The relationship between empowerment and stigma among the Chinese people with diabetes: the mediating role of self-management and the moderating role of psychological resilience.

BACKGROUND

Diabetes mellitus is highly prevalent in China, and individuals affected by this condition often experience stigma, which negatively impacts their psychological well-being and disease management. Empowerment interventions have the potential to reduce stigma by enhancing patients' knowledge and skills; however, the mechanisms underlying this effect are not yet fully understood. The present study aimed to examine the mediating role of self-management behaviors and the moderating effect of psychological resilience (PR) in this context.

METHOD: This study employed a cross-sectional design and included 329 individuals with diabetes, selected through a multistage stratified sampling method. Data collection instruments comprised the diabetes empowerment scale, the Connor-Davidson resilience scale, the stigma scale for chronic illness, and the diabetes management self-efficacy scale. Statistical analyses were performed using SPSS version 23.0, alongside the PROCESS macro, to investigate mediating and moderated mediation effects.

RESULTS

Empowerment (r = -0.451, p < 0.001), self-management (r = -0.397, p < 0.001), and PR (r = -0.325, p < 0.001) each demonstrated significant negative correlations with stigma. Furthermore, self-management was found to partially mediate the association between empowerment and stigma, accounting for 45.44% of the total effect [β = -0.169, 95% CI (-0.272, -0.088)]. PR significantly moderated the relationship between empowerment and self-management (β = 0.002, p < 0.001), as well as the direct relationship between empowerment and stigma (β = -0.012, p < 0.001). Simple slope analyses revealed that the positive influence of empowerment on self-management and the negative influence of empowerment on stigma were both more pronounced among individuals exhibiting higher levels of PR.

CONCLUSION

Our study demonstrates that empowerment has a direct impact on the stigma experienced by individuals with diabetes, as well as an indirect effect mediated by self-management, with PR acting as a moderating factor. These findings suggest that healthcare practitioners should prioritize the enhancement of empowerment-based education and implement tailored interventions that consider patients' varying levels of PR, in order to reduce stigma and promote better mental health outcomes.