Are people with diabetes mHealth-ready? Smartphone utilisation in a socioeconomically marginalised urban Australian general practitioner-led diabetes clinic
David Chua
A B * , Carina Vasconcelos Silve A B , Souhayel Hedfi A , Keren Pointon A , Tracy A. Comans A C , Hannah L. Mayr D E , Monika Janda A , Anthony W. Russell A F G and Anish Menon A B
A
B
C
D
E
F
G
Abstract
Mobile Health (mHealth), a subset of digital health, requires people to own smartphones, but ownership barriers overlap with social factors linked to type 2 diabetes (T2D) burden. We describe the prevalence of smartphone ownership, app use and mobile internet access and factors around uptake and utilisation among people with T2D accessing care in a community setting.
A cross-sectional survey was performed with people with diabetes attending a community-based general practitioner-led diabetes clinic located in Inala, a multiculturally diverse but socioeconomically marginalised suburban region of Brisbane, Queensland. The survey was read aloud to participants, with interpreters if required.
There were 104 participants, the median age was 63 years, 47.1% were female and 44.2% spoke language(s) other than English (LOTE) at home. Smartphone ownership was high (85.6%), and average self-rated confidence with advanced feature use was between ‘somewhat confident’ and ‘confident’. Older adults were significantly less likely to own smartphones, less confident with advanced features and less likely to use apps regularly, but many knew someone who could support uptake. LOTE spoken at home was not associated with ownership, mobile internet access, app use or self-rated confidence with advanced feature use, suggesting smartphone technology is already part of daily life.
Smartphone ownership and utilisation does not appear to be a major barrier to mHealth uptake in our context. Older adults need tailored supports and education to encourage mHealth uptake.
Keywords: cross-sectional survey, diabetes, digital health, health equity, healthcare accessibility, health services research, mHealth, older adults, primary care, self-management, telemedicine.
References
1 Jowsey T, Gillespie J, Aspin C. Effective communication is crucial to self-management: the experiences of immigrants to Australia living with diabetes. Chronic Illn 2011; 7(1): 6-19.
| Crossref | Google Scholar | PubMed |
2 Alzubaidi H, Mc Namara K, Browning C, Marriott J. Barriers and enablers to healthcare access and use among Arabic-speaking and Caucasian English-speaking patients with type 2 diabetes mellitus: a qualitative comparative study. BMJ Open 2015; 5(11): e008687.
| Crossref | Google Scholar | PubMed |
3 Lo C, Teede H, Fulcher G, Gallagher M, Kerr PG, Ranasinha S, Russell G, Walker R, Zoungas S. Gaps and barriers in health-care provision for co-morbid diabetes and chronic kidney disease: a cross-sectional study. BMC Nephrol 2017; 18(1): 80.
| Crossref | Google Scholar | PubMed |
4 Kitsiou S, Paré G, Jaana M, Gerber B. Effectiveness of mHealth interventions for patients with diabetes: An overview of systematic reviews. PLoS One 2017; 12(3): e0173160.
| Crossref | Google Scholar | PubMed |
5 Tapager I, Olsen KR, Vrangbæk K. Exploring equity in accessing diabetes management treatment: A healthcare gap analysis. Soc Sci Med 2022; 292: 114550.
| Crossref | Google Scholar | PubMed |
6 Zheng M, Bernardo C, Stocks N, Hu P, Gonzalez-Chica D. Diabetes mellitus monitoring and control among adults in Australian general practice: a national retrospective cohort study. BMJ Open 2023; 13(4): e069875.
| Crossref | Google Scholar | PubMed |
7 Lim S, Kang SM, Shin H, Lee HJ, Won Yoon J, Yu SH, et al. Improved Glycemic Control Without Hypoglycemia in Elderly Diabetic Patients Using the Ubiquitous Healthcare Service, a New Medical Information System. Diabetes Care 2011; 34(2): 308-13.
| Crossref | Google Scholar | PubMed |
8 Ding H, Fatehi F, Russell AW, Karunanithi M, Menon A, Bird D, et al. User Experience of an Innovative Mobile Health Program to Assist in Insulin Dose Adjustment: Outcomes of a Proof-Of-Concept Trial. Telemed J E Health 2018; 24(7): 536-43.
| Crossref | Google Scholar | PubMed |
9 Menon A, Fatehi F, Ding H, Bird D, Karunanithi M, Gray L. Outcomes of a feasibility trial using an innovative mobile health programme to assist in insulin dose adjustment. BMJ Health Care Inform 2019; 26(1): e100068.
| Crossref | Google Scholar | PubMed |
10 Moschonis G, Siopis G, Jung J, Eweka E, Willems R, Kwasnicka D, et al. Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials. Lancet Digit Health 2023; 5(3): e125-43.
| Crossref | Google Scholar | PubMed |
13 AIHW. Diabetes: Australian facts. Canberra: AIHW; 2023; Available at https://www.aihw.gov.au/reports/diabetes/diabetes/contents/summary
14 Javanparast S, Naqvi SKA, Mwanri L. Health service access and utilisation amongst culturally and linguistically diverse populations in regional South Australia: A qualitative study. Rural Remote Health 2020; 20(4): 1-15.
| Crossref | Google Scholar |
15 Cardona M, Fien S, Myooran J, Hunter C, Dillon A, Lewis E, et al. Clinical and cost-effectiveness of telehealth for Indigenous and culturally and linguistically diverse (CALD) people: a scoping review. Ethn Health 2022; 114-35.
| Google Scholar |
16 Russell AW, Baxter KA, Askew DA, Tsai J, Ware RS, Jackson CL. Model of care for the management of complex Type 2 diabetes managed in the community by primary care physicians with specialist support: an open controlled trial. Diabet Med 2013; 30(9): 1112-21.
| Crossref | Google Scholar | PubMed |
17 Russell AW, Donald M, Borg SJ, Zhang J, Burridge LH, Ware RS, et al. Clinical outcomes of an integrated primary–secondary model of care for individuals with complex type 2 diabetes: a non-inferiority randomised controlled trial. Diabetologia 2019; 62(1): 41-52.
| Crossref | Google Scholar | PubMed |
18 Donald M, Jackson CL, Byrnes J, Vaikuntam BP, Russell AW, Hollingworth SA. Community-based integrated care versus hospital outpatient care for managing patients with complex type 2 diabetes: costing analysis. Aust Health Rev 2021; 45(1): 42-50.
| Crossref | Google Scholar | PubMed |
19 Jackson CL. Beacon Model – Brisbane Diabetes. New York: The Commonwealth Fund; 2020. Available at https://www.commonwealthfund.org/publications/international-innovation/2020/oct/beacon-model-brisbane-diabetes [cited 2024].
20 PHIDU. Social Health Atlas: Index of Relative Socio-economic disadvantage 2021. 2024. Available at https://phidu.torrens.edu.au/current/maps/sha-aust/pha-single-map/qld/atlas.htm
21 PHIDU. Social Health Atlas: People born in predominantly NES countries 2021. 2024. Available at https://phidu.torrens.edu.au/current/maps/sha-aust/pha-single-map/qld/atlas.html
22 Qualtrics. How to calculate sample size. North Sydney: Qualtrics LLC; 2024; Available at https://www.qualtrics.com/au/experience-management/research/determine-sample-size/
23 Ball L, Jansen S, Desbrow B, Morgan K, Moyle W, Hughes R. Experiences and nutrition support strategies in dementia care: Lessons from family carers. Nutr Diet 2015; 72(1): 22-9.
| Google Scholar |
24 Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform 2019; 95: 103208.
| Crossref | Google Scholar | PubMed |
25 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42(2): 377-81.
| Crossref | Google Scholar | PubMed |
27 Tate RF. Correlation between a discrete and a continuous variable. Point-biserial correlation. Ann Math Stat 1954; 25(3): 603-7.
| Crossref | Google Scholar |
28 ITU. ITU Expert Group on Household Indicators (EGH), Background Document 3, Proposal for a Definition of Smartphone. Geneva: International Telecommunication Union; 2017; Available at https://www.itu.int/en/ITU-D/Statistics/Documents/events/egh2017/EGH%202017%20background%20document%203%20-%20Definition%20of%20smartphone.pdf [cited 2023].
29 Chua D, Vasconcelos Silva C, Comans T, Mayr HL, Janda M, Gray LC, et al. Study Protocol: Rethinking Integrated Models of Care for Type 2 Diabetes (Re-IMCD): Can Digital Health Better Integrate Care for People with Diabetes, Hospitals and Primary Care? SSRN 2023; 433575.
| Crossref | Google Scholar |
30 Triantafyllidis A, Kondylakis H, Votis K, Tzovaras D, Maglaveras N, Rahimi K. Features, outcomes, and challenges in mobile health interventions for patients living with chronic diseases: A review of systematic reviews. Int J Med Inform 2019; 132: 103984.
| Crossref | Google Scholar | PubMed |
31 Jahan E, Almansour R, Ijaz K, Baptista S, Giordan LB, Ronto R, et al. Smartphone Applications to Prevent Type 2 Diabetes: A Systematic Review and Meta-Analysis. Am J Prev Med 2024; 66: 1060-70.
| Crossref | Google Scholar | PubMed |
32 Kushner PR, Cavender MA, Mende CW. Role of Primary Care Clinicians in the Management of Patients With Type 2 Diabetes and Cardiorenal Diseases. Clin Diabetes 2022; 40(4): 401-12.
| Crossref | Google Scholar | PubMed |
33 ABS. Cultural diversity data summary 2021: Proficiency in spoken English. 2022. Available at https://www.abs.gov.au/articles/cultural-diversity-australia.
34 Gallegos-Rejas VM, Kelly JT, Lucas K, Snoswell CL, Haydon HM, Pager S, et al. A cross-sectional study exploring equity of access to telehealth in culturally and linguistically diverse communities in a major health service. Aust Health Rev 2023; 47(6): 721-8.
| Crossref | Google Scholar | PubMed |
35 Hughson JP, Daly JO, Woodward-Kron R, Hajek J, Story D. The Rise of Pregnancy Apps and the Implications for Culturally and Linguistically Diverse Women: Narrative Review. JMIR Mhealth Uhealth 2018; 6(11): e189.
| Crossref | Google Scholar | PubMed |
36 Oshima SM, Tait SD, Thomas SM, Fayanju OM, Ingraham K, Barrett NJ, et al. Association of Smartphone Ownership and Internet Use With Markers of Health Literacy and Access: Cross-sectional Survey Study of Perspectives From Project PLACE (Population Level Approaches to Cancer Elimination). J Med Internet Res 2021; 23(6): e24947.
| Crossref | Google Scholar | PubMed |
37 Artamonova O, Androutsopoulos J. Smartphone-Based Language Practices among Refugees: Mediational Repertoires in Two Families. J Medienlinguistik 2020; 2(2): 60-89.
| Crossref | Google Scholar |
38 McCaffrey KT, Taha MC. Rethinking the Digital Divide: Smartphones as Translanguaging Tools Among Middle Eastern Refugees in New Jersey. Ann Anthropol Pract 2019; 43(2): 26-38.
| Crossref | Google Scholar |
39 Bommakanti KK, Smith LL, Liu L, Do D, Cuevas-Mota J, Collins K, Munoz F, et al. Requiring smartphone ownership for mHealth interventions: who could be left out? BMC Public Health 2020; 20(1): 81.
| Crossref | Google Scholar | PubMed |
40 Zagorsky J. Rise and fall of the landline: 143 years of telephones becoming more accessible and smart. The Conversation; 2019. Available at https://theconversation.com/rise-and-fall-of-the-landline-143-years-of-telephones-becoming-more-accessible-and-smart-113295 [cited 2023].
42 Buss VH, Varnfield M, Harris M, Barr M. Mobile Health Use by Older Individuals at Risk of Cardiovascular Disease and Type 2 Diabetes Mellitus in an Australian Cohort: Cross-sectional Survey Study. JMIR Mhealth Uhealth 2022; 10(9): e37343.
| Crossref | Google Scholar | PubMed |
43 Bertolazzi A, Quaglia V, Bongelli R. Barriers and facilitators to health technology adoption by older adults with chronic diseases: an integrative systematic review. BMC Public Health 2024; 24(1): 506.
| Crossref | Google Scholar | PubMed |
45 Greenstock L, Naccarella L, Kron RW, Elliott K, Fraser C, Bingham A, et al. Telecommunications and health information for culturally and linguistically diverse communities: A community survey. Telecommun J Aust 2013; 63(1): 14.1-14.18.
| Crossref | Google Scholar |
46 Hong YA, Cho J. Has the Digital Health Divide Widened? Trends of Health-Related Internet Use Among Older Adults From 2003 to 2011. J Gerontol B Psychol Sci Soc Sci 2017; 72(5): 856-63.
| Crossref | Google Scholar | PubMed |
47 Mace RA, Mattos MK, Vranceanu AM. Older adults can use technology: why healthcare professionals must overcome ageism in digital health. Transl Behav Med 2022; 12(12): 1102-5.
| Crossref | Google Scholar | PubMed |
48 Harris MT, Blocker KA, Rogers WA. Older Adults and Smart Technology: Facilitators and Barriers to Use. Front Comput Sci 2022; 4: 835927.
| Crossref | Google Scholar |
49 Zaman SB, Khan RK, Evans RG, Thrift AG, Maddison R, Islam SMS. Exploring Barriers to and Enablers of the Adoption of Information and Communication Technology for the Care of Older Adults With Chronic Diseases: Scoping Review. JMIR Aging 2022; 5(1): e25251.
| Crossref | Google Scholar | PubMed |
50 Kim J, Park H-A. Development of a Health Information Technology Acceptance Model Using Consumers’ Health Behavior Intention. J Med Internet Res 2012; 14(5): e133.
| Crossref | Google Scholar | PubMed |
52 Venkatesh V, Thong JY, Xu X. Unified theory of acceptance and use of technology: A synthesis and the road ahead. J Assoc Inf Syst 2016; 17(5): 328-76.
| Crossref | Google Scholar |
53 Langford AT, Solid CA, Scott E, Lad M, Maayan E, Williams SK, et al. Mobile Phone Ownership, Health Apps, and Tablet Use in US Adults With a Self-Reported History of Hypertension: Cross-Sectional Study. JMIR Mhealth Uhealth 2019; 7(1): e12228.
| Crossref | Google Scholar | PubMed |
54 Ahmad A, Rasul T, Yousaf A, Zaman U. Understanding Factors Influencing Elderly Diabetic Patients’ Continuance Intention to Use Digital Health Wearables: Extending the Technology Acceptance Model (TAM). J Open Innov 2020; 6(3): 81.
| Crossref | Google Scholar |
55 van de Mortel TF. Faking It: Social Desirability Response Bias in Self-report Research. Aust J Adv Nurs 2008; 25(4): 40-8.
| Google Scholar |
56 Lee SK, Sulaiman-Hill CR, Thompson SC. Overcoming language barriers in community-based research with refugee and migrant populations: options for using bilingual workers. BMC Int Health Hum Rights 2014; 14(1): 11.
| Crossref | Google Scholar | PubMed |
