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Self-stigma predicts self-care behaviors in patients with type 2 diabetes
Japanese adults with type 2 diabetes and a higher level of self-stigma are less likely to practice proper self-care behaviors to manage the disease, according to research in BMJ Open Diabetes Research & Care.
Asuka Kato, of the Graduate School of Medicine at the University of Tokyo, and colleagues analyzed data from 209 outpatients with type 2 diabetes at two university hospitals, one non-university hospital and one clinic between November 2013 and March 2014 (168 men; mean age, 60 years; mean BMI, 26.3 kg/m²; mean diabetes duration, 13 years; mean HbA1c, 7.3%). Within the cohort, 73 patients were using injection therapy; the mean number of diabetes-related complications was 0.57.
Asuka Kato
Participants completed a questionnaire; researchers used the self-stigma scale to assess the level of self-stigma (possible scores ranged from 0-117), and the 13-question patient activation measure to assess patient self-engagement in treatment (possible scores ranged from 13-52; scores were converted into an interval scale of 0-100). Individual strengths in general self-efficacy across everyday life settings were assessed with the general self-efficacy scale (possible scores ranged from 0-16); depression symptoms during the prior 2 weeks were assessed with the patient health questionnaire (possible scores ranged from 0-36). Researchers used multiple linear regression analyses to test the relationship between activation levels for self-care behavior and self-stigma, self-efficacy and depression symptoms, all as independent variables.
After adjusting for age, sex, BMI, diabetes duration, HbA1c, diabetes-related complications and demographic data, researchers found an association between self-stigma and activation levels for self-care (P < .001). The standardized partial regression coefficient for self-stigma was –0.23 (P = .001) and 0.19 for self-efficacy (P = .007).
Patients with a higher HbA1c level with two or more diabetes-related complications, including eye problems, were more likely to report increased self-stigma, according to researchers.
“When self-stigma was included in the multiple linear regression model, the association between self-efficacy and self-care behaviors was slightly attenuated,” the researchers wrote. “However, in our findings, self-stigma had, at least, a similar impact to that of self-efficacy on patients’ self-care behaviors. Thus, results suggested that self-stigma strongly predicted patients’ with type 2 diabetes activation levels for self-care behaviors.” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Health care providers who work with individuals with type 2 diabetes can struggle with understanding the reasons why recommendations for therapy are not followed. Evidence is abundant on the positive effects of medications, diabetes self-management education and support, dietary interventions and activity. Yet often these interventions are not fully utilized by the individual to achieve the maximum benefits. Assessing for the underlying causes for this can be daunting in a busy practice. Yet the evidence presented on assessing for self-stigma can potentially influence the focus of the conversation and treatment with the individual with type 2 diabetes. The concept of self-stigma and its effect on health is an emerging area, and for the first time, here Kato and colleagues reported to influence diabetes activation of self-care behaviors. If we truly practice patient-centered care, it is essential that health care providers better understand the entire person and what influences his or her decisions and participation in self-care behaviors.