Understanding the acceptability of digital diabetes self-management tools among non-users: A qualitative study of personal, social and healthcare contexts
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Background
Diabetes 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.
Objectives
To (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.
Design
Cross-sectional qualitative study.
Methods
We 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.
Results
Digital 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.
Conclusions
Digital support for diabetes self-management is more likely to be acceptable when it aligns with people’s 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 Contribution
Public 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.
