Bridging the Digital Divide in Diabetes Care: An Integrative Review of Barriers and Facilitators to Technology Use

Abstract

Purpose

The purpose of this integrative literature review was to assess barriers and facilitators to diabetes technology use among underrepresented racial and ethnic adolescents and young adults with type 1 diabetes mellitus (T1DM) in the United States.

Methods

This integrative review followed Whittemore and Knafl’s methodology. A systematic database search was conducted in PubMed, CINAHL, EMBASE, PsycINFO, Scopus, and Web of Science from inception through December 2024. The inclusion criteria were English-language primary studies on diabetes technology targeting adolescents and young adults with T1DM from underrepresented racial and ethnic groups. Two independent reviewers identified articles for inclusion, extracted data, and assessed quality with the mixed-methods appraisal tool. The social ecological model guided thematic coding and deductive synthesis.

Results

Out of 1704 references, 8 articles met inclusion criteria. The most prevalent barriers to technology use were financial limitations, inadequate knowledge, limited patient-provider communication, insurance restrictions, lack of peer and family support, and cultural and psychosocial barriers. Facilitators included increased familiarity and support, positive experiences and involvement, effective communication, community-based education initiatives, and insurance and systemic advocacy.

Conclusion

The review highlights persistent inequities in technology use among underrepresented racial-ethnic adolescents and young adults with T1DM. Actions should aim at preventing and reforming barriers, including racism and inequitable access, support for community-based interventions, and incentivize technological innovations for underrepresented individuals.