Pathways to optimal diabetes management in primary care: an exploration of the role of social determinants of health among patients with diabetes in JS County, China

Objective The aim of this study is to investigate how specific social determinants of health influence diabetes self-management. Methods This study employed a structured questionnaire to collect the data and explore the pathway through which socioeconomic status influences medication adherence among patients with type 2 diabetes in JS county. Statistic analysis was employed including multiple linear regression, sobel-Goodman mediation test, mediation and moderating analysis to test the hypothesis. The results indicated that diabetes distress mediated the relationship between socioeconomic status and medication adherence, while self-efficacy moderated the first stage of this mediation pathway. Heterogeneity analysis was also performed to analyzed the differences across socioeconomic status groups and genders. Results The results of multiple linear regression indicate that socioeconomic status significantly influences medication adherence among patients with type 2 diabetes after controlling for basic demographic characteristics ( p  < 0.001). The ANOVA test revealed that there were statistically significant differences in medication adherence related to socioeconomic status ( p  < 0.001, F = 7.18). The result of sobel-Goodman mediation test demonstrated that socioeconomic status significantly influences diabetes patients’ medication adherence ( p  < 0.001) through diabetes distress. The result of interaction analysis showed that self-efficacy served as a moderator in socioeconomic status influenced diabetes distress in the pathway where socioeconomic status indirect influenced medication adherence ( β= -0.058, p  < 0.001). Conclusions These findings suggest that enhancing self-efficacy may help alleviate diabetes-related distress, especially among individuals with low socioeconomic status (SES), primary health care and community programs need to progress from passive knowledge dissemination to active, experiential learning that aims to build confidence and sense of mastery. The clinical practice should integrate systematic screening for both socioeconomic challenges and psychosocial distress into routine patient assessments. into primary healthcare services to enhance patients’ diabetes management.