A CFIR-guided qualitative study of digital health engagement among Black adults with type 2 diabetes

Digital health tools such as remote patient monitoring (RPM) and digital health coaching (DHC) offer promising strategies for type 2 diabetes (T2D) management, yet little is known about how underserved Black adults experience these technologies. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured interviews with 34 Black adults with uncontrolled T2D in Alabama and Mississippi (mean age 55 years; 71% female; 44% with food insecurity; most with Area Deprivation Index ≥8). Participants described multilevel factors shaping engagement. RPM increased disease awareness, provided real-time clinical feedback from a care team, and allowed flexible blood glucose monitoring, though fingerstick burden and emotional resistance to high glucose readings reduced use. DHC provided personalized, relationship-based support that motivated behavior change, yet environmental constraints and competing life demands limited sustained impact. Engagement often evolved from skepticism to confidence when benefits were evident and supported by social networks. Sustained participation requires trusted, personalized digital tools responsive to structural barriers.