[Paper Review] Impact of Culture on the Adoption of Diabetes Self-Management Applications: Cape Flats, South Africa

Fazlyn Petersen|arXiv (Cornell University)|Aug 23, 2021

Mobile Health and mHealth Applications19 references4 citations

TL;DR

This study investigates how cultural factors influence the adoption of diabetes self-management mobile applications among patients in Cape Flats, South Africa, using Hofstede’s cultural dimensions and the Theory of Planned Behavior. It finds that culture significantly shapes self-management behaviors, but has a weaker direct impact on application adoption, highlighting cultural barriers to digital health technology use in low-resource settings.

ABSTRACT

Diabetes is a global health problem with a high mortality rate. The research indicates low levels of technology use amongst diabetic patients in low socioeconomic environments and minority groups. We posit that the culture of patients is a potential reason for the low adoption and use of technology. However, research on the proliferation of culture at an individual level is limited. Therefore, this paper assessed the influence of culture on mobile application adoption and use amongst diabetic patients in the Cape Flats, South Africa. This study used key constructs from the Theory of Planned Behaviour (TPB) and Hofstede's cultural dimensions. It was analysed using survey data from 439 respondents using purposive sampling. It was found that the dimensions of Hofstede and the Theory of Planned Behaviour can identify how culture influences mobile application adoption of diabetic patients in the geographical Cape Flats area. However, this research indicates a stronger relationship between culture and diabetes self-management activities than culture and the adoption of mobile applications.

Motivation & Objective

• To examine the role of culture in shaping the adoption and use of diabetes self-management mobile applications in a low-income, culturally diverse community.
• To address the gap in research on individual-level cultural influences on digital health technology adoption among minority and low-socioeconomic groups.
• To assess how Hofstede’s cultural dimensions and the Theory of Planned Behavior jointly explain technology adoption behaviors in diabetic patients.

Proposed method

• Applied a mixed-methods survey design with 439 purposively sampled diabetic patients from Cape Flats, South Africa.
• Integrated Hofstede’s six cultural dimensions with key constructs from the Theory of Planned Behavior (TPB), including attitude, subjective norms, and perceived behavioral control.
• Used survey data to analyze relationships between cultural values and behavioral intentions toward using diabetes self-management applications.
• Employed statistical analysis to test hypotheses linking cultural dimensions and TPB constructs to application adoption and self-management behaviors.
• Focused on a real-world, low-income urban setting to ensure contextual relevance and practical insights.

Experimental results

Research questions

• RQ1 How do Hofstede’s cultural dimensions influence the intention to adopt diabetes self-management mobile applications in Cape Flats, South Africa?
• RQ2 To what extent do TPB constructs (attitude, subjective norms, perceived behavioral control) mediate the relationship between culture and mobile application adoption?
• RQ3 How does culture affect actual diabetes self-management behaviors compared to technology adoption?
• RQ4 What cultural factors act as barriers or facilitators to digital health intervention uptake in low-resource, minority communities?

Key findings

• Culture has a stronger influence on diabetes self-management behaviors than on the actual adoption of mobile applications.
• The Theory of Planned Behavior constructs—especially perceived behavioral control—were significant predictors of application adoption intentions.
• Hofstede’s cultural dimensions, particularly power distance and uncertainty avoidance, showed measurable but indirect effects on technology adoption.
• Patients in Cape Flats exhibited higher self-management engagement when cultural values aligned with health promotion norms, even if app adoption remained low.
• The study confirms that cultural context must be integrated into digital health design to improve acceptability and long-term use in marginalized communities.
• Despite high diabetes prevalence, low technology use persists in the community, suggesting cultural and structural barriers beyond individual attitudes.