Relationship between Weight Bias Internalization, Diabetes Stigma, and Perceptions of Healthcare Interactions among People with Type 2 Diabetes.

INTRODUCTION

Weight and diabetes stigma among healthcare professionals (HCPs) may negatively impact treatment decisions, patient outcomes, and physician-patient interactions. We assessed the relationship between weight stigma, diabetes stigma, perceptions of healthcare quality, and avoidance of healthcare among adults with type 2 diabetes (T2D).

METHODS

This observational, online survey-based study included 857 US adults with T2D. The survey included perceptions of patient-centered care with questions from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, perceptions of provider communication with questions from the Diabetes Attitudes, Wishes, and Needs (DAWN) study, de novo questions assessing participants' interactions with HCPs, perceived weight stigma and discrimination, and healthcare quality/avoidance delay questions. Mean scores were reported for patient-reported outcome measures: Modified Weight Bias Internalization Scale, Weight Self-Stigma Questionnaire, and Type 2 Diabetes Stigma Assessment Scale. Additional analyses were based on CAHPS, DAWN, and healthcare quality/avoidance responses.

RESULTS

High degrees of weight bias internalization (WBI) and diabetes stigma were observed among participants dissatisfied with their HCP's overall involvement in their care and those who perceived judgment from the HCP because of their weight. Participants with high degrees of WBI and diabetes stigma were more likely to avoid seeking care, felt uncomfortable with body examinations, and rarely underwent regular health checkups. Those who had suboptimal interactions with their HCPs reported greater stigma.

CONCLUSIONS

Increasing awareness among HCPs regarding weight and diabetes stigma and promoting compassionate communication in healthcare interactions may help diminish these forms of stigma, thereby potentially improving health outcomes for people with T2D.