Digital health for rural diabetes care: Implementation experience from China and India

Table 3 Key lessons from digital health tools applied for diabetes in rural China and India

Theme	Key lessons	Supporting evidence and examples
Health system context alignment	Digital interventions must align with existing healthcare structures and governance systems	SimCard tailored implementation to different health system contexts in China and India[9]; ROADMAP adapted to China's hierarchical healthcare system[8]
Targeting high-need populations	Digital interventions show greater effectiveness in populations with poorer baseline control and in remote areas	ROADMAP showed stronger effects for patients with baseline HbA1c > 8%[8]; Chunampet project demonstrated substantial HbA1c reduction in remote populations in India[31]; SMARTDiabetes was more effective in rural than urban areas in China[12]
Leveraging existing social structures	Family and community support structures are particularly effective in rural settings	Family Health Promoters assisting patients with self-management and use of the SMARTDiabetes app were associated with improved diabetes control in China[12]; Kerala Diabetes Prevention Program utilized trained peer leaders effectively in India[37]
Support task-sharing	Digital tools enable task-sharing among health professionals to reduce physician’s high workload	Dedicated digital platforms were developed for volunteer community health workers and licensed physicians who shared healthcare tasks in rural India in the SimCard trial[9]; India’s I-TREC model redistributed workflow from physicians to nurses, enabling nurses to conduct initial assessments[32]
Co-creation and stakeholder engagement	Co-creation enhances intervention acceptability, feasibility, and implementation potential	Jindal et al[32] developed I-TREC through multiple stakeholder advisory boards and formal partnerships with government agencies; Yin et al[33] systematically identified implementation barriers through stakeholder interviews before designing interventions in rural China