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Association between self-stigma and self-care behaviors in patients with type 2 diabetes: a cross-sectional study
  1. Asuka Kato1,2,
  2. Yuko Fujimaki3,
  3. Shin Fujimori3,
  4. Akihiro Isogawa4,
  5. Yukiko Onishi5,
  6. Ryo Suzuki6,
  7. Toshimasa Yamauchi6,
  8. Kohjiro Ueki6,
  9. Takashi Kadowaki6,
  10. Hideki Hashimoto7
  1. 1Division of Social Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  2. 2The Health Care Science Institute, Tokyo, Japan
  3. 3Department of Internal Medicine, School of Medicine, Teikyo University, Tokyo, Japan
  4. 4Mitsui Memorial Hospital, Tokyo, Japan
  5. 5The Institute for Adult Diseases Asahi Life Foundation, Tokyo, Japan
  6. 6Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  7. 7Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Tokyo, Japan
  1. Correspondence to Dr Asuka Kato; asukakato-tky{at}


Objective Growing qualitative evidence reveals that many patients with chronic illnesses struggle to rebuild a positive self-image after diagnosis while attempting to find a balance between their current physical status and their ongoing social duties. One factor destabilizing patients’ identities is self-stigma, which seems to affect their behavioral goals through decreased self-efficacy. We hypothesized that self-stigma would be an independent factor, distinct from self-efficacy, for developing self-care behaviors in patients with type 2 diabetes.

Methods We used a consecutive sample of 209 outpatients with type 2 diabetes treated by endocrinologists at two university hospitals, one general hospital and one clinic. We performed multiple linear regression analyses to test the relationship between the patients’ activation levels for self-care behaviors (dependent variable) and self-stigma, self-efficacy, and depression symptoms (independent variables), adjusting for covariates involving sociodemographic and clinical characteristics.

Results In a multiple linear regression model adjusted for prior covariates, there was significant association between self-stigma and activation levels for self-care behaviors in patients with type 2 diabetes (adjusted R2=0.26, F (12,196)=7.20, p<0.001). The standardized partial regression coefficient of self-stigma was −0.23 (p=0.001), whereas that of self-efficacy was 0.19 (p=0.007).

Conclusions Self-stigma is a negative independent factor, separate from self-efficacy, affecting the self-care behaviors of patients with type 2 diabetes. Self-stigma also has, at least, a similar impact on self-care behaviors to that of self-efficacy. To optimize treatment outcomes, patients’ self-stigma should be minimized, whereas their self-efficacy should be enhanced.

  • Psychological Aspects
  • Self-Care Behavior
  • Self-Efficacy
  • Depression

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