Background: Patients with diabetes mellitus often suffer from diabetes distress. Social support and certain psychological factors potentially influence diabetes distress, but studies exploring the mechanisms underlying these relationships are scarce.Objectives: To reveal the associations between social support, diabetes stigma, diabetes self-efficacy, and diabetes distress among patients with type 2 diabetes and the underlying mechanisms linking these variables.Design and methods: A multicenter cross-sectional study was adopted and a sample of 431 patients with type 2 diabetes was investigated. Social support, diabetes stigma, diabetes self-efficacy, and diabetes distress were surveyed with the Perceived Social Support Scale, Type 2 Diabetes Stigma Assessment Scale, Self-Efficacy for Diabetes Scale, and Diabetes Distress Scale, respectively. The hypothesized model was verified using structural equation modeling.Results: Social support and diabetes stigma had direct associations with diabetes distress. Diabetes stigma mediated the association between social support and diabetes distress, and the association between diabetes self-efficacy and diabetes distress. Diabetes stigma and self-efficacy exerted a chain mediation effect on the association between social support and diabetes distress.Conclusion: Social support and diabetes stigma were significant predictors of diabetes distress. Diabetes stigma and self-efficacy play essential mediating roles in relieving diabetes distress. This can provide guidance for the development of evidence- and theory-based interventions. Culturally sensitive interventions that aim to provide ongoing social support, decrease diabetes stigma, and enhance self-efficacy have the potential to relieve diabetes distress.

Background: Depression seriously affects the quality of life of breast cancer patients and even hinders treatment and recovery after diagnosis. Subthreshold depression should be worthy of attention, and the risk of subthreshold depression developing into depression increases if timely intervention is not available. However, there is limited research on interventions for subthreshold depression, especially for newly diagnosed breast cancer patients.Objective: Exploring the efficacy of a PERMA-based positive psychological intervention programme in newly diagnosed breast cancer patients with subthreshold depression.Methods: Using PERMA as a framework, we constructed the intervention programme through a literature review and expert discussion approach, and revised the programme using the Delphi method. Then we selected 84 newly diagnosed breast cancer patients for a randomised controlled trial. The control group received conventional care (primary care, specialist care, psychological care, etc.), and the observation group received a PERMA-based positive psychological intervention programme. Patient data were collected before and after the intervention, and the dataset consisted of patient responses to general information, the Depression Screening Scale (CES-D), the Hamilton Depression Inventory (HAMD-17), and the Questionnaire on Psychosocial Adjustment in Breast Cancer Patients.Results: A total of 79 patients completed the study (38 patients in the observation group and 41 patients in the control group), and before the intervention, there were no statistical differences in the comparison of general information, subthreshold depression scores, and psychosocial adaptation scores between the two groups (p &gt; 0.05). After the intervention, the subthreshold depression (CES-D and HAMD-17 scores) scores of the observation group were lower than those of the control group (p < 0.01), and the psychosocial adaptation scores were significantly higher than those of the control group (p < 0.01).Conclusion: A positive psychological intervention programme using PERMA as a framework was more effective in reducing subthreshold depression levels and promoting levels of psychosocial adjustment in newly diagnosed breast cancer patients.Implications for practice: Interventions for subthreshold depression are not limited to the traditional aftercare model, but rather from a positive psychology perspective. Especially for patients newly diagnosed with breast cancer, this is a new endeavour that has important implications for them. Because, instead of focusing on their negative emotions, we help them gradually adapt to their new identity and treatment process from a positive aspect during their most difficult period, thus reducing their subthreshold depression level and preventing it from developing into a more severe depression.

Background: While individual behavior is governed by both conscious control and unconscious automatic processes, the extent to which habit strength influences the relationship between self-efficacy and self-management behaviors in type 2 diabetes mellitus (T2DM) remains insufficiently quantified. Aims: To examine the associations among habit strength, self-efficacy, and diabetes self-management behaviors, and to explore whether habit strength may help explain the association between self-efficacy and diabetes self-management behaviors among patients with T2DM. Methods: This was a multicenter, cross-sectional study. A total of 292 patients with T2DM were recruited from four hospitals in Hainan Province, China. Self-efficacy, habit strength, and self-management behaviors were assessed using validated questionnaires. Associations among variables were examined using correlation. Path analysis was conducted using SPSS with the PROCESS macro to explore whether habit strength may explain the association between self-efficacy and self-management behaviors. Results: Patients demonstrated moderate levels of diabetes self-management behaviors (mean = 34.15 ± 13.51). Self-efficacy was positively associated with both habit strength and self-management behaviors, and habit strength was also positively associated with self-management behaviors. Path analysis suggested that habit strength may partially explain the association between self-efficacy and self-management behaviors, accounting for 18.6% of the total effect. Conclusion: Habit strength is associated with diabetes self-management behaviors and may partially explains the relationship between self-efficacy to behavioral performance in individuals with T2DM. Interventions that support habit formation may facilitate the application of patients’ self-efficacy to sustained self-management behaviors. Incorporating strategies that reduce cognitive burden and promote automatic behavioral engagement may enhance the effectiveness of diabetes self-management support.

Traditional interventions are largely offline, lack continuous support, and primarily focus on improving knowledge. This study aimed to explore the feasibility, acceptability, and preliminary effects of a phased online support program for patients with diabetes. A mixed-methods design with convenience sampling was adopted in this study. A total of 27 patients with diabetes were recruited from a tertiary hospital in Hainan Province. The patients underwent a phased online support program. Feasibility was assessed based on recruitment, participation, and retention rates. After the patients received the intervention at the 9-month follow-up, acceptability was assessed using one-on-one semi-structured interviews. The preliminary effects of the program were assessed by observing changes in clinical and psychosocial indicators. A designated researcher collected all the data from January 2022 to March 2023. The recruitment, participation, and retention rates were all over 80%. Participants perceived positive changes after participating in the program; they considered the program to be highly acceptable and expressed eagerness for ongoing support. Significant improvements were observed in HbA1c, fasting blood glucose, blood pressure, blood lipid profile, weight, body mass index, self-efficacy, diabetes distress, diabetes knowledge, self-management behavior, and chronic disease resource utilization at the 12-month follow-up. The phased online support program for patients with diabetes is feasible and acceptable, with promising preliminary results.The study was registered in the Chinese Clinical Trial Registry (ChiCTR2400082136, http//www.chictr.org.cn/, 21/3/2024).