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

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.