title: Association between self-stigma and self-care behaviors in patients with type 2 diabetes: a cross-sectional study.
abstract: 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 R(2)=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.
authors.affiliation: Division of Social Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; The Health Care Science Institute, Tokyo, Japan.
authors.forename: Asuka
authors.initials: A
authors.lastname: Kato
authors.affiliation: Department of Internal Medicine , School of Medicine, Teikyo University , Tokyo , Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Fujimaki
authors.affiliation: Department of Internal Medicine , School of Medicine, Teikyo University , Tokyo , Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Fujimori
authors.affiliation: Mitsui Memorial Hospital , Tokyo , Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Isogawa
authors.affiliation: The Institute for Adult Diseases Asahi Life Foundation , Tokyo , Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Onishi
authors.affiliation: Department of Diabetes and Metabolic Diseases , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Suzuki
authors.affiliation: Department of Diabetes and Metabolic Diseases , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan.
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Yamauchi
authors.affiliation: Department of Diabetes and Metabolic Diseases , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan.
authors.forename: Kohjiro
authors.initials: K
authors.lastname: Ueki
authors.affiliation: Department of Diabetes and Metabolic Diseases , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kadowaki
authors.affiliation: Department of Health and Social Behavior , School of Public Health, The University of Tokyo , Tokyo , Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Hashimoto
keywords: Depression; Psychological Aspects; Self-Care Behavior; Self-Efficacy
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