The Burden of Stigma in Type 2 Diabetes: Evidence from a Rural Primary Care Sample in Türkiye
Murat Gezer1, Zeliha Yelda Ozer1, Yusuf Kemal Arslan2, Servet Yuce3, Cagla Okyar41Department of Family Medicine, Çukurova University, Faculty of Medicine, Adana, Türkiye2Department of Biostatistics, Çukurova University, Faculty of Medicine, Adana, Türkiye
3Department of Public Health, İstanbul Provincial Health Directorate, İstanbul, Türkiye
4Department of Medical Education and Informatics, Çukurova University, Faculty of Medicine, Adana, Türkiye
Objectives: This study aimed to evaluate the presence of diabetes-related stigma and its relationship with disease control and family functioning among adults with type 2 diabetes mellitus (T2DM) living in rural Türkiye. A cross-sectional study was conducted between March and May 2025 at a Family Health Center (FHC). A total of 201 adults with physician-diagnosed T2DM participated in the study.
Methods: Data were collected through face-to-face interviews using a sociodemographic questionnaire, the Diabetes Stigma Assessment Scale-2 (DSAS-2), and the Family APGAR scale, which assesses family functioning. Statistical analyses included correlation tests, group comparisons, and logistic regression to identify independent predictors of stigma.
Results: The mean total DSAS-2 score was 39.4±9.2, indicating a moderate level of perceived stigma. Higher stigma scores were associated with very low income, polypharmacy, and the presence of comorbid chronic diseases (p<0.05). A positive correlation was found between the number of children and both the “Treated Differently” and “Self-Stigma” subdimensions of the DSAS-2 (r=0.202 and r=0.216, respectively). Family APGAR scores were generally high (mean=8.9±2.0), but no significant association was observed between family functioning and stigma levels. Logistic regression analysis showed that medication use was independently associated with higher stigma (OR: 2.48; 95% CI: 1.23–4.98; p=0.011), whereas moderate income was associated with lower stigma (OR: 0.165; 95% CI: 0.048–0.567; p=0.004).
Conclusion: Diabetes-related stigma remains a notable psychosocial challenge for adults with T2DM in rural settings. Socioeconomic disadvantage, comorbidity, and family burden contribute to the internalization of stigma, whereas family support alone may not mitigate its effects. Addressing stigma within primary care through culturally tailored psychoeducation and empower-ment programs may enhance both emotional well-being and disease management in rural populations.
Keywords: Family functioning, primary care, rural population, socioeconomic factors, stigma, type 2 diabetes mellitus
Manuscript Language: English