Effect of a psycho-spiritual intervention on medication adherence, self-management, and glycemic control in women with type 2 diabetes: A randomized controlled trial

Type 2 diabetes mellitus (T2DM) imposes significant challenges, particularly for women, due to psychosocial and cultural factors affecting self-care. Psycho-spiritual interventions integrating psychological and spiritual support show promise in enhancing diabetes management. This randomized controlled trial (RCT) evaluated a psycho-spiritual care program's impact on medication adherence, self-management, and glycemic control in women with T2DM. The study addresses a gap in rigorous, gender-specific RCTs for holistic diabetes care.

This single-blinded RCT enrolled 140 women with T2DM (aged 18-65) from an outpatient clinic in Bandarabbas, randomized 1:1 to intervention or control groups, stratified by age and baseline HbA1c. The intervention group received an 8-week psycho-spiritual program combining cognitive-behavioral therapy, mindfulness, and spiritual practices (e.g., prayer, gratitude journaling) tailored to cultural beliefs. The control group received enhanced routine diabetes education. Outcomes were assessed at baseline, post-intervention (week 8), and 2-month follow-up (week 16) using the Morisky Medication Adherence Scale (MMAS-8), Diabetes Self-Management Questionnaire (DSMQ), and HbA1c levels. Linear mixed-effects models analyzed group-by-time interactions, adjusting for baseline covariates. Missing data were handled using last observation carried forward (LOCF) in intent-to-treat analysis.

Of 140 participants, 134 completed the study (66 intervention, 68 control). Baseline characteristics were similar except for diabetes duration (p = 0.03) and BMI (p = 0.04), adjusted in analyses. The intervention group showed significant improvements in MMAS-8 scores (p < 0.001, Cohen's d = 1.35 post-intervention; d = 1.38 at follow-up) and DSMQ scores (p < 0.001, d = 1.79 post-intervention; d = 1.66 at follow-up) compared to controls. HbA1c reduction was significant at follow-up (p < 0.001, d = 1.02), but not immediately post-intervention (p = 0.59). Group-by-time interactions were significant for MMAS-8 (F(2,264) = 10.89, p < 0.001), DSMQ (F(2,264) = 13.12, p < 0.001), and HbA1c (F(2,264) = 6.45, p = 0.002). Sensitivity analyses confirmed robustness. Large effect sizes underscored the intervention's efficacy.

The psycho-spiritual care program significantly improved medication adherence, self-management, and glycemic control in women with T2DM. These findings support integrating psychological and spiritual components into diabetes care. Future research should explore long-term sustainability and generalizability across diverse populations.

The study was registered at the Iranian Registry of Clinical Trials (IRCT); trial registration number: IRCT20220704055367N6; available at https://irct.behdasht.gov.ir/, registered on 2025-01-11.

The online version contains supplementary material available at 10.1007/s40200-025-01821-3.