Meeting the Needs of Emerging Adults With Type 1 Diabetes Living in a Rural Area With Mobile Health Interventions: Focus Group Study (Preprint)

Abstract

BACKGROUND Emerging adults (age 18-30) with type 1 diabetes (T1D) have more challenges with diabetes management and glycemic control compared to other age groups. Living in a rural community introduces additional unique diabetes care challenges due to limited access to specialty care and ancillary support services. Yet, few interventions have been developed to improve diabetes management in rural-dwelling EAs with T1D. OBJECTIVE The goal of this research was to understand the diabetes management experiences of older adolescents and emerging adults (EAs; age 16-25 years) with type 1 diabetes living in a rural area and to assess their perceptions of the acceptability of four mHealth interventions to support diabetes management. METHODS Nine EAs [18.8 (± 2.7) years, 56% male, 89% White, duration of diabetes 8.6 (± 4.3) years] were identified by clinical staff through convenience sampling. Eight EAs participated in a single focus group and one completed an individual interview over Zoom. Discussions were transcribed and analyzed using conventional content analysis. RESULTS EAs described experiences with diabetes stigma and feelings of self-consciousness in their rural communities. They attributed these experiences to the small size of their communities and community members’ lack of knowledge about diabetes. EAs also reported social support for diabetes and diabetes care from family, friends, and other community members. Meeting their diabetes medical care needs was a challenge due to their diabetes care providers’ location and the limited accessibility of diabetes-specific and general medical care services in their local community. Overall, emerging adults found the four eHealth interventions applicable to their diabetes needs and appreciated the ability to tailor aspects of the interventions to their preferences. EAs suggestions for improving the interventions included more opportunities to tailor the interventions to their preferences, increasing opportunities for peer support within the interventions, and making the tone of the intervention more lively. CONCLUSIONS mHealth intervention aligned with EAs’ needs and preferences is a promising strategy to support EAs in communities where social support and resources might be limited. CLINICALTRIAL N/A, not an RCT