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Chinese immigrants suffer a disproportionately high type 2 diabetes (T2D) burden and tend to have poorly controlled disease. Mobile health (mHealth) interventions have been shown to increase access to care and improve chronic disease management in minority populations. However, such interventions have not been developed for or tested in Chinese immigrants with T2D.
This study aims to examine mobile device ownership, current use, and interest in mHealth interventions among Chinese immigrants with T2D.
In a cross-sectional survey, Chinese immigrants with T2D were recruited from Chinese community centers in New York City. Sociodemographic characteristics, mobile device ownership, current use of social media software applications, current use of technology for health-related purposes, and interest in using mHealth for T2D management were assessed. Surveys were administered face-to-face by bilingual study staff in the participant’s preferred language. Descriptive statistics were used to characterize the study sample and summarize technology use.
The sample (N=91) was predominantly female (n=57, 63%), married (n=68, 75%), and had a high school education or less (n=58, 64%); most participants had an annual household income of less than US $25,000 (n=63, 69%) and had limited English proficiency (n=78, 86%). The sample had a mean age of 70 (SD 11) years. Almost all (90/91, 99%) participants had a mobile device (eg, basic cell phones, smart devices), and the majority (n=83, 91%) reported owning a smart device (eg, smartphone or tablet). WeChat was the most commonly used social media platform (65/91, 71%). When asked about their top source for diabetes-related information, 63 of the 91 participants (69%) reported health care providers, followed by 13 who reported the internet (14%), and 10 who reported family, friends, and coworkers (11%). Less than one-quarter (21/91, 23%) of the sample reported using the internet to search for diabetes-related information in the past 12 months. About one-third of the sample (34/91, 37%) reported that they had watched a health-related video on their cell phone or computer in the past 12 months. The majority (69/91, 76%) of participants reported interest in receiving an mHealth intervention in the future to help with T2D management.
Despite high mobile device ownership, the current use of technology for health-related issues remained low in older Chinese immigrants with T2D. Given the strong interest in future mHealth interventions and high levels of social media use (eg, WeChat), future studies should consider how to leverage these existing low-cost platforms and deliver tailored mHealth interventions to this fast-growing minority group.
Type 2 diabetes (T2D) in Chinese Americans is a significant health concern for the US health care system [
Once diagnosed with T2D, Chinese immigrants demonstrate poorer self-management and worse glycemic control [
Diabetes self-management education and counseling programs are effective interventions for diabetes control [
Mobile health (mHealth) technology may be a promising way to address some of the previously mentioned barriers and reduce T2D health disparities. Research demonstrates SMS text messaging–based interventions improve glycemic control in patients with T2D, including minority populations [
This pilot study was informed by the National Institutes of Health (NIH) Stage Model for Behavioral Intervention Development [
In addition, we used the HINTS framework [
For this cross-sectional study, Chinese immigrants with T2D were recruited from 4 community centers in Chinatown areas in NYC. Study flyers were posted in the community centers. Community leaders introduced the study at social events sponsored by the centers, and interested participants self-referred to study staff who attended the events.
To be eligible for the study, participants had to (1) self-identify as a Chinese immigrant or Chinese American, (2) be 18 years of age or older, (3) self-report that they had been diagnosed with T2D over a year ago, and (4) be currently self-managing T2D at home. This study was approved by the New York University Grossman School of Medicine Institutional Review Board. All participants provided signed informed consent. All study materials were available in English, Mandarin, and Cantonese. Surveys were administered face-to-face by bilingual study staff in the participant’s preferred language. Participants received US $20 gift cards as an incentive for completing the survey.
Age, gender, marital status, education, income, employment status, duration of residence in the United States, language spoken at home, and English proficiency were assessed.
Measures on technology use were adapted from the HINTS framework, including questions assessing access to technology, current social media use, current use of technology for health management, interest in mHealth interventions, and family or friends’ involvement and interest in mHealth interventions.
Using questions adapted from the HINTS framework, we assessed mobile device ownership (basic cell phones, smartphones, tablets, or none) and access to Wi-Fi at home (yes, no, or don’t know/not sure). For those who owned a smartphone or tablet, we also asked whether they had an unlimited text messaging plan.
Current use of social media platforms and SMS text messaging was assessed by asking participants whether they currently used WhatsApp, WeChat (a Chinese version of WhatsApp), basic text messaging, Facebook, or other social media platforms.
We assessed the extent to which participants relied on technology by asking them to identify their primary source of information for diabetes-related questions. Response options included health care providers; the internet; family, friends, or coworkers; newspapers; and do not seek help. We also asked whether they had used the internet to search for diabetes-related information in the past 12 months and whether they had used mobile phones or computers to watch a health-related video in the past 12 months.
Participants were asked whether they would be interested in participating in a future mHealth program for T2D self-management.
Given the importance of family ties in the Chinese culture [
We recruited 101 participants between April 2018 and July 2018. Data analyses were limited to 91 participants with complete data from the technology use survey. Descriptive statistics were used to examine the distribution of sociodemographic variables in addition to technology ownership and use, whether participants had accessed a health-related video, and attitudes toward mHealth interventions. Means and standard deviations were calculated for continuous variables. Frequencies and percentages were reported for categorical variables. Sample characteristics were summarized. We performed all analyses with SPSS, version 25.0 (IBM Corp).
As shown in
Sample characteristics (N=91) and access to technology, current use, and interest in mHealth interventions among older Chinese immigrants with type 2 diabetes.
Characteristic | Value | ||
Age in years, mean (SD) | 70 (11) | ||
Age >65 years, n (%) | 61 (67) | ||
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Female | 57 (63) | |
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Male | 34 (37) | |
Currently married, n (%) | 68 (75) | ||
High school education or less, n (%) | 58 (64) | ||
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≤US $25,000 | 63 (69) | |
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≥US $25,000 | 12 (13) | |
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Declined to answer or don’t know | 16 (18) | |
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Currently employed | 30 (33) | |
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Not employed, not working | 9 (10) | |
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Retired | 52 (57) | |
Foreign-born, n (%) | 91 (100) | ||
Number of years living in the United States, mean (SD) | 19 (14) | ||
Limited English proficiency | 78 (86) | ||
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Basic mobile phone | 20 (22) | |
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Smartphone | 72 (79) | |
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Tablet | 49 (54) | |
Has a mobile device (basic mobile phone or smart device) | 90 (99) | ||
Has a smart device (smartphone or tablet) | 83 (91) | ||
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65 (71) | ||
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Basic SMS text messaging via cellular carrier | 62 (68) | |
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4 (4) | ||
Has Wi-Fi installed in home, n (%) | 66 (73) | ||
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Yes | 36 (40) | |
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No | 41 (45) | |
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Don’t know | 13 (14) | |
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Did not answer | 1 (1) | |
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Health care provider | 63 (69) | |
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The internet | 13 (14) | |
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Family, friends, or coworkers | 10 (11) | |
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Newspapers | 4 (4) | |
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Do not seek help | 1 (1) | |
Has used the internet to look for information about diabetes in the past 12 months, n (%) | 21 (23) | ||
Has watched a health-related video in the past 12 months, n (%) | 34 (37) | ||
Is interested in receiving mHealth interventions for T2D, n (%) | 69 (76) | ||
Has family/friends to talk to about their T2D, n (%) | 62 (68) | ||
Family/friends interested in receiving mHealth interventions to better support participanta, n (%) | 50 (81) |
aThis question was only assessed as a follow-up item among 62 participants who reported that they had family or friends to talk to about their T2D. The percentage was calculated accordingly.
Nearly all participants had a smart mobile device, and nearly three-quarters had Wi-Fi access at home. The most commonly used social media platform was WeChat, followed by basic text messaging. Very few participants used WhatsApp, and none reported using Facebook, Twitter, or Instagram.
The majority reported that their primary source for diabetes-related information is health care clinicians, with few participants reporting their first sources of information are the internet, family, friends, or coworkers. Less than one-quarter of the sample reported using the internet to search for diabetes-related information in the past 12 months. About one-third of the sample reported that they had watched a health-related video on their cell phone or computer in the past 12 months.
Despite the fact that the majority of participants were low-income older immigrants with limited education, over three-quarters expressed interest in receiving T2D management mHealth interventions in the future. About two-thirds reported having family or friends to talk to about their T2D. Of these, a large majority agreed that family or friends would be interested in receiving mHealth interventions to learn how to best support them in their efforts to manage their T2D.
To the best of our knowledge, this is the first study that provides data on technology ownership, current use, and interest in mHealth interventions in underserved Chinese immigrants with T2D. Although the majority of study participants were older immigrants with low income and limited education, they demonstrated high mobile device ownership and familiarity with a particular social media platform (ie, WeChat). This finding is consistent with a previous study reporting high social media use among immigrant populations to connect with their families and friends in their home countries [
Despite high smart device ownership and internet access, the use of technology for health-related purposes was low in our sample. While about 70% of US adults considered the internet as their top source for health information [
The success of T2D management depends largely on the social and environmental contexts in which patients live and perform diabetes self-care [
Our findings provide valuable implications in the era of the COVID-19 pandemic. It is well-documented that COVID-19 disproportionately affects racial and ethnic minorities and immigrant communities [
There are several limitations to be acknowledged. This study involved a relatively small, convenient sample. Participants were recruited from the NYC metropolitan area, limiting generalizability to other locations. Because recruitment was accomplished through community-based organizations, the results may not be representative of all Chinese Americans receiving care through primary care or hospital settings. Participants in this study had, on average, lived in the United States for almost 20 years. These results may not be applicable to newly arrived immigrants who might be less acculturated or less familiar with western approaches for T2D management.
Several strengths should also be noted. To the best of our knowledge, this is the first study that provides data on technology use in older low-income Chinese immigrants with T2D. These data are particularly relevant during the COVID-19 pandemic. Our data on the high usage of WeChat and basic text messages and rare usage of WhatsApp suggested future researchers may consider choosing linguistically and culturally tailored platforms to engage racial and ethnic minorities. In addition, Chinese immigrants have been reported to be a hard-to-reach population for research participation [
This study is important in that it focuses on a fast-growing, yet significantly understudied immigrant population [
This study addressed a critical gap in the literature with regard to technology ownership and use of and attitudes toward mHealth in a relatively older immigrant population with T2D. While current telehealth use remained low, the high mobile device ownership and social media use and strong interest in mHealth programs suggests that mHealth may be a promising approach to deliver health education and increase access to diabetes support to this fast-growing minority group. This study also provides timely preliminary data in the era of COVID-19 as older immigrant communities are among the hardest hit populations. With the rapid shift to telemedicine strategies, it is important for health care policymakers, clinicians, community partners, and researchers to consider how to leverage existing technologies to reduce health disparities and increase access to health care in this underserved population.
hemoglobin A1c
Health Information National Trends Survey
mobile health
National Cancer Institute
National Institutes of Health
type 2 diabetes
This research is supported in part by the National Institutes of Health (Grants U54MD000538-15, K99MD012811, R00MD012811, and P30DK111022).
None declared.