Psycho-social and behavioral trends in Type 2 Diabetes self-management amongst medically underserved patients during the COVID-19 pandemic in an mHealth intervention

ObjectiveTo examine behavioral and psychosocial aspects of Type 2 Diabetes Mellitus (T2DM) self-management among medically underserved adults during the COVID-19 pandemic. Materials and MethodsBaseline data were analyzed from T2 Coach, a randomized controlled trial testing a behavioral mHealth intervention using a conversational agent to support T2DM self-management. Participants (n=279) were recruited from Federally Qualified Health Centers in underserved areas of the New York City metropolitan area (2020-2023). Measures included demographics, HbA1c, BMI, mobile device proficiency, and validated surveys assessing self-care adherence (SCI-R), self-efficacy, diabetes distress (PAID), and pandemic-related experiences (e.g., food insecurity, dietary and exercise changes). Multiple linear regression models examined associations between demographic, clinical, and COVID-19-related variables with SCI-R, self-efficacy, PAID, and HbA1c outcomes. ResultsParticipants were primarily female (60.6%), Hispanic (63.4%), and foreign-born (65.9%), with substantial socioeconomic disadvantage (43.7% Medicaid enrollment; 42.7% food insecurity). Mean HbA1c was 10.1 (SD 1.7). Pandemic-related disruptions were common: 18.7% ate more, 34.5% exercised less, and [~]40% changed food purchasing habits. Regression models indicated that poorer self-reported health and dietary changes were linked to higher distress and lower self-efficacy. Increased exercise predicted better adherence (higher SCI-R), and women demonstrated stronger adherence than men. Older age was associated with lower HbA1c. Digital literacy was not associated with self-management outcomes. DiscussionCOVID-19 exacerbated challenges to diabetes self-management among underserved populations, particularly through lifestyle disruptions and psychosocial stressors. ConclusionFindings underscore the need for culturally responsive, technology-enabled interventions that address diet, exercise, and emotional well-being to improve diabetes outcomes during public health crises.