Kato Asuka, Fujimaki Yuko, Fujimori Shin, Izumida Yoshihiko, Suzuki Ryo, Ueki Kohjiro, Kadowaki Takashi, Hashimoto Hideki
The University of Tokyo, Graduate School of Medicine, Division of Social Medicine, Tokyo, Japan; The Health Care Science Institute, Tokyo, Japan.
Teikyo University, School of Medicine, Department of Internal Medicine, Tokyo, Japan.
Patient Educ Couns. 2016 Jul;99(7):1233-1239. doi: 10.1016/j.pec.2016.02.002. Epub 2016 Feb 8.
To explore how patients with type 2 diabetes (T2DM) psychologically and behaviorally respond to internalized stigma through social stigma.
A 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.
The 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.
Participants 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.
Internalized stigma can be assessed by observing a patient's illness-related negative self-image.
探讨2型糖尿病（T2DM）患者如何通过社会污名在心理和行为上对内化污名做出反应。
采用半结构式访谈进行定性研究，访谈内容录音后逐字转录，并运用扎根理论方法进行分析。参与者为年龄在30 - 64岁之间且被诊断为T2DM的成年人。共有26名患者参与。
定性数据显示，参与者对社会污名的反应虽各不相同，但可归纳为一个四步过程：遭遇负面经历、重新评估2型糖尿病自我、重构身份认同感以及维持患者角色与社会角色之间的平衡。当参与者对自身疾病形成负面形象和关系时，他们往往会内化污名，这可能会影响他们的自我价值感、对社会参与的态度以及依从性。
内化污名的参与者往往自我价值感较低，其社会参与程度介于严重受限（社会回避）和高度积极（角色冲突）之间。这可能会阻碍他们对治疗方案的投入，并影响他们对医生的依从程度。
可通过观察患者与疾病相关的负面自我形象来评估内化污名。
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