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

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 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article 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diabetes in JS County, China Linni Gu, Xin Na, Qinglu Wu, Zhuoqi Wu, Weijun Zhang, Rui Zhu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8586598/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract 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. Socioeconomic status Diabetes distress Self-efficacy Medication adherence Type 2 diabetes Full Text Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1questionnaire.pdf.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 12 Feb, 2026 Editor assigned by journal 10 Feb, 2026 Editor invited by journal 19 Jan, 2026 Submission checks completed at journal 17 Jan, 2026 First submitted to journal 17 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8586598","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":590632668,"identity":"7acd6046-254e-4d4d-8de3-016c09282cce","order_by":0,"name":"Linni 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Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Socioeconomic status, Diabetes distress, Self-efficacy, Medication adherence, Type 2 diabetes","lastPublishedDoi":"10.21203/rs.3.rs-8586598/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8586598/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThe aim of this study is to investigate how specific social determinants of health influence diabetes self-management.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe 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 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The ANOVA test revealed that there were statistically significant differences in medication adherence related to socioeconomic status (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, F\u0026thinsp;=\u0026thinsp;7.18). The result of sobel-Goodman mediation test demonstrated that socioeconomic status significantly influences diabetes patients\u0026rsquo; medication adherence (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;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 (\u003cem\u003eβ=\u003c/em\u003e-0.058, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThese 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\u0026rsquo; diabetes management.\u003c/p\u003e","manuscriptTitle":"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","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-19 10:52:34","doi":"10.21203/rs.3.rs-8586598/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-02-12T09:56:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-10T06:42:59+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-19T09:52:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-17T11:24:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Primary Care","date":"2026-01-17T11:16:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"aadb4d50-8cf0-4c16-bf4b-10ba2f57e10d","owner":[],"postedDate":"February 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-19T10:52:34+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-19 10:52:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8586598","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8586598","identity":"rs-8586598","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}