JMIR Publications

ABSTRACT

Background:

Type 2 diabetes (T2DM) is one of the leading chronic diseases worldwide, requiring effective long-term self-management (SM) to improve health outcomes and reduce complications. Although structured diabetes pathways exist in Belgium, national reports indicate that adherence to the recommended diabetes follow-up and routine monitoring remains suboptimal. Digital health technologies have shown promise in supporting SM; however, little is known about how stakeholders within the Flemish healthcare system perceive opportunities to improve SM and implement digital health interventions.

Objective:

This study explored stakeholders’ perspectives on improving diabetes SM and the potential role of digital tools in supporting people with T2DM in the Flemish healthcare system.

Methods:

A qualitative study was conducted using two online semi-structured focus group discussions with 19 stakeholders, including healthcare professionals (HCPs) from primary, secondary, and tertiary care, researchers, digital health experts and an individual living with T2DM. Participants were recruited using maximum variation purposive sampling followed by snowball sampling. The discussion guide was informed by the Consolidated Framework for Implementation Research (CFIR) and current evidence on diabetes SM and digital health. Discussions were audio-recorded, transcribed verbatim, translated from Dutch into English, analyzed using Braun and Clarke’s six-phase reflexive thematic analysis, supported by NVivo.

Results:

Five key themes were identified: 1. Empowerment Through Education, 2. Tailoring Education to Individual Needs, 3. Multidisciplinary and Cross-Sectoral Collaboration, 4. Opportunities for Digital Technology in Self-Management, and 5. Regional and National Systemic Limitations. Participants consistently emphasized that effective diabetes SM may extend beyond patients’ individual behaviors and depends on tailored education, coordinated multidisciplinary care across the healthcare sectors, supportive organizational structures, and enabling health policies. Digital health technologies were perceived as valuable tools to facilitate patient education, communication, information sharing, and continuity of care. However, participants also highlighted that successful implementation depends on addressing broader organizational and system-level barriers, including fragmented digital infrastructures, limited interoperability, and regulatory constraints within the Belgian healthcare system.

Conclusions:

Stakeholders viewed improving diabetes self-management as a shared responsibility between patients, healthcare professionals, and the healthcare system. While digital health technologies may strengthen self-management support, their value depends on how well they complement existing care processes and address contextual implementation challenges. These findings provide context-specific insights that may inform the development and implementation of digital interventions for T2DM in Belgium and similar healthcare settings. Further qualitative research involving a larger and more diverse sample of people living with T2DM is warranted to better understand patient experiences and support needs.