{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T20:18:30Z","timestamp":1786133910847,"version":"build-2736575974"},"reference-count":104,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Diabetes"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Despite advancements in digital health coaching (DHC) for type 2 diabetes self-management, a persistent digital divide limits access among underserved populations, necessitating low-tech, telephone-based alternatives.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This formative qualitative study explored the lived experiences of type 2 diabetes mellitus (T2DM) self-management challenges among adults in Alabama and elicited preferences for telephone-based DHC to inform intervention optimization.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This study was part of a larger National Institutes of Health clinical trial (5R01DK129378) that examined the feasibility and needs of a telephone-based DHC intervention for self-management of T2DM. The study employed a qualitative, phenomenological approach to assess patients\u2019 needs surrounding digital coaching. Twelve patients diagnosed with T2DM were recruited between August and December 2022. Data collection involved in-depth, semistructured interviews conducted via telephone calls or secure Zoom sessions. All interviews were audio-recorded, professionally transcribed, and verified for accuracy. Two independent coders analyzed the data using NVivo software version 14 Plus.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Two themes emerged: (1) multifaceted barriers to diabetes self-management spanning behavioral (dietary adherence and nutritional gaps), physical\/environmental (mobility limitations and weather constraints), and structural domains (medication shortages, insurance coverage limiting continuous glucose monitoring); (2) expectations for telephone-based DHC, including targeted education (meal planning, exercise adaptations, and medication effects), health coaches as accountability partners, daily reminders and check-ins via texts\/calls, and incentives as extrinsic motivators to adherence. Insights from the study directly shaped the intervention components of a pilot feasibility trial (NCT05344859).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Key challenges in day-to-day T2DM management included diet, physical activity, medication unavailability, and lack of insurance coverage for continuous glucose monitors. Expectations for a potential telephone-based DHC intervention included targeted education on diet, exercise, and medication effects; perceptions of health coaches as accountability partners; reminders via texts\/calls as beneficial; and monetary incentives as extrinsic motivators for adherence to the intervention.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/81441","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T10:50:22Z","timestamp":1783075822000},"page":"e81441-e81441","source":"Crossref","is-referenced-by-count":0,"title":["Bridging the Digital Divide in Diabetes Care With an AI-Powered Health Coaching Intervention: Qualitative Formative Study"],"prefix":"10.2196","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5224-2261","authenticated-orcid":false,"given":"Tejossy","family":"John","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8567-9571","authenticated-orcid":false,"given":"Sangeetha","family":"Mohanraj","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9823-0127","authenticated-orcid":false,"given":"Tanjila","family":"Nawshin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2016-2344","authenticated-orcid":false,"given":"Tapan","family":"Mehta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9768-3829","authenticated-orcid":false,"given":"Mohanraj","family":"Thirumalai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"R1","unstructured":"National diabetes statistics report. 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