Self-stigma among Korean patients with diabetes: A concept analysis.
AIMS AND OBJECTIVES
To conduct a concept analysis of self-stigma among patients with diabetes and introduce an operational definition of self-stigma.


BACKGROUND
Due to fears of being monitored, patients with diabetes often conceal their disease and/or withdraw from social relationships. These behaviours negatively affect patients' self-care and socialisation.


DESIGN
A concept analysis was conducted using a three-phase (theoretical phase, fieldwork phase and final analysis phase) hybrid method by Schwartz-Barcott and Kim (Nursing research methodology: Issues and implementations, 1986, Rockville, MD: Aspen).


METHODS
During the theoretical phase, a literature search was conducted using PubMed and CINAHL. Using COREQ guidelines, in the fieldwork phase, in-depth interviews were conducted with nine participants with diabetes. The recorded data were analysed using a grounded theory approach. Results from both were included in the analytic phase.


RESULTS
In the fieldwork phase, nine patients with diabetes (four men and five women; mean age = 57.00 ± 21.93 years) participated in the interview. The mean duration of diabetes was 21.44 ± 12.39 years. The self-stigma concept included three categories with nine attributes: affective (negative feelings and feeling sorry for others who have concerns about me), cognitive (low self-esteem and self-efficacy, perceived weakness, low expectations for the future, worry for children and disease burden) and behavioural factors (social withdrawal and avoiding disease disclosure). The nine attributes included 23 indicators.


CONCLUSIONS
Self-stigma among patients with diabetes is defined as a state in which patients develop negative self-feelings as they deal with the disease. This can cause diminished self-esteem and self-efficacy, as well as a tendency to avoid disclosing the illness along with social withdrawal.


RELEVANCE TO CLINICAL PRACTICE
Based on this self-stigma concept analysis, we clarified the attributes of diabetes self-stigma and distinguished it from social stigma in nurse professionals during patient education and clinical assessment.
['Seo|Kawoun|K|', 'Song|Youngshin|Y|https://orcid.org/0000-0002-2203-5840']
D000328:Adult D000368:Aged D003924:Diabetes Mellitus, Type 2 D005260:Female D066296:Grounded Theory D006801:Humans D008297:Male D008875:Middle Aged D011788:Quality of Life D056910:Republic of Korea D020377:Self Efficacy D057545:Social Stigma D055815:Young Adult
nursing social stigma concept formation diabetes mellitus