Accepted for/Published in: JMIR Diabetes
Date Submitted: Jan 24, 2025
Date Accepted: Feb 6, 2026
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited.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.
Design and Implementation of a mobile app to deliver mental health peer support to adults living with type 1 diabetes: Operational Feasibility Study
ABSTRACT
Background:
For adults living with type 1 diabetes (T1D), mental health support is limited. Peer support and digital health platforms are promising strategies to deliver mental health support to this population, particularly those from geographically marginalized communities. Mobile applications (apps), in particular, can enhance self-management and deliver support.
Objective:
We developed a novel mobile app, T1D REACHOUT, that delivers mental health support to adults with T1D. We aim to describe the iterative co-design and development process of the REACHOUT app, including its use in a pilot trial and subsequent revisions made before its evaluation in a randomized controlled trial (RCT).
Methods:
A co-creation approach was used to develop the REACHOUT app. An initial think tank and six focus groups were conducted with adults with T1D to better understand their support needs and identify requirements. Following this, we partnered with adults living with T1D, the “end users,” to iteratively co-design the REACHOUT app, enhancing usability and ensuring relevance. Adapting the open-source Rocket.chat platform to our specifications, we deployed the app in a single cohort pilot study. A network analysis of messages exchanged during the pilot study was performed to explore trends and patterns and to demonstrate implementation feasibility. Pilot study outcomes informed further refinement before implementation in an RCT.
Results:
Thirty-one focus group participants and 11 end-user partners participated in the development of REACHOUT. The current version of the REACHOUT app features six key components identified in the initial focus groups: a 24/7 community chat room (a customized group messaging function with threads), topic-specific discussion boards, a peer supporter library, peer supporter profiles for a user-driven matching process, small group virtual sessions, and direct (one-to-one) messaging. Forty-six participants were encouraged to use any or all of the features as frequently as they desired over a 5-month period during a pilot trial. During this time, 179 private small groups were created, and 10,410 messages were sent, including 1,389 chat room messages and 7,116 direct messages; among these were 3,446 messages exchanged between participants and their self-selected peer supporters.
Conclusions:
Key factors for successful implementation included (1) the co-design process involving comprehensive user engagement and (2) the opportunities realized through in-house development rather than contracting developers. The REACHOUT app offers a mechanism to access peer support for communities with limited mental health resources. Once validated in a prospective RCT, it may serve as a scalable mental health support intervention.
Citation
