RT Journal Article
SR Electronic
T1 How self-stigma affects patient activation in persons with type 2 diabetes: a cross-sectional study
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e034757
DO 10.1136/bmjopen-2019-034757
VO 10
IS 5
A1 Asuka Kato
A1 Yuko Fujimaki
A1 Shin Fujimori
A1 Akihiro Isogawa
A1 Yukiko Onishi
A1 Ryo Suzuki
A1 Kohjiro Ueki
A1 Toshimasa Yamauchi
A1 Takashi Kadowaki
A1 Hideki Hashimoto
YR 2020
UL http://bmjopen.bmj.com/content/10/5/e034757.abstract
AB Objectives Self-stigma is associated with lower patient activation levels for self-care in persons with type 2 diabetes mellitus (T2DM). However, the causal pathway linking self-stigma with patient activation for self-care has not been shown. In order to determine how self-stigma affects patient activation for self-care, we tested a two-path hypothetical model both directly and as mediated by self-esteem and self-efficacy.Design A cross-sectional study.Setting Two university hospitals, one general hospital and one clinic in Japan.Participants T2DM outpatients receiving treatment (n=209) completed a self-administered questionnaire comprising the Self-Stigma Scale, Patient Activation Measure, Rosenberg Self-Esteem Scale, General Self-Efficacy Scale, Patient Health Questionnaire, haemoglobin A1c test, age, sex and body mass index.Primary and secondary outcome measures Self-stigma levels were measured by using the Self-Stigma Scale. Patient activation levels were measured by the Patient Activation Measure.Results Path analysis showed a strong relationship between self-stigma and patient activation (χ2=27.55, p=0.120; goodness-of-fit index=0.97; adjusted goodness-of-fit index=0.94; comparative fit index=0.98; root mean square error of approximation=0.04). Self-stigma had a direct effect on patient activation (β=−0.20; p=0.002). Indirectly, self-stigma affected patient activation along two paths (β=0.31; p<0.001) by reducing self-esteem (β=−0.22; p<0.001) and self-efficacy (β=−0.36; p<0.001).Conclusions Due to the cross-sectional design of the study, longitudinal changes between all the variables cannot be established. However, the findings indicate that self-stigma affected patient activation for self-care, both directly and as mediated by self-esteem and self-efficacy. Interventions that increase self-esteem and self-efficacy may decrease self-stigma in patients with T2DM, thus increasing patient activation for self-care.