Culturally and linguistically adapted digital diabetes health applications improve self-management and clinical outcomes in racialized immigrants: a systematic scoping review.
TL;DR
Results demonstrate the importance of adapting, personalizing, creating a trusted environment, and integrating human supports to ensure long-term engagement and equitable health outcomes.
Abstract
Background
Despite public health efforts, the prevalence of diabetes has quadrupled since 1990, disproportionately impacting marginalized communities including immigrants and refugees. Immigrants and refugees face access, education and management inequities as the prevalence and cost of chronic disease management escalates in host countries. Digital health applications may offer effective and equitable solutions to support self-management and empower immigrants.
Objective
This study systematically scoped published evidence on digital health applications tailored for type 2 diabetes management among racialized immigrants, addressing an important intersection of digital innovation and health equity.
Methods
Searching multiple databases (2010-March 2025), 14 primary studies and 15 reviews were identified, featuring culturally adapted, multimodal interventions with human (peer or provider) support across patient-matched languages and cultures such as Arabic, Chinese, Spanish, and Vietnamese. The 15 reviews on mainstream digital education allowed us to contextualize digital features, outcomes, and practice mediators and challenges.
Results
Primary studies found that tailored digital health interventions significantly enhanced engagement, self-efficacy, health literacy and motivation for self-management, and most clinically significantly lowered HbA1c levels (moderate-high risk of bias). Tailoring included cultural food advice, education framed around family and faith, and apps in patients' native language. In comparing digital application features and type 2 diabetes outcomes with our review of reviews results, we were able to show successful replication in racialized immigrant populations, demonstrating health equity opportunities.
Conclusion
These results demonstrate the importance of adapting, personalizing, creating a trusted environment, and integrating human supports to ensure long-term engagement and equitable health outcomes.