Psychological Distress and Type 2 Diabetes Risk in High-Risk Adults with Low Social Determinants of Health (SDOH): A Qualitative Study

Extensive evidence indicates that social determinants of health (SDOH), shaped by cumulative life-course exposure to resource-deprived environments, play a substantial role in driving disparities in the risk, diagnosis, and outcomes of diabetes. A literature review found that psychological distress is associated with the prevalence of type 2 diabetes and is a contributing factor to the development of the disease, particularly among adult individuals with low SDOH. Multiple studies have demonstrated the association between psychological distress and the development of type 2 diabetes in high-risk adult populations. Furthermore, research has shown that psychological distress undermines individuals' commitment to making substantial long-term lifestyle changes and reduces adherence to pharmacological treatments. The overall research objective is to reduce type 2 diabetes risk in Lebanon in low SDOH, high-risk adult people, by understanding how primary care physicians (PCPs) can reduce type 2 diabetes risk in low SDOH adult people who are at high risk for developing the disease through their recognition and management of psychological distress for promoting better health behaviors. For this, two methods were implemented. The first method involved 42 participants (General Physicians, Family Medicine physicians, and Nurses) in seven online focus groups. The results uncovered the need for a patient-centric integrated model of care to support PCPs to better recognize, treat, and/or refer their patients to disease specialists and community-based services. The second method involved specialists (Endocrinology, Geriatric Medicine, Internal Medicine, Nursing, Psychiatry, and Psychology) who participated in a three-round electronic Delphi survey. By the end of the three rounds, panelists had a consensus on 80% of the total survey’s 25 questions and 84% of the 19 questions crafted around an integrated model of care. The implementation of an integrated model of care is instrumental in assisting PCPs with their disease prevention initiatives targeting adults with low SDOH who are at high risk of developing type 2 diabetes. This research emphasizes the significance of establishing a country-specific integrated model of care, driven by collaborative efforts among stakeholders, to efficiently address psychological distress and manage the risk of type 2 diabetes in high-risk adults with low SDOH.