Perceived role of digital health technologies for facilitating diabetes self-management and education among low-income adults with type 2 diabetes: a qualitative needs assessment to inform support for newly diagnosed adults

Abstract

Low-income adults with type 2 diabetes (T2D) face significant challenges engaging in self-management behaviors (SMBs), including physical activity, healthy eating, and medication adherence. Diabetes self-management education and support (DSMES) programs can promote SMBs, but participating in DSMES is often challenging. Digital health technologies may help address barriers to SMB and DSMES engagement. However, evidence remains limited among adults newly diagnosed with T2D, who may experience unique psychosocial challenges, and varying readiness for behavioral change. This study explored digital technologies perceived as desirable and relevant for promoting SMB and DSMES engagement among low-income adults newly diagnosed with T2D. We employed an exploratory qualitative design and conducted 27 semi-structured interviews with 23 low-income adults with T2D (15 females, 8 males) and 4 healthcare stakeholders involved in T2D care (3 registered dietitians and 1 registered nurse; all female). Data were analyzed using deductive and inductive thematic approaches. Participants with T2D ranged in age from 22 to 76 years (mean: 44±18), and all earned <$50,000/year. Only 7 of 23 adults had attended any form of diabetes education. Three major themes emerged regarding the role of digital health: 1) digital health enables flexible access to DSMES, 2) barriers to adoption exist at individual, technological, and system levels, and 3) there is a need for user-centered digital health solutions. Both individuals with T2D and healthcare stakeholders highlighted the importance of hybrid DSMES models that combine in-person education with synchronous and asynchronous digital formats to improve access, flexibility, and ongoing support during the early post-diagnosis period. Health monitoring technologies, including continuous glucose monitors and diet-and activity-tracking apps, were identified as important facilitators of behavioral change. Participants and stakeholders also emphasized the value of integrating digital tools and data visualization into in-person DSMES to strengthen clinician interaction and ongoing engagement. Key barriers highlighted include socioeconomic constraints, limited digital literacy, complex interfaces, and poor integration into clinical workflow. Digital health technologies that provide synchronous and asynchronous education, remote monitoring, enhanced communication, data visualization, and ongoing support may improve access to DSMES and strengthen engagement in SMBs among low-income adults newly diagnosed with T2D. Hybrid, user-centered approaches that integrate digital tools with in-person DSMES may help address the psychosocial, structural, and technological barriers to sustained diabetes self-management.