SuMMiT-D - Formative development of a mobile-health based system to support type 2 diabetes medication adherence in primary care: qualitative study with British South Asian patients

Problem

Type 2 diabetes is a lifelong condition affecting four million people in the UK. Alongside lifestyle change, medicines are used to lower blood glucose, blood pressure and lipids. However, up to half of these medicines are not taken as prescribed and many interventions for improving medicine use are ineffective. British South Asians are up to six times more likely to have type 2 diabetes than the general population, to develop the condition at a younger age, and to experience related complications. Evidence to support the use of mobile phones in type 2 diabetes management has shown positive impacts on glycaemic control. The Support through Mobile Messaging and digital health Technology for Diabetes (SuMMiT-D) project is developing and testing a mobile-device based system delivering short automated messages to offer support for medicine use alongside usual care to people with type 2 diabetes in primary care. This qualitative study explored the views of British South Asian patients with type 2 diabetes on the feasibility of such a system.

Approach

Sixty-seven adults took part in eight focus groups from the Punjabi Sikh, Pakistani Muslim, Gujarati Hindu, Bangladeshi Muslim and Gujarati Muslim communities. Purposive sampling reflected community diversity in terms of age group, educational and occupational background, fluency in English, place of birth, time since diagnosis and self-reported use of digital devices. Participants were recruited by the Centre for BME Health through local community organisations in Leicester, and discussions were conducted in Punjabi, Bengali, Sylheti, Urdu, Hindi and English.

Findings

Users and non-users of digital devices discussed a range of self-management challenges and suggested ways that a messaging system could help. Five themes were identified: message content and design; language preferences; family involvement; different digital formats for different groups; face-to-face groups for those who do not use digital devices. Participants found messages supporting medication adherence to be acceptable and relevant, but they also wanted more information on topics including South Asian foods and religious fasting. Other information needs included messages about diet, physical activity, stress management, natural and complementary approaches, and current research. Brief messages delivered in English were perceived to be acceptable.

Consequences

It is recognised that health interventions that are culturally adapted to the needs of specific groups are more likely to be acceptable, but evidence to support the effectiveness of adapted interventions is limited. A messaging intervention that addresses holistic self-management of type 2 diabetes is more acceptable to British South Asian people with type 2 diabetes than one that focuses only on medication adherence. However, for such an intervention to meet specific needs, encourage uptake and credibility, it would also have to include a range of culturally-relevant messages and consider the needs of those who do not routinely use digital devices.