Abstract
Background: The global prevalence of diabetes mellitus is rising, with a significant comorbidity of depression, a condition called “diapression”. Acceptance and Commitment Therapy (ACT) is a transdiagnostic approach that may benefit this population, and online delivery can improve accessibility. However, qualitative insights into the experiences of patients with diapression undergoing online ACT are lacking. Objective: This exploratory qualitative study aimed to investigate the perspectives of Chinese patients with type 2 diabetes and comorbid depression on an online, self-help ACT intervention, focusing on its acceptability and potential improvements. Methods: Semi-structured interviews were conducted with eight participants one month after they completed an 8-week online ACT program delivered via WhatsApp/WeChat. Data were analyzed using inductive thematic analysis. Results: Five key themes were identified: (1) the perceived usefulness of ACT techniques for improving self-management and reducing distress; (2) difficulties in understanding certain abstract ACT concepts; (3) a preference for brief, succinct intervention components; (4) the benefits of online delivery for flexibility and accessibility; and (5) need for more personalized interaction and prompt feedback Conclusion: Online ACT was generally acceptable to patients with diapression. The intervention was valued for its practical skills and flexible format but could be enhanced by incorporating more real-life examples, culturally adapting concepts, and integrating methods for increased interaction, such as AI chatbots. These findings provide crucial insights for refining online self-help psychotherapies for this population before conducting larger-scale trials.