How people with type two diabetes in England learn about digital health technologies, and what are the barriers to access and motivators for use? A qualitative study

Abstract

BackgroundType 2 Diabetes (T2D) is a common chronic disease, with socially patterned incidence and severity. Digital self-care interventions have the potential to reduce health disparities, by providing personalised low-cost reusable resources that can increase access to health interventions. However, if under-served groups are unable to access or use digital technologies, digital health interventions might make no difference, or worse, exacerbate health inequity. Study aimsTo gain insights into how and why people with T2D access and use web-based self-care technology and how experiences vary between individuals and social groups.MethodsA purposive sample of people with experience of using a web-based intervention to help them self-care for T2D were recruited through diabetes and community groups. Semi-structured interviews were conducted in person and over the phone. Data were analysed thematically.ResultsA diverse sample of 21 participants were interviewed. Health care practitioners were not viewed as a good source of information about Digital Health Technology (DHT) that could support T2D. Instead participants relied on their digital skills and social networks to learn about what DHT are available and helpful. The main barriers to accessing and using DHT described by the participants were availability of DHT from the NHS, cost and technical proficiency. However, some participants described how they were able to draw on social resources such as their social networks and social status to overcome these barriers. Participants were motivated to use DHT because they provided self-care support, a feeling of control over T2D, and personalised advice or feedback. The selection of technology was also guided by participants’ preferences and what they valued in relation to technology and self-care support, and these in turn were influenced by age and gender.ConclusionThis research indicates that low levels of digital skills and high cost of digital health interventions can create barriers to the access and use of DHT to support the self-care of T2D. However, social networks and social status can be leveraged to overcome some of these challenges. If digital interventions are to decrease rather than exacerbate health inequalities, these barriers and facilitators to access and use must be considered when interventions are developed and implemented.