Bridging the Digital Divide in Diabetes Care With an AI-Powered Health Coaching Intervention: Qualitative Formative Study.

Abstract

Background: Despite advancements in digital health coaching (DHC) for type 2 diabetes self-management, a persistent digital divide limits access among underserved populations, necessitating low-tech, telephone-based alternatives.

Objective: This formative qualitative study explored the lived experiences of type 2 diabetes mellitus (T2DM) self-management challenges among adults in Alabama and elicited preferences for telephone-based DHC to inform intervention optimization.

Methods: This study was part of a larger National Institutes of Health clinical trial (5R01DK129378) that examined the feasibility and needs of a telephone-based DHC intervention for self-management of T2DM. The study employed a qualitative, phenomenological approach to assess patients' needs surrounding digital coaching. Twelve patients diagnosed with T2DM were recruited between August and December 2022. Data collection involved in-depth, semistructured interviews conducted via telephone calls or secure Zoom sessions. All interviews were audio-recorded, professionally transcribed, and verified for accuracy. Two independent coders analyzed the data using NVivo software version 14 Plus.

Results: Two themes emerged: (1) multifaceted barriers to diabetes self-management spanning behavioral (dietary adherence and nutritional gaps), physical/environmental (mobility limitations and weather constraints), and structural domains (medication shortages, insurance coverage limiting continuous glucose monitoring); (2) expectations for telephone-based DHC, including targeted education (meal planning, exercise adaptations, and medication effects), health coaches as accountability partners, daily reminders and check-ins via texts/calls, and incentives as extrinsic motivators to adherence. Insights from the study directly shaped the intervention components of a pilot feasibility trial (NCT05344859).

Conclusions: Key challenges in day-to-day T2DM management included diet, physical activity, medication unavailability, and lack of insurance coverage for continuous glucose monitors. Expectations for a potential telephone-based DHC intervention included targeted education on diet, exercise, and medication effects; perceptions of health coaches as accountability partners; reminders via texts/calls as beneficial; and monetary incentives as extrinsic motivators for adherence to the intervention.