The Impact of Mobile Health Literacy, Socioeconomic Factors, and Engagement Patterns on DiabetesXcel App Usage in...

Type 2 Diabetes Mellitus (T2DM) poses a growing public health burden, particularly among underserved populations. Mobile health (mHealth) apps offer a promising solution for improving self-management of T2DM, yet user engagement remains inconsistent across demographic and socioeconomic groups. This study aims to investigate the association between mobile health literacy, socioeconomic factors (including the Area Deprivation Index, ADI), and user engagement in the DiabetesXcel app, a digital diabetes management tool.

A post-hoc analysis was conducted using data from 46 participants, and the analysis assessed app usage, clinical outcomes, and user characteristics. App engagement was measured by logins and in-app questions answered at four and six months.

Early users had significantly lower LDL levels after six months compared to sustained users (p = 0.02). Sustained users were more likely to have private insurance and less likely to have Medicaid (p = 0.04). Higher ADI was linked to increased eHealth literacy (p = 0.04) but lower social influence scores (p = 0.03). Non-private insurance users were less likely to answer more in-app questions at both four months (OR = 0.11, p = 0.05) and six months (OR = 0.14, p = 0.08), though these trends did not reach statistical significance.

Disparities in socioeconomic status and digital literacy may influence sustained engagement with mHealth tools. Tailoring mHealth interventions to address disparities in engagement may improve long-term self-management behaviors in diverse patient populations.

The online version contains supplementary material available at 10.1007/s40200-025-01725-2.