# ‘They use the little information they have to pass judgement’: A framework analysis of type 1 diabetes stigma experienced by UK adults living with type 1 diabetes

## TL;DR

This study explores how adults in the UK with type 1 diabetes experience stigma, revealing its sources, impacts, and coping strategies.

## Contribution

The first systematic qualitative analysis of type 1 diabetes stigma in the UK, including insights into stigma management.

## Key findings

- 96% of participants experienced at least one instance of T1D-stigma.
- Five themes and 19 sub-themes were identified, covering sources, experiences, and impacts of stigma.
- Participants described unsolicited advice, discrimination, and emotional impacts of stigma.

## Abstract

Type 1 diabetes stigma (T1D‐stigma), the negative social judgements towards people living with type 1 diabetes (T1D), is linked to poor psychological well‐being and suboptimal diabetes self‐management. This qualitative study explored the T1D‐stigma experiences of adults living with T1D in the UK.

UK‐based adults (aged ≥18 years) with T1D completed an online survey as part of a wider T1D‐stigma study. Respondents who endorsed at least one item on the Type 1 diabetes stigma assessment scale (DSAS‐1) were then invited to provide more information about their stigma experiences. Responses were analysed using framework analysis.

The majority of respondents (96%) endorsed experiencing at least one instance of perceived or experienced stigma. A framework analysis of N = 337 participants' responses developed five themes and 19 sub‐themes. The first and second themes explored the ‘Sources’ and ‘Drivers and facilitators’ of T1D‐stigma. The third theme encapsulated the ‘Experiences’ of T1D‐stigma, where participants described ‘unsolicited comments and advice’, ‘discrimination and rejection’ and ‘lack of understanding’. The fourth theme encompassed the ‘Impact’ of T1D‐stigma, where participants described its social, emotional, and behavioural impact. The final theme explored Stigma management’ and described ‘dealing with T1D‐stigma’, ‘changes over time in self, society and diabetes technology’ and ‘protective factors in T1D‐stigma encounters’.

This study has provided the first systematic qualitative analysis of T1D‐stigma in the UK. In line with other diabetes‐related stigma research, T1D‐stigma was broad in its manifestations and impact. Participants volunteered information about T1D‐stigma management, despite not being explicitly asked about this, highlighting approaches that could inform future interventions.