Expanding Diabetes Self-Management Education to Address Health-Related Social Needs: A Qualitative Feasibility Study

TL;DR

This study explores how diabetes education programs can better address social barriers like housing and food insecurity to improve health outcomes.

Contribution

The study provides new insights into the feasibility of integrating health-related social needs screening into community-based diabetes education programs.

Findings

DSME programs' structured design limits responsiveness to participants' social needs despite facilitators' openness to screening.

Community-based organizations need system-level support like funding and trained staff to effectively address social barriers.

A parallel support model with navigators or health workers is recommended to manage referrals and HRSN screening.

Abstract

Public Health Relevance—How does this work relate to a public health issue?
Diabetes self-management outcomes are strongly influenced by health-related social needs (HRSN), yet many diabetes self-management education (DSME) programs lack structured processes to identify and respond to these barriers, particularly in non-clinical settings.Community-based organizations deliver DSME to populations disproportionately affected by social and structural inequities, positioning them as critical but under-resourced sites for addressing HRSN within chronic disease management.

Diabetes self-management outcomes are strongly influenced by health-related social needs (HRSN), yet many diabetes self-management education (DSME) programs lack structured processes to identify and respond to these barriers, particularly in non-clinical settings.

Community-based organizations deliver DSME to populations disproportionately affected by social and structural inequities, positioning them as critical but under-resourced sites for addressing HRSN within chronic disease management.

Public Health Significance—Why is this work of significance to public health?
This study provides implementation-focused evidence on the feasibility of integrating HRSN screening into community-based DSME programs, addressing a critical gap between public health priorities and real-world delivery contexts.Findings highlight how misalignment between policy expectations, organizational capacity, and facilitator roles constrains equitable diabetes care, offering insight into why HRSN integration remains uneven despite growing emphasis in public health practice.

This study provides implementation-focused evidence on the feasibility of integrating HRSN screening into community-based DSME programs, addressing a critical gap between public health priorities and real-world delivery contexts.

Findings highlight how misalignment between policy expectations, organizational capacity, and facilitator roles constrains equitable diabetes care, offering insight into why HRSN integration remains uneven despite growing emphasis in public health practice.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Feasible integration of HRSN into DSME requires system-level supports including dedicated funding, clearly defined workforce roles (e.g., navigators or community health workers), and referral infrastructure rather than reliance on individual facilitators to absorb additional responsibilities.Policymakers and researchers should prioritize implementation strategies that align outer-setting expectations with inner-setting capacity in community-based settings, supporting early-stage feasibility and reducing unintended workforce burden.

Feasible integration of HRSN into DSME requires system-level supports including dedicated funding, clearly defined workforce roles (e.g., navigators or community health workers), and referral infrastructure rather than reliance on individual facilitators to absorb additional responsibilities.

Policymakers and researchers should prioritize implementation strategies that align outer-setting expectations with inner-setting capacity in community-based settings, supporting early-stage feasibility and reducing unintended workforce burden.

Diabetes self-management education (DSME) programs are evidence-based interventions that improve glycemic control and self-care behaviors, yet their effectiveness may be limited by unaddressed health-related social needs (HRSN) (e.g., food insecurity, housing or utility instability, transportation barriers). This qualitative multiple case study examined the feasibility of integrating HRSN assessments into DSME delivery within three community-based organizations (CBOs) across urban and rural U.S. settings. Guided by the Consolidated Framework for Implementation Research, semi-structured interviews were conducted with 15 DSME facilitators and program leadership to identify contextual factors influencing implementation. Findings revealed that while DSME’s structured, manualized design promotes fidelity and client autonomy, it constrains responsiveness to the client’s HRSN. Facilitators expressed openness to integrating HRSN screening, particularly during intake, yet cited limited infrastructure, role clarity, and training as key barriers. CBOs were recognized as trusted, accessible spaces for holistic care, but growing expectations to address HRSN without adequate resources for referral created sustainability concerns. Participants recommended a parallel support model involving navigators or community health workers to manage HRSN screening and referrals alongside DSME sessions. Integrating HRSN assessment processes into DSME may enhance engagement, reduce attrition, and extend the reach of diabetes education to populations most affected by HRSN. However, successful implementation requires dedicated funding, workforce development, and cross-sector coordination. Findings underscore the importance of supporting CBOs as critical partners in bridging diabetes education and social care to advance whole-person, chronic disease management.

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