JMIR Publications

ABSTRACT

Background:

Managing type 2 diabetes (T2D) requires ongoing attention to diet, physical activity, medication, and blood glucose monitoring. These cumulative demands can lead to diabetes distress, a common emotional strain that affects wellbeing, self-management, and clinical outcomes. Digital health interventions (DHIs) offer scalable, cost-effective support for both self-management and emotional wellbeing. However, many DHIs pay limited attention to the needs of underserved groups, who may experience higher distress, face additional barriers to engagement, and are often underrepresented in research. Evidence describing how DHIs are designed, delivered, and experienced across diverse populations remains fragmented, particularly from an equity perspective.

Objective:

This mixed-methods scoping review aims to map and characterise DHIs addressing the emotional burden of living with T2D and to examine how equity and inclusion are considered in these interventions.

Methods:

Searches will be performed in several electronic databases, including MEDLINE, CINAHL, and PsycINFO, and grey literature sources. Quantitative, qualitative and mixed-method studies published since 1998 involving adults with T2D who have used DHIs targeting diabetes distress or related emotional outcomes will be included. Equity-related elements, as outlined in the PROGRESS-Plus framework , will be identified and extracted to support analysis of how DHIs address the needs of underserved populations. Screening and data extraction will be performed independently by multiple reviewers, with findings synthesised through descriptive mapping and thematic analysis to identify trends, gaps, and barriers in DHI development and implementation.

Results:

This review will identify gaps in existing DHIs and provide guidance to improve their design, inclusivity, and responsiveness to the emotional needs of adults with T2D, particularly those from ethnic minority and other underserved groups, supporting the development of user-centred, equitable solutions.

Conclusions:

This scoping review will examine how DHIs for diabetes distress are designed, implemented, and experienced across diverse populations, with a particular focus on equity and inclusion, to inform inform future research efforts, as well as the development of an inclusive, user-centred, co-designed digital intervention for adults with T2D experiencing diabetes distress. Clinical Trial: The protocol of this scoping review has been registered on the Open Science Framework (https://osf.io/vr2hd/).