Using Contact-Based Education to Reduce Diabetes-Related Stigma Among Medical Residents in a Military Health System

Abstract

ABSTRACT Introduction Healthcare provider-related stigma against patients with diabetes is associated with worse doctor–patient relationships and patient self-care. A previous feasibility study showed benefit in using a contact-based education approach to improve attitudes of medical students toward patients with diabetes. We hosted a panel of people who had personal experience with diabetes. The panel was attended by internal medicine residents in a military health system. We compared diabetes-related stigma among the residents before and after the panel. Materials and Methods Panel participants included a Black male active duty service member diagnosed with type 2 diabetes, a Black veteran with type 2 diabetes, and a White woman with two sons who have type 1 diabetes. During a 1 hour panel for medicine residents, these panelists were asked to discuss their personal experiences with diabetes, common misconceptions regarding diabetes, and what they wish healthcare providers understood about diabetes. The validated Diabetes Attitude Scale-3 (DAS-3) questionnaire, which assesses diabetes-related attitudes based on a five-point Likert scale (strongly agree = 5, strongly disagree = 1), was given to the trainees before and after the panel. The survey also collected demographic information and contained short-answer questions about personal experiences with diabetes and diabetes-related stigma. Survey responses were linked with identifier questions to preserve anonymity. Results Twelve participants completed both the pre- and post-panel survey. Seven were female (58%), 10 were White (83%), and eight were from suburban communities (67%). Mean scores improved for all five DAS-3 subscales scores, with the largest improvement in the Patient Autonomy subscale (4.12 to 4.4), followed by Psychosocial Impact of Diabetes Mellitus (4.34 to 4.56), Seriousness of Non-Insulin Dependent Diabetes Mellitus (4.27 to 4.44), Need for Special Training (4.52 to 4.68), and Value of Tight Control (4.07 to 4.10). Conclusions Contact-based education can be considered as a tool for reducing diabetes-related stigma among medical trainees.