Negative self-image and diabetes in Appalachian Kentucky: Implications for local public health officials

Background: Rural Appalachia is characterized by higher-than-average diabetes rates. Extant qualitative research has identified social stigma as a corollary to diabetes diagnoses in Appalachian communities (Smith & Tessaro, 2005). Method: To quantify the level of social stigma in Appalachian Kentucky, we collected N = 168 quantitative intercept surveys at local shopping venues (e.g., Wal-Mart). Study participants were queried about their level of concern regarding different facets of social stigma that might accompany a diabetes diagnosis. Participants were Caucasian, 25 to 55 years old, and at-risk for diabetes. Nearly two-thirds (65%) were classified as being at moderate risk while more than one-third (35%) were considered at high risk for developing the disease. Additionally, 56% were female and 79% had a high school diploma. Results: Younger individuals (age 25-44) were significantly more likely to be concerned with negative self-image issues t(166) = 2.65, p = .009 than older individuals (age 45-55). For example, younger individuals felt that having diabetes would “make them feel like a bad person” more than the older individuals, t(166) = 2.55, p = 0.01 and that they would “not feel as good as others” if they had diabetes, t(166) = 2.97, p = .003. Implications: This finding highlights the importance of addressing self-image in diabetes prevention efforts with younger adults in Appalachian Kentucky. Local health officials may want to consider designing interventions that not only promote self-image enhancing behavior (e.g., healthy eating and physical activity), but also contemplate including intervention components that address participants' mental health.