Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Outcomes and Policy Research


Health Policy

Research Advisor

Shelley White-Means,PhD


Brandi Franklin, PhD Christa George, PharmD J. Carolyn Graff, PhD Christina Spivey, PhD


diabetes, health disparities, mhealth, smartphone app


Introduction. Diabetes mellitus is a condition with a growing morbidity and mortality burden. An estimated 30 million adults currently live with diabetes, with each individual spending over $9500 annually on medical care. The successful management of diabetes is a lifelong endeavor. This involves balancing a variety of factors including diet, medications, and glucose monitoring. It has been well established that successful control of diabetes depends largely upon patients’ daily lifestyle habits and activities. Not all patients, however, have the resources necessary for effective diabetes management. Health disparities lead to a higher rate of diabetes development in minority and poor populations. Since underserved patients have limited access to traditional healthcare avenues, providers should explore other means, like mobile health (mHealth), to help such patients. The rapid adoption of smartphones within the last decade has allowed an opportunity for patients to use mHealth and smartphone applications (apps) as a low-cost way to get health information and services. mHealth has the potential to address such disparities in access to health care. Little is known about the effectiveness of using apps to help underserved patients with their diabetes management. Assessing these patients’ current self-management practices and their interest in using smartphone apps for their diabetes management is the first step in determining how mHealth may benefit this patient population.

Purpose. The purpose of this study was to assess how underserved patients with limited access to primary care physicians handled their diabetes on their own at home, to determine what challenges they faced with their self-management, and to examine their willingness to use diabetes mHealth apps on their smartphones to assist with their diabetes management.

Methods. This study employed purposive sampling to select patients for individual interviews. Participant selection occurred at a Memphis hospital located in an area of town with predominately low-income and minority residents, as well as a high prevalence of diabetes. Semi-structured interviews were conducted on-site at the hospital based on McNamara’s interview staging. In all, 15 interviews were recorded, transcribed, and coded according to the interpretative phenomenological analysis framework.

Results. The data produced 5 topic clusters related to at-home diabetes management, which supported 2 overarching themes, and 7 clusters related to mHealth smartphone app use, which supported 3 overarching themes. The themes related to self-management are as follows: 1. Patients are aware that successful diabetes control requires active engagement on their part but voiced struggles related to balancing limited income and a healthy diet, how to manage fluctuating glucose readings throughout the day, and affording medications; and 2. Lacking a traditional relationship with a primary care doctor, these underserved patients turn to friends and family, written materials, and the internet as health care resources. The themes related to smartphone mHealth are as follows: 1. Despite limited knowledge about health apps and varying phone use patterns, patients were all willing to try at least one diabetes-related app; 2. App functions should be individualized to meet each patient’s needs for maximum benefit; and 3. Barriers to app use were varied but commonly included knowledge and technological challenges and security issues.

Conclusion. Interviews from this vulnerable population demonstrated that individuals understood the importance of their own active involvement in controlling their diabetes. Yet, because of limited economic and health care resources, these patients struggle with the implementation of effective lifestyle choices in their daily routine. Furthermore, interviewees expressed interest in trying mobile health apps for diabetes management, despite minimal knowledge about the technology. Responses showed that selecting apps tailored to each individual’s needs, instead of offering one blanket multifunctional app, would provide patients with the greatest benefit. Smartphone apps may be a low-cost health resource that patients without regular access to physicians can use for their at-home diabetes management.

Declaration of Authorship

Declaration of Authorship is included in the supplemental files.




2021-012-Luo-DOA.pdf (266 kB)
Declaration of Authorship