Bridging the digital health divide for patients with diabetes

Technologies for helping manage diabetes have proliferated in recent years and continue to develop at a rapid race. These include mobile health, patient portals, telehealth, and CGM/insulin pumps. While they provide increased convenience with self-management and are effective at improving behavioral and clinical outcomes, understanding who has access to and experience with these digital tools has implications for who can ultimately benefit. The digital divide has primary been focused on the gap in technology access across different groups; however, as access is becoming more widespread, there is evidence of a new type of digital inequality based on skills and confidence using digital tools. Unless we address differences in digital health literacy, there is a high potential for digital tools to exacerbate existing health disparities.

This proposal aims to develop a brief, comprehensive, and structured intervention to improve digital health literacy among patients with diabetes (PWD) and evaluate its feasibility and acceptability. In Aim 1, we will employ a user-centered Design Sprint methodology to develop the intervention. This will include convening expert stakeholders to review, select, and adapt existing available resources. We will also examine the utility of a new screening tool to identify patients who can benefit from the intervention and identify relevant processes for delivering the intervention. In Aim 2, we will conduct a pre-post pilot study with PWD recruited from primary care clinics at Vanderbilt University Medical Center to evaluate the intervention’s feasibility and acceptability. As secondary outcomes, we will also explore preliminary effects of the intervention on patients’ confidence using and frequency accessing digital tools. This will be one of the first interventions designed to improve PWD’s digital health literacy. This project will provide the preliminary data to inform a large-scale RCT that evaluates effects of the intervention, as well as explore models for implementation when the intervention is integrated into routine clinical care.