Designing Mobile Phone Text Messages Using the Behavior Change Wheel Framework to Influence Food Literacy in Adults With Type 2 Diabetes in Kenya: Protocol for a Systematic Development Study (Preprint)

Abstract

BACKGROUND The global prevalence of type 2 diabetes has risen alarmingly in the past decade in sub-Saharan Africa. At the same time, mobile phone use has increased in Africa, providing a potential for innovative mobile health (mHealth) interventions to support diabetes care. OBJECTIVE This study aimed to apply the Behaviour Change Wheel (BCW) to design and develop a mHealth intervention to optimize glycaemic control in adults with type 2 diabetes in urban Kenya METHODS The three stages of the BCW that include understanding the behaviour identifying the intervention options and identifying content and implementations options guided the development of this mHealth intervention. Recent preparatory studies from low- and middle-income countries (LMICs) provided information that was used to contextualize the three stages of intervention development. RESULTS Stage 1 revealed unhealthy eating patterns, characterized by low intake of fruits and vegetables and larger portion sizes of carbohydrates, as the key behaviour problem. In stage 2, target options to optimize glycaemic control were identified and related to food literacy components, including nutrition information, food selection, meal preparation and eating. In stage 3, text messages were selected as the delivery mode. A total of 36 mobile text messages were developed based on nine behaviour change techniques. CONCLUSIONS We developed a mHealth guided by the step-by-step BCW framework while using evidence from the target population. We, therefore, created contextualized intervention components and applied behaviour change techniques that were used to design mobile text messages to optimize glycaemic control for adults with type 2 diabetes in LMICs. The effectiveness of this intervention will be tested in a proof-of-concept study in the target population