Exploring the Use of Personal Technology in Type 2 Diabetes Management Among Ethnic Minority Patients: Cross-Sectional Analysis of Survey Data from the Lifestyle Intervention for the Treatment of Diabetes Study (LIFT Diabetes)

Abstract

Background

Minority populations have higher morbidity from chronic diseases and typically experience worse health outcomes. Internet technology may afford a low-cost method of ongoing chronic disease management to promote improved health outcomes among minority populations.

Objective

The objective of our study was to assess the feasibility of capitalizing on the pervasive use of technology as a secondary means of delivering diabetic counseling though an investigation of correlates to technology use within the context of an ongoing diabetes intervention study.

Methods

The Lifestyle Intervention for the Treatment of Diabetes study (LIFT Diabetes) randomly assigned 260 overweight and obese adults with type 2 diabetes mellitus to 2 intervention arms. At baseline, we administered a survey evaluating access to and use of various technologies and analyzed the responses using descriptive statistics and logistic regression.

Results

The sample population had a mean age of 56 (SD 11) years; 67.3% (175/260) were female and 54.6% (n=142) self-identified as being from ethnic minority groups (n=125, 88.0% black; n=6, 4.3% Hispanic; and n=11, 7.7% other). Minority participants had higher baseline mean body mass index ( P=.002) and hemoglobin A _1c levels ( P=.003). Minority participants were less likely to have a home computer (106/142, 74.7% vs 110/118, 93.2%; P<.001) and less likely to have email access at home ( P=.03). Ownership of a home computer was correlated to higher income ( P<.001), higher educational attainment ( P<.001), full-time employment ( P=.01), and ownership of a smartphone ( P=.001). Willingness to complete questionnaires online was correlated to higher income ( P=.001), higher education ( P<.001), full-time employment ( P=.01), and home access to a computer, internet, and smartphone ( P≤.05). Racial disparities in having a home computer persisted after controlling for demographic variables and owning a smartphone (adjusted OR 0.26, 95% CI 0.10-0.67; P=.01). Willingness to complete questionnaires online was driven by ownership of a home computer (adjusted OR 3.87, 95% CI 1.14-13.2; P=.03).

Conclusions

Adults who self-identified as being part of a minority group were more likely to report limited access to technology than were white adults. As ownership of a home computer is central to a willingness to use online tools, racial disparities in access may limit the potential of Web-based interventions to reach this population.

Trial Registration

ClinicalTrials.gov NCT01806727; https://clinicaltrials.gov/ct2/show/NCT01806727 (Archived by WebCite at http://www.webcitation.org/6xOq2b7Tv)