PMID- 32423931
OWN - NLM
STAT- MEDLINE
DCOM- 20210419
LR  - 20210419
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 10
IP  - 5
DP  - 2020 May 17
TI  - How self-stigma affects patient activation in persons with type 2 diabetes: a 
      cross-sectional study.
PG  - e034757
LID - 10.1136/bmjopen-2019-034757 [doi]
LID - e034757
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 (chi(2)=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 (beta=-0.20; p=0.002). Indirectly, self-stigma affected patient 
      activation along two paths (beta=0.31; p<0.001) by reducing self-esteem (beta=-0.22; 
      p<0.001) and self-efficacy (beta=-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.
CI  - (c) Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Kato, Asuka
AU  - Kato A
AUID- ORCID: 0000-0002-4578-3630
AD  - Department of Health and Social Behavior, School of Public Health, The University 
      of Tokyo, Tokyo, Japan asukakato-tky@umin.ac.jp.
FAU - Fujimaki, Yuko
AU  - Fujimaki Y
AD  - Department of Internal Medicine, School of Medicine, Teikyo University, Tokyo, 
      Japan.
FAU - Fujimori, Shin
AU  - Fujimori S
AD  - Department of Internal Medicine, School of Medicine, Teikyo University, Tokyo, 
      Japan.
FAU - Isogawa, Akihiro
AU  - Isogawa A
AD  - Diabetes Care Division, Mitsui Memorial Hospital, Tokyo, Japan.
FAU - Onishi, Yukiko
AU  - Onishi Y
AD  - Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life 
      Foundation, Tokyo, Japan.
FAU - Suzuki, Ryo
AU  - Suzuki R
AUID- ORCID: 0000-0002-2965-6906
AD  - Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The 
      University of Tokyo, Tokyo, Japan.
FAU - Ueki, Kohjiro
AU  - Ueki K
AD  - Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The 
      University of Tokyo, Tokyo, Japan.
FAU - Yamauchi, Toshimasa
AU  - Yamauchi T
AD  - Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The 
      University of Tokyo, Tokyo, Japan.
FAU - Kadowaki, Takashi
AU  - Kadowaki T
AD  - Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The 
      University of Tokyo, Tokyo, Japan.
FAU - Hashimoto, Hideki
AU  - Hashimoto H
AD  - Department of Health and Social Behavior, School of Public Health, The University 
      of Tokyo, Tokyo, Japan.
LA  - eng
SI  - Dryad/10.5061/dryad.dncjsxkwd
PT  - Journal Article
DEP - 20200517
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
SB  - IM
MH  - Cross-Sectional Studies
MH  - *Diabetes Mellitus, Type 2
MH  - Female
MH  - Humans
MH  - Japan
MH  - Male
MH  - Patient Participation
MH  - Self Concept
MH  - Social Stigma
MH  - Surveys and Questionnaires
PMC - PMC7239528
OTO - NOTNLM
OT  - diabetes & endocrinology
OT  - patient activation
OT  - patient education
OT  - psychosocial research
OT  - stigma
OT  - type 2 diabetes
COIS- Competing interests: None declared.
EDAT- 2020/05/20 06:00
MHDA- 2021/04/20 06:00
PMCR- 2020/05/17
CRDT- 2020/05/20 06:00
PHST- 2020/05/20 06:00 [entrez]
PHST- 2020/05/20 06:00 [pubmed]
PHST- 2021/04/20 06:00 [medline]
PHST- 2020/05/17 00:00 [pmc-release]
AID - bmjopen-2019-034757 [pii]
AID - 10.1136/bmjopen-2019-034757 [doi]
PST - epublish
SO  - BMJ Open. 2020 May 17;10(5):e034757. doi: 10.1136/bmjopen-2019-034757.