Focus groups to guide implementing an SDOH initiative using the health equity implementation framework

Results: Analyses revealed the following overarching themes: 1) diabetes, mental health, and HRSNs contribute to a cycle of diabetes distress (i.e., a person's experience with problems associated with diabetes) that is made worse by experience of stigma and impacts clinical outcomes, 2) clinicians try to use empathetic and non-judgmental communication but feel ill-equipped to discuss how these factors intersect during patient visits due to short appointments and clinical mandates and consequently feel helpless to break this cycle, and 3) in addition to longer appointment times and more community resources, implementing a team-based approach to care that involves diabetes-specific screening for mental health conditions and HRSNs and behavioral health and case management support and resources could help.Conclusion: This study highlights the complexities of treating chronic conditions like diabetes that involve a high degree of patient engagement and self-management over time, particularly among patients who experience co-occurring mental health conditions and HRSNs.Screening for mental health conditions and HRSNs that is specific to diabetes should be integrated into standardized workflows, but doing so successfully likely relies on the inclusion of an interdisciplinary care team.