Impact of digital health for adolescents with type 1 diabetes mellitus on health literacy

BACKGROUND: Adolescents with type 1 diabetes (T1DM) require high health literacy (HL) to prevent complications. However, little is known about the association between distal technologies (DT) use and HL, and the role of healthcare institutions in supporting DT remains unclear. METHODS: We conducted a systematic review (SR) following PRISMA guidelines to investigate the impact of DT on HL in adolescents with T1DM. Relevant studies published from 2011 to 2021 were identified through literature searches. We also conducted an exploratory study with medical doctors (n = 12) and adolescents with T1DM (n = 20) in Germany based on the SR. Interview data was analyzed using coding techniques to identify differences and similarities. RESULTS: Out of 981 studies, 22 were included. Findings suggest that social media interactions between healthcare providers and patients can improve HL, aligning with the ‘communication and interactions’ dimension of health literacy. In the exploratory study, medical doctors and adolescents with T1DM reported underutilization of DT due to resource and legal constraints, and a lack of structural conditions for the transition to adult healthcare. Peer support and trustworthy interactions with healthcare professionals were identified as factors that enhanced HL and patient empowerment. CONCLUSIONS: Further investigation is needed to determine the most effective social media platform for enhancing HL among adolescents, considering communication, interaction, and peer relationships as important factors. Promoting the use of DT and improving HL may require capacity building through patient-centered and participatory approaches. The findings of this study provide valuable insights for informing practice, research, and policy recommendations. KEY MESSAGES: • Distal technologies, have the potential to improve HL among adolescents with T1DM, but further investigation is needed to identify effective platforms for enhancing HL. • This study's findings highlight underutilization of distal technologies among adolescents with T1DM due to resource and legal constraints.