title: A qualitative study on the impact of internalized stigma on type 2 diabetes self-management.
abstract: To explore how patients with type 2 diabetes (T2DM) psychologically and behaviorally respond to internalized stigma through social stigma.
  
  
  
  A qualitative study with semi-structured interviews was recorded on audiotapes, transcribed verbatim, and analyzed using a grounded theory approach. Participants were adults aged 30-64 years and diagnosed with T2DM. A total of 26 patients participated.
  
  
  
  The qualitative data revealed that participants' responses to social stigma, although varied, could be organized into a four-step process: Encountering Negative Experiences, Reevaluating the Self with Type 2 Diabetes, Reconstructing a Sense of Identity, and Maintaining Balance between Patient and Social Roles. When participants form a negative image of and relationship to their illness, they tend to internalize stigma, which can affect their sense of self-worth, attitude toward social participation, and compliance.
  
  
  
  Participants who internalize stigma tend to have a lower sense of self-worth and their social participation falls somewhere between severely limited (Social Avoidance) and highly active (Role Conflict). This can hinder devotion to their treatment regimen and affect their degree of compliance with physicians.
  
  
  
  Internalized stigma can be assessed by observing a patient's illness-related negative self-image.
authors.affiliation: The University of Tokyo, Graduate School of Medicine, Division of Social Medicine, Tokyo, Japan; The Health Care Science Institute, Tokyo, Japan. Electronic address: asukakato-tky@umin.ac.jp.
authors.forename: Asuka
authors.initials: A
authors.lastname: Kato
authors.affiliation: Teikyo University, School of Medicine, Department of Internal Medicine, Tokyo, Japan. Electronic address: yukofuji@med.teikyo-u.ac.jp.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Fujimaki
authors.affiliation: Teikyo University, School of Medicine, Department of Internal Medicine, Tokyo, Japan. Electronic address: fujimori@med.teikyo-u.ac.jp.
authors.forename: Shin
authors.initials: S
authors.lastname: Fujimori
authors.affiliation: The University of Tokyo, Graduate School of Medicine, Department of Diabetes and Metabolic Diseases, Tokyo, Japan. Electronic address: yoshiiz-tky@umin.ac.jp.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Izumida
authors.affiliation: The University of Tokyo, Graduate School of Medicine, Department of Diabetes and Metabolic Diseases, Tokyo, Japan. Electronic address: ryosuzuki-tky@umin.ac.jp.
authors.forename: Ryo
authors.initials: R
authors.lastname: Suzuki
authors.affiliation: The University of Tokyo, Graduate School of Medicine, Department of Diabetes and Metabolic Diseases, Tokyo, Japan. Electronic address: ueki-tky@umin.net.
authors.forename: Kohjiro
authors.initials: K
authors.lastname: Ueki
authors.affiliation: The University of Tokyo, Graduate School of Medicine, Department of Diabetes and Metabolic Diseases, Tokyo, Japan. Electronic address: kadowaki-3im@h.u-tokyo.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kadowaki
authors.affiliation: The University of Tokyo, School of Public Health, Department of Health and Social Behavior, Tokyo, Japan. Electronic address: hidehashimoto-circ@umin.ac.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Hashimoto
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology*; D012649:Self Concept; D012919:Social Behavior; D012938:Social Perception; D057545:Social Stigma; D013240:Stereotyping; D011795:Surveys and Questionnaires
keywords: Internalized stigma; Qualitative study; Self-care; Type 2 diabetes