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The dissertation aims to examine the potential for diabetes self-management education (DSME) technology interventions to be used by underserved adults in routine clinical practice and issues regarding its use that may be unique to this population. In Chapter One, the problems of providing sufficient access and appropriate DSME to underserved adults with type 2 diabetes mellitus (T2DM) is introduced and their significance is described. In Chapter Two, a systematic review of the literature and meta-analysis synthesizes data from 3,257 subjects that participated in 13 randomized controlled trials that examined the effect of health information technology (HIT) DSME interventions on glycemic control in medically underserved adults. Chapter Three presents the general and technology-related characteristics of the urban, underserved sample of adults with type 2 diabetes mellitus from eight federally qualified health centers who participated in the Mobile Diabetes Detective (MoDD) randomized controlled trial. It also describes the technology training required to support use and engagement during the MoDD intervention period. In Chapter Four, the potential for broad dissemination of a novel HIT DSME intervention, MoDD, into everyday clinical practice is examined using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance). In Chapter Five the findings of these studies are summarized and the overarching conclusions are presented, which include the strengths, limitations and implications for practice, policy and future. |
