Association between self-stigma and self-care behaviors in patients with type 2 diabetes: a cross-sectional study

Abstract

ObjectiveGrowing qualitative evidence reveals that many patients with chronic illnesses struggle to rebuild a positive self-image after diagnosis while attempting to find a balance between their current physical status and their ongoing social duties. One factor destabilizing patients’ identities is self-stigma, which seems to affect their behavioral goals through decreased self-efficacy. We hypothesized that self-stigma would be an independent factor, distinct from self-efficacy, for developing self-care behaviors in patients with type 2 diabetes.MethodsWe used a consecutive sample of 209 outpatients with type 2 diabetes treated by endocrinologists at two university hospitals, one general hospital and one clinic. We performed multiple linear regression analyses to test the relationship between the patients’ activation levels for self-care behaviors (dependent variable) and self-stigma, self-efficacy, and depression symptoms (independent variables), adjusting for covariates involving sociodemographic and clinical characteristics.ResultsIn a multiple linear regression model adjusted for prior covariates, there was significant association between self-stigma and activation levels for self-care behaviors in patients with type 2 diabetes (adjusted R2=0.26, F (12,196)=7.20, p<0.001). The standardized partial regression coefficient of self-stigma was −0.23 (p=0.001), whereas that of self-efficacy was 0.19 (p=0.007).ConclusionsSelf-stigma is a negative independent factor, separate from self-efficacy, affecting the self-care behaviors of patients with type 2 diabetes. Self-stigma also has, at least, a similar impact on self-care behaviors to that of self-efficacy. To optimize treatment outcomes, patients’ self-stigma should be minimized, whereas their self-efficacy should be enhanced.

Self‐stigma among Korean patients with diabetes: A concept analysis

“…Hilbert, Braehler, Haeuser, and Zenger (2014) suggested self-hate, self-blame and a feeling of inadequacy were all attributes of self-stigma. Finally, Kato, Fujimaki, Fujimori, Isogawa et al (2016) and Kato, Fujimaki, Fujimori, Izumida et al (2016) suggested that a decreased sense of self-worth, social avoidance and role conflict were key attributes.…”

“…However, in the current qualitative study, studies have reported the signs of stigma such as blaming or hiding one's health condition and avoiding treatment, which have been frequently appeared for both type 1 and type 2 diabetes (Browne, Ventura, Mosely, & Speight, ; Nam, Song, Park, & Song, ). Differing from patients with AIDS, individual with diabetes experience a prejudicial attitude that fosters negative attitudes towards one's self (referred to as self‐stigma; Kato, Fujimaki, Fujimori, Isogawa et al, ; Kato, Fujimaki, Fujimori, Izumida et al, ). Those with self‐stigma regarding diabetes may show unconditional obedience or, on the other hand, excessive hesitation when changing their lifestyle or accepting medical advice (Kato, Fujimaki, Fujimori, Isogawa et al, ; Kato, Fujimaki, Fujimori, Izumida et al, ).…”

“…Stigma, which originates from a Greek word of the same spelling, is used to refer to a negative perception about something being abnormal, out of the ordinary or bad about a person (Goffman, 1963). With the emerging importance of chronic disease self-management for chronic conditions such as obesity, HIV/AIDS, leprosy and epilepsy, different magnitudes of stigma have been found depending on the health condition (Fernandes et al, 2007;Kato, Fujimaki, Fujimori, Isogawa et al, 2016;Kato, Fujimaki, Fujimori, Izumida et al, 2016). For example, while stigma in AIDS can be attributed to prejudice towards infection (referred to as social stigma), diabetes has typically been regarded as a chronic disease without stigma in the past (Schabert, Browne, Mosely, & Speight, 2013).…”

“…Differing from patients with AIDS, individual with diabetes experience a prejudicial attitude that fosters negative attitudes towards one's self (referred to as self-stigma; Kato, Fujimaki, Fujimori, Isogawa et al, 2016;Kato, Fujimaki, Fujimori, Izumida et al, 2016). Those with self-stigma regarding diabetes may show unconditional obedience or, on the other hand, excessive hesitation when changing their lifestyle or accepting medical advice (Kato, Fujimaki, Fujimori, Isogawa et al, 2016;Kato, Fujimaki, Fujimori, Izumida et al, 2016). Consequently, selfstigma can hinder psychological well-being and self-care, which may lead to an increase in blood glucose levels (Schabert et al, 2013).…”

“The land of the sick and the land of the healthy”: Disability, bureaucracy, and stigma among people living with poverty and chronic illness in the United States

“…These effects may be compounded by decreased medication adherence, poor self-care, and worsened health outcomes, all of which are associated with stigma in both HIV (I.T. Katz et al, 2013; Mahajan et al, 2008) and T2DM (Kato et al, 2016; Schabert et al, 2013). …”