Challenges of Ethnographic Research on Continuous Glucose Monitoring
A recent ethnographic project on Continuous Glucose Monitoring use among Type 1 Diabetes Patients in the US and Germany made use reflect on the following project management issues:
Recruitment and Selection Barriers
Finding representative participants for ethnographic research on continuous glucose monitoring (CGM) devices presented significant challenges in a recent study in US and Germany. In the US, the fragmented healthcare system creates access disparities, making it difficult to recruit across socioeconomic boundaries. Many lower-income patients lack access to advanced CGM technologies, potentially biasing research toward more affluent participants. In Germany, despite universal healthcare, we found recruitment often requires navigating multiple clinical gatekeepers and regional health authorities, extending timelines and adding administrative complexity.
Cultural Differences in Health Technology Perception
American and German patients approach health technology differently, complicating comparative analysis. US patients often view CGMs through a consumer technology lens, focusing on features and convenience. German patients typically prioritize precision, reliability, and data privacy, reflecting broader cultural attitudes toward healthcare and technology. These differences influence how patients interact with devices and their willingness to share experiences, requiring researchers to adapt their methodological approaches for each context.
Data Privacy and Regulatory Compliance
Germany's strict data protection laws under GDPR created additional hurdles for collecting observational data about CGM use in natural settings. Requirements around explicit consent for each data collection point posed a challenge for ethnographic work. The US presents different challenges with HIPAA compliance and varied state-level privacy regulations, particularly when research crosses insurance and provider boundaries.
Technology Ecosystem Variations
The surrounding technology ecosystem significantly impacts CGM usage patterns. US patients typically use a wider range of connected apps and digital platforms to manage their diabetes, while German users often rely more heavily on their primary healthcare provider's recommended systems. We had to account for these different ecosystems when analysing how patients integrate CGMs into their daily diabetes management routines.
Longitudinal Engagement Challenges
Maintaining consistent participation proved a challenge both countries. In the US, high patient mobility and insurance changes caused challenges. German participants may exhibit greater stability but often show more reluctance toward continuous remote monitoring aspects of research, particularly when it involves sharing data outside their immediate healthcare environment.
