This study examined how structural and contextual barriers, including social needs and gender, influence diabetes self-management (DSM) through psychosocial pathways, particularly diabetes distress (DD) and self-efficacy (SE). Although these barriers are well documented, their interactions with psychosocial factors remain underexplored.
We analyzed cross-sectional baseline data from the REAL-T (Resilient Empowered Active Living Telehealth) study (n = 198). Using hierarchical regression, we assessed factors influencing DSM. Structural predictors included unmet social needs and limited insulin access; contextual predictors included gender and ethnicity. Hypothesized mediators were the scores on the Diabetes Distress Scale, the Diabetes Empowerment Scale, and the Audit of Diabetes Dependent Quality of Life. After identifying significant predictors and potential mediators through hierarchical multivariate regression analysis, separate path models were tested for each hypothesized mediator.
Unmet social needs, as well as female and nonconforming genders, were found likely to increase DSM challenges. All selected predictors became nonsignificant when accounting for all psychosocial variables. DD mediated all tested relationships, and SE partially mediated the relationship between unmet social needs and DSM.
The proposed model suggests the need for targeted interventions addressing psychosocial pathways, particularly DD and SE, to mitigate the downstream effects of structural barriers to DSM. Inclusive gender-specific care models and systemic reforms to reduce social inequities are crucial for improving DSM outcomes and overall well-being.
