Table 3.

Key recommendations for the design and research of mobile and Internet interventions for disadvantaged and vulnerable persons with diabetes

Access issues	Use technology patients already access and use Compensate for participation, but do not pay for technology to understand potential real-word use and sustainability If providing/paying for technology, consider cost analyses to determine sustainability
Program design and usability	Tailor content on the individual level (e.g., person-reported personal data) Apply existing standards to make digital design acceptable to persons of all health literacy and numeracy levels Consider literacy and numeracy when designing content and functionality; report how design accommodates all levels For now, disparities in internet access persist, so consider non-internet-dependent technology Test interventions for usability with the target population; report usability data (not just self-reported satisfaction)
The human element	Utilize personnel familiar with/known to the study population (e.g., community health workers) Trained personnel can tailor to individuals’ needs and experiences with the technology and may help overcome mistrust Systematically evaluate when and how humans can and should be used to improve the reach or effectiveness of digital interventions
Understand the user population	Report data on socioeconomic status (e.g., income, education, insurance status), health literacy and numeracy of study samples or study catchment populations to inform next steps for interventions When possible, examine differential effects by socioeconomic status, health literacy status When possible, examine differential engagement with the intervention by socioeconomic and/or health literacy status
Use more agile science	Focus on comparative effectiveness/superiority trials, pragmatic trials and cost analyses rather than efficacy trials with a treatment-as-usual control group Studies with an active comparison are more likely to engage disadvantaged/vulnerable persons with diabetes Use adaptive study designs to address the need for continued quality improvement and rapid iteration
Long-term evaluation	Studies with interventions lasting longer than 3 or 6 months are needed Studies with post-intervention follow-up periods are needed
Economic evaluations	Make efforts to understand costs and savings associated with digital interventions to determine if effects are “worth” costs associated with the technologies Consider cost analyses in two ways: (1) without providing/paying for technology, (2) evaluating whether providing/paying for technology is cost-effective in light of savings associated with improvements in health outcomes
Conduct studies in low-/top-income countries	More studies in low-/top-income countries are needed Develop interventions specifically for the population or describe rigorous efforts to adapt existing interventions to the context