How self-stigma affects patient activation in persons with type 2 diabetes: a cross-sectional study.

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  • Additional Information
    • Source:
      Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE
    • Publication Information:
      Original Publication: [London] : BMJ Publishing Group Ltd, 2011-
    • Subject Terms:
      Diabetes Mellitus, Type 2*; Cross-Sectional Studies ; Female ; Humans ; Japan ; Male ; Patient Participation ; Self Concept ; Social Stigma ; Surveys and Questionnaires
    • Abstract:
      Objectives: Self-stigma is associated with lower patient activation levels for self-care in persons with type 2 diabetes mellitus (T2DM). However, the causal pathway linking self-stigma with patient activation for self-care has not been shown. In order to determine how self-stigma affects patient activation for self-care, we tested a two-path hypothetical model both directly and as mediated by self-esteem and self-efficacy.
      Design: A cross-sectional study.
      Setting: Two university hospitals, one general hospital and one clinic in Japan.
      Participants: T2DM outpatients receiving treatment (n=209) completed a self-administered questionnaire comprising the Self-Stigma Scale, Patient Activation Measure, Rosenberg Self-Esteem Scale, General Self-Efficacy Scale, Patient Health Questionnaire, haemoglobin A1c test, age, sex and body mass index.
      Primary and Secondary Outcome Measures: Self-stigma levels were measured by using the Self-Stigma Scale. Patient activation levels were measured by the Patient Activation Measure.
      Results: Path analysis showed a strong relationship between self-stigma and patient activation (χ 2 =27.55, p=0.120; goodness-of-fit index=0.97; adjusted goodness-of-fit index=0.94; comparative fit index=0.98; root mean square error of approximation=0.04). Self-stigma had a direct effect on patient activation (β=-0.20; p=0.002). Indirectly, self-stigma affected patient activation along two paths (β=0.31; p<0.001) by reducing self-esteem (β=-0.22; p<0.001) and self-efficacy (β=-0.36; p<0.001).
      Conclusions: Due to the cross-sectional design of the study, longitudinal changes between all the variables cannot be established. However, the findings indicate that self-stigma affected patient activation for self-care, both directly and as mediated by self-esteem and self-efficacy. Interventions that increase self-esteem and self-efficacy may decrease self-stigma in patients with T2DM, thus increasing patient activation for self-care.
      Competing Interests: Competing interests: None declared.
      (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
    • References:
      N Engl J Med. 1993 Sep 30;329(14):977-86. (PMID: 8366922)
      Asian J Psychiatr. 2014 Aug;10:39-44. (PMID: 25042950)
      Eur Psychiatry. 2005 Dec;20(8):529-39. (PMID: 16171984)
      Lancet. 1998 Sep 12;352(9131):837-53. (PMID: 9742976)
      J Ambul Care Manage. 2005 Jul-Sep;28(3):262-73. (PMID: 15968219)
      Psychiatr Serv. 2001 Dec;52(12):1621-6. (PMID: 11726753)
      J Diabetes Investig. 2014 Mar 23;5(2):162-9. (PMID: 24843756)
      JAMA. 2002 Nov 20;288(19):2469-75. (PMID: 12435261)
      J Psychosom Res. 2007 May;62(5):589-94. (PMID: 17467414)
      Health Serv Res. 2005 Dec;40(6 Pt 1):1918-30. (PMID: 16336556)
      Patient. 2013;6(1):1-10. (PMID: 23322536)
      Psychol Rep. 2007 Dec;101(3 Pt 1):952-60. (PMID: 18232454)
      Addict Res Theory. 2008;16(2):149-165. (PMID: 27746709)
      BMJ Open Diabetes Res Care. 2016 Jan 05;4(1):e000156. (PMID: 26835138)
      J Psychiatr Ment Health Nurs. 2008 Jan;15(1):59-65. (PMID: 18186830)
      Sociol Health Illn. 2009 Apr;31(3):441-55. (PMID: 19366430)
      Am J Orthopsychiatry. 2010 Apr;80(2):267-81. (PMID: 20553520)
      Health Serv Res. 2004 Aug;39(4 Pt 1):1005-26. (PMID: 15230939)
      Patient Educ Couns. 2016 Jul;99(7):1233-1239. (PMID: 27873575)
      BMJ Open. 2013 Nov 18;3(11):e003384. (PMID: 24247325)
      Psychol Rev. 1977 Mar;84(2):191-215. (PMID: 847061)
      JAMA. 1999 Nov 10;282(18):1737-44. (PMID: 10568646)
      Health Serv Res. 2007 Aug;42(4):1443-63. (PMID: 17610432)
      Health Qual Life Outcomes. 2014 Dec 12;12:179. (PMID: 25495723)
    • Contributed Indexing:
      Keywords: diabetes & endocrinology; patient activation; patient education; psychosocial research; stigma; type 2 diabetes
    • Molecular Sequence:
      Dryad 10.5061/dryad.dncjsxkwd
    • Publication Date:
      Date Created: 20200520 Date Completed: 20210419 Latest Revision: 20210419
    • Publication Date:
      20240628
    • Accession Number:
      PMC7239528
    • Accession Number:
      10.1136/bmjopen-2019-034757
    • Accession Number:
      32423931