1594-P: When Diabetes Education Isn't Enough: Multilevel Implementation Determinants for Health-Related Social Needs Integration

Introduction and Objective: Diabetes self-management education (DSME) is key for improving health behaviors among individuals with chronic conditions. Yet, persistent health-related social needs (HRSN) (e.g., food insecurity, unstable housing) limits DSME participation and impedes outcomes, particularly among infrequently engaged populations. This study examined how community-based organizations (CBOs) delivering DSME navigate the integration of HRSN screening and referral processes. Methods: A qualitative multiple case study design guided by the Consolidated Framework for Implementation Research (CFIR) was conducted across three diverse CBOs. Semi-structured interviews were completed with 15 DSME facilitators and organizational leaders. Thematic analysis across five CFIR domains identified implementation determinants, workflow integration points, adaptations, and contextual factors. Results: Ten themes revealed multilevel determinants shaping HRSN screening integration within CBO-delivered DSME. DSME characteristics illustrated the interplay between DSME’s high fidelity and limited adaptability to emergent HRSN. Inner setting themes identified DSME intake and informal interactions as key touchpoints for screening. Outer setting reflected rising expectations on CBOs amid limited capacity. Individual characteristics revealed role ambiguity and emotionally-vested staff burden. Process themes emphasized client disengagement tied to unmet and missed HRSN and the value of parallel navigator support to enhance engagement, referrals, and accessible participation. Conclusion: Embedding HRSN within DSME offers a promising pathway to more holistic and equitable diabetes care. Achieving this vision requires investment in supportive infrastructure, role clarity, and trauma-informed approaches. Findings underscore the multilevel implementation dynamics and organizational adaptations needed to scale DSME as a mechanism for addressing HRSN and enhancing diabetes management. Disclosure N. Verdecias-Pellum: None. G. D'Apolito: None. A.M. Lohr: None. A. Rascon: None. K.N. Palmer: None.