Adaptation of an mHealth Solution for the Nutritional Management of Diabetes in a Low- and Middle-Income Country: Pre-Post Mixed Methods Pilot Study

Background: Carbohydrate counting (CC) is vital for individuals living with type 1 diabetes mellitus (T1DM); yet, formal training is often lacking in many contexts. To bridge this gap, the parents of a person living with diabetes and a team at the Geneva University Hospital (HUG) developed WebDia, a free-access app that helps patients with T1DM assess meal carbohydrates and make informed decisions regarding insulin dosage. In the context of Peru, where dietary patterns and meal compositions may differ, customizing WebDia to suit the components of the Peruvian diet becomes particularly relevant. Objective: This study aimed to customize WebDia according to the composition of the Peruvian diet to facilitate CC, and to provide training to health care workers (HCWs), children and adolescents living with T1DM, and their caregivers in the proficient use of WebDia-Mundi (new version of the Swiss app WebDia adapted to other geographic contexts). Methods: A dietitian compiled a database of Peruvian foods and their carbohydrate content. This was reviewed by a Swiss nurse specialized in diabetes, a Peruvian pediatric endocrinologist, and 2 researchers. Validation was conducted with a small group of children and adolescents living with T1DM and their caregivers. Subsequently, a 3-day workshop was held in 3 Peruvian regions for HCW and children and adolescents living with T1DM. The first 2 days were a training course for HCW to gain knowledge in T1DM and learn CC skills. This was followed by a 1-day workshop involving HCW, children and adolescents living with T1DM, and their caregivers. At the end of the workshop and 3 months later, an evaluation was performed to assess the app’s usability, glycated hemoglobin, quality of life, and knowledge perception for children and adolescents living with T1DM and their caregivers. Furthermore, changes in knowledge among HCWs and overall workshop satisfaction were measured. Results: WebDia-Mundi was customized for the Peruvian context in 2022-2023. The training was attended by 25 HCWs, 25 children and adolescents living with T1DM, and 31 caregivers. Following the training, HCWs exhibited a significant 3.5-point increase in their knowledge of T1DM, while achieving positive results regarding the usability of WebDia-Mundi. Children and adolescents living with T1DM and their caregivers also reported a favorable perception of the ease of use and functionality of WebDia-Mundi, which enhanced their CC skills. Conclusions: This study underscores the importance of collaboration among multidisciplinary teams and the involvement of individuals with T1DM. Adapting mobile health solutions to new contexts and sharing experiences can help standardize this process.