, which can drive high dropout rates in traditional, site-based trials. But virtual study participants complete study tasks from the privacy and comfort of their homes.

DCTs create a safe space between participants and researchers, so people feel more at ease discussing symptoms and changes in their health. “Virtual trials give us just the right amount of human connection, because we’re engaging virtually without seeing each other physically,” ObvioHealth medical director Dr. Parth Shah says. “This creates an environment where participants feel less vulnerable and more in control of their experience.”

Research teams can also get more precise, granular information from electronic patient-reported outcomes (ePRO). This is because participants can complete ePRO in real time rather than waiting for an in-person appointment, and they can report sensitive symptoms in a more discreet setting compared with a physical interview.

The ongoing development of artificial intelligence also allows study teams to use machine learning to discreetly capture and interpret new sources of data. For instance, participants could take and save images of stool samples within a study app, rather than storing images to their camera rolls.

However, virtual trial participants should still be able to get support when they need or want it. ObvioHealth’s virtual study team, known as the Clinical Oversight and Coordination Hub (COACH), engages participants with phone calls, texting and an online chat feature.

Constant access to the COACH team provides participants the encouragement they need to remain engaged, and regular notifications help them remain compliant with the study protocol. The beauty of a virtual trial is that participants can complete study tasks and engage with the research team in the ways that best support their needs and wishes.

Best practices for DCT participant engagement: Virtual study teams should offer ongoing support tailored to participants’ needs and comfort levels. “Being patient-centric in a virtual trial means that we listen to how participants describe changes in their symptoms, and we take our cues from the types of words they prefer,” ObvioHealth medical director Parth Shah says.

Bringing it all together

Recruiting and prescreening decentralized research on “taboo” topics deserves more investment because new therapies for “taboo” health conditions offer life-changing potential. By breaking down traditional barriers to research, virtual trials help sponsors bring these vital products to market, maximizing their impact for patients.

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Marketing and Strategic Communications Western Michigan University Kalamazoo MI 49008-5200 USA (269) 387-8400

Taboo topics course uses dialogue to break through barriers

KALAMAZOO, Mich.—Shortly before the fall 2019 winter break, at a popular Kalamazoo breakfast eatery, Claire Hernandez found herself listening to a friend contemplate committing suicide. The Western Michigan University senior knew something was amiss, but didn’t expect the morning conversation to veer in the direction that it did. As it turned out, however, their crucial talk happened at a time when Hernandez was best-equipped to receive the information: near the conclusion of her Communicating About Taboo Topics course. 

Designed and taught by Dr. Mark Orbe , Taboo Topics relies on dialogic learning—discussion-based study—to address sensitive subjects that are typically off-limits to speak about in North American culture. Therefore, matters pertaining to race, death, sex, religion, and other subjects are the foci. According to Orbe, students have conversations about weighty material that many of us tend to avoid. 

“Family secrets, race, faith and religion, death, interracial romantic relationships, kinks/sex/masturbation and fear were just a few of the topics we discussed,” says WMU alumna Hailey Mangrum , who is now the assistant director of leadership development for fraternity and sorority life at Virginia Polytechnic Institute and State University.

Resulting is a classroom atmosphere that’s infused with respectful and non-judgmental exchange. Although confusion, shame and anger are also natural emotions that surface when discussing oppositional views, such negativity tends to take a backseat to diverse perspective-sharing, Orbe says.

In the process, classmates often form strong emotional connections with each other, and gain insight about human interaction and communication that will last them a lifetime. Because he and so many students have found the course to be so impactful, Orbe has considered hosting a reunion for students from previous “generations,” which is how he refers to members of each successive course iteration.

“This was the top course that transformed my thinking, that I can easily draw from in everyday life,” says Jonathan Pulley , who took Taboo Topics in 2015 and currently serves as the W.K. Kellogg Foundation’s Racial Equity Program officer. 

Outsiders, such as parents and roommates, tend to react with shock and curiosity when they hear about this elective course offering in WMU’s School of Communication . Why, they wonder, would students want to learn about topics so contemptible and controversial, and what educational value do those lessons offer?

Mangrum says this lack of comprehension from those not taking the class disappointed her. 

“Other folks weren’t able to understand the importance of engaging in conversations of difference. It was almost like we were in a bubble, although a true microcosm of the campus as we had a spectrum of perspectives and beliefs in the classroom,” she says.

Students, however, flock to the annual fall course. Orbe said Taboo Topics, which he has taught for the past 11 years, is the most popular course he has ever instructed during his decades-long teaching career. Upperclass students, student-athletes, honors students and others who have enrollment priority at the university typically register as the 30 available spaces immediately fill.

The effect the course has on students and Orbe alike is tangible. Orbe learned after his inaugural Taboo Topics course that, because class interaction is so mentally draining, it must be the last class he teaches on those days; he can then take those opportunities to drive home listening to soothing music and thinking about what was just discussed instead of prepare for another class. He also requires students to have a check-in partner after each class who can help them recapture their emotional bearings. He says he also often sits with students immediately after class until they’re ready to leave, “just so they can process” what they’ve heard and said.

Discussions can be traumatic. They can trigger anger and fear. Eyebrows are raised and deep breaths are taken. For a book chapter, Orbe wrote how a provocative hypothetical question about his children once caused him to openly sob. But negativity is not always the prevailing feeling. Participants have also been known to uproariously laugh, he says.

“The norm is to emote,” says Orbe.

Purposeful Perturbance

The course objective is challenging to attain, but invaluable: come to understand contrary viewpoints about forbidden topics, especially those you oppose, and, in the process, become transformed. Argumentation and debate are taught elsewhere, Orbe explains. 

“This class is about mutual understanding” that’s not predicated upon persuasion; one can comprehend a particular stance without agreeing with it, he says.

Pulley, who self-identifies as a Black male Christian, was initially taken aback by some stances that didn’t align with his race, culture and faith. But ultimately, he says he came to appreciate oppositional beliefs instead of dismiss them outright as wrong. 

“One thing I drew from this class is, I can be who I am, but honor and respect people with different experiences and who believe differently,” says Pulley.

Class members discover the power and virtue of learning from a humanistic perspective. They also realize the essentialness of delving into the reasons for why someone thinks the way they do. Students begin to realize at a deeper level that everyone’s unique experiences shape how they acquire and interpret knowledge. For instance, a parent’s political preferences may influence how someone votes, or residing in a particular region of the country might influence someone’s views about immigrants. 

History and context are important, says Orbe, whose intersectional interests in communication, culture, race and qualitative research and pedagogy have resulted in hundreds of articles, chapters, books and presentations.

Starting from Scratch

When Orbe created Taboo Topics, there was no teaching template, no existing syllabus that could be used as a model, he says. Interactions within his interracial communications course, subsequent suggestions from students, and the obvious absence of literature and teaching experiences that directly tackle taboo areas instead of tiptoeing around them enticed Orbe to venture into the pedagogical unknown. 

Addressing a culture’s most forbidden subjects can stimulate critical thinking for broader use, and create a desire to understand alternative perspectives, particularly within today’s diverse and polarized society where ideological differences are fostering combative attitudes, Orbe says. His class leads participants to more thoroughly consider, for instance, how an international student at WMU may feel while being away from their country for the first time, contending with their first Michigan winter, and learning a new language.

“Our world is increasingly diverse on so many different levels, and unless we’re teaching the skills on how to understand, we’re never going to have communication, which requires sustained shared meaning. We’re never going to have intercultural communication,” Orbe says.

The course is party based on the teachings of the late Paulo Freire, a contemporary Brazilian educator and philosopher whose critical pedagogy advocacy has influenced teachers the word over in regards to learner-centered empowerment. Freire believed that encouraging students to critically question authority and established meaning is a social justice imperative and the only path to liberation.

Thus, Orbe’s Taboo Topics students are required to respectfully interrogate the motives and mechanisms that contribute to a subject’s unspeakable nature. Why do U.S. Americans avoid discussing the active stages of death? Why are miscarriages kept secret? What’s so embarrassing about masturbation? Students dive into such turbulent conversation waters.

Methods to the Madness

Raised in a multiracial home on the East Coast during a time when interracial marriage was still largely forbidden socially, Orbe’s quest to understand and teach others about his own identity, and to help others understand theirs too, began early on and continues to this day. Orbe and his multiracial spouse have children who acknowledge their African, Asian, Native and European ancestry, and he says he has learned valuable lessons about gender identity, gender expression and sexualities thanks to different family members. Engaging with taboo topics with his students has allowed him to do so willingly and gracefully. His life encompasses a vivid and dynamic tapestry of people, places and experiences. 

Understandably, Orbe academically embraces autoethnography, a form of qualitative research that incorporates self-reflection about lived activities to learn more about larger social, cultural and political realms. Orbe includes autoethnographic practices in many of his communication lessons, and also organizes experiential learning trips abroad. For an autoethnography course in Costa Rica, students learn more about themselves within the context of differing racial, cultural and communicative settings. For instance, to be Black in Central and South America is culturally different than being Black in the U.S., he points out.

For Taboo Topics, Orbe aims to disrupt. He wants students to willingly get uncomfortable, to face their notions head on and to become vulnerable so that the silence surrounding certain subjects is shattered, and power thereby redistributed. 

“Naming it (topic) changes it. That’s one of our themes,” Orbe says. “When you’re able to name the taboo and articulate it, you take some of the power away from it.”

Orbe refers to the classroom for this course as one that reflects a “brave space rather than the safe space.” Confessions are common. Although not required, many students find themselves sharing personal information that they’d previously never shared with anyone. They’ll articulate challenges they’ve faced that they’ve never said aloud before, thereby revealing additional layers of their humanity. As trust builds within the considerate and honest classroom environment, situations such as sexual assaults, eating disorders, announcements regarding gender identity, damaging family secrets and mental illnesses have been offered.

“It was not group therapy, but an expressive environment,” says Pulley. 

“There were some really personal moments that people shared and there were moments that people were crying in class. I’m sure at least half the class shared something that they had never shared with somebody before. That was really shocking to me because I had never been in a classroom setting where something like that happened,” says Hernandez.

Some discussion tools that Orbe uses to facilitate conversations include provocative questions and well-researched student-led interactions. 

He has had students divide into groups and address “Sophie’s Choice”-type hypotheticals, he says, referring to the 1982 fictional film about a Holocaust survivor. One memorable question: if you had to choose between being Jewish during the Holocaust or a North American slave prior to the Civil War, which would you be? 

The “would you rather” activity requires students to guess which stances their classmates have taken on particular topics, and talk about their guesses’ accuracy or inaccuracy. 

During the Fall 2019 course, a group facilitated a class on concepts about the afterlife, including out-of-body experiences, which Orbe says “was crazy powerful” because it generated several insightful questions. 

An exercise called “four corners,” which required people to segregate into groups according to levels at which they think they’ve been affected by sexual violence revealed gendered differences and sparked discussion around ideas of masculinity and cultural expectations, Hernandez says.

Mangrum recalls her class having a powerful discussion about secrecy. 

“Participants were instructed to finish a prompt disclosing a secret they have in their family,” she says. “Maybe something going on or something that nobody knows about except family. A classmate then collected the ‘secrets,’ written on pieces of paper and placed them in his backpack, wore it, and continued to facilitate the conversation. It was such a powerful representation of how we carry things with us wherever we go and how that could continue to stay in the family for generations to come.” According to Orbe, this is one of the many powerful activities created and facilitated by students over the years.

Magical Moments

“Dumela” is a term Orbe uses as a Taboo Topics theme and as a greeting for all his students. Derived from Botswana in South Africa, it means “I believe in you, I affirm you, and I see great potential in you.” He finds it exceptionally relevant to use in this course, where students are willingly sharing thoughts that could very well lead to being stigmatized if expressed anywhere else. Dumela’s tone-setting nature helps contribute to classroom power-sharing. The “magic” occurs when the class realizes its “synergistic power” through dialogue, says Orbe.

Defining communication as “shared meaning,” dialogue, Orbe says, works as a necessary tool to enhance understanding and increase mindfulness. It’s a “peak communicative event” that enables individuals to understand why someone believes and behaves in the ways that they do. 

“It can be something as easy as saying ‘I love you.’ And you’re like, ‘Wow, that’s so nice.’ But you have not interrogated what is meant by another person’s use of the word. So, there are a lot of times where people hear what they want to hear and interpret that, and it’s just not the same,” says Orbe. Contributing to misunderstandings can also be nonverbal cues, differing socioeconomic backgrounds, generational dissonance and many more socio-cultural factors. 

To achieve “dialogic moments,” listening is just as important as questioning, Orbe says. Knowing when to be quiet, and to actually embrace silence, is a learned skill set that runs counter to the notion of “winning,” he notes. “How can we use communication in a powerfully affirmative way and not in a Machiavellian way where you’re trying to dominate others?” he asks. 

The paperclip activity is typically the most memorable class experience where everyone in the class, including Orbe, mindfully and dialogically listens to one another’s self-disclosures. This “was the moment for me where I realized how important it is to listen… where I knew I could say a bunch of things that would make you feel better, but I can’t contribute to your situation because I don’t understand it,” Hernandez says. 

“I learned a valuable lesson that I apply in staff meetings today: when you talk, you potentially could be robbing someone else of their opportunity to speak,” Pulley says. “I realized that just because you have something to say doesn’t mean that, 1) it has to be said, and 2) you can learn from not speaking, too.”

Thus, by tapping into the taboo, students learn how to reach an understanding about why, for instance, someone supports Donald Trump or Hillary Clinton, or why someone has chosen to become estranged from their parents.

How do you know that peak dialogue has occurred? When you have “experienced transformation,” Orbe explains. “And transformation means that you have changed how you see yourself, you’ve changed how you see others, and/or you’ve changed how you see the world.”

Taboo Takeaways

Hernandez, Pulley and Mangrum say they regularly apply the dialogic lessons and techniques they learned in Taboo Topics to their careers and personal lives.

Hernandez, an Ontario, Canada native who is studying behavior analysis and is multiracial, said she’ll approach this year’s presidential election differently than she did in 2016. Along with asking more questions about why people think and feel the way they do about candidates and issues, she will also speak more about her beliefs instead of remaining reticent in order to not distress others, she says.

“I didn’t want to make anyone upset, and I think that was a problem in itself, not saying what my truth was so that I wouldn’t offend somebody else,” Hernandez says “I think that’s a really important thing to do in a respectful way. ‘I hear what you’re saying and this is why I disagree with you.’”

Hernandez’s friend who expressed suicidal thoughts to her has survived, she said. 

“She’s still here, thankfully. Every day is a battle and you can really see it on her face, you can see she’s working really hard,” Hernandez explains. Listening to her friend without judging or demanding action from her, as some family members were doing, contributed to their meaningful dialogue, Hernandez thinks. She wrote her final paper for the course on that important breakfast conversation, and has carried those lessons with her.

“There has been no better training for how to be an advocate and facilitator than my courses with Orbe,” says Mangrum. “Literally, from the way I set up a space for dialogue, engage people from opposite ends of the spectrum, to helping folks understand the negotiations we make every day based on the intersections of our identity, I learned from him. I am a better professional, educator, learner and conversationalist simply because I was able to take a class with Dr. Orbe,” Mangrum says.

Taboo Topics has helped Pulley navigate complex ideas stemming from his work on the Kellogg Foundation’s Racial Equity Team and made his work far more impactful and rewarding than it otherwise might have been, he says. 

“The way I approach difficult dialogue on hard topics now is through a lens of, how can I affirm someone in the process,” Pulley says. By honoring their viewpoints while also making an effort to access their origins and simultaneously remaining true to himself, Pulley’s identity remains intact and his curiousity to learn more about others, even those whose beliefs he considers abhorrent, continues to flourish.

As for Orbe, he says he hopes to teach Taboo Topics as long as he can remain a student-teacher who is learning along with his pupils.

“Dare I say, if we give students the opportunity to teach us, they will teach us. I’m not the only teacher,” says Orbe. “Yes, you’ll learn some stuff from me, but there are other important teachers in the room. There’s a certain cultural humility that has to come in here from everyone. All of us has something to learn. 

Also, Orbe said the class continuously impresses and humbles him because it brings out the best in everyone involved.

“Students come in and they’re just so inquisitive and willing to share and teach and learn. It also, to be quite frank, has given me a lot of faith and hope in our future because these young people are amazing,” he says.

For more WMU News, arts and events, visit  WMU News  online.

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Researching taboo topics using Social Data - Talkwalker

Discover consumer intelligence inspiration

When I started at my first ever real job, I worked in a large open-plan office. People could see each others’ screens – not the details, but the larger things. This meant I would quite often have co-workers I didn’t know coming up to me and asking about my unusual desktop background. It’s my favorite piece of art, I’d reply. It’s called Another Storm by Lee Krasner. I like it because it reminds me of how I feel when I’m on my period. 

Another Storm, by Lee Krasner. Krasner, incidentally, was married to Jackson Pollock and is unfairly much less famous.

The reactions to this were always varied, but most people found, after their initial shock or surprise, that they were quite capable of having a normal conversation about a completely natural bodily function without fainting or vomiting.

Breaking taboos is a sensitive subject

I’ve always enjoyed breaking taboos. There’s something about playing with the rules of conversation, of exploring why some things are forbidden and whether they really need to be – but as a researcher, that’s where the really interesting insights lie. In the unspoken, the later spoken, the only spoken with those one feels really comfortable with.

However, I’d thought my serious workplace taboo breaking would be restricted to internal culture changes brought about through open conversation. It was only when I joined discover.ai/Talkwalker*, that I found that this could be something that I could bring to my client work as well. And the thing that made this possible, was that I was suddenly immersed in social data and social media analytics .

‘Taboo’ is an interesting concept. It contains a sense of the ‘unspoken’, but that in itself is a contradiction. Taboo topics are those which are spoken about, but without the sense of safety that comes with ‘normal’ communication topics. Taboo topics are those which come with a risk of repercussion in raising them, and therefore ones where people don’t always want to be directly associated with the thing they want to say, for fear of shame, embarrassment or even punishment.

Hiding openly on the Internet

Enter – the internet. Since its inception, the internet has been a space where people have embraced anonymity and distance to say the things they would not say to people’s faces, in ‘real life’. 

Quite often, when I take a brief, I have to say to my clients – you need to be realistic about whether people are really going to be talking about this online, in a manner that will be useful. But when it comes to taboo topics – menstruation, sex, mental health, erectile dysfunction, condoms, incontinence, menopause, cervical cancer (all real project topics) – I never have that worry.

Traditional research vs the Internet

What’s brilliant about this is that it is the opposite reaction that my clients are used to when it comes to doing traditional market research . In interviews or focus groups, you have to build a careful rapport with your respondents in order to help them feel comfortable opening up on sensitive topics in a way that feels safe. 

On the internet, they’ll do it for you, and gladly.

Understand taboo topics with social data analysis

When we presented some of our work with Durex on understanding the behaviors of their consumers, we called the presentation, Using the newest methodologies to understand the world’s oldest problems. 

Click above to watch the Old Problems, New Methodologies presentation (Only available on YouTube)

I think this goes to the heart of what’s so inspiring about using social data to understand taboo topics. The reason that people are going online to talk about the things they can’t talk about anywhere else is that the silencing that turns natural bodily processes and common conditions into something shameful means that people are going online looking for help.

They are sharing knowledge and advice, and seeking it in return, because this is something they’re not getting in traditional spaces. Brands who want to truly help their consumers, and to find ways to make genuine change in spaces that have been calling out for it for decades, can tap into this using social data and AI research. They can find new perspectives on these old, pervading problems.

As with any form of research, there are watch-outs and there are dangers. We build source data from consumer forums, discussion groups, book reviews, expert sites, bloggers, influencers – anywhere that someone might be sharing their feelings and reactions.  But the very thing that makes this so rich also makes it risky.

Don't be a stranger

We saw in a project understanding vaginal pain conditions like vulvodynia and vaginismus , produced in collaboration with Jessica Marcus (Storyful),  that people would go to r/sex to understand why they couldn’t have sex with their partners, and a stranger on the internet would end up diagnosing them at a distance. Often this would then empower their conversations with their doctor – but also leaves them vulnerable to misinformation and quack remedies.

Talkwalker’s Quick Search identified 68.8k mentions of vulvodynia and vaginismus over 13 months. But it requires human insight and analysis to learn more from that data.

Avoid online echo chambers

We also have to work as hard as possible to ensure that our data is coming from diverse sources. Social data can cut across and share voices from people of different ethnicities, races, religions, gender identities, and those with disabilities or chronic conditions.

These are all people who might find structural and logistical barriers to attending focus groups, or who might not be heard if they are present. But bias is ever present, and we must strive to avoid online echo chambers, and ensure our data accurately represents as wide a gamut of voices as possible.

Humans + AI = real solutions

This is why it’s always so important for us to combine human sensitivity in our analysis of AI and social media data. The AI does not know which science is real, or which voices are ‘bad actors’. Technology can help us get to new perspectives, but it is the humans working with it who will come up with the real, working solutions. 

Period-talk is no longer a code red

It has been a long time since anyone has been ‘shocked’ by my desktop background. Working in an environment comfortable with common taboo subjects and challenging insight, talking about my period at work is not a notable event.

Find data, human & cultural insights

But our immersion in these topics never quite prepares you for the moment of shock when you realize all of the ways in which people’s lives, their health, their reality are impacted by not being able to talk openly about the things that matter to them. Finding the data is only the first challenge, and we have the tools to do that – but what we do with that information, is the bigger, more pressing challenge, and that is where the real work begins.

When Talkwalker acquired discover.ai , a consumer and cultural insight platform, it created a unique combination of machine learning and human insight. This means we now provide our clients with a deeper reading into the human stories and emotive human drivers that lie behind consumer intelligence . 

If you’d like to find out more, you can sign up for a personalized demo . To help with your research, download our consumer behavior dashboard…

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First Impressions

The social impact of discussing taboo topics, research reveals how first impressions are impacted by conversation topics.

Posted April 10, 2021 | Reviewed by Lybi Ma

• Self-disclosure topics during initial interactions can influence social, physical, and task attractiveness.
• When social norms regarding appropriate conversation topics are violated, people are less satisfied from interactions.
• People who make us uncomfortable may have engaged in taboo topics in the past.

You are getting to know a new acquaintance. The conversation is fun and easy as he tells you about his last job, his hometown, and favorite sports. It turns out you both grew up in small towns with no airports, graduated from out-of-state universities with winning football teams, and are now laughing about the long drives you both had returning home for summer break. But suddenly, the relational momentum comes to a screeching halt, when he crosses a line. “Thank God we have public transportation here. With the amount of time I spend behind the wheel, I can’t afford to get another DUI. Have you ever been pulled over for drunk driving?” Regardless of what the answer is, your interest in continuing the conversation is likely over.

Many relationships never take flight because they are grounded early on by inappropriate questions. Questions that perhaps would be appropriate once relationships have been formed, but not beforehand. Research explains how this happens.

First Impressions and Conversation Topics

Hye Eun Lee et al., in a piece entitled “Effects of Taboo Conversation Topics on Impression Formation and Task Performance Evaluation” (2020),[i] examined how taboo conversation topics impact impression formation and task performance.

Their experiment included 109 women who interacted with a female research confederate, believed to be another study participant. They found that when the confederate performed well and discussed appropriate topics, participants were more likely to form a more positive impression and a more positive evaluation of her task performance. Lee et al. note that when social norms regarding appropriate topics of conversation are not followed, people are less satisfied from the interaction, and may evaluate the task performance of the norm-breaker more negatively.

When People Talk Taboo

What topics are appropriate, and what topics are taboo? Lee et al. note that past researchers believed that within the first two hours of conversation, the list of inappropriate topics included income, personal problems, and sexual behavior. People are not likely to evaluate others positively when they violate this expectation. They note that appropriate conversation topics include current events, culture, sports, and good news, where inappropriate or taboo topics include sex, money, religion, and politics .

In their own study, Lee et al. tested some of these findings, having the appropriate conversation partner confederate reveal personal information and ask the study participant about their hometown, major, classes they were planning to take next semester, and what they like to do in their free time. In the taboo topic condition, the confederate revealed personal information and asked about the cost of the participant’s outfit (shoes or earrings), as well as questions about her income, romantic status, weight, religion, and arrest history (“I was out partying this weekend and the police stopped me! I thought they were going to arrest me or something. Have you ever been arrested?”)

Lee et al. found that self-disclosure topics during initial interactions can influence social, physical, and task attractiveness , as well as satisfaction with communication, and perceptions of task performance. Not surprisingly, the confederates who discussed appropriate topics were rated more favorably on all measures.

The Way You Make Me Feel

Most people can think of friends or acquaintances they feel most comfortable being around; they can also think of those they don’t. Someone who makes us uncomfortable simply by walking into the room has probably engaged in inappropriate behavior or conversation in the past.

Research appears to corroborate practical experience in noting that particularly when strangers becoming acquainted, conversation topics matter. As noted succinctly by Lee et al., “some topics are, in fact, taboo.”

[i] Lee, Hye Eun, Catherine Kingsley Westerman, Emi Hashi, Kyle B. Heuett, Stephen A. Spates, Katie M. Reno, and Erica W. Jenkins. 2020. “Effects of Taboo Conversation Topics on Impression Formation and Task Performance Evaluation.” Social Behavior and Personality: An International Journal 48 (8): 1–11. doi:10.2224/sbp.8322.

Wendy L. Patrick, J.D., Ph.D., is a career trial attorney, behavioral analyst, author of Red Flags , and co-author of Reading People .

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Research reveals that intensive treatment for diabetes can reduces gum disease inflammation

by Osaka University

While the link between diabetes and periodontal disease is known, the impact of diabetes treatment on periodontal health is less well understood. Research published in Diabetes, Obesity and Metabolism demonstrates that periodontal inflammation can be positively affected just by receiving intensive diabetes treatment.

It is widely believed that there is an interrelationship between diabetes and periodontal disease . While it has been shown that treatment of periodontal disease improves blood glucose control, the effect of diabetes treatment on periodontal disease has remained largely unknown.

A collaborative research team involving the Graduate Schools of Dentistry, Medicine, and Engineering at Osaka University administered a two-week intensive diabetes treatment to 29 type 2 diabetes patients, analyzing systemic and dental indicators before and after treatment.

No dental interventions were performed as part of this study; patients only received diabetes treatment. Results showed improvements in both glycoalbumin, a marker of blood sugar control, and PISA (periodontal inflamed surface area), indicating reduced blood glucose levels and periodontal inflammation.

Further, comparison of subjects based on PISA improvement revealed that those with significant improvement had higher pre-treatment C-peptide levels, suggesting better insulin secretion and better CVRR and ABI values, indicating less severe diabetic neuropathy and peripheral vascular disorders.

"These research findings are expected to advance our understanding of the mechanisms underlying the relationship between diabetes and periodontal disease," says senior author Masae Kuboniwa.

"This study demonstrates that improving periodontal disease in diabetic patients requires not only periodontal treatment but also early diabetes management. We anticipate that promoting collaboration between medical and dental care from the early stages of diabetes can significantly contribute to preventing the onset and progression of periodontal disease in diabetic patients."

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