The Role of Community Health Workers in Improving Diabetes Device Use Among Youth With Type 1 Diabetes: A Web-Based Qualitative Study Using Human-Centered Design With Clinicians

Background: Inequity in diabetes technology use persists among Black and Hispanic youth with type 1 diabetes (T1D). Community health workers (CHWs) can address social and clinical barriers to diabetes device use. However, more information is needed on clinicians’ perceptions to inform the development of a CHW model for youth with T1D. Objective: This study aimed to identify barriers to diabetes technology use and cocreate solutions in collaboration with diabetes and school-based clinicians serving Black and Hispanic youth with T1D. Methods: Using human-centered design, the study team conducted 2-hour web-based workshops with clinicians from a diabetes clinic or school-based clinics at a safety net hospital in the Bronx, New York. The workshops promoted active ideation of barriers and co-design of a CHW intervention prototype to address self-reported challenges. Workshops were analyzed using a qualitative inductive approach. Results: A total of 17 participants completed the human-centered design workshops and surveys. Of these, 11 (65%) were clinicians from the diabetes clinic and 6 (35%) were school-based clinicians from elementary, middle, and high schools in the Bronx. A total of 4 workshops were conducted. The perceived diabetes device barriers for youth with T1D and their families by participants were general health-related social needs (HRSNs) and diabetes technology–specific HRSNs that interfered with technology uptake, such as housing and financial insecurity, as well as digital social needs; and difficulty navigating health care systems, insurance, and pharmacy benefits due to the high level of care coordination required by caregivers. In addition, the participants identified barriers that interfered with their ability to support youth with T1D with diabetes technology, such as limited support for using diabetes technology in school and lack of time and technology support to troubleshoot problems in diabetes clinics. Ways in which a CHW could help mitigate these barriers include (1) identifying and addressing HRSNs by directing patients to appropriate resources; (2) providing peer support for caregivers to navigate diabetes device logistics; (3) acting as a school liaison to improve communication and coordination between caregivers, schools, and diabetes clinicians; and (4) offering administrative support to offload the logistical burden of clinicians. Conclusions: Important needs related to specialized technology support, enhanced care coordination, family-clinician communication, and administrative task shifting were identified by clinicians to inform a CHW model for youth with T1D. Continued co-design and pilot testing are needed to refine the model.