Using telemedicine to support care for people with type 2 diabetes mellitus: a qualitative analysis of patients’ perspectives
Open accessAbstract
Objective: Telemedicine has been promoted as an economical and effective way to enhance patient care, but its acceptance among patients in low-income and middle-income countries is poorly understood. This study is aimed to explore the experiences and perspectives of people with type 2 diabetes mellitus that used telemedicine to manage their condition. Design: In-depth and focus group interviews were conducted with participants who have engaged in telemedicine. Questions included were participants’ perception on the programme being used, satisfaction as well as engagement with the telemedicine programme. All interviews and focus groups were audio-recorded and transcribed verbatim. Data were analysed using a thematic approach. Participants and setting: People with type 2 diabetes (n=48) who participated in a randomised controlled study which examined the use of telemedicine for diabetes management were recruited from 11 primary care clinics located within the Klang Valley. Results: Twelve focus groups and two in-depth interviews were conducted. Four themes emerged from the analysis: (1) generational difference; (2) independence and convenience, (3) sharing of health data and privacy and (4) concerns and challenges. The main obstacles found in patients using the telemedicine systems were related to internet connectivity and difficulties experienced with system interface. Cost was also another significant concern raised by participants. Participants in this study were primarily positive about the benefits of telemedicine, including its ability to provide real-time data and disease monitoring and the reduction in clinic visits. Conclusion: Despite the potential benefits of telemedicine in the long-term care of diabetes, there are several perceived barriers that may limit the effectiveness of this technology. As such, collaboration between educators, healthcare providers, telecommunication service providers and patients are required to stimulate the adoption and the use of telemedicine. NCT0246680.
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The technology acceptability and feasibility theme arose in six studies and comprised three sub-themes: convenience and acceptability, technology feasibility, and barriers of rural areas.
“This theme arose in six studies [19, 22–25, 27] and comprise the following sub-themes: (1) Convenience & Acceptability; (2) Technology feasibility; and (3) Barriers of rural areas.”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [24]
Participants in one study were concerned about poor internet connectivity in certain villages, suggesting that technology feasibility may depend on available digital infrastructure, limiting its usability.
“However, participants in one study [24] were concerned about poor internet connectivity in certain villages, suggesting the results regarding technology feasibility may be dependent on the available digital infrastructure, thereby limiting its usability.”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [24]
Three studies suggested that the barrier of device difficulty could be better managed with improved education and support.
“Three studies [24, 25, 27] however, suggested this barrier could be better managed with improved education and support.”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [24]
Some patients and HCPs expressed concerns over data confidentiality.
“Some patients and HCPs expressed concerns over data confidentiality. [22, 24, 25]”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [24]
Older participants typically found telemonitoring devices more difficult to use than younger patients.
“Older participants typically found telemonitoring devices more difficult to use than younger patients. [24]”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [24]
Patients commonly reported enjoying not having to attend surgery so often while being more regularly monitored.
“Patients commonly reported enjoying not having to attend surgery so often whilst being more regularly monitored. [23, 24]”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [24]
The importance of education regarding device usage was highlighted in three studies, though this is likely dependent on the specific devices used.
“Whilst this is likely to be dependent on specific devices used, the importance of education regarding device usage was highlighted in three studies. [24, 25, 27]”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [24]
Concerns about the telemonitoring intervention were commonly reported across two sub-themes: privacy and security of personal data, and generational differences.
“Concerns about the telemonitoring intervention were commonly reported [19, 22, 24, 25] across two sub-themes: (1) Privacy and security of personal data; and (2) Generational differences.”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [24]
One older patient contradicted views that older patients cannot use devices, suggesting that improved device education and training is likely to directly correlate with telemonitoring take-up.
“Nonetheless, one older patient contradicted these views, explaining that “as long as someone shows me… I can do it.”, [24] suggesting that improvement to device education and training is likely to directly correlate with telemonitoring take-up.”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [24]
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“positive experience with the program [63].”
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Digital tools and self-administered home blood tests: A convergent mixed methods pilot study
Hebib, L., Hedov, E. G., Storgärds, M., af Geijerstam, P., Löf, M., Wu, J. H. Y., Kastbom, L., & Rådholm, K. (2025) · Digital Health · doi:10.1177/20552076251365063 · Cited by 2 · see citing works
“24,28 To facilitate participation, we used BankID , a widely adopted digital identi fi cation method in Sweden, accessible to 92% of the population and 98.7% of citizens aged 18 – 75.”
InfluentialPutri, S. I., Supriyono, N. D., Fajriah, A. S., & Akbar, P. S. (2025) · Majalah Kesehatan Indonesia · doi:10.47679/makein.2025261 · Cited by 2 · see citing works
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“Such challenges are not unique to CKD and similarly affect the management of other long-term conditions [30], including diabetes [31] and chronic obstructive pulmonary disease [32], and musculoskeletal conditions [33].”
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Telemedicine and multichronic comorbidities in the days of COVID-19
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Cipolla, M., Capello, F., & Gaddi, A. V. (2020) · Mediterranean Journal of Nutrition and Metabolism · doi:10.3233/mnm-200408
“…Lee et al, underlines how – although some barriers may still limit the use of this technology – the participants to the study “were primarily positive about the benefits of telemedicine, including its ability to provide real-time data and disease monitoring and the reduction in clinic visits” [17].”
Mobile Application for Malaysian Diabetes Dietary Monitoring System (My-DDMS)
Din, M. M., Ali, N. R., Tajuddin, T. B., Dawam, S. R. M., & Mansor, S. (2021) · IEEE International Conference on Recent Advances and Innovations in Engineering (ICRAIE) · doi:10.1109/icraie52900.2021.9704006 · Cited by 1 · see citing works
“Indeed, a systematic review of 21 articles that evaluated mobile health apps for diabetes management reported that 76% of studies have shown improved clinical outcomes after the use of the mobile apps [6][7][8].”
BackgroundKnowledge Comparison amongst Telehealth Service Utilized and Unutilized Adults in BangladeshPreprint
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“19 A study in South Memphis, USA, documented that smartphone apps may be a feasible, low-cost resource for patients with limited access to traditional healthcare.”
Digital Health Technology and Advanced Analytics in Lifestyle Medicine
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Mobile Technology Adoption in Healthcare—A Behavioral Understanding of Chronic Patients’ Perspective
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Self-citation
- Authors
- Lee, J. Y., Chan, C. K. Y., Chua, S. S., Paraidathathu, T., Lee, K. K.-C., Tan, C. S. S., Nasir, N., & Lee, S. W. H.
- Affiliations
- Monash University Malaysia (MY)
- La Trobe University (AU)
- Taylor's University (MY)
- HELP International Corporation (Malaysia) (MY)
- Ministry of Health (MY)
- Corresponding author
- Lee, Shaun Wen Huey
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2019-10
- Volume
- 9
- Issue
- 10
- Pages
- e026575
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC6830613
- OpenAlex
- W2981325486
- Semantic Scholar
- 10906950805435c20984c7b64729adc0426b3410
- Cited by
- 60
- References
- 40
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 14 · 2023: 10 · 2022: 7 · 2021: 11 · 2020: 6 · 2019: 1
- FWCI
- 5.75
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- Monash University Research Portal (Monash University) (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Kementerian Sains, Teknologi dan Inovasi (03-02-10-SF0238)
- SEGi University (SEGi/2013/SKK/04/1)
- Monash University (52140757-314-00)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- telemedicine, type 2 diabetes, patient perspectives, diabetes self-management, patient satisfaction, telehealth adoption barriers, internet access, health data privacy, generational differences, cost concerns, primary care, low- and middle-income countries
- MeSH terms
- Internet Access, Age Factors, Attitude to Computers, Confidentiality, Costs and Cost Analysis, Diabetes Mellitus, Type 2, Female, Humans, Interviews as Topic, Malaysia, Male, Middle Aged, Self Care, Computer Security, Focus Groups, Telemedicine, Personal Autonomy, Information Dissemination
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