Currently submitted to: JMIR Diabetes
Date Submitted: Sep 21, 2026
Open Peer Review Period: Sep 28, 2026 - Nov 23, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Assessing Engagement with a Mobile Health Diabetes Intervention Among Vietnamese Americans: Results from a Pilot Study
ABSTRACT
Background:
Vietnamese Americans face language, cultural, and access barriers to diabetes self-management education and support (DSMES). Culturally tailored mobile health (mHealth) interventions may expand DSMES access, but their effectiveness depends on participant uptake and sustained engagement. The Blended Automated Links Augmented by Nurse Calls and Engagement (BALANCE) study, a culturally tailored mHealth DSMES intervention for Vietnamese Americans with type 2 diabetes (T2D), was previously evaluated and published. However, little is known about the engagement patterns and factors influencing participation.
Objective:
To identify factors associated with intervention uptake and adherence and explore barriers and facilitators to initiating and sustaining engagement through in-depth interviews.
Methods:
This mixed-methods analysis used data collected during the BALANCE pilot study. In the parent study, participants received a handbook, weekly coaching calls, and daily mHealth messaging over 12 weeks. Quantitative measures of mHealth uptake and adherence were analyzed, followed by in-depth interviews to explore barriers and facilitators to engagement with the mHealth messaging component of the intervention.
Results:
Of 87 participants, the uptake of treatment was 85.1% with a mean adherence rate of 56.1%. Demographic was not associated with initial uptake. Older age and higher HbA1c were associated with lower adherence, whereas higher BMI was associated with higher adherence. While men demonstrated higher adherence than women, overall adherence declined over time, with each additional week associated with a 17% reduction in engagement odds (OR=0.83, p <.001). Engagement was facilitated by the convenience and cultural relevance of the messages, while changed mobile phone service was the primary reported barrier.
Conclusions:
High initial uptake supports the potential of culturally tailored messaging to improve DSMES access among Vietnamese Americans. However, declining adherence over time highlights the need for intervention refinement to identify and address barriers to sustain engagement.
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