Introduction

Type 2 diabetes mellitus (T2DM) is a rapidly expanding global health crisis, with significant morbidity and mortality [1]. The burden of T2DM is growing disproportionately in low- and middle-income countries (LMICs) compared to high-income nations, driven by rapid urbanization, lifestyle changes, and limited healthcare access [2]. According to the International Diabetes Federation (IDF) [1], the Middle East and North Africa (MENA) region has the highest regional adult prevalence—1 in 6 adults (approximately 85 million people) currently live with diabetes—and this number is projected to nearly double, reaching 163 million by 2050. Mounted evidence has shown the detrimental consequences of T2DM microvascular (such as retinopathy, neuropathy and nephropathy), or macrovascular complications (including cardiometabolic, cerebrovascular, and peripheral vascular disease) [3] that are associated with poor quality of life and adverse financial burden on households and national health care cost and economy [4].

Reducing hemoglobin A₁c (HbA₁c) by approximately 1% has been associated with significant decreases in macrovascular and microvascular complications [5], improvements in glycemic management [6], and reductions in diabetes-related distress [7]. However, sustaining optimal glycemic control for people with T2DM is perplexing and burdensome as it requires multiple daily self-management decisions and care. Embracing “no one size fits all” paradigm, as endorsed by American Diabetes Association standards of Care (2022), diabetes education self-management needs to be culturally sensitive and delivered by qualified interprofessional team to optimize self-management and glycemic and cardiometabolic outcomes (blood pressure and lipid control [8,9].

Method

Recruitment of participants

Participants were recruited from two clinical sites in major medical center in Beirut (Private and Public). Following the approval of the Institutional Review Board (IRB), the physicians of all sites initially sought participants’ approval to be contacted by the primary investigator of the study. Following the participants’ consent to be contacted, the PI contacted candidate participants to confirm their agreement to participate in the study and to arrange a convenient appointment. Co-PI secured the participants’ written consent through their signatures before the interview. All face-to-face interviews were conducted in a quiet environment to ensure privacy and smooth interviewing process.

Sample description.

The sample consisted of six females and three males; age ranged between 52 years and 77 years with a mean age of 62 years. Participants experience with T2DM ranged between five and eleven years (Table 1.)

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Table 1. Demographic characteristics of participants (N = 9).

https://doi.org/10.1371/journal.pone.0343711.t001

Setting.

All interviews took place in a private room at a convenient place for the participant.

Findings

Four themes that illuminate the participants’ viewpoints on this new approach for diabetic care were identified. It is worth noting that these themes represent the first substantiated approach to using an mHealth for follow-up on diabetic care in Lebanon. All participants stated clearly that mHealth will not replace physicians’ visits, but it could be used as a complementary approach for follow-up. Moreover, it is worth noting that none of the participants expressed skepticism towards using mHealth.

1. 1). Transformative approach to care: feeling safe and secure

All participants expressed a feeling of safety and security when providing feedback about the use of mHealth. They described the mHealth as a new approach to care that would give them a sense of security and safety. They all mentioned that this new approach will make them feel supported by the healthcare team and that they will not be left on their own, which gives them a sense of reassurance.

Dani, a 77-year-old participant with 11 years of diabetes, said: “I like the feeling that my health team is interested in me and they are following up with me…. This shows that we still have morals… if there is no politics in it, I am very ok…”

Jimmy a 65 years old participant with also 11 years of diabetes also mentioned,” For me, this approach is perfect and I feel contented and happy because a health team will follow me up….. I feel safe and I am well followed up…..I feel secure

Indeed, feeling secure was closely tied to feeling surrounded. The participants explained that mHealth would make them feel heard and attended to their needs in a timely fashion. As such, they would not feel left out in managing their diabetes regime alone.

Biggs a 52 years participant with more than 11 years of diabetes said:”…. It feels fantastic to know that professional people are ready to listen to you according to your needs. This feeling empowers me as I think that professionals surround me…. This technology will help me to feel connected wherever I travel ….”

Selwa a 57 years participant with 11 years with diabetes mentioned “ … this approach is excellent and it will help for easy follow-up. I always have questions, but I do not call my physician every time because I do not want to bother him, but now with this approach, I can pose all my questions…”.

1. 2). One Approach does not fit all

Two aspects surfaced under this theme: usability and individualization. Regarding usability, all participants welcomed the use of mHealth, particularly short video calls. They perceived it as an easy and practical tool to expand their knowledge on diabetes self-management. However, all participants’ views consolidated around individualization of use in terms of content and delivery process. In this regard, each participant had a different concern and request regarding language, time of call, and materials to be shared. Some prefer to be called in the morning; others in the afternoon, and some in the evening. They also stressed on receiving relevant information that addresses to their diabetes regime rather than broad knowledge.

Batoul a 52 years old participant with 7 years with diabetes said “I do not mind if I share with a group my concerns…. I wish to have information about the appropriate food that I need to take … I like to listen to others’ concerns because I would learn from them….”

However, Alida a 67 years old participant with 12 years of diabetes emphasized privacy “….I do not like to share the call with other patients. I do not want anyone to know about my condition and the type of questions I ask. Privacy is important to me; information needs to be tailored to my needs and not general. I prefer individualized information between the health team and me only….”.

1. 3). Addressing psychological well-being

Participants mentioned the negative psychological toll of being a patient with diabetes. They all hoped that this mHealth approach would also tackle this aspect of care that they think is neglected. In addition, participants verbalized the fear messages that they receive from health care practitioners and emphasized the need for positive tone and framing of the delivered information on diabetes self-management.

Gigi a 69 years old participant with 13 years of diabetes said:“….there should be among the team psychologists because diabetes has an impact on the psychology … the psychologist plays an important role. It is neglected in the care….”

Maria a 52 years old participant with 6 years of diabetes said “…. the psychological support is essential for the patient with diabetes. The way we communicate with the patient is meaningful. Positive communication is a must….”

“In psychological follow-up, you don’t want someone to call and talk with you and listen—you just want things like phrases and quotes… they help a bit.”

1. 4). Time & financial gains:

All participants verbalized the convenience of the utilization of mHealth, which saves mainly time and money spent on resources and physicians’ visitation fees. Some mentioned that their care does not get interrupted during travel. They also acknowledged that mHealth fits the purpose of technology in terms of convenient outreach. The participants highlighted the current economic crisis and the affordability of medical care and perceived that mHealth can help save costs.

Dani a 77 years old participant with 14 years of diabetes said:”… it saves the cost of commuting, traffic, and energy … and it will decrease the need for visiting the doctor….”

Jimmy a 65 years ola participant with 13 years of diabetes said:”… I do not mind paying minimal fees for the service, it would still be cheaper than visiting the physician, particularly in our current economic situation…”

It is worth noting that despite highlighting that mHealth would decrease their care cost, all participants mentioned that mHealth will not replace the physician’s visits but might decrease the frequency.

Discussion

In this study, we investigated the acceptability of using mHealth as a supportive tool for diabetes self-management among Lebanese adults with Type 2 Diabetes Mellitus (T2DM). The findings demonstrate a positive reception to mHealth among participants, with emphasis on its ability to offer psychosocial support, enhance disease self-management, and address logistical barriers such as cost and accessibility. This approach aligns with the results of a study by Drake af Hagelsrum and colleagues [40], which highlights the importance of understanding users’ perceptions of mHealth services when developing person-centered digital interventions. These findings are significant in the Lebanese context, where ongoing economic instability and strain on the healthcare system call for innovative, scalable, and patient-centered solutions.

Participants strongly associated mHealth with a sense of safety, security, and continuous support with healthcare providers. This sense of being “connected and not alone” aligns with previous research, which shows that mHealth can enhance patients’ perception of being monitored and cared for, thereby improving treatment adherence, sense of control, and empowerment in decision-making [13,41]. Consistent with previous literature [40], mHealth was viewed as a means to bridge the continuity of care gap between clinic visits which is a critical element in chronic disease care. As chronic diseases mandate daily management, having the appealing feature of mHealth to serve as a “constant companion”—especially during stressful times like travel, crisis, or health deterioration—was valued by participants. The findings compare to a study conducted by McCurdie and colleagues [42] on the role of mHealth as a “care companion” that bridges gaps in time, geography, and emotional access. Similarly, Lyles and colleagues [43] found that such tools contribute to a sense of “being watched over,” especially in low-income settings where routine in-person follow-up is often disrupted.

The use of mHealth is further valued due to its cultural congruence. In the MENA context, where collectivism and interpersonal connectedness are core values, the concept of “being followed up” resonates deeply. One participant in the current study noted that “this shows that we still have morals”—a powerful expression of how health interventions are judged not only by their utility, but also by their perceived humanity and ethical alignment. For Lebanese participants in this study, this sense of being monitored by a competent care team was particularly valued given their fragmented and under-resourced healthcare status quo [27,28].

Participants consistently emphasized the need for individualized and culturally sensitive content. While all found mHealth usable, preferences varied widely regarding the mode (e.g., video vs. text), timing (morning vs. evening), group vs. individual interaction, and content focus (diet, exercise, emotional support). Lauffenburger et al. [44] and Hagelsrum and colleagues [40], in two qualitative studies conducted in the US and Sweden, respectively, emphasized the importance of tailoring mHealth interventions according to individuals’ needs and requests. The results of this study highlight the importance of treating every individual as a unique being with specific needs and requests. Indeed, a systematic review of technology-enabled Diabetes Self-Management Education, conducted by Greenwood and colleagues [13], reinforced those interventions were most effective when they included individualized feedback, tailored education, and bidirectional communication—three features that enhance not only glycemic outcomes but also psychosocial well-being and user satisfaction. Our study contributes to this evidence by revealing that, in an LMIC context such as Lebanon, personalization also addresses privacy concerns, language nuances, and time constraints.

The psychological impact of T2DM was highlighted as a neglected yet critical component of care. Participants called for the inclusion of psychological well-being support within mHealth content, particularly emphasizing the need for positive communication, unlike the conventional fear-based communication. The mHealth content and interactions should convey positive messages to patients and encourage them to approach their diabetes more positively [45]. Sending positive quotes every morning was verbalized as one strategy that alleviates the psychological burden. In comparison, the findings from Lauffenburger and colleagues [44] emphasized the importance of positive communication as a means of contacting patients. This approach is considered a pivotal point in the process of mHealth adoption and acceptance. The use of uplifting messages and access to professional psychological support through mobile platforms could foster a more holistic and humane approach to diabetes care. Incorporating psychological well-being and healthy coping as mandated by the American Diabetes Association [46] standards of care, even if using a mHealth venue, is foundational for achieving positive health behaviors. For populations facing political instability and socioeconomic hardship, such as in Lebanon, this dual focus on physical and psychological well-being is particularly essential to mitigate the burden of diabetes self-management.

Participants acknowledged the financial and logistical burdens associated with frequent clinic visits, especially amid Lebanon’s economic collapse. mHealth was perceived as a time-saving and cost-effective alternative that allows continuity of care regardless of geographic or financial limitations. This is consistent with Hearn and colleagues [20] and Kruse and colleagues (2019) [19], who found that mHealth interventions were not only clinically effective but also financially advantageous in LMICs. Participants in this study were also open to paying a small fee for mHealth services, viewing them as more affordable than conventional physician visits. This insight highlights the potential sustainability of mHealth models that blend minimal patient fees with continuous medical support.

In the Lebanese context, where the World Bank [27] has documented a dramatic increase in poverty, out-of-pocket health spending, and a mass migration of healthcare professional and Lebanese citizens, participants’ feedback reflects mHealth’s potential to offset systemic inefficiencies and address equity gaps. For instance, some participants in the study noted that mobile follow-up would enable them to continue their care regimen while traveling or during times of political unrest, thereby further enhancing the resilience and continuity of their treatment. Furthermore, participants viewed the ability of mHealth to reduce indirect costs, such as emotional strain, transportation, and waiting time. These savings have been shown to be especially valuable to patients with chronic diseases, who require lifelong monitoring and regular counseling that would eventually improve self-efficacy, adherence, and reduced hospitalizations, emergency visits, and complications [47]. Notably, this theme illustrates that mHealth could serve as a resilience mechanism for strained health systems by reducing clinical load and offering remote support. As Lebanon continues to face healthcare workforce shortages and resource constraints, integrating mHealth may offer a scalable, efficient adjunct to traditional care models. In view of the stability feelings that the idea of mhealth provides to patients with diabetes in Lebanon, it would be beneficial to integrate this approach in the care provided by the public and private sector mainly in Primary Health care centers that provide care to the less privileged population.

A key strength of this study lies in its qualitative descriptive design, which allowed in-depth exploration of patients’ nuanced perceptions, rooted in personal experience. The use of maximum variation sampling ensured diversity across sociodemographic and clinical characteristics, increasing the transferability of findings which is an important goal of this type of qualitative study.

Further, this study assessed acceptability rather than actual use. Future research should include pilot testing and evaluating real-world usability and outcomes.

Conclusion

This study provides compelling evidence that mHealth is highly acceptable among Lebanese adults with T2DM and potentially other non-communicable diseases as well and offers significant potential to enhance diabetes care in LMICs. Participants embraced mHealth as a complementary tool that enhances communication, supports psychological well-being, and reduces financial barriers. mHealth represents not only a technological innovation, but also a person-centered approach to diabetes care, especially in settings where healthcare infrastructure is under significant strain. Notably, the study highlights that culturally responsive, contextually grounded mHealth interventions can be effectively integrated even in resource-constrained environments. The study recommends a scalable, adaptable framework that can be replicated and adapted to diverse cultural and healthcare contexts beyond Lebanon. Moreover, it adds to the limited yet growing body of evidence from the Middle East and similar LMICs, offering insights that can inform global efforts to reduce diabetes-related disparities. Importantly, in LMICs where patients may differ widely in digital literacy, education level, and access to technology, personalization also acts as an equity-enhancing strategy. mHealth platforms, when used by health professionals and persons with diabetes as described, could accommodate rather than exacerbate disparities, providing tailored support to those who may otherwise be marginalized in a conventional medical model.