Social construction of diabetes-related stigma in Appalachia: Implications for local public health officials

Background: The Appalachian region is characterized by high type 2 diabetes rates. Past research identified social stigma among those diagnosed with diabetes in Appalachia. We sought to further examine how diabetes-related stigma is socially constructed among Appalachians. Method: We conducted 28 depth-interviews in three communities with individuals who had differences in family history of diabetes (e.g., immediate family member not/diagnosed) and different diagnoses (e.g., low risk, pre-diabetes, diabetes). Participants discussed their perceptions of: the consequences of others knowing about a diabetes diagnosis (personalized stigma); others' reactions in learning about their current/future diagnosis (disclosure); guilt/shame about being at risk/diagnosed (negative self-image); and other's/public attitudes. Results: A thematic analysis revealed that responses from individuals with diabetes differed from those without. Compared with their undiagnosed counterparts, those with diabetes described feeling more negative self-image, recounting feelings of guilt through statements such as “I know it is my fault”. Less prominent, but still notable, a few diagnosed participants described instances in which they felt different than others (e.g., church picnics when someone would point out the “special” sugar-free pie). Implications: Overall, negative self-image appeared to be the most prominent type of stigma among diagnosed Appalachians, but we also identified low levels of “in-group versus out-group” differentiation. Those not diagnosed did not present strong themes of social stigma, and family history was undifferentiating. Still, these findings suggest that successful diabetes management interventions in Appalachia will not only promote self-image enhancing behavior (e.g., healthy eating and physical activity), but also address participants' mental health.