Author Credentials

Corresponding Author: Dr. Ranjita Misra Professor Department of Social & Behavioral Sciences West Virginia University School of Public Health Brenna Kirk, MPH PhD Candidate Department of Social and Behavioral Sciences West Virginia University School of Public Health William D. Lewis, MD, FAAFP Clinical Associate Professor Department of Family Medicine Harpers Ferry Family Medicine

Author ORCID Identifier

Ranjita Misra: 0000-0001-7314-0184

Brenna Kirk: 0000-0002-8346-1659


patient counseling, provider perceptions, diabetes distress, health literacy, provider-patient communication


Community Health and Preventive Medicine | Medicine and Health Sciences | Nutritional and Metabolic Diseases | Public Health | Public Health Education and Promotion



West Virginia is an Appalachian rural state that ranks highest in the nation in the prevalence of diabetes (16.2%). The COVID-19 pandemic impacted routine diabetes care. As a result, individuals experienced diabetes distress over the physical and psychological burdens of diabetes management. In rural and medically underserved counties (71%), diabetes care is often provided by primary care physicians. However, healthcare providers’ perspectives on diabetes distress and related counseling to address them are unclear. This cross-sectional study’s objective was to explore healthcare providers’ (HCP) perspectives regarding their patient’s diabetes distress and how it guided their counseling for diabetes self-care during clinic visits.


Participants included 72 West Virginia Practice-Based Research Network members who completed an online survey in June 2021. However, only HCPs (physicians and advanced practice professionals, N=59) were included in the analysis. Data was collected using validated measures of diabetes distress, health literacy, and counseling for diabetes self-care.


HCPs frequently evaluated their patients’ diabetes distress and health literacy levels to guide their conversations. Furthermore, HCPs perceived high diabetes distress (58.5%) in their patients during the pandemic and provided optimal counseling, especially for healthier diets and improved physical activity (98%). Multivariable logistic regression showed a significant reduction in diabetes distress with diabetes counseling. Results also showed HCPs were less likely (65%) to counsel for diet and 4.2 times more likely to counsel for exercise for patients with high diabetes distress.


Formal training of providers on the importance of assessing diabetes distress and tailoring their counseling can further improve diabetes management.