How might diabetes organisations addressdiabetes-related stigma? Findings from a deliberative democratic case study.

Abstract

This study sought to identify how diabetes organisations conceptualize the problem of diabetes-related stigma and how this shapes the selection of stigma-reduction interventions. A qualitative deliberative democratic methodology was used to access an informed dialogue about what should be done by diabetes organisations to address diabetes-related stigma, drawing from the perspectives of board members, healthcare services staff, and communications and marketing staff from a single state-wide diabetes organisation in Australia (n = 25). Participants navigated the stigma concept along two axes: one that drew attention to either disease attributes or personal moral attributes as the object of stigmatisation, and one that positioned stigma as an individual or structural problem. This shaped the selection of stigma-reduction interventions, which included interventions to: (i) reduce the prevalence of stigmatized attributes, (ii) correct misunderstandings about diabetes, (iii) modify representations of persons with diabetes, (iii) enhance coping amongst persons with diabetesand (iv) make healthcare more person-centred and democratic. This study identified several grievances with 'diabetes-related stigma', which are grievances that can be conceptualized and addressed at both individual and structural levels, and involve correcting misinformation about diabetes or challenging and communicating alternative representations of persons living with diabetes. The organisation's management and board were consulted throughout all stages of research development, analysisand reporting. The information and vignettes presented to participants drew from illness narratives obtained from earlier research involving adults with type 2 diabetes. Research participants included adults with various diabetes types.