The Effect of a Spirituality-Based Intervention on Diabetes Distress, Spiritual Well-Being, and Quality of Life in Women With Type 2 Diabetes: A Randomized Controlled Trial Publisher



Montazeri S ; Nickbin Poshtamsary S ; Khanchemehr Y ; Abdi F ; Jahangasht Ghoozlu K ; Erjaee A
Source: Journal of Nursing and Midwifery Sciences Published:2025

Abstract

Background: Type 2 diabetes (T2D) disproportionately affects women, increasing diabetes distress and reducing quality of life. Spirituality-based interventions may improve coping and resilience. This study evaluated a 12-week spirituality-based intervention’s efficacy in reducing diabetes distress and enhancing spiritual well-being and quality of life in women with T2D, with spiritual well-being as a mediator. Objectives: This study evaluated a 12-week spirituality-based intervention versus routine care in reducing diabetes distress and improving spiritual well-being and quality of life in women with T2D. Methods: A randomized controlled trial (RCT) enrolled 88 women with T2D (aged 18-75) in Bandar Abbas, Iran (November 2024-May 2025), randomized to a 12-week spirituality-based intervention (n = 43; mindfulness, journaling, discussions, psychoeducation) or routine care (n = 45). Outcomes [Diabetes Distress Scale (DDS-17), Spiritual Well-Being Scale (SWBS), Diabetes Quality of Life (DQOL) Measure] were assessed at baseline, post-intervention, and 1-month follow-up. Data were analyzed using t-tests, chi-square, and mixed-effects linear regression. Results: Participants had a mean age of 53.8 years (intervention) and 54.6 years (control), with 70.5% having at least a high school education. The intervention group demonstrated significantly lower DDS-17 scores compared to the control group immediately after the intervention (2.0 ± 0.5 vs. 2.6 ± 0.6, P < 0.001, Cohen’s d = 1.05) and at the 1-month follow-up (2.1 ± 0.5 vs. 2.7 ± 0.7, P = 0.001, Cohen’s d = 0.94). The S0WBS also improved substantially in the intervention group, with higher post-intervention scores (91.5 ± 10.2 vs. 79.0 ± 11.8, P < 0.001, Cohen’s d = 1.12) and sustained improvement at follow-up (89.8 ± 10.5 vs. 78.5 ± 11.9, P < 0.001, Cohen’s d = 1.00). Mediation analysis revealed that SWBS accounted for 65% of the intervention’s total effect on reducing diabetes distress, with a statistically significant indirect effect (P < 0.001). The DQOL scores showed a non-significant trend toward improvement (70.8 ± 11.7 vs. 67.5 ± 12.5, P = 0.18). Conclusions: The 12-week spirituality-based intervention reduced diabetes distress and improved spiritual well-being in women with T2D, with sustained effects at 1-month follow-up. Spiritual well-being mediated distress reductions. Non-significant quality of life improvements suggest potential benefits, supporting spirituality-based approaches in T2D psychosocial care. © 2025 Elsevier B.V., All rights reserved.