Diabetes distress remains highly prevalent among adults with type 1 diabetes and is infrequently addressed in routine care. A rapid realist review was conducted to identify how, why, for whom, and in what contexts group-based interventions reduce elevated diabetes distress, informing co-adaptation of a UK intervention (‘D-Stress Reduce’).
Using established rapid realist review methods, investigators synthesized data from 27 papers relating to two existing diabetes distress interventions and the psychological and social theories underpinning them. Evidence synthesis focused on identifying contexts, mechanisms, and outcomes, supported by methodological experts and program architects. The study was published in Diabetic Medicine.
Seven program theories were generated and articulated through 20 “If–Then–Because” statements. Key mechanisms associated with reduced distress included emotional regulation, peer support, and person-centered facilitation. Additional program theories involved regular assessment and follow-up, motivation for action, and empowerment in self-management. Interventions were reported as most effective when adults felt emotionally safe, listened to, and respected, and when facilitators adopted collaborative rather than directive communication styles. Outcomes were influenced by contextual factors such as group composition, facilitator skill, and individual readiness for change.
Limitations include a non-exhaustive search consistent with rapid realist methodology, predominance of Western high-income country literature, and focus exclusively on adults with type 1 diabetes.
This review provides a theory-driven framework to inform development and evaluation of a co-adapted diabetes distress intervention. Future research should assess applicability to adults with type 2 diabetes.