Facilitators to and experience of psychological resilience during disease response among people with diabetes: a mixed-methods study using resilience framework

BackgroundIn people with diabetes, strong psychological resilience can help them effectively adapt to the lifestyle changes and emotional fluctuations caused by the disease. Integrating quantitative research (identifying key factors and their statistical associations) and qualitative research (exploring in-depth individual experiences) can provide a more comprehensive understanding of resilience facilitators, which has important implications for integrating resilience interventions into future psychological care practices.ObjectiveInformed by the resilience framework, this study elucidates the factors contributing to the development of a positive level of psychological resilience and examines how/why people responded to diabetes.DesignConvergent mixed-methods study with a phenomenological qualitative component.MethodsThis mixed-methods study combined a cross-sectional survey (N = 290) with in-depth interviews (N = 15) in two hospitals in China (Sep, Nov 2023). Quantitatively, standardized questionnaires assessed psychological resilience in adults (≥18y) with physician-diagnosed diabetes. Qualitatively, phenomenological interviews explored post-diagnosis psychological experiences and resilience facilitators guided by Kumpfer's resilience framework. Regression and thematic analyses were applied, with joint displays for integration.ResultsA total of 290 people with diabetes completed the survey questionnaires, and 15 completed an interview. From the environmental context, social support (β = 0.34, p < 0.001) and social resources accessibility enhanced resilience. Regarding internal resiliency factors, self-efficacy (β = 0.99, p < 0.001) and positive mindset emerged as strong positive correlates, while depression (β =, 29.31, p < 0.001) constituted a significant barrier. Notably, qualitative research revealed a novel dimension of “Altruism”, many patients cited responsibility for their children's health as a driving force. Additionally, Qualitative data added “diabetes learning journey” and “physiological reserve” as internal resilience resources. The most compelling findings emerged from Person-environmental transactional process: quantitative data showed avoidance coping to be ineffective (p = 0.81). Acceptance coping showed paradox: harmful quantitatively (β =, 0.98) but helpful qualitatively. This discrepancy likely stems from the fundamental difference between “adaptive acceptance” vs. “passive surrender.” Both cognitive reappraisal and the power of role models promoted resilience. The most crucial integrative finding reveals a bidirectional reinforcement between psychological resilience and self-efficacy, challenging traditional unidirectional models.ConclusionsOptimizing resilience facilitators while addressing barriers is likely to be associated with higher psychological resilience in diabetes patients. Key findings demonstrate the importance of expanding social support networks and promoting resources access, empowering patients through positive mindset building and cognitive reappraisal techniques (e.g., humor coping, benefit-finding), and implementing motivational strategies anchored in altruism (e.g., family health goals). The study particularly underscores the need to differentiate adaptive acceptance from passive surrender in coping processes. In clinical and psychological practice, dynamic monitoring tools should be integrated to quantify the dual effects of acceptance coping and track the bidirectional reinforcement cycle between resilience and self-efficacy. Systematically incorporating these strategies into chronic disease health education and psychological interventions may be beneficial for both mental health and disease management.