structural effect of informational-motivational-behavioral skills and acceptance-commitment in self-management, adherence, and hba1c in diabetes: the mediating role of distress

Objective: psychological and behavioral factors play a critical role in diabetes management. this study investigates the structural relationships among the informational-motivational-behavioral skills (imb) and acceptance and commitment processes with self-management, treatment adherence, and glycated hemoglobin (hba1c) levels in diabetic patients, with distress as a mediator.method: a cross-sectional study was conducted with 321 patients with type 2 diabetes patients referred to health centers in jiroft, iran. data were collected using the diabetes self-management questionnaire-revised (dsmq-r), the imb-based diabetic self-management scale (imb-dsms), the diabetes distress scale (dds-17), the diabetes acceptance and action scale-revised (daas-r), and the diabetes mellitus treatment adherence scale (dmtas). structural equation modeling (sem) was employed using lisrel-8.8 for analysis.results: acceptance and commitment were positively associated with imb skills (β = 0.34, p < 0.001), self-management (β = 0.51, p < 0.001), and treatment adherence (t = 8.19, β = 0.55), while negatively associated with distress (β = -0.24, p < 0.001). imb skills were associated with increased self-management (β = 0.43, p < 0.001) and adherence (β = 0.46, p < 0.001), and also negatively associated with distress (β = -0.40, p < 0.001). distress was also negatively associated with self-management (β = -0.22, p < 0.001) and adherence (β = -0.29, p < 0.001), and positively associated with hba1c levels (β = 0.19, p < 0.001). bootstrap results confirmed distress as a mediator between imb skills, acceptance, and commitment, and self-management/adherence (p < 0.05). the model showed excellent fit (rmsea = 0.046, χ²/df = 2.51).conclusion: this cross-sectional study tested a structural model integrating acceptance-commitment and imb frameworks. findings highlight associations among psychological flexibility, imb skills, reduced distress, and improved self-management. these relationships inform potential intervention targets. longitudinal and experimental studies are required to evaluate causal effects and clinical implementation.