The ‘Miracle Question’ (MQ) is a questioning tool used in a solution-focussed approach to care. The goal is to help individuals envision a desired future state and focus on what ‘will happen’ as opposed to what they ‘will not be doing’.1 Incorporating this approach ultimately reframes the conversation towards one of solutions instead of ‘problem talk’.
In the oral podium presentation at the European Association for the Study of Diabetes (EASD) Congress, the authors presented data from a Twitter chat that took place on World Diabetes Day: November 14, 2018. During the Twitter chat, constituting 1 hour of a longer diabetes social media advocacy (#DSMA) chat, the attendees were walked through a virtual implementation of the MQ approach in order to understand their perceptions of life with diabetes and what their desired future state would look like. Through this process, the authors hoped to understand the common and overarching themes regarding life with diabetes when the ‘problems are gone’.
The original MQ is: ‘Suppose tonight while you sleep, a miracle happens. When you wake tomorrow morning, what will you see yourself doing, thinking, or believing, about yourself that will tell you a miracle has happened in your life?’2 For this study the MQ was modified for a diabetes-specific population: ‘If you could fast-forward to a time where you feel satisfied with your diabetes management, what will be different in your life that will let you know things are better?’ Ten questions were asked during the 1-hour chat to progress through the MQ process.
To analyse the Twitter chat data, the authors implemented a qualitative content analysis. The five themes that resulted from the analysis indicate that the desired future state of participants included more of a ‘living’ life, laughter and humour, self-compassion, resilience, and support. Most importantly, this style of engagement was successful; participants expressed gratitude and positive sentiment towards the approach. A previous survey conducted by the authors showed that people with diabetes are not satisfied with existing diabetes education services. Survey respondents asked for more psychosocial and behavioural aspects of diabetes to be addressed. They desire mutual respect between clinicians and people with diabetes and improved communication. These research and survey data set the foundation for more research in diabetes care and education adopting a solution-focussed approach.
The MQ and a solution-focussed approach also addresses the language we use when speaking to or about people with diabetes. The approach requires a person-centered, person-first, empowering approach to elicit outcomes. We know that healthy communication is required to improve health outcomes.3
Traditional diabetes management is problem-focussed. That focus may also result in feelings of blame and shame. The use of a solution-focussed approach in medicine can improve behavioural and psychosocial outcomes.4 The authors encourage the diabetes healthcare community to consider adopting a solution-focussed approach to conversations with clients with diabetes to help them envision their future, generate solutions, and set small, achievable goals to get there.