Dietary self-monitoring is a key strategy in diabetes self-management and may be facilitated by mHealth. However, smartphone applications are typically designed for high resource audiences and may exacerbate health inequity if they fail to meet user needs in underserved groups.
We aimed to understand user experiences with a dietary self-monitoring smartphone application designed for patients with Type 2 diabetes in a New York City neighborhood with high levels of health disparity.
Study Design, Settings, Participants
As part of the Personal Informatics Technology for Engagement in Community Health (PI-TECH) study, we applied user-centered design to develop Platano, a self-determination theory-based app that promotes self-tracking of diet and blood glucose in diabetes via motivationally-tailored user interfaces. During an ongoing pilot evaluation, we conducted face-to-face, in-depth interviews with English-speaking users (n = 9, age range = 28-61, 88% female, 89% non-white, 88% household income <$20,000) after using Platano for six weeks.
Interviews were recorded and transcribed verbatim; data were managed in NVivo 12. Two authors coded interviews using Thematic Analysis, resolving differences through consensus.
Five themes emerged: a) context: external circumstances (e.g., food insecurity, cultural norms) were central to participants’ user experience; b) flexible tool: participants used Platano for both self-discovery and accountability, reporting benefits including learning their personal glycemic response to specific foods and maintaining self-discipline in making dietary choices; c) empowerment: users attributed dietary changes, weight loss, and improved patient-provider communication to Platano; d) individual characteristics (e.g., nutrition literacy, motivation, self-efficacy), and e) in-the-moment barriers (e.g., social pressure) both influenced app usage and diet goal adherence.
Findings suggest Platano was well-received and viewed as a supporting tool for diabetes self-management among underserved urban adults. Further, findings reinforce the need for more comprehensive and personalized solutions to reduce barriers to engaging in dietary behavior change to improve diabetes outcomes.
Funding: Robert Wood Johnson Foundation, National Institute of Health, National Library of Medicine
Appendix. Supplementary data
© 2019 Published by Elsevier Inc.