The purpose of the study was to explore the facilitators and barriers of health behaviors in patients with type 2 diabetes (T2D), providing a reference for the development of health behavior interventions programs.

A qualitative descriptive research design was adopted, and interviews were conducted with 25 patients with T2D. The interview guide was developed based on the health action process approach theory. The interviews were audio-recorded and transcribed verbatim. Data analysis was performed using thematic analysis.

Through the analysis of interview data, 2 main themes were identified: facilitators and barriers of health behaviors, comprising 18 subthemes. The facilitators included self-efficacy, outcome expectations, risk perception, intention, action planning, coping planning, emotional regulation, proactive and sustained sense of responsibility, and multidimensional social support. The barriers included insufficient disease awareness, insufficient self-control, impact of social activities, low self-efficacy, accessibility of personal conditions, lack of problem-solving skills, lack of disease management knowledge, lack of social support, and cognitive decline.

When designing health behavior intervention programs for patients with T2D, it is crucial to consider both facilitators and barriers to enhance the effectiveness of the interventions to encourage patients to adopt healthy lifestyles, improve their quality of life, and reduce the occurrence of complications.

Observationally, family and social support are important for optimal diabetes self-management; however, interventions targeting family/social support have not consistently been effective. A novel, diabetes-specific family functioning typology offers the opportunity to classify types of baseline family functioning to determine for whom family interventions may be effective.

We examined the effects of an intervention by baseline type of family functioning post hoc, to inform differential benefit from interventions.

Participants were randomized to enhanced treatment as usual or a 9-month, mobile phone-delivered, family-focused, self-care support intervention. Adults with type 2 diabetes (N = 318) who participated in the randomized clinical trial (RCT) and provided baseline data were included. We determined participants' diabetes-specific family functioning types at baseline using a validated, survey-administered, typology assessment tool. We investigated the associations between type and engagement (eg, attending coaching sessions and responding to text messages) and psychosocial (eg, well-being and diabetes distress) and glycemic outcomes at mid- and post-treatment.

Despite overall high engagement, there was variability across types in engagement and effects. WantMoreInvolvement benefited the most; Satisfied withLowInvolvement showed early improvements that waned; Collaborative &Helpful were highly engaged but derived minimal benefits from the intervention; and CriticallyInvolved benefitted the least and may have experienced some harm.

We demonstrated the utility of a novel diabetes-specific family functioning typology to explain variability in response to a family-focused intervention. Findings from this work answer the calls for systems-level consideration in precision behavioral medicine and drive hypothesis generation for future, tailored interventions.

The larger RCT is registered with ClinicalTrials.gov (NCT04347291).

Type 2 diabetes (T2D) is a chronic metabolic disorder characterized by impaired glucose regulation. This study aimed to compare the effectiveness of Acceptance-Based Emotion Regulation Therapy (ABERT) and Acceptance and Commitment Therapy (ACT) on HbA1c levels and self-care behaviors in patients living with T2D. Participants were randomly assigned to ABERT (n = 16), ACT (n = 17), and control (n = 17) groups. The treatment groups received therapy based on treatment manuals, while the control group received treatment as usual (i.e., standard medical treatment). Assessments were conducted pre- and post-treatment, with a six-month follow-up, measuring HbA1c levels and self-care behaviors. Results from repeated-measures ANOVAs and post-hoc analysis demonstrated that both ABERT and ACT led to significant improvements compared to the control group. However, ABERT was more effective than ACT in reducing HbA1c levels and enhancing self-care behaviors, with sustained benefits observed in the long term. At the individual level, a higher percentage of participants in the ACT and ABERT groups experienced a global improvement in HbA1c compared to the control group during the post-test assessment. Furthermore, a higher percentage of participants in the ABERT group showed global improvement compared to both the ACT and control groups in the post-test to follow-up period. No statistically significant differences in self-care behaviors were observed between the groups at the individual level. These findings suggest that the ABERT may be a valuable intervention for individuals living with T2D, though more studies are needed to examine this subject.

We still do not have comprehensive knowledge of which framework of patient-centered care (PCC) is appropriate for diabetes care, which elements of PCC are evidence-based, and the mechanism by which PCC elements are associated with outcomes through mediators. In this review, we elaborate on these issues. We found that for diabetes care, PCC elements such as autonomy support (patient individuality), cooperation and collaboration (system-level approach), com-munication and education (behavior change techniques), emotional support (biopsychosocial approach), and family/other involvement and support are critically important. All of these factors are directly associated with different patient outcomes and indirectly associated with outcomes through patient activation. We present the practical implications of these PCC elements.

Diabetes distress (DD) is a negative emotion related to diabetes management and a predictor of depression; it affects diabetic retinopathy (DR) patients' quality of life and disease outcomes. The prevalence of DD was higher in patients undergoing surgery for DR. However, few studies have been conducted on DD in DR surgery patients. The present study aims to investigate the status of DD in DR surgery patients and identify factors associated with DD.

Using a convenience sampling method, 210 DR surgery patients who were admitted to 2 tertiary-level hospitals in Wenzhou City (Zhejiang Province) and Zhengzhou City (Henan Province) from February to June 2023 were selected as research subjects. A questionnaire collecting demographic and disease-related information, the Diabetes Distress Scale, the Summary of Diabetes Self-Management Activities, the Family Care Index Scale, and the Social Support Rating Scale were used to collect data. Statistical analyses included descriptive statistics, t tests, ANOVAs, Pearson's correlation analyses and stepwise multiple linear regression. This study is reported according to the STROBE guidelines.

In total, 156 out of 210 (74.29%) DR surgery patients experienced DD, with an average score of 2.13±0.63. The results of the stepwise multiple regression analysis showed that residential location, employment status, self-management level, family support, and social support were significantly associated with DD. These variables accounted for 30.6% of the total variation in DD.

DR surgery patients exhibit moderate levels of distress. Health care professionals should pay attention to DD in DR surgery patients and develop targeted interventions to improve the self-management ability of these patients, increase their family support and social support to reduce their DD levels.

The ability to regulate one's emotional state is an important predictor of several behaviors such as reframing a challenging situation to reduce anger or anxiety, concealing visible signs of sadness or fear, or focusing on reasons to feel happy or calm. This capacity is referred to as emotion regulation. Deficits in this ability can adversely affect one's adaptive coping, thus are associated with a variety of other psychopathological symptoms, including but not limited to depression, borderline personality disorder, substance use disorders, eating disorders, and somatoform disorders.

The present study examined emotion regulation in relation to the virtue-based psychosocial adaptation model (V-PAM). 595 participants were clustered based on their Difficulties in Emotion Regulation Scale (DERS) score, producing two clusters (i.e., high functioning vs. low functioning). Then, emotion regulation group membership was discriminated by using five V-PAM virtue constructs, including courage, integrity, practical wisdom, committed action, and emotional transcendence.

Results show that five virtues contribute to differentiating group membership. Practical wisdom was the strongest contributor, followed by integrity, emotional transcendence, committed action, and courage. Predictive discriminant analysis was conducted and 71% of cases were correctly classified. A discussion of the relationship between emotion regulation and virtues was elaborated.

The concept of virtue holds significant importance in the comprehension of an individual's capacity to regulate their emotions, meriting future study.

We validated longitudinally a typology of diabetes-specific family functioning (named Collaborative and Helpful, Satisfied with Low Involvement, Want More Involvement, and Critically Involved) in adults with type 2 diabetes.

We conducted k-means cluster analyses with nine dimensions to determine if the typology replicated in a diverse sample and if type assignment was robust to variations in sampling and included dimensions. In a subsample with repeated assessments over 9 months, we examined the stability and validity of the typology. We also applied a multinomial logistic regression approach to make the typology usable at the individual level, like a diagnostic tool.

Participants (N = 717) were 51% male, more than one-third reported minority race or ethnicity, mean age was 57 years, and mean hemoglobin A1c (HbA1c) was 7.9% (63 mmol/mol; 8.7% [72 mmol/mol] for the longitudinal subsample). The typology was replicated with respect to the number of types and dimension patterns. Type assignment was robust to sampling variations (97% consistent across simulations). Type had an average 52% stability over time within participants; instability was not explained by measurement error. Over 9 months, type was independently associated with HbA1c, diabetes self-efficacy, diabetes medication adherence, diabetes distress, and depressive symptoms (all P < 0.05).

The typology of diabetes-specific family functioning was replicated, and longitudinal analyses suggest type is more of a dynamic state than a stable trait. However, type varies with diabetes self-management and well-being over time as a consistent independent indicator of outcomes. The typology is ready to be applied to further precision medicine approaches to behavioral and psychosocial diabetes research and care.

Type 2 diabetes self-management occurs within social contexts. We sought to test the effects of Family/friend Activation to Motivate Self-care (FAMS), a self-care support intervention delivered via mobile phones, on psychosocial outcomes for persons with diabetes (PWDs) and their support persons.

PWDs had the option to enroll with a friend/family member as a support person in a 15-month RCT to evaluate FAMS versus enhanced usual care. FAMS included 9 months of monthly phone coaching and text message support for PWDs, and text message support for enrolled support persons.

PWDs (N = 329) were 52% male and 39% reported minoritized race or ethnicity ; 50% enrolled with elevated diabetes distress. Support persons (N = 294) were 26% male and 33% reported minoritized race or ethnicity. FAMS improved PWDs' diabetes distress (d = -0.19) and global well-being (d = 0.21) during the intervention, with patterns of larger effects among minoritized groups. Post-intervention (9-month) and sustained (15-month) improvements were driven by changes in PWDs' self-efficacy, self-care behaviors, and autonomy support. Among support persons, FAMS improved helpful involvement without increasing burden or harmful involvement.

FAMS improved PWDs' psychosocial well-being, with post-intervention and sustained improvements driven by improved self-efficacy, self-care, and autonomy support. Support persons increased helpful involvement without adverse effects.

Type 2 diabetes self-management occurs within social contexts. We sought to test the effects of Family/friends Activation to Motivate Self-care (FAMS), a self-care support intervention delivered via mobile phones, on psychosocial outcomes for persons with diabetes (PWDs) and their support persons.

PWDs had the option to enroll with a friend/family member as a support person in a 15-month RCT to evaluate FAMS versus enhanced usual care. FAMS included 9-months of monthly phone coaching and text message support for PWDs, and text message support for enrolled support persons.

PWDs (N=329) were 52% male and 39% from minoritized racial or ethnic groups; 50% enrolled with elevated diabetes distress. Support persons (N=294) were 26% male and 33% minoritized racial or ethnic groups. FAMS improved PWDs' diabetes distress ( d =-0.19) and global well-being ( d =0.21) during the intervention, with patterns of larger effects among minoritized groups. Post-intervention and sustained (15-month) improvements were driven by changes in PWDs' self-efficacy, self-care behaviors, and autonomy support. Among support persons, FAMS improved helpful involvement without increasing burden or harmful involvement.

FAMS improved PWDs' psychosocial well-being, with post-intervention and sustained improvements driven by improved self-efficacy, self-care, and autonomy support. Support persons increased helpful involvement without adverse effects.

Family function plays a pivotal role in self-management among patients with early chronic kidney disease (CKD), which has been especially important during the COVID-19 pandemic. Previous studies have investigated the relationships between family function and self-management using total scores through self-report questionnaires while ignoring the different components in both family function and self-management. The specific objective of this study was to explore the network structure of family function and self-management at the component level.

A total of 360 patients with early CKD from three tertiary hospitals were enrolled in our cross-sectional survey from September to December 2021 in China. Components of family function were measured by the Family Adaptation Partnership Growth and Resolve Index, and components of self-management were measured by the Chronic Kidney Disease Self-management Instrument. Network analysis was used to establish the network structure.

Edges across the community of family function and self-management were mainly positive. Edges between F3 "Growth" and M1 "Self-integration", F2 "Partnership" and M3 "Seeking social support," F5 "Resolve" and M3 "Seeking social support" were the strongest. F3 "Growth" had the greatest positive bridge expected influence of family function community (0.12), and M3 "Seeking social support" had the greatest positive bridge expected influence of self-management community (0.16).

We explored the potential pathways between different components of family function and self-management among patients with early CKD during the COVID-19 pandemic and found fine-grained relationships between them. The two nodes F3 "Growth" and M3 "Seeking social support" may provide a new idea from the perspective of family function for interventions to improve self-management.