This study was conducted in the Region of North Jutland, Denmark, and was a part of a telemonitoring feasibility trial. The trial protocol has been published elsewhere [27].

This qualitative study used a hermeneutic phenomenological approach to explore participants’ lived experiences and perceptions of intervention acceptability. This theoretical framework was chosen due to its capacity to support an in-depth, interpretive understanding of how individuals make sense of their experiences within the specific context of telemonitoring [28] and informed both data collection and the analytical process.

Two telemonitoring intervention designs were evaluated, with the aim of identifying the most suitable design for a forthcoming large-scale randomized controlled trial. These 2 designs, based on essential components of effective T2D management [29-35], were tested over a 3-month period (Figure 1). Participants from groups 1 and 2 measured self-monitoring blood glucose (SMBG; Contour Next One), sleep, and mental health. Group 1 additionally monitored blood pressure (BP; A&D UA-651BLE) and step counts (Beurer AS97).

Participants with non–insulin-dependent T2D were recruited through general practices in 4 municipalities in the Region of North Jutland, Denmark, as part of the telemonitoring feasibility trial. In the Danish health care system, general practitioners serve as patients’ primary point of contact and act as gatekeepers to specialized care. The participating general practices identified and referred eligible patients during routine diabetes-related consultations. Adults aged 18 years or older with poorly controlled T2D (HbA_1c >58 mmol/mol), diagnosed for at least 12 months, who could read and understand Danish and were willing to use a smartphone were eligible for participation. Prior to the intervention start, participants received an introductory consultation with their assigned municipal HCP, including an intervention overview and device training. All municipality HCPs had a nursing background with a key focus on diabetes management in a municipality health care setting.

Participants followed a structured monitoring plan. During the first 6 weeks, they measured on 2 weekdays per week and submitted data to HCPs via the tablet. The remaining 6 weeks were tailored with HCPs, typically involving 2 to 3 measurement days per week. Biweekly scheduled consultations with HCPs supported data review of self-monitored data and diabetes management discussions. Participants could log dietary intake on measurement days to further support these conversations.

Participants were asked to follow a blood sampling schedule with HbA_1c measurements prior to the intervention, after the 3-month monitoring period, and again at 6 and 12 months post initiation. Furthermore, four questionnaires were completed prior to and at the end of the intervention: the World Health Organization Five Well-being Index, the Problem Areas in Diabetes Questionnaire, the Short Form 12 Questionnaire, and the Patient Activation Measure questionnaire, comprising 35 questions in total.

Participants who completed the telemonitoring trial were eligible for interview and were recruited continuously by one author (IEG) from May 2024 to January 2025. At trial completion, HCPs asked participants if they were interested in an interview; those who agreed had their contact details forwarded to IEG, who then contacted them by phone.

One author (IEG) conducted all interviews. IEG has a background in physiotherapy and holds a master’s degree in clinical science and technology. At the time of the study, IEG was employed as a research assistant working within the field of diabetes and telemonitoring. IEG had prior experience in the qualitative research field, particularly with semistructured interviews. There was no personal relationship between IEG and the participants.

The data were collected through semistructured interviews. The interview guide was developed by the authors IEG and SH, and was based on the medical technology assessment model [36], focusing on 3 domains: technology, patient, and organizational aspects. Within each domain, open-ended and follow-up questions were formulated to explore participants’ experiences with and acceptance of the 2 designs. A pilot test of the interview guide with one coauthor, SHL, who was not involved in its development, led to minor wording and sequencing adjustments before finalization.

Interviews were conducted once, either in the participant’s home or at their respective health center, with only the participant and interviewer present. Interviews lasted between 28 and 44 minutes. A Dictaphone was used to record and transcribe verbatim using Microsoft Word. Audio recordings and transcripts were stored on a protected server at Aalborg University. Transcripts were pseudonymized, and participants were referred to as “Id 1,” “Id 2,” and so forth. To enhance accuracy and credibility, participant validation was performed, allowing them to review and comment on their transcripts. The final transcripts were subsequently uploaded to NVivo 15 (version 15.1.1; Lumivero) for analysis.

Data analysis followed the 6-phase reflexive thematic approach outlined by Braun and Clarke [37,38]: (1) familiarization with the data, (2) generating initial codes, (3) searching for themes, (4) reviewing themes, (5) defining and naming themes, and (6) producing the final report [37]. IEG transcribed the interviews, after which IEG, SHL, and SH read them repeatedly for familiarization. They independently generated initial codes. These codes were discussed to reach a shared agreement on how to apply them consistently across the dataset. Agreed-upon codes were organized by the same 3 authors into potential candidate themes and subthemes and afterward reviewed and refined to ensure they accurately reflected the data. Finally, themes were further refined, named, and finalized for reporting.

The telemonitoring feasibility trial was approved by the North Denmark Region Committee on Health Research Ethics (ID: N-20230026). The approved protocol included the assessment of participants’ experiences and the acceptability of the telemonitoring intervention designs as study outcomes. Participants received written information and were informed of their right to a 24-hour reflection period before consenting to participate. All participants provided both written and verbal informed consent to participate in the study, to be audio-recorded, and to allow the use of their data for research purposes. All data were pseudonymized as described in the Data Collection section or presented in aggregated form only to prevent identification of individual participants, thereby ensuring privacy and confidentiality. Participants did not receive any compensation for their participation.

A total of 12 participants were invited to participate in an interview, all of whom accepted. Participants had a mean age of 63.8 (SD 9.6) years and a mean diabetes duration of 8.2 (SD 6.5) years. Two participants were female, and all participants were of Danish origin. Five participants had primary school or high school as their highest level of education, while the remaining participants had completed vocational education or higher education. Five participants belonged to group 1, while 7 belonged to group 2.

Four themes emerged from the analysis. Each theme included 2 to 3 subthemes (Figure 2). A detailed overview of the themes, subthemes, and associated codes is available in Multimedia Appendix 1.

This theme focuses on participants’ experiences with the structure and flow of the intervention, including procedures, monitoring, and training.

This theme examines how communication with HCPs influences participants’ experience, highlighting the role of support and trust in fostering motivation and acceptability.

This theme highlights how the intervention enhanced participants’ insight into diet, activity, and blood glucose, motivating healthier choices and supporting self-management.

This study explored experiences and perceptions regarding the acceptability of 2 different telemonitoring interventions and associated trial procedures among people with non–insulin-dependent T2D. SMBG, physical activity, and dietary logging were highly valued, while BP, sleep, and mental health monitoring were perceived as less relevant. Gaining access to personal data, combined with HCP consultations, provided valuable insights and enhanced perceived self-management competencies.

Prior research has demonstrated that the quality of sleep and mental health status are associated with glycemic control and are therefore relevant factors to monitor and address in diabetes management [30,31,39,40]. Surprisingly, participants in this study perceived these data as difficult to relate to diabetes, as they found it difficult to interpret the results or see their relevance for diabetes management. This highlights the importance of collecting data in telemonitoring that is meaningful and understandable to users. Previous research shows that perceived usefulness and ease of interpretation strongly influence sustained health monitoring [41,42]. This suggests that telemonitoring interventions must consider not only clinical validity but also users’ subjective experience of relevance [41,42]. Furthermore, if mental health or sleep-related measures are to be included in future telemonitoring interventions, considerations regarding how these data are presented and how frequently they are collected may be important to enhance perceived relevance and usability.

Participants greatly valued the supportive role of HCPs. This is consistent with previous research showing that people with T2D regard empathy, inclusion, clear communication, and personalized guidance as essential for maintaining motivation and engagement in self-management [43,44]. Preserving and strengthening this supportive role should therefore be a central consideration in future telemonitoring trials.

Access to their own health data such as blood glucose levels enhanced participants’ understanding of diabetes and motivated them to make lifestyle adjustments. This perceived empowerment aligns with previous research highlighting that telemonitoring interventions promote lifestyle modifications and an increased sense of disease ownership among people with chronic conditions such as diabetes [45]. In similar studies, participants valued the increased visibility of their blood glucose fluctuations and used the data to inform their decisions related to diet and physical activity, helping them maintain glycemic control [46,47].

Participants described SMBG as uncomfortable, time-consuming, and difficult to integrate into daily life. This experience is consistent with the findings of Ong et al [48], who identified pain from finger pricks, inconvenience of the procedure, and the need to carry devices as key barriers to SMBG. Several participants in this study wished to replace SMBG with CGM, not only to overcome the aforementioned challenges but also due to the advantage of continuous and easily accessible glucose data. Previous research has demonstrated that CGM significantly reduces HbA_1c compared to SMBG in people with T2D [49,50]. Moreover, CGM use in people with T2D enhances self-care behaviors, strengthens self-efficacy, and improves diabetes-related knowledge [51]. Thus, integrating CGM into future telemonitoring interventions may increase feasibility and acceptability.

A limitation of this study is that only participants who completed the telemonitoring feasibility trial were invited to participate in the interviews. Consequently, perspectives from those who withdrew from the telemonitoring intervention were not captured. The findings may overrepresent positive experiences and higher acceptability of the intervention, potentially overlooking critical feedback. This limits the transferability of the findings to a broader population of people with T2D. Future research would benefit from actively including participants in qualitative evaluations who withdrew from the telemonitoring intervention to provide a more nuanced understanding of experiences and acceptability.

An additional limitation of this study is the relatively small sample size (n=12), which may limit the transferability of the findings beyond the specific study context. However, it can be assumed that data saturation was achieved, as no substantially new perspectives emerged during the later interviews, suggesting that the key themes were sufficiently explored [52]. However, caution is warranted, as a small sample may not fully capture the diversity of experiences among individuals with T2D, particularly across different contexts.

The qualitative design constitutes a strength of this study, as it enables an in-depth exploration of participants’ lived experience and an assessment of the acceptability of the telemonitoring intervention designs. The hermeneutic phenomenological approach was therefore considered to be well suited to capture the nuanced insights [37,53]. However, this approach also entails an interpretive analytical process, which may introduce subjectivity and potential researcher bias, as the findings are shaped through the researchers’ preunderstandings [53]. To enhance analytical rigor, the analysis was guided by a structured analytical method and involved ongoing discussions among multiple authors throughout the analytical process [37]. However, qualitative data analysis remains inherently interpretive, and alternative interpretations of the data are possible. The findings should therefore be understood within the context of this analytical framework and with consideration of the limited generalizability inherent to qualitative research.

In conclusion, 12 people with T2D who completed the feasibility trial were overall satisfied with telemonitoring, mainly due to structured measurement combined with biweekly consultations with HCPs. Blood glucose, physical activity, and diet monitoring were perceived as particularly relevant, whereas BP, sleep, and mental health were considered less useful. Tailoring interventions to user-perceived relevance, providing clear feedback, and integrating CGM may enhance motivation and adherence in future telemonitoring interventions.