Self-esteem mediates the relationship perceived stigma with self-efficacy for diabetes management in individuals with type 2 diabetes mellitus

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.

Relationships of Psychosocial Factors to Diabetes Self-efficacy: A Cross-sectional, Correlational Study

BACKGROUND

Self-care in people with diabetes is poor, which could be influenced by positive and negative psychosocial factors. Self-efficacy is an important factor affecting self-care, and depressive symptoms and diabetes distress may directly and indirectly affect self-efficacy.

OBJECTIVE

The aim of this study was to examine the relationships of depressive symptoms, diabetes distress, age, sex, self-compassion, resilience, self-esteem, and social support to diabetes self-efficacy and the mediating roles of diabetes distress and depressive symptoms in the relationships among people with diabetes.

METHODS

In this cross-sectional, correlational study, data on all the psychosocial and demographic factors were collected (N = 148; 57.6 years old) through Research Electronic Data Capture in 2023. The PROCESS macro for SPSS was used to address the purpose.

RESULTS

The mean score of diabetes self-efficacy was 28.6 (range, 8-40). In 1 model, depressive symptoms were directly and indirectly associated with diabetes self-efficacy through diabetes distress (direct effect, -3.524; t = -3.020, P = .003; indirect effect, -2.089; 95% bootstrap confidence interval, -3.494 to -0.911). In another model, diabetes distress was directly and indirectly associated with diabetes self-efficacy through depressive symptoms (direct effect, -3.778; t = -3.638, P < .001; indirect effect, -0.785; 95% bootstrap confidence interval, -1.868 to -0.089). In addition, self-esteem was associated with both depressive symptoms and diabetes distress. Resilience was associated with diabetes self-efficacy in 1 model.

CONCLUSIONS

Negative psychological factors were directly and indirectly associated with diabetes self-efficacy. Depressive symptoms, diabetes distress, self-esteem, and resilience can be important targets of interventions to improve diabetes self-efficacy.

Stroke knowledge and health-promoting behaviors: Mediating effect of patient self-esteem

OBJECTIVE

To investigate the levels of and associations between stroke knowledge, self-esteem, and health-promoting behavior (HPB) among stroke patients, and examine the mediating effect of self-esteem in the stroke knowledge-HPB relationship.

METHODS

This descriptive correlational study involved a total of 150 stroke patients. We collected data through questionnaires during outpatient visits at two Korean secondary hospitals, inquiring about general and disease-related characteristics, stroke knowledge, self-esteem, and HPB. Correlation and mediation analyses were performed.

RESULTS

Stroke knowledge significantly increased patients' self-esteem (β = .53, p = .001) and HPB (β = 1.64, p < .001). Self-esteem mediated the relationship between stroke knowledge and HPB, with the mediating effect coefficient determined to be 1.68 [95 % CI (0.56,-2.46)].

CONCLUSION

Education and intervention programs that increase both self-esteem and stroke knowledge need to be developed and evaluated such that stroke patients are motivated to engage in HPB.

PRACTICE IMPLICATIONS

Stroke patients are often physically and mentally impaired, and low self-esteem can be a barrier to engaging in HPB after diagnosis, negatively affecting their health outcomes. Nursing interventions focused on enhancing self-esteem can empower these patients to effectively engage in HPB. Healthcare professionals should adequately communicate and impart disease-related knowledge to patients with poor disease-related knowledge or education.

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.

Relationships of Multidimensional Factors to Diabetes Complications: A Cross-Sectional, Correlational Study

BACKGROUND

Diabetes complications are prevalent in people with diabetes, causing considerable individual suffering and increased health costs. However, the relationships of multidimensional, modifiable, and nonmodifiable factors to diabetes complications and the role of diabetes distress have been rarely examined.

OBJECTIVE

The aims of this study were to examine the associations of age, sex, knowledge, self-efficacy, self-compassion, resilience, self-esteem, depressive symptoms, diabetes distress, social support, and body mass index with diabetes complications and to investigate the mediating role of diabetes distress.

METHODS

In this cross-sectional, correlational study, data on all study variables were collected from 148 people with diabetes through REDCap in 2023. Multiple regression analysis and the PROCESS macro for SPSS were used to address the aims.

RESULTS

Older age and higher levels of diabetes distress were associated with more diabetes complications. Depressive symptoms were associated with diabetes distress; and diabetes distress, but not depressive symptoms, was associated with diabetes complications, controlling for all other variables.

CONCLUSIONS

Depressive symptoms and diabetes distress were directly or indirectly associated with diabetes complications, and diabetes distress was a mediator in the relationship between depressive symptoms and diabetes complications. Health care providers can target reduction of depressive symptoms and diabetes distress to reduce diabetes complications.

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.

Type 2 diabetes stigma and its association with clinical, psychological, and behavioral outcomes: a systematic review and meta-analysis

AIM

To synthesize quantitative research evidence on the association between type 2 diabetes (T2D) stigma and psychological, behavioral, and clinical outcomes.

METHODS

We searched APA PyschInfo, Cochrane Central, Scopus, Web of Science, Medline, CINAHL and EMBASE through November 2022. Peer-reviewed observational studies examining the association between T2D stigma and psychological, behavioral, and/or clinical outcomes were eligible for inclusion. Risk of bias was assessed with the JBI critical appraisal checklist. Correlation coefficients were pooled in random effect meta-analyses.

RESULTS

Our search produced 9642 citations, 29 met the inclusion criteria. Included articles were published between 2014 and 2022. We found a weak positive correlation between T2D stigma and HbA1C (r=0.16, 95% CI:0.08 to 025, I²=70%, N=7 studies), a moderate positive correlation between T2D stigma and depressive symptoms (r=0.49, 95% CI: 0.44 to 0.54, I²=26.9%, n=5 studies) and diabetes distress (r=0.54, 95% CI: 0.35 to 0.72, I²=96.9%, n=7studies). Persons with T2D stigma who experienced stigma tended to have less engagement in diabetes self-management, though this association was weak (r=-0.17, 95% CI: -0.25 to -0.08, I²=79.8%, n=7studies).

CONCLUSIONS

T2D stigma was associated with negative health outcomes. Further studies are required to disentangle the underlying causal mechanisms to inform the development of appropriate stigma-reduction interventions.