The Association Between Resilience And Stigma In Rural Patients With Type 2 Diabetes Mellitus In Shandong Province:The Moderating Effect Of Social Support

BackgroundAs the number of patients with type 2 diabetes mellitus continues to rise,this group reports unfair treatment that internalizes stigma.Stigma research in patients with type 2 diabetes is a late start compared to conditions such as mental illness,HIV and cancer,but it is relatively rich and concentrated almost abroad,in some places such as Australia.Studies have shown that the higher the level of resilience of patients,the lower the level of stigma.Maintaining good resilience is of great significance to reduce the level of stigma.Secondly,patients with low resilience can also alleviate their negative emotions if they have enough social support.The higher the level of social support,the better the disease self-management behavior of patients with type 2 diabetes mellitus,thus helping to reduce the level of stigma.There is a lack of quantitative research on stigma of rural patients with type 2 diabetes mellitus and research on measures to improve stigma of diabetes patients.Although the literature has confirmed that resilience is a protective factor of stigma,the mechanism of the three subdimensions of social support between resilience and stigma has not been systematically answered,nor has the strategy of reducing stigma in rural patients with type 2 diabetes mellitus been systematically answered.ObjectivesThe purpose of this study was to understand the current status of stigma in rural patients with type 2 diabetes mellitus in Shandong province,analyze its influencing factors,explore the relationship between resilience and stigma and the moderating effect of social support in the relationship,and explore strategies to reduce stigma in rural patients with type 2 diabetes mellitus.MethodsField research was conducted mainly based on self-made questionnaires.661 rural patients with type 2 diabetes mellitus were surveyed by random sampling in Changqing District of Jinan City,Yanggu County of Liaocheng City,Shouguang City of Weifang City in 27 sample villages,9 towns and townships,and 27 sample villages in Shandong Province,to study the stigma of rural patients with type 2 diabetes mellitus in Shandong Province.Epidata,SPSS26.0 and Excel were used for data entry and analysis.The independent variable is:Basic information of the patients(gender,age,education level,marital status,occupation,type of medical insurance,per capita monthly income of the family,family economic burden,debt,pet ownership,living conditions,number of activities),prevalence situation(diabetes course,fasting blood glucose,treatment methods,complications,complicity of other chronic diseases,family history,degree of discrimination against diabetes,comprehensive self-rated health)and resilience,with social support as the moderating variable and stigma in people with type 2 diabetes mellitus as the dependent variable.Descriptive analysis and difference test were carried out on the basic situation and disease condition of diabetic patients.Pearson correlation analysis was used to analyze the relationship between resilience,social support and stigma.Multiple linear regression was used to analyze the effects of patients’ basic information,disease status,resilience and social support on the status of stigma.The moderating effects of social support on the association between resilience and stigma in patients with type 2 diabetes mellitus were analyzed.ResultsAmong the 660 patients with type 2 diabetes mellitus in this study,66.8%were female,most of them were 65 years old and above,34.8%were illiterate,and 82.7%were married.69.2%of rural patients were engaged in agricultural work,and 94.7%were covered by medical insurance for urban and rural residents.79.5%of the patients’ family per capita income was only 2,000 yuan or less,10.5%of the patients reported serious family economic burden,and 9.5%of the patients also had family debts.In terms of residence,63.0%of patients lived with their spouse.Only 29.8 percent of patients had pets.In addition,37.0 percent of patients never participated in activities.In terms of the disease,34.1%of the patients had a diabetes course of 10 years or more,and 37.8%of the patients had fasting blood glucose of 7,0～8.4 mmol/1.86.4%of the patients were treated with oral drugs only,79.7%of the patients had complications and other chronic diseases.The number of patients who believed that the degree of discrimination against diabetes patients was serious and not serious was about the same,63.2%of patients also had no family history,and 29.5%of patients reported having a family history.In addition,48.5%of the patients reported good overall health status.The total score of stigmas of rural patients with type 2 diabetes mellitus in Shandong province was 49.50±13.64 points,and the average score of each dimension from high to low was 2.62±0.69 points on blame and criticism,2.61 ±0.93 points on self-shame and 2.59±0.70 points on discrimination.The overall stigma level was above the medium level.The total score of resilience of rural patients with type 2 diabetes mellitus in Shandong province was 26.05±8.16 points,and the scores of various dimensions were 12.82±4.27 points for fortitude,7.81 ±2.56 points for strength and 5.42±1.76 points for optimism.The total social support score of this group was 34.77±6.49 points,the subjective social support score was 20.34±3.73 points,the objective support dimension was 8.50±2.59 points,and the support utilization score was 5.93±2.10 points.Among them,90.0%of rural patients with type 2 diabetes mellitus in Shandong Province were in the medium level of social support.Single factor results showed that gender,age,marital status,occupation,type of medical insurance,family economic burden,number of activities,whether there were complications,whether there were other chronic diseases,comprehensive self-reported health and stigma of rural patients with type 2 diabetes mellitus in Shandong Province were statistically significant(p<0.05).The results of Pearson correlation analysis showed that the resilience scores of rural diabetic patients in Shandong province were significantly negatively correlated with the total score of stigma and the scores of its three sub-dimensions(p<0.001).The total score of social support(p<0.001)and the score of subjective support dimension(p<0.001)were negatively correlated with the scores of stigma and its dimensions,and the utilization of support was also negatively correlated with the total score of stigma and the dimensions of discrimination and self-stigma(p<0.01).But there was no significant difference between objective support and stigma and its dimension scores(p>0.05).Multiple linear regression results showed that gender,marital status,family economic burden,type of medical insurance,social support and mental resilience were the influencing factors of stigma in rural patients with type 2 diabetes mellitus in Shandong Province.The results of moderating effect model analysis showed that social support(β=-0.025,p<0.001)and objective support dimension(β=-0.058,p<0.001)played a moderating effect in the relationship between resilience and stigma in rural patients with type 2 diabetes mellitus in Shandong province.Conclusions and SuggestionsConclusions1.Rural patients with type 2 diabetes in Shandong Province scored the highest on the blame and criticism dimension caused by the disease,and the stigma was above the medium level on the whole;Resilience is generally at a low level and needs to be further improved.The overall social support was at a medium level,with the highest score in the subjective support dimension and the lowest score in the support utilization dimension.2.The higher the resilience of rural patients with type 2 diabetes mellitus,the lower the level of stigma.3.Women,65-70 years old,married,farming,medical insurance for urban and rural residents,perceived serious family economic burden,do not participate in activities,have complications,have other chronic diseases,and overall self-rated health status as poor,their level of stigma is higher.4.The dimensions of total social support and objective support had a significant moderating effect on the relationship between resilience and stigma level,and higher social support had a protective effect on reducing stigma level of patients.Suggestions1.Strengthen peer support education to relieve patients’ negative emotions;2.Mindfulness-based stress reduction therapy can enhance the psychological suggestion of patients and improve the level of resilience;3.Encourage patients to actively seek social support and improve the utilization of social support4.Strengthen the training of clinical medical staff;5.Promote the training of case health managers for patients with type 2 diabetes mellitus;6.Strengthen knowledge publicity and education on diabetes.