JMIR Publications

ABSTRACT

Background:

Over 40% of Hispanics (34.2 million people) have below basic health literacy levels, significantly impacting their ability to manage chronic conditions such as type 2 diabetes (T2D). This issue, coupled with disproportionate chronic disease burdens among older Hispanic patients, contributes to high rates of medication non-adherence compared to non-Hispanic whites. Non-adherence among Hispanics leads to poorer health outcomes, increased hospitalizations, and higher healthcare costs. Chronic disease self-management, essential for improving adherence, is often hindered by modifiable factors such as health literacy. Ambulatory care clinical pharmacists, through comprehensive medication management (CMM), play a critical role in addressing these barriers, yet current methods for delivering CMM vary significantly, limiting effectiveness. Digital technology may offer significant potential for improving engagement and education in medication adherence, particularly among Hispanic patients who actively use smartphones to seek health information.

Objective:

The objective is to revise, develop and pilot-test a culturally adapted, individually tailored digital health app designed to enhance health literacy and medication adherence among older Hispanics with T2D by integrating interactive educational modules into pharmacist-delivered CMM.

Methods:

Our team previously developed a prototype computer-delivered, culturally adapted intervention targeting health literacy and adherence among older Hispanics. The proposed project involves transforming this intervention into a modernized digital health app. We will achieve two specific aims. The first aim is to refine and modernize previously developed content into an interactive digital health app suitable for older Hispanics with T2D and ambulatory care clinical pharmacists. A total of 20 patients and 10 ambulatory care clinical pharmacists will review and provide feedback on the app modules. Usability and acceptability will be measured using validated tools (System Usability Scale, Adjectival Ease of Use Scale, Technology Acceptance Model). The second aim is to conduct a pilot test of the digital health app with 40 Hispanic adults (≥ 50 years) diagnosed with T2D. Participants will be recruited from a local Federally Qualified Health Center where ambulatory care clinical pharmacists currently manage diabetes care. Patients will complete a baseline CMM session, interact with the app modules over two weeks, and return for one or two subsequent CMM follow-up visits spaced 3-4 months apart. We will assess medication adherence, hemoglobin A1c, and fasting glucose levels as primary outcomes.

Results:

Results are pending

Conclusions:

At the conclusion of the study, it is expected that the culturally adapted digital health app achieves high usability and acceptance rates (≥ 90%) among both patients and pharmacists. Additionally, anticipated health outcomes include improvements in medication adherence (> 80%), hemoglobin A1c (≥ 0.75% reduction), and fasting glucose (≥ 25% reduction) from baseline. Successful results will enable wider dissemination of the refined app and establish a framework adaptable to other chronic diseases, diverse languages, cultures, and healthcare settings.