Managing diabetes across borders and screens: mHealth use among older late-life South Asian migrants in the United States

OBJECTIVES: This study explores how older South Asian migrants in the United States navigate mobile health (mHealth) tools for type 2 diabetes self-management. The goal is to identify multilevel facilitators and barriers to digital engagement within culturally and structurally embedded contexts. METHODS: We conducted a qualitative descriptive study using semi-structured interviews with 21 South Asian adults aged 55 and older who had migrated to the U.S. later in life and had recent experience using a diabetes management app. Thematic analysis was guided by the Social-Ecological Model (SEM) and the Consolidated Criteria for Reporting Qualitative Research (COREQ). RESULTS: Participants' engagement with mHealth tools was shaped by personal confidence, emotional response, and adaptive strategies at the individual level; family and peer dynamics at the interpersonal level; lack of provider support and culturally misaligned features at the organizational level; culturally rooted norms and informal peer networks at the community level; and broader systemic exclusions related to language access, insurance coverage, and technology infrastructure at the policy level. While participants demonstrated motivation and resilience, emotional fatigue, app complexity, and cultural mismatches often limited sustained use. CONCLUSIONS: Older South Asian migrants are not disinterested in digital health; rather, they are systemically excluded. For mHealth to meaningfully support diabetes self-management, tools and systems must be designed with linguistic access, cultural alignment, and policy-level support in mind. Findings underscore the need for culturally tailored, relationally supported, and digitally inclusive interventions that affirm the everyday realities of aging immigrant populations.