Impacts of Diabetes Stigma on Acute Health Care Utilization Among Adults With Type 2 Diabetes

Abstract

Purpose

The purpose of this study was to examine the relationships between diabetes stigma, patient activation, and acute health care use. It was predicted that greater diabetes stigma would be associated with lower patient activation and greater likelihood of acute health care utilization.

Methods

Primary data were collected cross-sectionally using a web-based panel of US adults with type 2 diabetes (N = 371). Participants were screened for eligibility by providing informed consent, reporting a type 2 diabetes diagnosis from a health care provider, and passing an end-of-survey check to corroborate participants’ initial self-reported diagnosis of type 2 diabetes. The Diabetes Stigma Assessment Scale, with its 3 subscales, assessed blame and judgment, perceived discrimination, and self-stigma associated with having diabetes. Patient activation was measured using the Patient Activation Measure. The frequency of diabetes-related emergency department visits and hospitalizations during the prior 12 months measured acute health care use.

Results

Self-stigma was significantly associated with lower levels of patient activation, and blame and judgment and perceived discrimination were not. Perceived discrimination was also significantly associated with greater risk of emergency department visits and hospitalizations, and self-stigma and blame and judgment were not associated with either indicator of acute health care use.

Conclusions

Results suggest self-stigma is associated with lower levels of patient activation and that perceived discrimination is related to increased use of acute health care. Future research may examine avenues to reduce diabetes stigma and its effect on patient activation and acute health care utilization.