A Qualitative Study on Self-Perceived Burden in Elderly Patients with Diabetes and Frailty Based on Social Ecological Theory

Abstract

Objective To explore the formation mechanism of self-perceived burden (SPB) in elderly patient with diabetes with frailty from the perspective of social ecological theory. Methods Using purposive sampling, 21 frail elderly patient with diabetes (aged ≥60 years, Tilburg Frailty Index ≥5, Self-Perceived Burden Scale score ≥20) were recruited from a tertiary hospital in Wuxi, China. One-on-one semi-structured interviews were conducted using an interview guide based on social ecological theory. Data were analyzed with NVivo 12.0 using theory-driven and data-driven qualitative content analysis. Results Five themes with core connotations and 12 sub themes were identified: (1) Physiological disability: the loss of self-integrity caused by the progression of complications, debilitating experiences and impairment of self-care; (2) Management dilemma: management frustration and loss of life meaning caused by the conflict between subjective efforts and poor outcomes; (3) Relationship tension: the common sense of emotional debt in spousal care, intergenerational support and social withdrawal; (4) Environmental exclusion: the double marginalization experience caused by barriers to the physical environment at home and the intensification of the digital divide; (5) System imbalance: the sense of powerlessness caused by the lack of humanistic care in medical services and limited medical insurance support. Conclusion SPB is shaped by multi‑level interactions within the social ecological system. Findings can inform clinical practice and policy: stratified psychological interventions, family support optimization, age‑friendly environmental and digital inclusion, and chronic disease insurance refinement. Nurses can serve as cross‑level integrators in implementing these strategies.