Influence of Diabetes Knowledge, Self-Stigma, and Self-Care Behavior on Quality of Life in Patients with Diabetes

The relationship between perceived stigma and health-promoting self-care in adult patients with type 2 diabetes

Objectives

The study was conducted to examine the relationship between perceived self-stigma and health promotion self-care in patients with type 2 diabetes.

Methods

The study was conducted with 206 patients with type 2 diabetes who were hospitalized in the endocrinology clinic of a state hospital between July and September 2023 and met the study inclusion criteria. Data were collected using a patient identification form, the Type 2 Diabetes Stigma Assessment Scale (DSAS-2) and the Diabetes Health Promotion Self-Care Scale (DHPSC). Data were analyzed using SPSS Statistical software (Version 22), which combines descriptive and analytical statistics.

Results

The participants' DSAS-2 and DHPSC total mean scores were 47.85 ± 17.81 and 87.83 ± 19.19, respectively. A moderate, negative and statistically significant relationship was found between the participants' DSAS-2 and DHPSC total mean scores (r: 0.467, p:0.000), suggesting that health-promotion self-care is a predictor of perceived stigma.

Conclusion

The study revealed that the patients with type 2 diabetes experienced moderate levels of stigma, and as the level of perceived stigma increased, their self-care behaviors were negatively affected.

The Effect of Stigmatization on Diabetes Health Promotion Self-Care Behaviours and Predictors of Stigma and Self-Care Behaviours in Individuals With Type 2 Diabetes

BACKGROUND

Individuals with type 2 diabetes are at risk of delaying or not performing diabetes health promotion self-care behaviours because of their social or self-stigmatization.

AIM

The study aimed to reveal the effect of stigmatization on diabetes health promotion self-care behaviours and predictors of stigma and diabetes health promotion self-care behaviours in individuals with type 2 diabetes.

METHODS

This cross-sectional study included 235 individuals with type 2 diabetes. The Diabetes Stigma Assessment Scale (DSAS) and Diabetes Health Promotion Self-Care Scale (DHPSCS) were used for data collection.

RESULTS

There was a significant, negative correlation between the DSAS and DHPSCS scores. High mean scores on the DSAS and its subscales treated differently, blame/judgement and self-stigma were predictors of a negative effect on diabetes self-care behaviours. Poor health status, alcohol intake and diabetes complications are predictive of stigma. Insulin use and self-monitoring blood glucose are predictors of self-care behaviours.

CONCLUSION

Stigma negatively affects diabetes self-care behaviours in individuals with type 2 diabetes. Nurses could provide education on improvement of health status, harms of alcohol intake and management of diabetes complications. Counselling for coping with stigma and performing self-care could be provided. Nurses could organize interventions to raise awareness about diabetes in society.

Bringing an end to diabetes stigma and discrimination: an international consensus statement on evidence and recommendations

People with diabetes often encounter stigma (ie, negative social judgments, stereotypes, prejudice), which can adversely affect emotional, mental, and physical health; self-care, access to optimal health care; and social and professional opportunities. To accelerate an end to diabetes stigma and discrimination, an international multidisciplinary expert panel (n=51 members, from 18 countries) conducted rapid reviews and participated in a three-round Delphi survey process. We achieved consensus on 25 statements of evidence and 24 statements of recommendations. The consensus is that diabetes stigma is driven primarily by blame, perceptions of burden or sickness, invisibility, and fear or disgust. On average, four in five adults with diabetes experience diabetes stigma and one in five experience discrimination (ie, unfair and prejudicial treatment) due to diabetes, such as in health care, education, and employment. Diabetes stigma and discrimination are harmful, unacceptable, unethical, and counterproductive. Collective leadership is needed to proactively challenge, and bring an end to, diabetes stigma and discrimination. Consequently, we achieved unanimous consensus on a pledge to end diabetes stigma and discrimination.

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 psychological resilience and quality of life among the Chinese diabetes patients: the mediating role of stigma and the moderating role of empowerment

BACKGROUND

Although some factors, such as stigma and empowerment, influence the complex relationship between psychological resilience and quality of life, few studies have explored similar psychological mechanisms among patients with diabetes. Therefore, this study explored the mediating role of stigma and the moderating role of empowerment in the psychological mechanisms by which psychological resilience affects quality of life.

METHODS

From June to September 2022, data were collected by multi-stage stratified sampling and random number table method. Firstly, six tertiary hospitals in Wuhu were numbered and then selected using the random number table method, resulting in the First Affiliated Hospital of Wannan Medical College being selected. Secondly, two departments were randomly selected from this hospital: endocrinology and geriatrics. Thirdly, survey points were set up in each department, and T2DM patients were randomly selected for questionnaire surveys. In addition, we used the Connor-Davidson Elasticity Scale (CD-RISC) to measure the psychological resilience of patients, and used the Stigma Scale for Chronic Illness (SSCI) to measure stigma. Empowerment was measured by the Diabetes Empowerment Scale (DES). Quality of Life was assessed by the Diabetes Quality of Life Scale (DQoL). We used SPSS (version 21) and PROCESS (version 4.1) for data analysis.

RESULTS

(1) Psychological resilience was negatively correlated with stigma and quality of life, and positively correlated with empowerment. Stigma was positively associated with empowerment and quality of life. Empowerment was negatively correlated with quality of life. (2) The mediation analysis showed that psychological resilience had a direct predictive effect on the quality of life, and stigma partially mediated the relationship; Empowerment moderates the first half of "PR → stigma → quality of life"; Empowerment moderates the latter part of "PR → stigma → quality of life."

CONCLUSIONS

Under the mediating effect of stigma, psychological resilience can improve quality of life. Empowerment has a moderating effect on the relationship between psychological resilience and stigma, and it also has a moderating effect on the relationship between stigma and quality of life. These results facilitate the understanding of the relationship mechanisms between psychological resilience and quality of life.

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.