Digital divide in diabetes care: qualitative insights from the DIG-EQUITY study, India

Digital health technologies have the potential to improve health outcomes in underserved settings. However, in low and middle-income countries with weak public health systems, unequal access to digital tools can worsen existing healthcare disparities. The DIG-EQUITY study explored the facilitators and barriers to equitable use of mobile and telehealth solutions for diabetes care in India, incorporating perspectives from people with diabetes, their family members (caregivers), healthcare providers, policymakers, and community organisations. A qualitative design was employed across urban (Chennai) and rural (Chunampet) settings in Tamil Nadu, following the 32-item COREQ checklist. A total of 54 participants (including type 1 diabetes (T1DM), type 2 diabetes (T2DM), and gestational diabetes mellitus (GDM)) were included in four focus group discussions (FGDs) and 12 key informant interviews (KIIs). Participants were purposively sampled to ensure diversity in demographics and healthcare exposure. The analysis was guided by the Social Ecological Model (SEM), which informed the structuring and interpretation of themes across domains. The different domains of the SEM influenced the utilisation of digital health. Individual factors such as age, digital literacy, and diabetes type shaped preferences. Interpersonal support from caregivers enabled access, particularly for older adults and children. Organisational and community influences included urban–rural infrastructure gaps, socioeconomic constraints, and shared device ownership. Policy-level concerns regarding data privacy, security, and app reliability affected trust and continued engagement. Socioeconomic status, sex, and geographic location influenced access and adoption of digital solutions. Bridging the divide through targeted digital literacy initiatives and inclusive strategies is essential to ensure equitable and effective use of digital health solutions for diabetes care in India. The trial was registered with Central Trials Registry of India (CTRI/2022/04/041941).