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The Use of Diabetes Self-Management Apps by African-American Women


The rapid development of new technologies in recent decades offers countless avenues for health promotion and disease prevention. Web-based and smart mobile applications and Web 2.0 are increasingly used by healthcare professionals for delivering tailored health messages focusing on prevention activities in areas such as nutrition, fitness, and lifestyle (Bert, Giacometti, Gualano, & Siliquini, 2014). Therefore, nurses who are willing to excel in the field of health promotion should recognize the practicality of digital technology use.

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The aim of this paper is to discuss a technological education program and how it can be used to develop healthy behaviors. It will be argued that diabetes self-management mobile phone applications should be recognized by healthcare professionals as effective instruments for the promotion of healthy behaviors.


Target Audience

A target audience for this brief is the student’s colleagues who can use the technology for helping their patients to engage in healthy behaviors necessary for diabetes management. By raising the healthcare professional’s consciousness about the value of digital technology in health promotion, it is possible to bring about a meaningful health change in the whole community.


The population of interest is African-American women with type 2 diabetes. The choice of the population is dictated by the fact that an ethnic health disparity with respect to the condition has reached catastrophic proportions. A study by Gucciardi, Chan, Manuel, and Sidani (2013) reveals that the prevalence of diabetes for non-Hispanic Blacks dramatically differs from that for Whites—11.8 percent and 6.6 percent, respectively. Furthermore, African-American women are statistically more prone to having poor glycemic control and complications associated with diabetes (Gucciardi et al., 2013). The precarious position of the population with regards to the disease is underscored by the fact that women are more likely to suffer from depression, anxiety disorders, and cardiovascular disease that can hamper self-care behaviors (Gucciardi et al., 2013). Therefore, it is especially important to ensure that African-American females are provided with support in the coordination of diabetes care.

Targeted Behavior

Type 2 diabetes is a chronic condition that requires several self-management behaviors and complex care activities that should be performed on a daily basis. Diabetes self-management should also be supplemented by cardiovascular risk factor management that revolves around glucose control, smoking cessation, change of lifestyle, blood pressure control (Inzucchi et al., 2015). Many individuals find it extremely difficult to adhere to the stringency of self-management activities and algorithms of care without external support. Therefore, mobile technology can be especially useful for diabetic patients.


The self-management of diabetes is complicated by a wide range of factors that lie inside and outside the area of patients’ control. It is critical to acknowledge and enumerate these factors to understand how the use of mobile apps can help affected individuals to adhere to self-management plans. According to Powers et al. (2015), the most critical elements of interference with health-directed behaviors for patients with diabetes are “ability to manage and cope with diabetes complications, other health conditions, medications, physical limitations, emotional needs, and basic living needs” (p. 1325). While the technology is not capable of addressing psychological, physical, and emotional factors interfering with self-management behaviors, it can be used for adjusting medications, adhering to a diet, and maintaining proper activity levels.


Mobile phone applications have the potential to help African-American women with diabetes to enhance their self-care behaviors. A recent study conducted by Pew Research Center shows that as of 2016, more than 95 percent of Americans owned smartphones (as cited in “TFFRS,” 2017). It follows that the high level of communication technology’s saturation in the country can be used for chronic disease management. Currently, more than 70 percent of disease-management apps are diabetes-related (Fatehi, Gary, & Russell, 2017).

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Diabetes self-management mobile phone apps are “mobile phone software that accepts data (transmitted or manual entry) and provide feedback to patients on improved management (automated or by a healthcare professional)” (Hou, Carter, Hewitt, Francisa, & Mayor, 2016, p. 2089). The technology is similar to previous attempts to improve diabetes management such as telemedicine interventions in that it combines network data transmission and feedback provision. However, it is much cheaper, which is particularly important for patients from disadvantaged economic backgrounds; therefore, it is more successful. In addition, unlike other technology-based interventions, the apps are more interactive and engaging.

Upon analyzing twelve diabetes management apps, Hou et al. (2016) argue that they are extremely effective in helping patients with glycemic control. The authors review the results of fourteen studies on technologically-assisted diabetes management and state that the mean reduction in HbA1c in patients who use the apps is 0.49 percent (Hou et al., 2016). It is extremely important since glycemic control is a mainstay of diabetes management.

The Community Preventive Services Task Force (CPSTF) takes active steps to assess studies related to technology-based disease management. The group recommends using apps to reinforce conventional care practices. The findings of a review of nine articles conducted by the task force fall in lines with the Hou and associates’ study and show that the median glucose levels reduction in patients relying on diabetes management apps is 0.4 percent (“TFFRS,” 2017).


The technology is extremely inexpensive and cost-effective, which makes its use equitable. Specifically, the technological support apps can be purchased for $4 on average (Cronenberg, 2017). There are also many free apps that can be efficiently used by patients from disadvantaged economic backgrounds. When it comes to cost savings, the use of technology can save hundreds of dollars for patients who currently rely on telecare.

Key Stakeholders

The aim of these papers is to change healthcare professionals’ perception of technology use in the management of the disease; however, it is also necessary to target another key group of stakeholders—patients. To this end, it is important to engage African-American women with type 2 diabetes at a community level. The population has to be explained numerous benefits associated with the use of the apps as well as the dangers of life-threatening conditions related to the disease. Their attention should be drawn to the fact that millions of individuals with diabetes are already using technology to improve their health outcomes (Hou et al., 2016).


The use of technology is associated with several barriers. Specifically, the apps have to be compliant with the Health Insurance Profitability and Accountability Act (HIPAA), which makes them more expensive (“TFFRS,” 2017). Other resource requirements that raise barriers to the use of technology for some populations groups are the cost of a smartphone and data service interruptions. Older adults and people with low levels of educational attainment can also experience difficulties in navigating the apps (“TFFRS,” 2017). It should also be mentioned that some smartphone software solutions for diabetes management require the involvement of healthcare professionals, which creates another obstacle for their use. Although these barriers are substantial, most of them can be easily overcome with the help of governmental involvement.

The Diffusion of Innovations Theory

The diffusion of innovations theory has been put forward to explain the spread and adoption of new ideas and technological solutions (Al-Suqri & Al-Aufi, 2015). The theory can be used to facilitate the adoption of self-management apps by African-American women with diabetes. To this end, healthcare practitioners should understand the core components of diffusion: innovations, time, social systems, and communication mediums (Pender, Murdaugh, & Parsons, 2014). A health promotion program that aims to encourage the population to use the technology has to include these elements. Taking into consideration the fact that the degree of adoption is already substantial, health practitioners should not find it difficult to convince their patients to take advantage of the innovation. If some African-American women view the apps with skepticism, they can be encouraged to use the technology with the help of informal authority leaders whose advice is respected in their community.

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When designing a program for behavioral change, it is necessary to consider how its success can be evaluated (Sharma & Romas, 2012). When it comes to the evaluation of the effectiveness of diabetes self-management mobile apps, it is clear that they provide immediate effects, which is extremely useful for positive behavior reinforcement. To assess the impact of the technology in tangible terms, lifestyle and physical activity questionnaires and weight measurements can be used. Also, the evaluation of blood glucose levels can show the degree of the program’s effectiveness.


The paper has discussed the use of self-management smartphone apps for reinforcing and enhancing health behaviors in African-American women with diabetes. It has been argued that technology can be highly effective in helping the population to maintain complex diabetes self-management routines as well as to coordinate their activities with healthcare professionals. The assertions provided in the paper are supported by multiple lines of investigation.


Al-Suqri, M. N., & Al-Aufi, A. S. (2015). Information seeking behavior and technology adoption: Theories and trends. Hersey, PA: IGI Global.

Bert, F., Giacometti, M., Gualano, M. R., & Siliquini, R. (2014). Smartphones and health promotion: A review of the evidence. Journal of Medical Systems, 38(1), 1-11.

Cronenberg, C. (2017). The best diabetes apps of the year. Web.

Fatehi, F., Gary, L. C., & Russell, W. (2017). Mobile Health (mHealth) for diabetes care: Opportunities and challenges. Diabetes Technology & Therapeutics,19(1):1-3.

Gucciardi, E., Chan, V. W. S., Manuel, L., & Sidani, S. (2013). A systematic literature review of diabetes self-management education features to improve diabetes education in women of Black African/Caribbean and Hispanic/Latin American ethnicity. Patient Education and Counseling, 92(2), 235-245.

Hou, C., Carter, B., Hewitt, J., Francisa, T., & Mayor, S. (2016). Do mobile phone applications improve glycemic control (HbA1c) in the self-management of diabetes? A systematic review, meta-analysis, and GRADE of 14 randomized trials. Diabetes Care, 39(11), 2089-2095.

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Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M.,… Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes, 2015: A patient-centered approach: Update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care, 38(1), 140-149.

Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2014). Health promotion in nursing practice. Upper Saddle River, NJ: Pearson.

Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H.,… Vivian, E. (2015). Diabetes self-management education and support in type 2 diabetes: A joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Journal of the Academy of Nutrition and Dietetics, 115(8), 1323-1334.

Sharma, M., & Romas, J. A. (2012). Theoretical foundations of health education and health promotion (2nd ed.). Sudbury, MA: Jones & Bartlett Learning.

TTFRS-diabetes management: Mobile phone applications used within healthcare systems for type 2 diabetes self-management. (2017). Web.

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