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Multicenter Study
. 2017 Mar 29;7(3):e013425.
doi: 10.1136/bmjopen-2016-013425.

Psychological and Behavioural Patterns of Stigma Among Patients With Type 2 Diabetes: A Cross-Sectional Study

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Free PMC article
Multicenter Study

Psychological and Behavioural Patterns of Stigma Among Patients With Type 2 Diabetes: A Cross-Sectional Study

Asuka Kato et al. BMJ Open. .
Free PMC article

Abstract

Objectives: The aim of this study was to test the psychological and behavioural patterns of stigma (self-esteem and social participation) and their relationship to self-stigma, patient activation for engaging in self-care and glycaemic control among patients with type 2 diabetes mellitus (T2DM).

Design: A cross-sectional study.

Setting: 2 tertiary-level hospitals and 2 secondary-level hospitals in Japan.

Participants: A consecutive sample of 209 outpatients with T2DM. Inclusion criteria were as follows: presence of T2DM, age 20-74 years, no diagnosis of dementia and/or psychosis, and no need for urgent medical procedures.

Outcome measures: Study measures included a self-administered questionnaire to assess the Rosenberg Self-Esteem Scale (SES), the 3 subscales of 36-question Short Form Health Survey (SF-36; Social Function, Role Physical, Role Emotional), Self-Stigma Scale and Patient Activation Measure (PAM-13). Glycated haemoglobin was obtained from same day blood work. In our previous qualitative study, we found that psychological and behavioural patterns of stigma varied according to patients' levels of illness-related self-esteem as well as attitudes towards social participation. For quantitative consistency, we used the SES scale to measure self-esteem and the SF-36 subscales to measure social participation. We then divided participants into 4 groups by exhibited psychological and behavioural patterns: group A (high SES/high SF-36), group B (high SES/low SF-36), group C (low SES/high SF-36) and group D (low SES/low SF-36).

Results: Using analysis of covariance after controlling for age and sex, there was a significant difference in self-stigma levels between the four groups (F[3203]=15.70, p<0.001). We observed the highest mean self-stigma levels in group D. Group D also had significantly lower PAM-13 scores than those of groups A (p<0.001) and B (p=0.02).

Conclusions: The psychological and behavioural pattern of group D was found to be associated with higher levels of self-stigma and poorer patient activation for self-care.

Keywords: Diabetes education; Psychosocial, behavioral medicine; Stigma.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Psychological and behavioural patterns of stigma in patients with type 2 diabetes—a hypothesis generated from results of a qualitative study. SF-36, 36-question Short Form Health Survey.
Figure 2
Figure 2
Mean self-stigma levels (SSS-J) of different psychological and behavioural patterns of stigma (n=209). ANCOVA, analysis of covariance; SF-36, 36-question Short Form Health Survey; SSS-J, Japanese version of Self-Stigma Scale.
Figure 3
Figure 3
Mean patient activation scores (PAM-13) and HbA1c levels of different psychological and behavioural patterns of stigma (n=209). ANCOVA, analysis of covariance; HbA1c, glycated haemoglobin; PAM-13, Patient Activation Measure; SF-36, 36-question Short Form Health Survey.

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