Diabetes management in the context of social needs: A qualitative process evaluation from care team members'...

Clinical management of Type 2 diabetes (T2D) can be hindered by patients' nonmedical, health-related social needs such as financial strain, housing instability, or food insecurity.

The objective of this study was to characterize the contextual factors and processes that influence care team members' abilities to address social needs impacting T2D management in outpatient settings.

We conducted semistructured, qualitative interviews (N = 38) in tandem with the launch of a randomized controlled trial testing a patient-level intervention to improve diabetes outcomes in individuals experiencing food insecurity. We purposively selected a diverse array of care team members (e.g., physicians, social workers, diabetes educators, dietitians, community health workers) working across varying ambulatory clinics (e.g., family medicine, general internal medicine, endocrinology). All were affiliated with an academic medical center serving a diverse population in a Midwestern metropolitan area. Guided by a process evaluation framework, interview transcripts were coded and analyzed for themes via iterative deductive and inductive processes.

Contextual factors influencing T2D management for patients with social needs included telehealth policy, insurance coverage, and partnerships. Relevant implementation processes were categorized along a temporal continuum: previsit (i.e., transportation, social needs screening), during visit (i.e., appointment duration, care team member awareness, and communication of resources), and postvisit (i.e., closed-loop referrals). Mechanisms of impact included availability of support staff as well as availability of programs and resources to address social needs.

Strengthening partnerships and considering logistics can help promote awareness of existing programs, facilitate bidirectional communication about use of services, and support overall clinical management of T2D for patients with social needs.