@Article{info:doi/10.2196/40164,
author="Levy, Natalie K
and Park, Agnes
and Solis, Daniela
and Hu, Lu
and Langford, Aisha T
and Wang, Binhuan
and Rogers, Erin S",
title="Social Determinants of Health and Diabetes-Related Distress in Patients With Insulin-Dependent Type 2 Diabetes: Cross-sectional, Mixed Methods Approach",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="12",
volume="6",
number="10",
pages="e40164",
keywords="social determinants of health; income; socioeconomic; cross sectional; insulin; diabetic; HbA1c; barrier; diabetes-related distress; type 2 diabetes; ambulatory care; healthcare; health care; distress; epidemiology; T2DM; diabetes",
abstract="Background: Social determinants of health (SDOH) refer to the social, economic, and psychosocial conditions that influence health. Lower levels of SDOH factors including income, education, and employment are associated with a higher prevalence of diabetes, poorer glycemic control, and increased diabetes-related mortality. Few studies have conducted a comprehensive evaluation of multiple SDOH factors in a population with type 2 diabetes mellitus (T2DM). Objective: This study aimed to identify the range of SDOH challenges---including diabetes-related distress---that impact patients with insulin-dependent diabetes at an urban safety-net clinic using the 5-domain SDOH framework developed by the Healthy People 2020 initiative. Methods: The pilot study used a cross-sectional, mixed methods approach. Participants were recruited from 3 programs within a general internal medicine clinic that provides ambulatory care for patients with uncontrolled T2DM. We administered an investigator-developed SDOH survey based on the Healthy People 2020 framework and the validated Diabetes Distress Scale (DDS), which assesses 4 domains of diabetes-related distress. One-on-one interviews were conducted to gain in-depth information about challenges. Results: In total, 57 participants had an average hemoglobin A1c level of 11.0{\%} (SD 2.6{\%}). Overall, 92{\%} (52/57) of participants had a barrier in at least one SDOH domain. SDOH challenges were most commonly reported in the domain of Health and Health Care (84{\%}, 48/57), followed by Economic Stability (54{\%}, n=31), Neighborhood and Built Environment (53{\%}, n=30), Education and Health Literacy (47{\%}, n=27), and Social and Community context (37{\%}, n=21). The mean overall DDS score was 2.09 (SD 0.84), where scores of ≥2 indicate distress. Further, 79{\%} (45/57) of participants had at least moderate diabetes-related distress in one of the 4 DDS domains. General themes that emerged from participant interviews included job interference with healthy behaviors, concerns about burdening others, challenges communicating with providers, and difficulty getting appointments in a timely manner. Conclusions: We found high levels of SDOH barriers across all 5 domains of the Center for Disease Control and Prevention's Healthy People 2020 framework, including significant levels of diabetes-related distress. Future programs to address SDOH barriers in patients with uncontrolled insulin-dependent diabetes should consider screening for and focusing on a wide range of challenges. ",
issn="2561-326X",
doi="10.2196/40164",
url="https://formative.jmir.org/2022/10/e40164",
url="https://doi.org/10.2196/40164",
url="http://www.ncbi.nlm.nih.gov/pubmed/36222807"
}