Health disparities cause a higher rate of diabetes development in poor and minority groups and also limit the care these people receive. Smartphone applications (apps) may be a low-cost, accessible resource to patients with diabetes who experience barriers to traditional health care. Currently, little is known about using health apps to help underserved patients in the United States. This study aimed to investigate the willingness to use diabetes apps in patients with limited access to primary care providers. Fifteen personal interviews were collected and analyzed according to the interpretative phenomenological analysis framework. The interviews produced three overall themes: (1) Despite having little previous knowledge about health apps, patients were all willing to try at least one diabetes-related app; (2) app functions should be individualized to each patient’s needs for maximum benefit; and (3) barriers to app use were varied but commonly included knowledge and technological challenges and security issues. Underserved patients with diabetes expressed a willingness to try health apps, despite limited experience with the technology. Choosing apps individualized to each patient’s needs, instead of a blanket multifunctional app, would provide the greatest benefit for patient-driven diabetes management. Smartphone apps may be a feasible, low-cost resource for patients with limited access to traditional healthcare.

Background: The successful management of diabetes is a chronic endeavor. It involves a whole host of factors ranging from a consistent patient-provider relationship to regular physical activity. Not all patients with diabetes, however, have access to the resources needed for effective disease management. Health disparities contribute to a higher frequency of diabetes development in poor and minority populations. Moreover, health care disparities limit the care these patient populations receive. Because underserved populations have little to no access to traditional means of health care, providers must explore other avenues to reach this patient group. Mobile health (mHealth) has grown significantly in the last decade. With the fast-paced adoption of cell phones across all socioeconomic groups, mobile health presents the opportunity to offer patients a low-cost way to receive health information, to communicate with providers, and to self-manage chronic conditions. It has been well established that low-income, minority populations experience several barriers to receiving basic health care including uninsurance, limited transportation, and high out-of-pocket costs. The provision of health care via mobile devices may have the potential to address such health disparities. Little is known about the effectiveness of using mobile health and smartphone applications (apps) in underserved populations to help with diabetes management. Knowledge of these patients’ interest in using mobile apps to augment their home self-management may have use in future implementations. Objective: The objective of this study is to examine the perception of and willingness to use diabetes mobile health apps on smartphones in patients with limited access to primary care providers. Methods: This study used purposive sampling to select patients for personal interviews. The study was conducted at a general hospital located in a part of town with predominate minority and low-income residency, as well as the highest diabetes prevalence rates. Semi-structured interviews were conducted according to McNamara’s interview staging. A total of 15 interviews were collected and coded by the researcher according to the interpretative phenomenological analysis framework. An independent committee reviewed all interview transcripts and coding to verify trustworthiness of collection and analysis. Results: The data produced 7 clusters related to smartphone app use and mHealth, each highlighting a component of the patient experience, which supported 3 overarching themes. The themes are as follows: despite limited knowledge about health apps and varying phone use patterns, patients were all willing to try at least one diabetes-related app; apps functions should be individualized to meet each patient’s needs for maximum benefit; and barriers to app use were varied but commonly included knowledge and technological challenges and security issues. Conclusions: Personal interviews of this underserved patient population demonstrated an interest in and willingness to try mobile health apps, despite limited knowledge about the technology. Responses indicate that tailoring app choices to individual needs, instead of choosing a multi-functional one-size-fits-all app, would provide the most benefit for at-home diabetes self-management. Smartphone apps may serve as a viable low-cost resource for patients with diabetes who have limited access to traditional health care providers.

Introduction. Diabetes mellitus is a condition with a growing morbidity and mortality burden. An estimated 30 million adults currently live with diabetes, with each individual spending over $9500 annually on medical care. The successful management of diabetes is a lifelong endeavor. This involves balancing a variety of factors including diet, medications, and glucose monitoring. It has been well established that successful control of diabetes depends largely upon patients’ daily lifestyle habits and activities. Not all patients, however, have the resources necessary for effective diabetes management. Health disparities lead to a higher rate of diabetes development in minority and poor populations. Since underserved patients have limited access to traditional healthcare avenues, providers should explore other means, like mobile health (mHealth), to help such patients. The rapid adoption of smartphones within the last decade has allowed an opportunity for patients to use mHealth and smartphone applications (apps) as a low-cost way to get health information and services. mHealth has the potential to address such disparities in access to health care. Little is known about the effectiveness of using apps to help underserved patients with their diabetes management. Assessing these patients’ current self-management practices and their interest in using smartphone apps for their diabetes management is the first step in determining how mHealth may benefit this patient population. Purpose. The purpose of this study was to assess how underserved patients with limited access to primary care physicians handled their diabetes on their own at home, to determine what challenges they faced with their self-management, and to examine their willingness to use diabetes mHealth apps on their smartphones to assist with their diabetes management. Methods. This study employed purposive sampling to select patients for individual interviews. Participant selection occurred at a Memphis hospital located in an area of town with predominately low-income and minority residents, as well as a high prevalence of diabetes. Semi-structured interviews were conducted on-site at the hospital based on McNamara’s interview staging. In all, 15 interviews were recorded, transcribed, and coded according to the interpretative phenomenological analysis framework. Results. The data produced 5 topic clusters related to at-home diabetes management, which supported 2 overarching themes, and 7 clusters related to mHealth smartphone app use, which supported 3 overarching themes. The themes related to self-management are as follows: 1. Patients are aware that successful diabetes control requires active engagement on their part but voiced struggles related to balancing limited income and a healthy diet, how to manage fluctuating glucose readings throughout the day, and affording medications; and 2. Lacking a traditional relationship with a primary care doctor, these underserved patients turn to friends and family, written materials, and the internet as health care resources. The themes related to smartphone mHealth are as follows: 1. Despite limited knowledge about health apps and varying phone use patterns, patients were all willing to try at least one diabetes-related app; 2. App functions should be individualized to meet each patient’s needs for maximum benefit; and 3. Barriers to app use were varied but commonly included knowledge and technological challenges and security issues. Conclusion. Interviews from this vulnerable population demonstrated that individuals understood the importance of their own active involvement in controlling their diabetes. Yet, because of limited economic and health care resources, these patients struggle with the implementation of effective lifestyle choices in their daily routine. Furthermore, interviewees expressed interest in trying mobile health apps for diabetes management, despite minimal knowledge about the technology. Responses showed that selecting apps tailored to each individual’s needs, instead of offering one blanket multifunctional app, would provide patients with the greatest benefit. Smartphone apps may be a low-cost health resource that patients without regular access to physicians can use for their at-home diabetes management.