Perspectives From Underserved African Americans and Their Health Care Providers on the Development of a Diabetes Self-Management Smartphone App: Qualitative Exploratory Study

Abstract

Background Type 2 diabetes mellitus (T2DM) affects approximately 10% of the US population, disproportionately afflicting African Americans. Smartphone apps have emerged as promising tools to improve diabetes self-management, yet little is known about the use of this approach in low-income minority communities. Objective The goal of the study was to explore which features of an app were prioritized for people with T2DM in a low-income African American community. Methods Between February 2016 and May 2018, we conducted formative qualitative research with 78 participants to explore how a smartphone app could be used to improve diabetes self-management. Information was gathered on desired features, and app mock-ups were presented to receive comments and suggestions of improvements from smartphone users with prediabetes and T2DM, their friends and family members, and health care providers; data were collected from six interactive forums, one focus group, and 15 in-depth interviews. We carried out thematic data analysis using an inductive approach. Results All three types of participants reported that difficulty with accessing health care was a main problem and suggested that an app could help address this. Participants also indicated that an app could provide information for diabetes education and self-management. Other suggestions included that the app should allow people with T2DM to log and track diabetes care–related behaviors and receive feedback on their progress in a way that would increase engagement in self-management among persons with T2DM. Conclusions We identified educational and tracking smartphone features that can guide development of diabetes self-management apps for a low-income African American population. Considering those features in combination gives rise to opportunities for more advanced support, such as determining self-management recommendations based on data in users’ logs.

The Use of Digital Health Interventions for Cardiometabolic Diseases Among South Asian and Black Minority Ethnic Groups: Realist Review

“…IPT 6 describes the technical and design factors of DHIs that impact individuals’ willingness to initiate and maintain use; this was supported in our review in two ways. First, the studies identified technical factors that can improve the use of the DHI, namely the inclusion of a search function within the app and the option to integrate the DHI with other apps or devices [ 53 , 60 , 66 ]. It was recognized that using a DHI was convenient as participants were attached to their phones “at all times and locations” [ 54 ].…”

“…Such behavioral changes were incentivized via a variety of methods. Positive feedback encouraged users to persist with the self-management of both diabetes [ 60 ] and cardiovascular health [ 53 ]. Others used “prizes” in the form of healthy recipes [ 66 ].…”

“…Others used “prizes” in the form of healthy recipes [ 66 ]. These personalized aspects of DHIs were found to encourage continued use and allowed greater self-monitoring of one’s health [ 53 , 54 , 56 , 59 , 60 , 64 - 66 ]. However, behavior change was not always successful, even with an incentive [ 65 ].…”

“…Easily accessible health education was extremely important for users, including information regarding disease physiology [ 51 , 53 , 56 , 58 , 60 , 62 , 65 ] and affordable local resources [ 60 ], learning was enhanced by interactive components such as quizzes [ 53 , 65 ]. Elements that allowed users to track progress and set goals and reminders were identified as important and useful within DHIs [ 56 , 60 ] and increased participants’ sense of accountability to meet personal goals and remain active [ 53 , 54 , 56 , 60 , 61 , 64 , 66 ]. Interestingly, this level of interactivity was not provided by the DHI in the study conducted by Anand et al [ 51 ], which was unsuccessful in improving cardiac risk scores in South Asian groups.…”

“…Information from trusted sources such as health care professionals was identified as a strong motivator to continue using DHIs [ 52 , 53 , 61 ]. The presence of community support within DHIs to share stories and testimonials from people of the same ethnic group was shown to be beneficial to DHI use and increase self-efficacy [ 53 , 56 , 58 , 60 , 65 , 66 ], building on the findings from IPT4, about the role of social experiences shaping the use of DHIs. In a study that did not include a community facility, 1 participant mentioned that they would not recommend the intervention to a friend, as it “didn’t allow for building fitness connections,” underlining the need for social support in DHIs [ 56 ].…”