Digital Health Interventions for People With Type 2 Diabetes to Develop Self-Care Expertise, Adapt to Identity Changes, and Influence Other’s Perception: Qualitative Study (Preprint)

Abstract

BACKGROUND A diagnosis of type 2 diabetes (T2D) results in widespread changes to a person’s life and can be experienced as an assault on their sense of self. The resources available to an individual influences how they adapt to their diabetic identity and subsequently engage in self-care. Digital interventions can be viewed as a resource people can draw on to adapt to the diagnosis. However, there is an indication that people from disadvantaged groups find digital health technologies more challenging to access and use, which may increase health inequalities. OBJECTIVE To gain insights into how and why people with T2D use digital self-care technology and how experiences vary between individuals and social groups. METHODS A purposive sample of people who had used a digital intervention to help them self-care for their T2D. Semi-structured interviews were conducted and data were analysed thematically. RESULTS A diverse sample of 21 participants were interviewed. Participants used digital interventions to help them understand and feel more in control of their bodies. They used digital tools to project positive identities, and as a defence against the stigmatised diabetic identity. Some participants used technology to increase their sense of power in their interaction with clinicians, while others used technology to demonstrate their ‘good’ness. These benefits were not equally distributed. There was some indication that those who could afford to, purchased more expensive equipment. Privately purchased blood glucose monitors were more discrete than those provided on the NHS so were preferred by those who wanted to keep their condition hidden. Some attributed their success at keeping their diabetes under control to the purchase of more sophisticated and more expensive equipment. CONCLUSIONS The technology people with T2D have access to shapes the way they are able to understand and control their bodies and support preferred social identities.

The role of economic, educational and social resources in supporting the use of digital health technologies by people with T2D: a qualitative study

“…This study provided examples of how each of these resources were drawn on to overcome barriers to accessing DHTs that were used by participants to gain a feeling of control over their diabetes. DHTs can also be used to support social status through projection of a positive identity and avoidance of the stigmatised illness identity [35]. Social capital theory addresses inequities at a community level, and proposes there is a social hierarchy in 'the ability of actors to secure benefits by virtue of membership in social networks and other social structures' [36].…”

The role of economic, educational and social resources in supporting the use of digital health technologies by people with T2D: a qualitative study

“…DHT can also be used to support social status through projection of a positive identity and avoidance of the stigmatised illness identity [34]. Social capital theory addresses inequities at a community level, and proposes there is a social hierarchy in 'the ability of actors to secure bene ts by virtue of membership in social networks and other social structures' [35].…”

Understanding the patients’ experience in Primary Technology Enhanced Care Home HbA1c Testing (PTEC HAT) programme - A Qualitative Study

“…Numerous recent qualitative studies have focused on the patients' perception of using telehealth for T2DM management, as well the factors for supporting primary care physician engagement with patient mobile app for T2DM self-management. The studies have yielded mixed result 16,17,18 . In recent years, there have been newer approved HbA1c self-test kits available in the market but there is no study describing the deployment of these devices in published literature.…”