Psycho-social and behavioral trends in Type 2 Diabetes self-management amongst medically underserved patients during the COVID-19 pandemic in an mHealth intervention
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To examine behavioral and psychosocial aspects of Type 2 Diabetes Mellitus (T2DM) self-management among medically underserved adults during the COVID-19 pandemic.
Materials and Methods
Baseline data were analyzed from T2 Coach, a randomized controlled trial testing a behavioral mHealth intervention using a conversational agent to support T2DM self-management. Participants (n=279) were recruited from Federally Qualified Health Centers in underserved areas of the New York City metropolitan area (2020–2023). Measures included demographics, HbA1c, BMI, mobile device proficiency, and validated surveys assessing self-care adherence (SCI-R), self-efficacy, diabetes distress (PAID), and pandemic-related experiences (e.g., food insecurity, dietary and exercise changes). Multiple linear regression models examined associations between demographic, clinical, and COVID-19-related variables with SCI-R, self-efficacy, PAID, and HbA1c outcomes.
Results
Participants were primarily female (60.6%), Hispanic (63.4%), and foreign-born (65.9%), with substantial socioeconomic disadvantage (43.7% Medicaid enrollment; 42.7% food insecurity). Mean HbA1c was 10.1 (SD 1.7). Pandemic-related disruptions were common: 18.7% ate more, 34.5% exercised less, and ∼40% changed food purchasing habits. Regression models indicated that poorer self-reported health and dietary changes were linked to higher distress and lower self-efficacy. Increased exercise predicted better adherence (higher SCI-R), and women demonstrated stronger adherence than men. Older age was associated with lower HbA1c. Digital literacy was not associated with self-management outcomes.
Discussion
COVID-19 exacerbated challenges to diabetes self-management among underserved populations, particularly through lifestyle disruptions and psychosocial stressors.
Conclusion
Findings underscore the need for culturally responsive, technology-enabled interventions that address diet, exercise, and emotional well-being to improve diabetes outcomes during public health crises.
