Abstract
Medically underserved communities have limited access to effective disease management resources in the U.S. Mobile health applications (mHealth apps) offer patients a cost-effective way to monitor and self-manage their condition and to communicate with providers; however, current diabetes self-management apps have rarely included end-users from underserved communities in the design process. This research documents key stakeholder-driven design requirements for a diabetes self-management app for medically underserved patients. Semi-structured survey interviews were carried out on 97 patients with diabetes and 11 healthcare providers from medically underserved counties in South Texas, to elicit perspectives and preferences regarding a diabetes self-management app, and their beliefs regarding such an app’s usage and utility. Patients emphasized the need for accessible educational content and for quick access to guidance on regulating blood sugar, diet, and exercise and physical activity using multimedia rather than textual forms. Healthcare providers indicated that glucose monitoring, educational content, and the graphical visualization of diabetes data were among the top-rated app features. These findings suggest that specific design requirements for the underserved can improve the adoption, usability, and sustainability of such interventions. Designers should consider health literacy and numeracy, linguistic barriers, data visualization, data entry complexity, and information exchange capabilities.
Highlights
Patients requested the creation of a schedule feature, which would likely help them track their medication intake. Patients emphasized their preference to have a list of the types of foods they can consume to maintain glycemic control and to have a feature that can serve as a carbohydrate “tracker.” Research has shown that people with diabetes in low income and minority neighborhoods have limited access to healthy foods and limited discussions with healthcare providers about healthy eating [47]
Patients interviewed in the study were part of a program that provided diabetes education, our results indicate their preference to have access to dietary tips and educational content in a mobile health (mHealth) app
This paper highlights key features and functional requirements for the design of a diabetes self-management app tailored to the underserved community
Summary
In 2020, over 30 million individuals in the United States suffered from diabetes, most (about 90%) with type 2 diabetes [1]. Rural/medically underserved areas—defined as populations with low access to primary care providers, high infant mortality, high poverty, and/or high elderly population [2]—have shown relatively poor diabetes outcomes compared to the urban/well-served areas [3]. Type 2 diabetes disproportionately affects people of certain racial and ethnic groups, many of whom may live in areas identified as rural/medically underserved [4], such as Hispanics/Latinx Americans. Recent estimates from the Centers for Disease Control showed that individuals from Hispanic/Latinx American heritage were more likely (17%) to suffer from diabetes than the non-Hispanic White population (8%) [5]. Data from the U.S Department of Health and Human
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