Diabetes-related stigma and associated factors among individuals with type 2 diabetes living in rural areas: A cross-sectional study

Objectives: In recent years, research on diabetes-related stigma has increased, demonstrating its adverse effects on self-care behaviors, psychosocial functioning, and clinical outcomes. This study aimed to assess the level of disease-related stigma among individuals with type 2 diabetes mellitus (T2DM) living in rural areas, and to evaluate its associations with sociodemographic and clinical characteristics as well as family functionality. Materials and Methods: This cross-sectional study was conducted in the Karataş Central Family Health Center, located in the Karataş district of Adana Province. The study population included 279 individuals diagnosed with T2DM who were registered with the center. Of these, 201 individuals who volunteered to participate were interviewed face-to-face between March 1 and May 30, 2025, after being contacted by phone. Data were collected using the "Sociodemographic Information Form," the "Family APGAR Scale," and the "Diabetes Stigma Assessment Scale-2 (DSAS-2)." Statistical analysis was performed using IBM SPSS Statistics 20.0, and a p-value of <0.05 was considered statistically significant. Results: Of the 201 participants, 94 (46.8%) were female and 107 (53.2%) were male, with a mean age of 62.2±10.7 years (range: 28–64). The majority reported very low (76.6%) or low (10.9%) income levels. Educational attainment was low: 23.9% were illiterate, 58.7% had completed primary school, and only 5% had higher education. The mean number of children was 4.1. Chronic comorbidities other than diabetes were reported by 68.2% of participants. The mean DSAS-2 score was 39.4±9.2, with the highest variation observed in the self-stigma subdomain. Participants with low income (p=0.005) and those using medications for comorbid chronic conditions (p=0.008) had significantly higher total stigma scores. While family functionality was generally high (88.6% had high APGAR scores), no significant correlation was found between family functioning and stigma (r=0.0244, p=0.738). Social support during diabetes management was reported by 58.2% of participants, with spouses being the most common source (31.3%). A positive correlation was identified between number of children and total stigma (p=0.035), stigma related to differential treatment (p=0.006), and self-stigma (p=0.003). Conclusion: Individuals with T2DM residing in rural areas experience significant levels of disease-related stigma. Notably, stigma scores were higher among those with lower income, those with comorbid chronic diseases requiring medication, and those with higher numbers of children. These findings underscore the need to enhance stigma awareness in primary healthcare settings, and to strengthen patient education and social support mechanisms. Keywords: Type 2 Diabetes, Stigma, Rural Area, Family Functioning, Primary Care, Psychosocial Impact