Adaptation and Feasibility Study of a Digital Health Program to Prevent Diabetes among Low-Income Patients: Results from a Partnership between a Digital Health Company and an Academic Research Team

Abstract

Background. The feasibility of digital health programs to prevent and manage diabetes in low-income patients has not been adequately explored. Methods. Researchers collaborated with a digital health company to adapt a diabetes prevention program for low-income prediabetes patients at a large safety net clinic. We conducted focus groups to assess patient perspectives, revised lessons for improved readability and cultural relevance to low-income and Hispanic patients, conducted a feasibility study of the adapted program in English and Spanish speaking cohorts, and implemented real-time adaptations to the program for commercial use and for a larger trial of in multiple safety net clinics. Results. The majority of focus group participants were receptive to the program. We modified the curriculum to a 5th-grade reading level and adapted content based on patient feedback. In the feasibility study, 54% of eligible contacted patients expressed interest in enrolling (n = 23). Although some participants' computer access and literacy made registration challenging, they were highly satisfied and engaged (80% logged in at least once/week). Conclusions. Underserved prediabetic patients displayed high engagement and satisfaction with a digital diabetes prevention program despite lower digital literacy skills. The collaboration between researchers and a digital health company enabled iterative improvements in technology implementation to address challenges in low-income populations.

Barriers to and Facilitators of Engagement With Remote Measurement Technology for Managing Health: Systematic Review and Content Analysis of Findings (Preprint)

“…Technical malfunctions were by far the most widely reported barriers, with 11 studies reporting ways in which these factors affected usability of the RMT systems [6,10,17,[20][21][22][23][24][25][26][27]. This included not receiving notifications, or receiving them at the wrong time, disappearance of the app, the system freezing, losing power or restarting without warning, and difficulties connecting remote (wearable and other 'smart' technology) devices with applications.…”

“…This caused difficulties with specific processes such as setting up resources [21], with two participants withdrawing due to difficulties in acquiring a consistent wireless service [14]. Other problems with accessibility included poor telephone network coverage, which caused delays in receiving text messages [15] and, in one case, resulted in 39% of participants missing training sessions [7].…”

“…Lack of familiarity and knowledge about how to use technology, such as websites, smartphone applications and wearable devices, was reported as a challenge with using RMT systems and a source of frustration for participants [21,26]. But the impact on engagement was not quantified.…”

“…Forgetfulness was raised as interfering with the individual's ability to access passwords, complete questionnaires, wear their device, and sync their wearable device to their smartphone [10, 16,21,26] but again this was not quantified. Digital literacy and other practical barriers have been overcome through offering instructions and support from the study co-ordinator [9,28].…”

“…However, the studies did not manipulate these factors in an experimental design to test their impact and this needs further research. Additional practical problems such as poor WIFI access, mobile data and network coverage, or compatible devices proved prohibitive to engagement [14,15,21]. Individual adaptation is exemplified by the size of devices.…”