Understanding the acceptability of digital diabetes self-management tools among non-users: A qualitative study of personal, social and healthcare contexts
- 1University of Manchester
Abstract
BackgroundDiabetes poses a major global health and economic burden, and effective self-management is essential for preventing complications. The National Health Service in England has recently announced plans to shift from analogue to digital services in their 10-year plan. However, digital health technology may also risk widening existing inequalities. MyWay Diabetes is a digital self-management intervention implemented in three regions across England. Understanding the acceptability of online and digital tools to support diabetes self-management, particularly among non-users and underserved groups, is essential to ensure equitable engagement and implementation.
ObjectivesTo (1) explore barriers to using online and digital support across diverse demographic groups with type 1 and type 2 diabetes who had not used the MyWay Diabetes platform, and (2) identify factors that could improve uptake and continued engagement.
DesignCross-sectional qualitative study.
MethodsWe conducted six focus groups with n=35 people living with diabetes (27F, 8M; 40% Asian British Pakistani) across three regions in England. The Theoretical Framework of Acceptability (TFA) informed data collection and analysis. Data were transcribed and analysed thematically using template analysis, mapped onto constructs of the TFA.
ResultsDigital engagement in diabetes self-management was shaped by intersecting personal, social, and healthcare system factors. Participants confidence with navigating digital environments was constrained by the emotional and practical burden of living with diabetes. Social and structural barriers, including cultural mismatch, accessibility challenges, financial constraints, and reliance on family further limited meaningful use of digital tools. Engagement was strongly influenced by trust in healthcare professionals and services; digital tools were considered acceptable when they complemented person-centred care, but resisted when perceived as replacing personalised, face-to-face support.
ConclusionsDigital support for diabetes self-management is more likely to be acceptable when it aligns with peoples capabilities, social circumstances, and trusted healthcare relationships. Therefore, to prevent widening inequalities, digital tools should be accessible, culturally relevant, and embedded within supportive, person-centred models of care.
Lived Experience or Public ContributionPublic contributors with lived experience of diabetes (3F, 3M) reviewed participant materials and pseudonymised focus group transcripts, providing feedback on recruitment, data collection, and interpretation. Their insights informed analysis and theme development, ensuring a lived-experience perspective. Our public co-applicant is a co-author on this manuscript.
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BibTeX
@misc{hawkes2026understanding,
title = {{Understanding the acceptability of digital diabetes self-management tools among non-users: A qualitative study of personal, social and healthcare contexts}},
author = {R. E. Hawkes and H. Osei-Kwasi and D. Taylor and D. Ashpole and C. E. Reiger and D. M. A. Amutike and M. Baxter and A. Bickerton and S. G. Cunningham and D. J. Wake and T. Willis and M. K. Rutter and J. Brooks},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.29.26364317},
url = {https://www.medrxiv.org/content/10.64898/2026.09.29.26364317v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Understanding the acceptability of digital diabetes self-management tools among non-users: A qualitative study of personal, social and healthcare contexts
AU - R. E. Hawkes
AU - H. Osei-Kwasi
AU - D. Taylor
AU - D. Ashpole
AU - C. E. Reiger
AU - D. M. A. Amutike
AU - M. Baxter
AU - A. Bickerton
AU - S. G. Cunningham
AU - D. J. Wake
AU - T. Willis
AU - M. K. Rutter
AU - J. Brooks
PY - 2026
DA - 2026/09/29
PB - medRxiv
DO - 10.64898/2026.09.29.26364317
UR - https://www.medrxiv.org/content/10.64898/2026.09.29.26364317v1
AB - BackgroundDiabetes poses a major global health and economic burden, and effective self-management is essential for preventing complications. The National Health Service in England has recently announced plans to shift from analogue to digital services in their 10-year plan. However, digital health technology may also risk widening existing inequalities. MyWay Diabetes is a digital self-management intervention implemented in three regions across England. Understanding the acceptability of online and digital tools to support diabetes self-management, particularly among non-users and underserved groups, is essential to ensure equitable engagement and implementation. ObjectivesTo (1) explore barriers to using online and digital support across diverse demographic groups with type 1 and type 2 diabetes who had not used the MyWay Diabetes platform, and (2) identify factors that could improve uptake and continued engagement. DesignCross-sectional qualitative study. MethodsWe conducted six focus groups with n=35 people living with diabetes (27F, 8M; 40% Asian British Pakistani) across three regions in England. The Theoretical Framework of Acceptability (TFA) informed data collection and analysis. Data were transcribed and analysed thematically using template analysis, mapped onto constructs of the TFA. ResultsDigital engagement in diabetes self-management was shaped by intersecting personal, social, and healthcare system factors. Participants confidence with navigating digital environments was constrained by the emotional and practical burden of living with diabetes. Social and structural barriers, including cultural mismatch, accessibility challenges, financial constraints, and reliance on family further limited meaningful use of digital tools. Engagement was strongly influenced by trust in healthcare professionals and services; digital tools were considered acceptable when they complemented person-centred care, but resisted when perceived as replacing personalised, face-to-face support. ConclusionsDigital support for diabetes self-management is more likely to be acceptable when it aligns with peoples capabilities, social circumstances, and trusted healthcare relationships. Therefore, to prevent widening inequalities, digital tools should be accessible, culturally relevant, and embedded within supportive, person-centred models of care. Lived Experience or Public ContributionPublic contributors with lived experience of diabetes (3F, 3M) reviewed participant materials and pseudonymised focus group transcripts, providing feedback on recruitment, data collection, and interpretation. Their insights informed analysis and theme development, ensuring a lived-experience perspective. Our public co-applicant is a co-author on this manuscript.
ER -