Relationship between perceived social stigma and diabetes self-care activities in Iranian participants with type 1 diabetes

Connections matter: Exploring the relationship between belonging and psychosocial well-being in type 1 diabetes in Iran

AIM

Identify the relationship between a sense of belonging and psychosocial well-being in individuals with type 1 diabetes (T1D) in Iran.

BACKGROUND

Understanding this relationship is vital for tailored nursing interventions to enhance individual's sense of belonging and improve diabetes outcomes.

METHODS

This cross-sectional study included 205 participants selected via multi-stage cluster and simple random sampling from health centers in Iranian. Electronic surveys designed on Google Forms, using valid and reliable scales and compliant with HIPAA, assessed sense of belonging, distress, and burnout. Data were analyzed using SPSS (version 25).

RESULTS

Participants reported high sense of belonging with varying levels of diabetes distress and burnout. Multiple regression analysis of 205 participants showed that sense of belonging index (SOBI) scores significantly predicted diabetes distress (F(2,203) = 39.71, p < 0.001) and burnout (F(2, 203) = 42.319, p < 0.001). Sense of Belonging Instrument-Psychological (SOBI-P) scores were negatively correlated with both distress (r = -0.52, p < 0.001) and burnout (r = -0.53, p < 0.001), indicating higher belonging is linked to lower distress and burnout. Sense of Belonging Instrument-Antecedents (SOBI-A) scores had positive but non-significant correlations (distress: r = 0.07, p = 0.27; burnout: r = 0.10, p = 0.13). SOBI-P accounted for ∼30 % of the variance in distress (R2 = 0.275) and burnout (R2 = 0.288), with significant contributions to both models (t = -8.8, p < 0.001; t = -9.02, p < 0.001). Anticipated belonging showed no significant correlations with distress or burnout.

CONCLUSION

The negative correlations between personal belonging, self-reported distress, and burnout suggest that enhancing the psychological sense of belonging may be an effective strategy to mitigate diabetes-related distress and burnout Stigmatization and financial strain in Iran may exacerbate emotional burden, regimen related distress, and burnout. The lack of association between anticipated belonging and psychosocial well-being underscores differences in present and future perceptions of support, emphasizing the need for culturally sensitive nursing interventions.

Exploring patient's perspective of barriers to diabetic medication adherence in Jazan, Saudi Arabia, using the social determinants of health model

Background

Type 2 diabetes mellitus is usually associated with long-term macrovascular and microvascular complications that negatively impact the patient's quality of life and add economic burden to the healthcare system. Understanding patients' perspectives on medication nonadherence is essential for planning the appropriate methods and strategies to improve medication adherence among patients with uncontrolled diabetes.

Aim

Therefore, this study aims to explore patients' perceptions of the barriers to medication adherence through the Social Health determinants framework.

Method

After obtaining ethical approval, qualitative face-to-face interviews with a sample of patients with type 2 diabetes mellitus (uncontrolled diabetes) were conducted. Interviews were audio-recorded, and then the data were analyzed using thematic analysis to identify essential themes related to the patient's views.

Results

Fifteen patients with type 2 diabetes mellitus were interviewed. Potential barriers to antidiabetic medications were identified and categorized based on the Social Determinants of Health domains. The patient's health perceptions and behaviors were found to positively or negatively impact medication adherence. Beliefs toward antidiabetic medications, polypharmacy, medication-related problems, and the relationship between patients and their healthcare providers that related to healthcare access and quality domains were also reported as potential barriers to medications. Financial constraints, social stigma, and family support were other social health determinants factors that were found to have either positive or negative impacts on adherence. Nevertheless, using mobile health applications was suggested to facilitate medication adherence.

Conclusion

Social Determinants of Health, such as education about type 2 diabetes mellitus, quality and access to healthcare, and social stigma and support, might significantly affect medication adherence among type 2 diabetes mellitus patients. This study's findings can aid the development of suitable patient-specific tools and strategies to enhance medication adherence.

Patient-Centered Positive Factors Influencing Glycemic Control in Adolescents with Type 1 Diabetes Mellitus in China: A Cross-Sectional and Longitudinal Study

Objective

This study aimed to explore the stable longitudinal patient-centered self-protective factors of glycosylated hemoglobin (HbA1c) in adolescents with type 1 diabetes mellitus (T1DM).

Methods

We used both cross-sectional and longitudinal datasets at the Diabetes Education Center and National Endocrine and Metabolism Centre of a university hospital in China from April 2020 to July 2022. Participants were assessed using the Adolescent Diabetic Behavior Rating Scale (DBRS), Diabetes Strengths and Resilience Measure for Adolescents (DSTAR-Teen). HbA1c and other clinical variables were obtained from the medical record at the same time. 266 adolescents (131 male, age 14.1±3.9 years) completed the cross-sectional assessments and 131 (62 male, age 14.6±3.3 years) participated in a follow-up at a 1-year visit interval.

Results

Logistic regression analysis of cross-sectional data of 266 cases showed that there were significant positive effects between pump treatment (β=0.090, OR 2.460, P=0.005), DBRS scores (β=2.593, OR 13.366, P=0.002) and the meeting of standard HbA1c (<7.5%, 58 mmol/mol). Disease duration (β=-0.071, OR 0.932, P=0.033) was negatively correlated with it. The longitudinal multivariate generalized estimation equation model showed that DBRS scores (β=3.165, OR 23.681, P=0.009) and DSTAR-Teen scores (β=0.050, OR 1.051, P=0.012) had a positive influence on the meeting of standard HbA1c over one year time of 131 cases.

Conclusion

Self-care and resilience had higher cross-temporal stability in influencing glycemic control over time. To reach a better glycemic control and improve long-term health outcomes, attention should be paid to the detection and enhancement of these patient-centered promoters.

The impact of stigma on the management of type 1 diabetes: A systematic review

AIMS

To systematically review the literature investigating the links between stigma and the management of type 1 diabetes.

METHODS

A systematic literature review was conducted in accordance with PRISMA guidelines. Both quantitative and qualitative data were considered. Included papers were subject to quality assessment using the Mixed Methods Appraisal Tool (MMAT), and a narrative synthesis of results was reported.

RESULTS

Nineteen articles met the inclusion criteria and were included in the final analysis. Amongst these, one study used mixed methods, nine were qualitative, and nine were quantitative. All studies found a negative relationship between stigma and type 1 diabetes management. Qualitative studies provided a further understanding of the effects observed in the quantitative studies and found that stigma can affect self-care activities, disclosure of diabetes, and the uptake of diabetes technology. Systemic causes of stigma and intersectional stigma were also observed.

CONCLUSIONS

This review highlights that people with type 1 diabetes are negatively affected by stigma, irrespective of their age, gender, culture, or use of diabetes technology. Quantitative studies were limited, in that all studies were cross-sectional, and there was a lack of standardisation across outcome measures. There is a need for interventions to target stigma on both an individual and a systemic level, particularly where people experience multiple intersecting stigmas.

Lifestyle in Emerging Adults with Type 1 Diabetes Mellitus: A Qualitative Systematic Review

Emerging adulthood is a transitional stage with significant lifestyle changes, making it especially challenging for those living with type 1 diabetes mellitus. This systematic review synthesizes qualitative research to explore how emerging adulthood (18-29 years) influences lifestyle behaviors in individuals with type 1 diabetes mellitus. CINAHL, Cochrane Library, Global Health, Nursing & Allied Health Premium, PsycINFO, PubMed, Scopus, and WOS were searched for original qualitative studies addressing the lifestyle of 18-31-year-olds with type 1 diabetes mellitus, published between January 2010 and March 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Thirty-five studies met the inclusion criteria and their findings were categorized into eight topics (emotions and feelings, nutrition, perceptions, risky behaviors, self-care, sleep, social relationships, and stigma) using meta-aggregation, as outlined in the Joanna Briggs Institute Manual for Evidence Synthesis. The spontaneity characteristic of emerging adulthood can undermine self-care. This is because new environments, schedules, and relationships encountered during this life stage often lead to the neglect of diabetes management, owing to the various social, academic, and occupational demands. This review highlights the necessity of creating health promotion strategies tailored to the unique lifestyle aspects of emerging adults with type 1 diabetes mellitus.

The Mediating Role of Acceptance Action and Self-Care in Diabetes Self-Stigma's Impact on Type 2 Diabetes Quality of Life: A Cross-Sectional Study

Recently, the quality of life of individuals with diabetes has been reduced, owing to self-stigma that occurs in the process of managing the disease. This process can be improved by accepting diabetes. This study aimed to verify the dual mediating effect of acceptance action and diabetes self-care on the effect of diabetes self-stigma on the quality of life of individuals with type 2 diabetes mellitus (T2DM) in Korea. In this study, 300 of 400 data collected to develop and evaluate health equilibrium tools for individuals with T2DM were randomly selected and analyzed. Data were collected from 1 September 2020 to 31 September 2020 using a structured online questionnaire. For data analysis, descriptive statistics and Pearson's correlation analysis were performed using the Statistical Package for the Social Sciences (SPSS), version 24.0. Additionally, the dual mediation effect was analyzed using PROCESS Macro for SPSS, version 4.1. Acceptance action (B = -0.088, 95% confidence interval [CI], -0.127 to -0.054) and diabetes self-care (B = 0.046, 95% CI, 0.022-0.072) had a mediating effect on the relationship between diabetes self-stigma and quality of life in patients with T2DM in Korea. In particular, these two variables had dual mediating effects (B = 0.017, 95% CI, 0.015-0.019). This study confirmed that diabetes self-care and quality of life can be increased by improving acceptance behavior to overcome the negative impact of self-stigma on the quality of life of patients with T2DM. Establishing a strategy to increase acceptance action as part of an intervention to reduce the negative impact of self-stigma on the quality of life of patients with T2DM is necessary.

The relationship between stigma and psychological distress among people with diabetes: a meta-analysis

BACKGROUND & AIMS

Diabetes may perceive or experience varying degrees of stigma and psychological distress. The association between diabetes-related stigma and psychological distress has been examined in many studies, but no research has used a quantitative synthesis method to investigate the severity of this association and the moderators of the relationship. Thus, we conducted a meta-analysis to quantitatively integrate previous findings to identify the magnitude of the association between stigma and psychological distress among people with diabetes.

REVIEW METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, we systematically searched four English academic databases (PubMed, Embase, Web of Science, and PsycINFO) and three Chinese databases (China National Knowledge Infrastructure [CNKI], WANFANG Data, China Science and Technology Journal Database [VIP]). The databases were searched from the inception of each database to the end of March 2023. The pooled correlation coefficient of the association between stigma and psychological distress among people with diabetes was calculated by a random effects model using Stata software (version 17.0), and several moderators that impacted this relationship were identified.

RESULTS

Eligible studies (N = 19) with a total of 12,777 participants were analysed. The pooled correlation was high between diabetes-related stigma and psychological distress (r = 0.50, 95% CI: [0.43-0.57]). Moreover, the association was moderated by the diabetes stigma measurement tools and diabetes distress measurement tools used. However, the relationship was not moderated by type of diabetes, age, gender, geographical location, or type of stigma.

CONCLUSIONS

The results of the meta-analysis showed that stigma is strongly related to psychological distress among people with diabetes. Longitudinal or experimental research should be expanded in the future to further identify the causal pathways in the relationship between diabetes stigma and diabetes distress.

Identification of Sociodemographic and Clinical Factors Influencing the Feeling of Stigmatization in People with Type 1 Diabetes

BACKGROUND

A large percentage of people with type 1 diabetes experience stigma, which may directly affect diabetes management. Moreover, it may adversely influence the acceptance of the disease and, thus, the treatment process, including compliance with medical and dietary recommendations. Therefore, it is important to seek adequate forms of counteracting the phenomenon of stigmatization. Thus, the aim of the study was to determine the factors influencing the level of perceived stigma by T1D patients, with particular emphasis on sociodemographic factors (including sex, place of residence, and education) and clinical factors related to the course of the disease.

METHODS

An observational cross-sectional online questionnaire was conducted in a group of 339 people with T1D. The link to the questionnaire was shared via social media. The DSAS-1 questionnaire translated into Polish was used as the research tool.

RESULTS

A moderate level of stigmatization was found (49.78 ± 14.54 points). It was significantly lower in people living in small towns compared to rural residents (ß = -0.121, p = 0.038), lower in people in relationships compared to those who are single (ß = -0.175, p = 0.001), in people diagnosed with T1D at an older age (ß = -0.107, p = 0.048), and in those who rated their financial situation as very good vs. bad (ß = -0.314, p < 0.001). It was also found that the level of stigma significantly decreased with age (ß = -0.181, p = 0.001). In addition, a significantly higher stigma perception was uncovered in the group of people with HbA1C > 7% than in the group ≤ 7% (ß = 0.118, p = 0.030).

CONCLUSIONS

Due to the occurrence of stigma among people with T1D, which can directly affect the management of diabetes, effective and comprehensive efforts should be made to provide support to people with diabetes. It is also necessary to raise awareness among the general public and disseminate knowledge about diabetes, which can reduce stigmatization as a result. Anti-stigma messages should be included in the prevention programs about the potential side effects and risks associated with mistreating people with T1D.

Diabetes Distress and Self-Care Activities Among Patients With Diabetes Type II: A Correlation Study

Introduction

Diabetes mellitus (DM) is a main, highly prevalent, and challenging public health issue. Suboptimal self-care for type II diabetes can lead to poor glycemic control, complications, and even death.

Objective

This study investigated the incidence of distress and its link with self-care habits of patients with diabetes type II.

Methods

A correlational, cross-sectional design with a convenient sample of 200 patients was used to conduct this study. Three questionnaires were administered: (A) the demographic and medical data questionnaire; (B) diabetes self-care activities in brief; and (C) the diabetes distress scale in Arabic language.

Results

The patients' mean age was 51.78 ± 11.34; 80% of patients practiced lower levels of diabetes self-care, and 37% of them had a high level of diabetes distress. Self-care is associated with diabetes distress (R = -0.152, p-value = .032).

Conclusion

Self-care activities can help in the early detection and management of diabetes distress. Sustained self-care education is promising to minimize diabetes distress. The potential advantages of association between diabetes distress and self-care can offer self-care programs that enhance diabetes distress management.