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

Area of Science:

• Medical Psychology
• Endocrinology
• Behavioral Medicine

Background:

• Self-stigma is a known correlate of reduced patient activation for self-care in type 2 diabetes mellitus (T2DM).
• The precise causal mechanisms linking self-stigma to patient activation in T2DM remain underexplored.
• Understanding these pathways is crucial for developing effective interventions to improve self-management in T2DM patients.

Purpose of the Study:

• To investigate the causal pathway between self-stigma and patient activation for self-care in individuals with T2DM.
• To examine the direct effect of self-stigma on patient activation.
• To assess the indirect effects of self-stigma on patient activation, mediated by self-esteem and self-efficacy.

Main Methods:

• A cross-sectional study was conducted with 209 outpatients with T2DM in Japan.
• Participants completed questionnaires measuring self-stigma, patient activation, self-esteem, and self-efficacy.
• Path analysis was employed to test a hypothetical model of the relationships between these variables.

Main Results:

• Path analysis confirmed a significant relationship between self-stigma and patient activation.
• Self-stigma exerted a direct negative effect on patient activation (β=-0.20; p=0.002).
• Indirect effects were observed, with self-stigma reducing patient activation by lowering self-esteem (β=-0.22; p<0.001) and self-efficacy (β=-0.36; p<0.001).

Conclusions:

• Self-stigma significantly impacts patient activation for self-care in T2DM, operating both directly and indirectly.
• The findings underscore the mediating roles of self-esteem and self-efficacy in this relationship.
• Interventions aimed at enhancing self-esteem and self-efficacy may be effective in reducing self-stigma and improving patient activation for self-care in T2DM.