Co-designing a digital type 2 diabetes risk communication tool using participatory action research in Singapore (Preprint)

Abstract

BACKGROUND Diabetes is a serious public health concern worldwide. Despite public health efforts encouraging early screening and improving knowledge of effective interventions for those at increased risk of T2D, the incorporation of preventative behaviours into an individual’s daily life remains sub-optimal. Solutions tailored for the local population to communicate individual’s T2D risk can motivate lifestyle changes. Successfully and accurately increasing risk perception has demonstrated to increase behavioural intention. OBJECTIVE The study objectives are to (i) identify key characteristics that contribute to an effective risk communication tool, and (ii) test and iterate to develop culturally sensitive and meaningful risk communication tool that can motivate T2D preventative behaviours. METHODS Using various participatory action research methods like ideation workshops and “Patient and Public Involvement (PPI) Hawkers” where we approached patrons at a public space frequented by all local residents, to evaluate and test three prototypes for the tool. The three prototypes were: (i) “Diabetes Onset” – estimated age of diabetes onset of T2D based on one’s risk factors, (ii) “Relative Risk” – the relative risk of T2D is presented in a 1-10 scale indicating where one’s risk score lie in relation to others, and (iii) “Metabolic Age” – the median age of the risk category based on one’s risk factors, presented to be compared against their chronological age. We gathered reactions and feedback through rapid testing and iteration to understand which risk result presentation would be received the best. At the end, all the data collected was revisited and analysed using an inductive thematic analysis to identify the key characteristics that contributed to an effective risk communication tool. RESULTS The overall findings of the key characteristics that were important to participants emerged in 4 main themes: (i) Appeal and user experience, in terms of format and readability (ii) Trust and validity, of the institution providing the tool and the accuracy of the risk result (iii) Threat Appraisal: Salience of risk information, that influenced their risk perception and (iv) Coping Appraisal: Facilitators for behaviour change, which impacted their intention for implementing T2D preventative behaviours. The prototype entitled “Diabetes Onset” was poorly received and removed after the first iteration. The Relative Risk prototype was valued for being straightforward but feared to be boring. The Metabolic Age prototype was anticipated to be more motivating for behaviour change, but there were some concerns that the terminology may not be understood by everyone. CONCLUSIONS Participants were divided on which of the two prototypes, ‘Metabolic Age’ or ‘Relative Risk’, they would favour adopting. Further testing is now required to determine which prototype will yield to be more effective in motivating behaviour change. Insights on the design process and valued characteristics of a risk communication tool from this study will inform future development of such interventions.