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How self-stigma affects patient activation in persons with type 2 diabetes: a cross-sectional study.
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- Author(s): Kato A;Kato A; Fujimaki Y; Fujimaki Y; Fujimori S; Fujimori S; Isogawa A; Isogawa A; Onishi Y; Onishi Y; Suzuki R; Suzuki R; Ueki K; Ueki K; Yamauchi T; Yamauchi T; Kadowaki T; Kadowaki T; Hashimoto H; Hashimoto H
- Source:
BMJ open [BMJ Open] 2020 May 17; Vol. 10 (5), pp. e034757. Date of Electronic Publication: 2020 May 17.- Publication Type:
Journal Article- Language:
English - Source:
- 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:
- 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)
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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
- Source:
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