Honors Theses

Date of Award

Spring 5-8-2022

Document Type

Undergraduate Thesis



First Advisor

Aaron Lee

Second Advisor

Joseph Wellman

Third Advisor

Marilyn Mendolia

Relational Format



Introduction: Individuals frequently experience public and self-stigma stemming from type 2 diabetes. Prior studies have linked stigma with higher levels of poorer diabetes outcomes such as greater disease-related distress and worse glycemic control. However, few if any studies have examined the association between diabetes-related stigma and healthcare utilization. This gap in the literature is critically important given the importance of proactive disease management and preventive care as well the high costs of acute service use in this population. Therefore, the purpose of the present study was to examine the relationship between type 2 diabetes stigma, patient activation, and acute medical service use.

Methods: The study sample (N = 373) was recruited from a web-based panel of U.S. adults with type 2 diabetes. The mean age was 55.9 years (SD=15.67), approximately half female (57%), and primarily white (78.6%). Diabetes stigma was measured using the 19-item Type 2 Diabetes Stigma Assessment Scale (DSAS-2) which included 3 subscales: Self-Stigma, Perceived Blame and Shame, and Discrimination. Patient activation was measured using the 13-item Patient Activation Measure (PAM-13). We assessed two indicators of self-reported acute healthcare use: diabetes-related emergency department visits and hospitalizations during the past 12 months. Hierarchical linear and logistic regressions were used to test our hypotheses.

Results: Self-stigma was significantly associated with lower levels of patient activation, (B = -.55, 95%CI: [-0.99, -0.11], p = .014) while perceived blame and shame and discrimination were not (p > .05). Diabetes-related discrimination was significantly associated with greater risk of hospitalizations (OR = 1.14, 95%CI: [1.01, 1.28], p = .031), and emergency department visits (OR = 1.21, 95%CI: [1.08, 1.34], p < .001), while self-stigma and perceived blame and shame were not associated with either indicator of acute healthcare use.

Discussion: These results suggest that Diabetes Self-Stigma is associated with low levels of patient activation, while diabetes discrimination is related to increased use of acute medical care. Future studies should examine different avenues to reduce diabetes-related stigma and their effect on patient activation and acute healthcare utilization.



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.