# Developing a Culturally Adapted Digital Health Application for Older Hispanic Adults With Type 2 Diabetes: Protocol for a Qualitative and Pilot Study

## TL;DR

This study aims to create a culturally adapted digital health app to improve medication adherence and health literacy in older Hispanic adults with type 2 diabetes.

## Contribution

The novelty lies in developing and testing a modernized, culturally tailored digital health app integrated with pharmacist-delivered care for this population.

## Key findings

- The app will be tested for usability and acceptability with older Hispanic adults and pharmacists.
- Expected improvements in medication adherence, hemoglobin A1c, and fasting glucose levels are predicted.
- Successful results could lead to broader use of the app for other chronic diseases and populations.

## Abstract

Over 40% of Hispanic individuals have below basic health literacy levels, significantly impacting their ability to manage chronic conditions such as type 2 diabetes (T2D). Chronic disease self-management, essential for improving adherence, is often hindered by modifiable factors such as health literacy. Ambulatory care clinical (ACC) pharmacists, through comprehensive medication management (CMM), play a critical role in addressing these barriers; however, current methods for delivering CMM vary significantly, limiting effectiveness. Digital technology may offer significant potential for improving medication adherence, particularly among Hispanic individuals who use smartphones to seek health information.

This study aims to revise, develop, and pilot test a culturally adapted, individually tailored digital health app designed to enhance health literacy and medication adherence among older Hispanic adults with T2D by integrating interactive educational modules into pharmacist-delivered CMM.

Our team previously developed a prototype computer-delivered, culturally adapted intervention targeting health literacy and adherence among older Hispanic individuals. The proposed project involves transforming this intervention into a modernized digital health app. We will achieve 2 specific aims. The first aim is to refine and modernize previously developed content into an interactive digital health app suitable for older Hispanic adults with T2D and ACC pharmacists. A total of 20 patients and 10 ACC pharmacists will review and provide feedback on the app modules. Usability and acceptability will be measured using validated tools, including the System Usability Scale, Adjectival Ease of Use Scale, and the technology acceptance model. The second aim is to conduct a pilot test with 40 Hispanic adults (aged ≥50 years) diagnosed with T2D. Participants will be recruited from a local Federally Qualified Health Center where ACC pharmacists manage diabetes care. Patients will complete a baseline CMM session, interact with the app modules, and return for 1 or 2 CMM follow-up visits. We will assess medication adherence, hemoglobin A1c, and fasting glucose levels as primary outcomes.

The digital app has been modernized and completed for acceptability and usability testing. We will begin testing the hypothesis that the app will have above-average usability and acceptability (System Usability Scale: mean score ≥71 and Adjectival Ease of Use Scale: mean score ≥5), with an overall goal that the digital app will be acceptable (via the technology acceptance model) by ≥90% of the patient participants and ACC pharmacists. In addition, anticipated health outcomes for aim 2 include improvements in medication adherence (>80%), hemoglobin A1c (≥0.75% reduction), and fasting glucose (≥25% reduction) from baseline.

When the study is completed, it is expected that the culturally adapted digital health app will be acceptable and usable among both patients and pharmacists. Successful results will enable wider dissemination of the refined app and establish a framework adaptable to other chronic diseases, diverse languages, cultures, and health care settings.