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

2 university hospitals, 1 general hospital, and 1 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, hemoglobin A1c test, age, sex, and BMI.

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; GFI = 0.97; AGFI = 0.94; CFI = 0.98; RMSEA = 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 T2DM patients, thus increasing patient activation for self-care.

Please see the README file for more information on the dataset.