JMIR Publications

ABSTRACT

Background:

Inequity in diabetes technology use among Black and Hispanic youth with type 1 diabetes (T1D) persists. Community health workers (CHW) can address social and clinical barriers to diabetes device use, but more information is needed on clinicians’ perceptions to inform a CHW model for youth with T1D.

Objective:

This study aimed to identify barriers and co-create solutions for diabetes technology inequity with clinicians of Black and Hispanic youth with T1D.

Methods:

Using human-centered design, we conducted virtual workshops with 17 participants from an urban safety-net hospital (eleven diabetes and six school clinicians). Workshops promoted active ideation of barriers and co-design of a CHW intervention prototype to address self-reported challenges. Workshops were analyzed using a qualitative inductive approach.

Results:

Participants reported: 1) general and specific health-related social needs (HRSNs) that interfered with technology uptake, 2) difficulty navigating healthcare systems, insurance, and pharmacy benefits, 3) limited support to use diabetes technology in school, and 4) lack of time and technology support to troubleshoot problems in clinic. Ways that a CHW could help included: 1) HRSN identification and navigation, 2) peer support for caregivers to navigate diabetes device logistics, 3) acting as a school liaison to improve communication between caregivers, schools, and diabetes clinicians, and 4) administrative support to offload logistical burden for clinicians.

Conclusions:

Important needs related to specialized technology support, family-clinician communication, and administrative task-shifting were identified by clinicians to inform a CHW model for youth with T1D. Continued co-design and pilot testing are needed to refine the model.