The use of digital health interventions by people with type two diabetes and implications for health inequalities: A qualitative study
Type 2 Diabetes (T2D) is a common chronic disease that shows social patterning in incidence and severity. The use of digital health technologies such as apps and websites has been suggested as a way to to increase access to low-cost support. This may be a route to tackling inequalities. However, if underserved groups are excluded from digital technologies due to issues with access and usability, digital health interventions may exacerbate existing health inequity. This study aimed to gain an insight into how and why people with T2D use web-based self-care technology and how experiences vary between individuals and social groups.
A purposive sample of people diagnosed with T2D and experience of using a web-based intervention to help them self-care for T2D were recruited through diabetes groups, including groups that served Black, Asian and Minority Ethnic and lower income neighbourhoods. Semi-structured interviews were conducted in person and over the phone. Data were analysed thematically.
Twenty-seven people with T2D were eligible to enter the study, and data saturation on the key themes was reached after 21 interviews. The sample was diverse in terms or age (median 60 years, range 29-74), gender (11 men), socioeconomic situation and household income. Two thirds had a University degree or equivalent 17 participants identified as White British. Digital health interventions used included: websites, Blood Glucose Monitors (BGMs) with apps, wearable technology (e.g. Fitbits), access to electronic health records, diabetic specific and general health apps. Participants used their digital skills to learn about and navigate digital interventions. BGMs were particularly valued by the participants because they believed they provided greater control over their diabetes. There was a belief that the NHS rationed access to digital interventions (particularity BGMs) and not everyone who would benefit had access. Both material and social assets were used by participants to gain or support access to digital interventions. Participants used material assets to buy digital interventions. Participants used their social networks to learn about new interventions (in person and in the ‘online world’). They also used their networks and social status to gain access to the interventions through gifting, use with personal trainers, discounts, free samples and quick replacements for faulty technology. Participants also described how a lack of digital skills could be barrier to the use of digital-health interventions, but could be overcome by drawing on support from ‘tech buddies’ in their social network.
This research indicated that a person’s internal (digital skills and knowledge), and external (material and social assets) resources influences whether they hear about, have access to, and can benefit from digital self-care interventions. If digital interventions are to decrease not exacerbate health inequalities, differences in internal, external, material and social resources must be considered.