The role of digital health interventions as a resource for people with type 2 diabetes to develop self-care expertise, adapt to identity changes and influence how they are viewed by others: a qualitative study

Abstract Pre-Print Background: A diagnosis of type 2 diabetes (T2D) results in widespread changes to a person’s life and can be experienced as an assault on their sense of self. The resources available to an individual influences how they adapt to their diabetic identity and subsequently engage in self-care. Digital interventions can be viewed as a resource people can draw on to adapt to the diagnosis. However, there is an indication that people from disadvantaged groups find digital health technologies more challenging to access and use, which may increase health inequalities. Objective: To gain insights into how and why people with T2D use digital self-care technology and how experiences vary between individuals and social groups. Methods: A purposive sample of people who had used a digital intervention to help them self-care for their T2D. Semi-structured interviews were conducted and data were analysed thematically. Results: A diverse sample of 21 participants were interviewed. Participants used digital interventions to help them understand and feel more in control of their bodies. They used digital tools to project positive identities, and as a defence against the stigmatised diabetic identity. Some participants used technology to increase their sense of power in their interaction with clinicians, while others used technology to demonstrate their ‘good’ness. These benefits were not equally distributed. There was some indication that those who could afford to, purchased more expensive equipment. Privately purchased blood glucose monitors were more discrete than those provided on the NHS so were preferred by those who wanted to keep their condition hidden. Some attributed their success at keeping their diabetes under control to the purchase of more sophisticated and more expensive equipment. Conclusions: The technology people with T2D have access to shapes the way they are able to understand and control their bodies and support preferred social identities.