From leadership research to district action: Expanding Diabetes Self-Management Education to Address Health-Related Social Needs: A Qualitative Feasibility Study

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Highlights Public Health Relevance—How does this work relate to a public health issue? Diabetes self-management outcomes are strongly influenced by health-related social needs (HRSN), yet many diabetes self-management education (DSME) programs lack structured processes to identify and respond to these barriers, particularly in non-clinical settings. Community-based organizations deliver DSME to populations disproportionately affected by social and structural inequities, positioning them as critical but under-resourced sites for addressing HRSN within chronic disease management. Public Health Significance—Why is this work of significance to public health? This study provides implementation-focused evidence on the feasibility of integrating HRSN screening into community-based DSME programs, addressing a critical gap between public health priorities and real-world delivery contexts. Findings highlight how misalignment between policy expectations, organizational capacity, and facilitator roles constrains equitable diabetes care, offering insight into why HRSN integration remains uneven despite growing emphasis in public health practice. Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health? Feasible integration of HRSN into DSME requires system-level supports including dedicated funding, clearly defined workforce roles (e.g., navigators or community health workers), and referral infrastructure rather than reliance on individual facilitators to absorb additional responsibilities. Policymakers and researchers should prioritize implementation strategies that align outer-setting expectations with inner-setting capacity in community-based settings, supporting early-stage feasibility and reducing unintended workforce burden. Abstract Diabetes self-management education (DSME) programs are evidence-based interventions that improve glycemic control and self-care behaviors, yet their effectiveness may be limited by unaddressed health-related social needs (HRSN) (e.g., food insecurity, housing or utility instability, transportation barriers). This qualitative multiple case study examined the feasibility of integrating HRSN assessments into DSME delivery within three community-based organizations (CBOs) across urban and rural U.S. settings. Guided by the Consolidated Framework for Implementation Research, semi-structured interviews were conducted with 15 DSME facilitators and program leadership to identify contextual factors influencing implementation. Findings revealed that while DSME’s structured, manualized design promotes fidelity and client autonomy, it constrains responsiveness to the client’s HRSN. Facilitators expressed openness to integrating HRSN screening, particularly during intake, yet cited limited infrastructure, role clarity, and training as key barriers. CBOs were recognized as trusted, accessible spaces for holistic care, but growing expectations to address HRSN without adequate resources for referral created sustainability concerns. Participants recommended a parallel support model involving navigators or community health workers to manage HRSN screening and referrals alongside DSME sessions. Integrating HRSN assessment processes into DSME may enhance engagement, reduce attrition, and extend the reach of diabetes education to populations most affected by HRSN. However, successful implementation requires dedicated funding, workforce development, and cross-sector coordination. Findings underscore the importance of supporting CBOs as critical partners in bridging diabetes education and social care to advance whole-person, chronic disease management.

Study methods

Study Design: We employed a qualitative multiple case study design grounded in implementation science. Guided by CFIR, the study explored the feasibility of integrating HRSN assessments within the standard DSME program delivery in CBO settings. Guided by implementation science, feasibility was conceptualized as the perceived appropriateness and operational fit of HRSN screening within existing DSME workflows, rather than as an evaluation of intervention (i.e., DSME) effectiveness or outcomes. This approach aligns with implementation-focused feasibility assessments conducted prior to intervention adaptation.

Limitations

In contrast, facilitators also described limited adaptability within the DSME curriculum, noting that strict fidelity requirements constrained their ability to respond to emergent HRSN or integrate local resource information. This conflict between fidelity and adaptability was consistently described across sites.

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one school improvement question with teachers. Protect a short shared planning cycle, agree an instructional change and use a common rubric for examining student work. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Review implementation fidelity, teacher time and independently scored student work against a recorded baseline. Examine access differences and competing explanations before attributing changes to leadership. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Niko Verdecias-Pellum; Gianna D’Apolito; Abby M. Lohr; Aliria M. Rascón; Kelly N. B. Palmer. Expanding Diabetes Self-Management Education to Address Health-Related Social Needs: A Qualitative Feasibility Study. International Journal of Environmental Research and Public Health (2026-01-08). https://doi.org/10.3390/ijerph23010088

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.