Diabetes is a complex disease that requires ongoing patient self-management to achieve optimal health outcomes. Patient engagement, or the active involvement of patients and caregivers in their care process, has improved health outcomes and quality of life for those with diabetes (Powers et al., 2020). However, low health literacy and other socioeconomic barriers often hinder meaningful patient engagement, contributing to poor glycemic control and the development of preventable complications. This paper explores how leveraging promising health technologies can help address diabetes patient needs and promote engagement to support quality care, especially for vulnerable populations.
Importance of addressing patient engagement in the management of diabetes
Patient engagement is crucial to effectively managing chronic conditions like diabetes due to the complex self-care behaviors required. When patients are actively engaged in their treatment through activities like medication adherence, regular monitoring, lifestyle changes, and open communication with providers, they are better equipped to problem-solve challenges and proactively manage their health in their daily lives. A strong body of evidence from the past five years supports the health benefits of engagement. Meta-analyses show that patient engagement improves clinical outcomes, such as lower A1c levels (Hosseinzadeh et al., 2021). Qualitative research finds that engagement allows patients to gain self-efficacy and confidence in navigating social and economic barriers through personalized goal-setting and accessing community resources (Rocha et al., 2022). For vulnerable populations facing disproportionate obstacles, engagement supported through technology and cultural coordination more effectively empowers patients to overcome real-world constraints and achieve optimal self-care customized to their needs (Smithwick et al., 2023).
Potential use and impact of information and communication technology tools
Several healthcare technology modalities show promise in improving diabetes consumer health literacy. Mobile applications designed to facilitate daily diabetes self-management tasks, such as glucose monitoring, nutrition logging, medication tracking, and appointment reminders, have demonstrated benefits. Studies have found that diabetes apps with easy-to-use dashboards visualizing glucose data over time and analytics on dietary impacts can positively change patient behaviors by motivating continued use (Moonian et al., 2020). Telehealth features like online patient portals and secure messaging with providers allow for simplified, virtual communication that may address barriers posed by lack of transportation or time off work. Research reviews have concluded that telehealth is effective at improving clinical outcomes like A1c when combined with remote patient monitoring or medical advice (Hosseinzadeh et al., 2021)
Other technology showing utility for patient care includes Bluetooth-enabled glucose meters that seamlessly upload readings to apps and health records without manual input. This streamlines the process and facilitates more consistent self-monitoring that providers can remotely access to identify worsening trends or gaps in care. Virtual group medical visits via video chat hold the potential to supplement in-person diabetes education classes by offering flexible, low-intensity follow-up support. Preliminary studies suggest these group telehealth sessions led by educators and diabetes specialists help sustain knowledge gained initially and allow for continued peer exchange that supports long-term self-care.
Evaluation of value and relevance of the technology modalities
The technology modalities proposed can encourage ethical and culturally sensitive patient engagement by facilitating honest communication that accounts for individual needs. Diabetes apps and telehealth portals promoting patients’ secure access to their personal health information empower transparency (Weitzman & Floyd, 2022). These modalities allow two-way sharing of only the clinical data providers, who can disclose while restricting broader privacy violations. They also enable simplifying complex medical concepts for diverse comprehension levels. For example, dashboards visualizing trends over time instead of dense numbers make self-monitoring data understandable regardless of health literacy or language proficiency with translations.
Interoperability between technologies amplifies their value by streamlining information exchange to continuous care. Seamless syncs from glucose meters to apps and then to patient medical records mean all care team members have access to the latest readings. This supports more proactive remote monitoring and care coordination to address any issues promptly. Interoperable systems also facilitate collaborative telehealth visits, including patients, providers, and care managers exchanging updates and adjusting treatment plans efficiently based on real-time data (Aminabee, 2024). Shared health information empowers engagement through clarity on progress and unified support from all stakeholders.
Health information exchange further enhances technology’s value in equitable care delivery. Integrating apps, telehealth, and medical records into larger clinical databases enables population health analytics. Communities could identify higher-risk patients and barriers to care, then target culturally tailored technology-assisted interventions, including patient education materials translated into preferred languages. Aggregated de-identified data also supports diabetes research and health system planning to continuously improve resources and allocate them to underserved groups most in need.
Innovative strategies for leveraging technology
Innovative community health worker (CHW) models partnering digital technologies with in-person care coordination and education have great potential to reach underserved diabetes patient populations effectively. Research has shown that Pairing mobile technologies, which can facilitate around-the-clock access to care, with in-person CHW coordination optimizes resources to provide continuous virtual and physical touchpoints (Ingram et al.,2021). This addresses barriers due to lack of transportation, schedules, or comfort with telemedicine alone. It also empowers CHWs to monitor patients remotely and efficiently identify trends or non-adherent behaviors through data synced from apps and sensors. Early intervention prevents exacerbations requiring urgent visits or hospitalizations that overburden the healthcare system.
This blended approach is also culturally and linguistically attuned to accommodate diverse patient populations. Equipping bilingual CHWs with telehealth capabilities extends their educational impact while maintaining a trusted community member interface. Partnering CHWs with technology allows individualizing virtual diabetes self-care plans according to health beliefs, traditions, and language preferences. Apps and portals optimized for varying digital literacy can display materials in a patient’s most comfortable language. Two-way text, video, and screen-sharing further support CHW-guided navigation of apps or clarify complex topics for those with low health literacy. This blended technology-CHW model promotes quality care through continuous patient-centered support sensitive to cultural norms and efficiently addresses real-world barriers.
How the proposed strategies will mitigate the risk of adverse outcomes
There are some potential risks associated with inequitable access to personal health data and technologies that could lead to adverse outcomes for vulnerable diabetes patient groups. One key risk is that underserved populations without reliable access to devices and the internet could be excluded from engaging virtual care resources (Mistry et al., 2022). This could exacerbate existing health inequities over time if not addressed. To help mitigate this risk, the proposed strategies aim to close the digital divide. Partnering CHWs with technology platforms allows CHWs to provide devices, digital literacy training, and tech support to improve access. Aggregating de-identified patient data through these partnerships also enables identifying access barriers at the community level to target solutions.
Previous studies have demonstrated how integrating CHWs into technology-supported care models can reduce barriers to equitable care. Anderson et al. (2022) showed that a telehealth and CHW program providing no-cost tablets, internet plans, and training to underserved Hispanic patients with diabetes significantly improved virtual care access and clinical outcomes. Community advisory boards have also aided diabetes tech pilots by surfacing local concerns to guide culturally appropriate, inclusive solutions that avoid potential harms like privacy violations. For example, advisory input helped address data-sharing issues and informed consent in similar programs. Drawing from these examples, the proposed strategies aim to establish participatory governance and technology assistance through CHWs to facilitate access and provide safeguards against the unintended marginalizing impacts of virtual platforms on vulnerable groups.
In conclusion, thoughtfully integrating patient-centered mHealth and telehealth modalities with in-person CHW coordination represents an innovative strategy for overcoming barriers to patient engagement in diabetes care. While digital tools hold promise, safeguarding equitable access and community partnerships will be vital to ensure vulnerable populations are not left behind or harmed. A blended care model pairing CHWs, diabetes self-care apps, and telehealth visits holds great potential for promoting sustained behavior change, proactive disease management, and quality care that is culturally responsive, accessible, and affirming for underserved communities disproportionately impacted by diabetes. With appropriate clinical validation and ethical governance, this approach could help transform community-based chronic care delivery and advance health equity.
References
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