Association between self-stigma and self-care behaviors in patients with type 2 diabetes: a cross-sectional study.
Association between self-stigma and self-care behaviors in patients with type 2 diabetes: a cross-sectional study.
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DOI：
10.1136/bmjdrc-2015-000156
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发表时间：
2016
影响因子：
4.1
通讯作者：
Hashimoto H
中科院分区：
文献类型：
--
作者：
Kato A;Fujimaki Y;Fujimori S;Isogawa A;Onishi Y;Suzuki R;Yamauchi T;Ueki K;Kadowaki T;Hashimoto H
越来越多的定性证据表明，许多慢性病患者在诊断后很难重建积极的自我形象，同时试图在他们目前的身体状况和持续的社会责任之间找到平衡。不稳定患者身份的一个因素是自我耻辱，这似乎通过降低自我效能感来影响他们的行为目标。我们假设自我污名是2型糖尿病患者自我照顾行为发展的一个独立因素，与自我效能不同。我们使用了一个连续的样本，209例2型糖尿病门诊患者治疗的内分泌学家在两所大学医院，一个综合医院和一个诊所。我们进行了多元线性回归分析，以测试患者的自我护理行为的激活水平（因变量）和自我耻辱，自我效能和抑郁症状（自变量）之间的关系，调整涉及社会人口统计学和临床特征的协变量。在校正了先前协变量的多元线性回归模型中，2型糖尿病患者的自我耻辱和自我护理行为的激活水平之间存在显著相关性（校正R2=0.26，F（12，196）=7.20，p<0.001）。自我耻辱的标准化偏回归系数为-0.23（p=0.001），而自我效能的标准化偏回归系数为0.19（p=0.007）。自我污名是独立于自我效能之外，影响2型糖尿病患者自我照顾行为的一个负性独立因素。自我污名对自我照顾行为的影响至少与自我效能感的影响相似。为了优化治疗效果，应尽量减少患者的自我污名，而他们的自我效能应该提高。
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. 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. 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). 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.