Abstract
Background: Diabetes distress (DD) is common psychosocial issue among adults with type 2 diabetes mellitus (T2DM) and is associated with maladaptive coping, inadequate self-care practices and suboptimal glycemic control. Despite the high prevalence of DD among adults with T2DM in Pakistan, psychosocial screening and supportive interventions are not well integrated into routine care. Mindfulness-based stress reduction (MBSR) has shown potential in decreasing emotional distress and enhancing coping and glycemic outcomes in people with T2DM. However, evidence regarding the feasibility, acceptability and effectiveness of culturally adapted MBSR interventions in low-resource settings is limited.
Objective: This study aims to evaluate the preliminary effectiveness, feasibility, acceptability and perceived usefulness of a nurse-led MBSR intervention in improving DD, coping and glycemic control among T2DM adults in Pakistan.
Methods and Analysis: A multi-methods study employing a single-arm pre-test post-test design and qualitative interviews will be conducted at the outpatient department of a public sector tertiary care hospital of AJK, Pakistan. Approximately 60 T2DM adults with moderate or high DD will be recruited using consecutive sampling. The study participants will receive a culturally adapted 4-week nurse-led MBSR intervention delivered in weekly group sessions. Quantitative outcomes will include DD, coping strategies and HbA1c, measured at baseline and 3-month follow-up. A purposive subsample of participants will be selected for qualitative semi-structured interviews to assess the feasibility, acceptability and perceived usefulness of the intervention. The qualitative data will be analyzed using inductive-deductive hybrid thematic analysis.
Keywords: diabetes distress, coping; feasibility, glycemic control; type 2 diabetes, mindfulness-based stress reduction; Pakistan.
