Self-stigma directly and indirectly affects patient activation in type 2 diabetes
medwireNews: Self-stigma has a direct effect on patient activation in type 2 diabetes as well as an indirect effect via its negative impact on self-esteem and self-efficacy, Japanese study findings suggest.
Based on their data, Asuka Kato (University of Tokyo) and co-investigators suggest: “To better manage patient self-care behaviours so as to optimise treatment outcomes, healthcare professionals should first assess patient levels of self-stigma for [type 2 diabetes] and then strive to encourage self-stigmatised patients to develop a positive personal image of their illness and a sense of accomplishment as they make steady efforts toward daily self-care.”
The cross-sectional study included 209 people (mean age 60 years, 80% men) with type 2 diabetes (mean duration 13 years) receiving outpatient treatment at one of four clinics in Japan.
All participants completed a written questionnaire that included the Self-Stigma Scale, Patient Activation Measure 13, Rosenberg Self-Esteem Scale, General Self-Efficacy Scale, and Patient Health Questionnaire.
Statistical path analyses showed self-stigma had a significant direct negative effect (β=−0.20) on patient activation for engaging in self-care such as exercising or eating properly as well as their knowledge, skills, and beliefs in relation to managing their diabetes. Self-stigma also had significant indirect effects on patient activation by reducing self-esteem (β=−0.22) and self-efficacy (β=−0.36).
In turn, decreased patient activation had a significant negative effect on glycated hemoglobin and BMI (both β=−0.18).
The researchers also found that lower self-esteem and self-efficacy were significantly related to higher depression symptoms (β=−0.25 and −0.19, respectively), but depression symptoms were not significantly associated with decreased patient activation.
“To the best of our knowledge, ours is the first study to report this finding, which indicates that factors underlying depression, such as low self-esteem and low self-efficacy, may be more appropriate intervention targets compared with depression,” Kato and co-authors write in BMJ Open.
“That is, our path analysis suggests that while interventions aiming to improve patient activation among persons with [type 2 diabetes] should continue to target self-stigma directly, they should also target self-esteem and self-efficacy,” they add.
The investigators note that their study has a number of limitations including the inability to examine how the relationships they identified change over time and the potential lack of generalizability outside of Japan.
They therefore suggest a longitudinal study in a more representative sample of the population would help to clarify their findings.
Nonetheless, Kato et al also point out that their results “are consistent with those from studies of psychiatric patients on the process by which self-stigma affects the attainment of behavioural goals by decreasing self-esteem and self-efficacy.”
And they believe “[t]he strength of this study is that it provides practical targets for possible intervention such as self-esteem, self-efficacy and self-stigma in order to improve patient activation for self-care.”
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