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Bridging the Digital Divide in Diabetes Care With an AI-Powered Health Coaching Intervention: Qualitative Formative
Tejossy John1,2, Sangeetha Mohanraj3, Tanjila Nawshin4
1Department of Orthopedic Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.
JMIR Diabetes
|August 7, 2026
Summary
Digital health coaching for type 2 diabetes faces access barriers. Telephone-based coaching offers a solution, with participants desiring targeted education, accountability, reminders, and incentives for better diabetes self-management.
Area of Science:
- Health Services Research
- Digital Health
- Diabetes Management
Background:
- Digital health coaching (DHC) for type 2 diabetes (T2DM) self-management has advanced, but a digital divide limits access for underserved populations.
- Low-tech, telephone-based alternatives are needed to bridge this gap and ensure equitable access to diabetes support.
Purpose of the Study:
- To explore the lived experiences of T2DM self-management challenges.
- To identify preferences for telephone-based DHC among adults in Alabama.
- To inform the optimization of telephone-based DHC interventions.
Main Methods:
- Formative qualitative study using a phenomenological approach.
- In-depth, semistructured telephone or Zoom interviews with 12 adults with T2DM.
- Data analyzed using NVivo software by two independent coders.
Main Results:
- Multifaceted barriers to T2DM self-management identified: behavioral (diet, nutrition), physical/environmental (mobility, weather), and structural (medication shortages, insurance).
- Participant expectations for telephone-based DHC: targeted education (diet, exercise, medication), health coaches as accountability partners, daily reminders (text/call), and incentives.
- Study insights directly informed intervention components for a pilot feasibility trial.
Conclusions:
- Key T2DM management challenges include diet, physical activity, medication access, and insurance for continuous glucose monitoring.
- Telephone-based DHC expectations include education, accountability, reminders, and incentives for adherence.
- Addressing these challenges and preferences can optimize telephone-based DHC for T2DM self-management.
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