A qualitative study on the impact of internalized stigma on type 2 diabetes self-management

- This is the first study exploring the impact of internalized stigma on persons with type 2 diabetes.
- Participants who internalize stigma severely limit or increase social activities.
- Consequently, they cannot devote themselves to their treatment regimen.
- Noncompliance can be a manifestation of their behavioral response to stigma.

ObjectiveTo explore how patients with type 2 diabetes (T2DM) psychologically and behaviorally respond to internalized stigma through social stigma.MethodsA 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.ResultsThe 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.ConclusionParticipants 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.Practice implicationsInternalized stigma can be assessed by observing a patient's illness-related negative self-image.