Journal of health research in community

Introduction
Type 2 diabetes, as a chronic and prevalent disease, demands continuous and multidimensional management that extends beyond individual actions and is profoundly influenced by the socio-familial context. The family health climate (FHC), encompassing the shared perceptions, attitudes, values, and behaviors of family members concerning healthy nutrition and physical activity [11], is a key determinant of adherence to therapeutic regimens and metabolic control in diabetic patients. Procrastination, characterized as a self-regulatory failure involving the irrational delay of essential tasks [2], not only elevates psychological consequences, like stress and depression but also disrupts familial relationships and undermines the supportive family atmosphere [4]). In recent years, interdisciplinary research in neuroscience and evolutionary psychology has proposed models to explain the neuro-cognitive underpinnings of these behaviors. According to these models, the behavioral inhibition system (BIS), which operates as a threat- and punishment-avoidance system, and the behavioral activation system (BAS), which governs responsiveness to reward and pleasurable cues [14], can underlie individual differences in sensitivity to reward and punishment, thereby influencing emotional and behavioral patterns, including health-related behaviors [6]. Despite numerous studies on the role of behavioral systems in chronic diseases [5] and the impact of FHC on disease management [7], a clear research gap exists regarding the concurrent investigation of these variables. Notably, the mediating role of procrastination as a self-regulatory failure in explaining the relationship between these neuro-cognitive constructs and the family’s psychosocial climate in diabetic patients has received less attention. Therefore, the primary objective of this study was to determine the mediating role of procrastination in the association between behavioral activation/inhibition systems and the FHC in patients with type 2 diabetes.

Methods
This correlational-analytical study used structural equation modeling (SEM). The statistical population consisted of type 2 diabetes patients attending a health center in Shahin Shahr, Isfahan, in 2025. Based on the rule of 5 to 15 observations per item and considering 70 items across the research instruments, an initial sample size of 250 was estimated; following the exclusion of 30 participants due to non-fulfillment of inclusion criteria (uncertainty regarding illness duration), the final sample comprised 220 patients selected via convenience sampling. Data were collected using three instruments: (1) the Family Health Climate Scale (FHC-Scale), developed by Niermann et al. (2014), which encompasses physical activity and nutrition subscales [11]; (2) the Tuckman Procrastination Scale (TPS), designed by Tuckman (1991), with its 16-item version utilized in the current study [8, 9]; and (3) the Behavioral Inhibition/Activation Systems Scale (BIS/BAS), constructed by Carver and White (1994), which includes one BIS subscale (7 items) and three BAS subscales: drive, reward responsiveness, and fun seeking [14]. For data analysis, SEM was conducted using AMOS software. Prior to the main analysis, statistical assumptions, including normality of data distribution (verified through the Kolmogorov-Smirnov test and skewness/kurtosis indices) and independence of errors (verified through the Durbin-Watson test), were examined and confirmed. Model fit was evaluated using various indices, including the χ²/df ratio, RMSEA, CFI, TLI, NFI, IFI, and AGFI.

Results
Among the 220 participants, 48.2% (106) were female and 51.8% (114) were male. The majority were married (78.2%, n=172) and had elementary education or were illiterate (41.9%, n=92). Additionally, 62.3% (n=137) had a family history of the disease. The mean scores for procrastination, FHC, the BIS subscale, and the BAS subscale were 36.33±8.19, 31.55±9.28, 20.03±2.68, and 39.99±6.85, respectively. Pearson correlation analysis revealed that procrastination had a significant negative correlation with FHC (r=-0.276) and the BIS subscale (r=-0.160), and a significant positive correlation with the BAS subscale (r=0.201) (P<0.05). The results of SEM indicated that the proposed model exhibited a relatively good fit (χ²/df=2.360, CFI=0.930, TLI=0.907, NFI=0.908, and RMSEA=0.079). Examination of the direct hypotheses revealed that BIS had a significant negative direct effect on procrastination (β=-0.11, P=0.011) and a significant positive direct effect on FHC (β=0.16, P<0.001). BAS had a significant positive direct effect on procrastination (β=0.23, P<0.001). Furthermore, procrastination had a significant negative direct effect on FHC (β=-0.29, P<0.001). The direct effect of BAS on FHC was non-significant and was consequently removed from the model to improve fit. Regarding indirect effects, the results showed that the indirect paths of both BIS and BAS on FHC through procrastination were significant (P<0.001). The calculated R² values indicated that the predictor variables explained 5% and 11% of the variance in procrastination and FHC, respectively.

Conclusion
The findings demonstrate that the BIS plays a supportive role in improving the FHC by enhancing sensitivity to negative outcomes and reducing procrastinatory behaviors. In contrast, the BAS, by promoting pleasure-seeking and diminishing adherence to low-reward tasks, indirectly contributes to tension and the deterioration of the FHC through increased procrastination [16]. Individuals with high BAS tend to delay low-reward tasks (such as dietary adherence), and this behavioral pattern can spread to other family members, adversely affecting the health climate [19]. Therefore, psychological interventions for families managing type 2 diabetes should not focus solely on medical education; they should also target procrastination and the modulation of behavioral systems—particularly BAS, by enhancing self-control—to improve the family’s emotional and supportive climate more effectively [2, 10]. Identifying these psychological mechanisms can contribute significantly to the development of more comprehensive and effective therapeutic programs, ultimately improving diabetes management and enhancing the quality of life of patients and their families [23, 24]. 

Data Availability Statement
The data collected in this study are not publicly available to protect participant privacy and comply with ethical guidelines. However, summary data and final analyses are presented in the article. Interested researchers may contact the corresponding author.

Use of Artificial Intelligence
The authors declared that artificial intelligence tools were used solely for editing and improving the English language of the abstract.

Ethical Considerations
Compliance with ethical guidelines
This study was conducted in accordance with ethical guidelines outlined in the Declaration of Helsinki. Written informed consent was obtained from all participants. The study was approved by the Ethics Committee of Yazd University  (Code: IR.YAZD.REC.1403.031).

Funding
This article was derived from the master’s thesis of Ghazal Rahimi in the field of family counseling at the Faculty of Humanities and Social Sciences, Ardakan University. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors contributions
Initial draft preparation, data collection, and data analysis: Ghazal Rahimi; Study design, initial draft preparation, editing & review: Yasser Rezapour Mirsaleh; Editing & review: Azra Mohammadpanah Ardakan. All authors read and approved the final version of the manuscript.

Conflicts of interest
The authors declared no conflicts of interest.

Acknowledgments
The authors would like to thank all participants for their cooperation in this study. 

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