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

Abstract

Aims and Objectives To conduct a concept analysis of self‐stigma among patients with diabetes and introduce an operational definition of self‐stigma. Background Due to fears of being monitored, patients with diabetes often conceal their disease and/or withdraw from social relationships. These behaviours negatively affect patients’ self‐care and socialisation. Design A concept analysis was conducted using a three‐phase (theoretical phase, fieldwork phase and final analysis phase) hybrid method by Schwartz‐Barcott and Kim (Nursing research methodology: Issues and implementations, 1986, Rockville, MD: Aspen). Methods During the theoretical phase, a literature search was conducted using PubMed and CINAHL. Using COREQ guidelines, in the fieldwork phase, in‐depth interviews were conducted with nine participants with diabetes. The recorded data were analysed using a grounded theory approach. Results from both were included in the analytic phase. Results In the fieldwork phase, nine patients with diabetes (four men and five women; mean age = 57.00 ± 21.93 years) participated in the interview. The mean duration of diabetes was 21.44 ± 12.39 years. The self‐stigma concept included three categories with nine attributes: affective (negative feelings and feeling sorry for others who have concerns about me), cognitive (low self‐esteem and self‐efficacy, perceived weakness, low expectations for the future, worry for children and disease burden) and behavioural factors (social withdrawal and avoiding disease disclosure). The nine attributes included 23 indicators. Conclusions Self‐stigma among patients with diabetes is defined as a state in which patients develop negative self‐feelings as they deal with the disease. This can cause diminished self‐esteem and self‐efficacy, as well as a tendency to avoid disclosing the illness along with social withdrawal. Relevance to Clinical Practice Based on this self‐stigma concept analysis, we clarified the attributes of diabetes self‐stigma and distinguished it from social stigma in nurse professionals during patient education and clinical assessment.

Development and validation of the self‐stigma scale in people with diabetes

“…The initial question of the DSSS was developed based on the definition, dimensions and attributes obtained during concept analysis of self‐stigma for diabetes (Seo & Song, 2019). Results of concept analysis revealed that the scale was composed of nine attributes in three dimensions: affective, cognitive and behavioural factors.…”

“…The self‐stigma concept included three categories with nine attributes: affective (negative feelings and feeling sorry for others who have concerns about me), cognitive (low self‐esteem and self‐ efficacy, perceived weakness, low expectations for the future, worry for children and disease burden) and behavioural (social withdrawal and avoiding disease disclosure) factors. Detailed methods and results can be found in our main published paper (Seo & Song, 2019). Based on this, 40 questions were derived using existing self‐stigma tools and in‐depth interview data of patients with diabetes.…”

“…This study was conducted in two phases (Figure 1) (Netemeyer et al., 2003). In the development phase, preliminary questions were developed based on the definitions and attributes of the concepts presented through concept analysis (Seo & Song, 2019). The preliminary tool underwent content validation with the expert group and diabetes patients group.…”

“…Stigma for diabetes has already been discussed in several studies (Browne et al., 2016; Kato et al., 2014, 2016; Song & Ah, 2016). However, previous studies do not clearly focus on the types of stigma of diabetes, but simply refer to it as “stigma” or “social stigma” (Seo & Song, 2019). Patients with diabetes can hide their disease because their symptoms are not visible (Song & Ah, 2016); thus, self‐stigma, which is related to self‐perception, is more important than social stigma.…”

It’s Not Just a Virus! Lived Experiences of People Diagnosed With COVID-19 Infection in Denmark

“…When people with a COVID-19 infection in our study described how the illness interfered in ordinary social relationships, stigma might be present as they, during the period of illness, were marked as different special cases and are thereby not able to meet ordinary social requirements. A recent research study has, however, described how individuals may try to reduce stigma by acting as normal or selectively disclosing their stigmatized attributes (Seo & Song, 2019).…”