Health ecology-based nursing impact on stigma, anxiety, and depression in young and middle-aged type 2 diabetes patients

Table 1 Content and methods of health ecological theory model-based nursing intervention in the observation group

Level	Intervention content	Intervention method
Individual level	(1) Daily life support: Provide individualized daily self-management education to patients, enabling them to acquire self-management skills and enhancing their confidence and self-efficacy; (2) Emotional support: Explain the disease and treatment information to patients, improving their understanding of the disease. Encourage patients to communicate with each other. Encourage patients to express their feelings and understand their viewpoints, correcting their incorrect perceptions; and (3) Medical care support: During the patient’s hospitalization, diabetes specialist nurses and psychologists jointly provide mental health education to the patients. Before the patient is discharged, assist the patient in completing the installation of the MMC software APP on their mobile phone. Set up medication reminder through the MMC software APP client to prevent patients from forgetting to take medication after discharge. Automatically synchronize the designated blood glucose instrument to the MMC software APP (that is, the blood glucose values monitored by the patient through the blood glucose meter can be automatically transmitted to the MMC software APP). Doctors can understand the patient’s blood sugar situation through the MMC software and adjust the medication reminder according to the blood sugar fluctuation. Patients complete the medication according to the reminder. Nurses regularly push diabetes-related health content to the patient through the MMC software APP, such as healthy recipes, exercise plan formulation, etc. Patients can directly feedback their questions to the medical staff through the MMC software APP client, and the medical staff will reply through the APP client	(1) On the first day of the patient’s admission, the health ecology theory was utilized to conduct a comprehensive assessment of the patient; and (2) During the second to fourth days of hospitalization, the responsible nurse provided face-to-face guidance on the patient’s daily life, emotional support, and medical care, lasting approximately 30 minutes to 60 minutes
Family aspect	(1) The responsible nurse provides education on diabetes self-management knowledge to the family members, enabling them to supervise the patient’s diet and treatment, informing them of the key points of diabetes treatment and care, and enhancing the self-care ability and compliance behavior of both the patient and the family members; (2) The responsible nurse helps the family members deepen their understanding of their loved one, providing emotional and material support, and building the patient’s confidence in life; and (3) The responsible nurse encourages the family members to organize gatherings with relatives and friends to obtain emotional and information support, in order to alleviate the patient’s sense of shame and negative psychological state	From the 5th to the 8th day of the patient’s hospitalization, the responsible nurse conducted face-to-face communication and guidance for the patient’s family members, which lasted for approximately 30 minutes to 60 minutes
Community aspect	(1) The diabetes specialist nurses are responsible for coordinating and guiding the care with community family doctors and family nurses, and informing them about the need to address patients’ feelings of stigma and negative psychological issues; and (2) The specialist nurses contact community staff to hold regular diabetes knowledge popularization lectures, reducing discrimination against diabetes patients among the community population	After the patient is discharged, the endocrinologist, the head nurse and the diabetes specialist nurse will conduct a diabetes knowledge popularization lecture in the community once a month for three consecutive months. Each lecture lasts approximately 50 minutes to 60 minutes
Social aspect	(1) Endocrinologists and nurses collaborate with social media to disseminate knowledge about diabetes and the reasons for the stigma faced by diabetic patients to the general public, enabling them to understand the physical and psychological challenges that patients with diabetes encounter, and reducing the public’s prejudice and negative stereotypes towards diabetes; and (2) Help the public correctly understand diabetes, generate a positive public opinion, increase society’s acceptance of diabetic patients, and at the source, reduce the stigma faced by patients and the psychological challenges they encounter due to the disease	Through the media, relevant videos, QR codes or websites about diabetes stigma should be shared and disseminated on platforms such as WeChat, Douyin, and hospital official accounts

APP: Application; MMC: Metabolic Management Center; QR: Quick response.

Table 2 Comparison of baseline data between the two groups, n (%)

Baseline data	Control group (n = 30)	Observation group (n = 30)	t/χ2 value	P value
Age			0.341	0.559
18-44 years old	7 (23.33)	9 (30.00)
45-59 years old	23 (76.67)	21 (70.00)
Gender			0.271	0.602
Male	16 (53.34)	18 (60.00)
Female	14 (46.66)	12 (40.00)
Marital status			0.098	0.754
Married	23 (76.67)	24 (80.00)
Unmarried/divorced	7 (23.33)	6 (20.00)
Educational level			0.317	0.573
High school and below	8 (26.67)	10 (33.33)
College degree or above	22 (73.33)	20 (66.67)
Combined hypertension			0.131	0.718
Yes	4 (13.33)	5 (16.67)
No	26 (86.67)	25 (83.33)
Combined hyperlipidemia			0.373	0.542
Yes	6 (20.00)	8 (26.67)
No	24 (80.00)	22 (73.33)
Monthly household income (yuan)			0.673	0.724
< 5000	8 (26.67)	7 (23.33)
5000-8000	15 (50.00)	18 (60.00)
> 8000	7 (23.33)	5 (16.67)
Course of T2DM			0.326	0.850
< 1 year	8 (26.67)	7 (23.33)
1-3 years	14 (46.66)	13 (43.34)
> 3 years	8 (26.67)	10 (33.33)
Treatment method			0.743	0.863
No-pharmacological treatment	7 (23.33)	8 (26.67)
Oral hypoglycemic drugs	15 (50.00)	13 (43.34)
Injecting insulin	5 (16.67)	7 (23.33)
Oral hypoglycemic drugs combined with insulin injection	3 (10.00)	2 (6.66)
Medical expense payment method			0.162	0.688
Self-funded	3 (10.00)	4 (13.33)
Medical insurance	27 (90.00)	26 (86.67)

T2DM: Type 2 diabetes mellitus.

Table 3 Comparison of blood glucose indicators between the two groups, mean ± SD

Project	Phase	Control group (n = 30)	Observation group (n = 30)	t value	P value
HbA1c	On admission	9.35 ± 1.54	9.41 ± 1.62	0.147	0.884
	On the day of discharge	6.17 ± 0.82	6.01 ± 0.75	0.789	0.434
	Three months after discharge	6.76 ± 0.93	6.15 ± 0.87	2.624	0.011
FBG (mmol/L)	On admission	7.82 ± 1.15	7.89 ± 1.22	0.229	0.820
	On the day of discharge	6.31 ± 0.53	6.25 ± 0.51	0.447	0.656
	Three months after discharge	6.93 ± 0.62	6.36 ± 0.58	3.667	0.001
2hPBG (mmol/L)	On admission	13.87 ± 1.56	13.92 ± 1.63	0.122	0.904
	On the day of discharge	7.54 ± 0.67	7.34 ± 0.58	1.236	0.221
	Three months after discharge	8.63 ± 0.95	7.81 ± 0.72	3.768	0.001

HbA1c: Hemoglobin; FBG: Fasting blood glucose; 2hPBG: 2-hour postprandial blood glucose.

Table 4 Comparison of diabetes self-management, family support, and social support scores between the two groups of patients, mean ± SD

Project	Phase	Control group (n = 30)	Observation group (n = 30)	t value	P value
DSCS (divide)	On admission	48.43 ± 8.69	47.22 ± 8.93	0.532	0.597
	On the day of discharge	65.76 ± 10.65	74.49 ± 11.72	3.019	0.004
	Three months after discharge	62.54 ± 9.83	71.58 ± 10.93	3.368	0.001
PSS-Fa (divide)	On admission	5.63 ± 0.75	5.56 ± 0.72	0.369	0.714
	On the day of discharge	7.42 ± 1.06	9.98 ± 1.25	8.555	< 0.001
	Three months after discharge	6.95 ± 1.02	9.09 ± 1.17	7.551	< 0.001
SSRS (divide)	On admission	20.46 ± 2.67	20.37 ± 2.55	0.134	0.894
	On the day of discharge	23.75 ± 3.73	24.98 ± 2.91	1.424	0.159
	Three months after discharge	23.49 ± 3.65	30.64 ± 5.78	5.729	< 0.001

DSCS: Diabetes Self-Care Scale; PSS-Fa: Perceived Social Support from Family Scale; SSRS: Social Support Rating Scale.

Table 5 Comparison of stigma scores between the two groups of patients, mean ± SD

Project	Phase	Control group (n = 30)	Observation group (n = 30)	t value	P value
DSAS-2 (divide)	On admission	72.85 ± 8.47	73.76 ± 8.43	0.417	0.678
	On the day of discharge	57.46 ± 5.88	54.45 ± 5.61	2.029	0.047
	Three months after discharge	53.35 ± 4.87	46.92 ± 3.04	6.135	< 0.001

DSAS-2: Type 2 Diabetes Stigma Assessment Scale.

Table 6 Comparison of anxiety and depression scores between the two groups of patients, mean ± SD

Project	Phase	Control group (n = 30)	Observation group (n = 30)	t value	P value
SAS (divide)	On admission	59.91 ± 5.34	59.46 ± 5.29	0.328	0.744
	On the day of discharge	48.83 ± 3.12	46.34 ± 2.87	3.217	0.002
	Three months after discharge	48.65 ± 5.09	43.97 ± 3.86	4.013	< 0.001
SDS (divide)	On admission	57.21 ± 5.13	58.18 ± 5.05	0.738	0.463
	On the day of discharge	47.64 ± 3.25	45.25 ± 2.59	3.150	0.003
	Three months after discharge	46.48 ± 4.27	42.85 ± 3.24	3.709	< 0.001

SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale.