Understanding the acceptability of digital diabetes self-management tools among non-users: A qualitative study of personal, social and healthcare contexts
This qualitative study of non-users of the MyWay Diabetes platform reveals that the acceptability of digital diabetes self-management tools is shaped by intersecting personal, social, and healthcare system barriers, underscoring the need for culturally relevant, accessible digital solutions that complement rather than replace trusted, person-centered care to prevent widening health inequalities.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of a preprint that has not been peer-reviewed. It is not medical advice. Do not make health decisions based on this content. Read full disclaimer
Living with diabetes is a constant, quiet negotiation. It requires checking blood sugar, counting carbohydrates, adjusting medication, and navigating a diet that often clashes with cultural traditions and family habits. For millions of people, this daily work is not just a medical routine but a heavy emotional and practical load. In recent years, health systems have looked to technology to lighten this burden. The idea is that digital tools—apps, websites, and online platforms—could offer instant advice, track health data, and connect patients with doctors without the need for a hospital visit. This shift is part of a broader plan to move healthcare from paper and face-to-face meetings toward digital services. Yet, while these tools work well for some, they risk leaving others behind. If the people who need support the most cannot use the technology, the gap between the healthy and the sick could widen rather than close.
To understand why some people do not use these digital tools, researchers gathered a group of thirty-five adults living with diabetes in England. These participants had not signed up for a specific digital platform called MyWay Diabetes, which is used in several regions to help manage the condition. The researchers wanted to know why these individuals had stayed away. They did not send out surveys or ask people to fill out forms; instead, they brought people together in six small discussion groups. Some groups met in person at community centers, while one met online. The participants included men and women of various ages, with a significant number from Asian British Pakistani backgrounds, as well as people from Black British and White British communities. Many lived in areas with high levels of economic hardship. By listening to their stories, the researchers aimed to uncover the real-world barriers that stop people from engaging with digital health.
The conversations revealed that the decision to use or ignore a digital tool is rarely about a simple lack of interest or a refusal to learn. Instead, it is shaped by a complex mix of personal feelings, social circumstances, and trust in the medical system. For many participants, the emotional weight of managing diabetes was already so heavy that adding a new app felt like too much. They described the daily effort of changing long-held eating habits and the anxiety of monitoring their health as exhausting. When they looked at digital tools, they did not see a helpful assistant; they saw another task to master, another screen to stare at, and another place where they might make a mistake. Some expressed a genuine fear of technology, worrying that they might click the wrong button, lose their data, or have their private information stolen. This anxiety was not unfounded; many had experienced scams or received confusing, contradictory information online, which made them wary of putting their health data into a system they did not fully understand.
Beyond the fear of technology itself, the study highlighted that digital tools often fail to fit the lives of the people they are meant to help. The apps and websites were frequently described as generic, designed for a "standard" user that did not exist. Participants felt that the advice given by these tools ignored their specific cultural backgrounds, their family traditions, or their other health problems. A person with heart disease, high blood pressure, and diabetes might find a diet plan on an app that is safe for one condition but dangerous for another. Furthermore, the tools often assumed that everyone had a fast, modern smartphone and a reliable internet connection. For those living on a tight budget, the cost of a new device or the data required to run an app was a barrier they could not cross. The technology was not just difficult to use; it was often physically or financially out of reach.
Another critical finding was the role of family and community. Because of the barriers to using technology alone, many participants relied on their children or other family members to navigate the digital world. They would ask their kids to check test results or explain what an app was saying. However, this reliance created a new problem: the children were often busy with their own lives and could not always be there to help. This left the adults feeling isolated and dependent. The participants also spoke about the value of talking to other people who understood what they were going through. They found comfort in face-to-face conversations with friends, family, or doctors, where they could read a person's face and feel a sense of connection. They worried that digital tools would replace these human interactions, leaving them to manage a difficult condition alone with a machine that could not offer empathy or reassurance.
Trust in healthcare professionals emerged as the most important factor in whether someone would try a digital tool. The participants were not against technology in principle; they were against technology that felt like a cold, impersonal substitute for a doctor. If a doctor simply handed them a leaflet saying "download this app," they were likely to ignore it. But if a trusted doctor took the time to explain why the tool was useful, showed them how to use it, and offered to help if they got stuck, they were much more willing to try. The key was that the technology had to feel like an addition to their care, not a replacement for it. They wanted to know that if they had a crisis, a human being would still be there to help them. When digital tools were presented as a way to cut costs or speed up the system at the expense of personal attention, people resisted.
The study concludes that for digital health to work for everyone, it must be designed with the whole person in mind, not just the disease. It needs to be culturally relevant, affordable, and easy to use for people with different levels of literacy and confidence. Most importantly, it must be introduced by trusted healthcare workers who can guide patients through the process. The researchers suggest that simply building more apps is not the solution. Instead, the focus must be on ensuring that these tools fit into the real lives of people, respecting their social networks, their financial limits, and their need for human connection. If digital health is to succeed, it must be built on a foundation of trust and support, ensuring that the shift to digital services does not leave the most vulnerable people behind.
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