Digitally Supported Lifestyle Intervention to Prevent Type 2 Diabetes Through Healthy Habits: Secondary Analysis of Long-Term User Engagement Trajectories in a Randomized Controlled Trial

Abstract

Background Digital health interventions may offer a scalable way to prevent type 2 diabetes (T2D) with minimal burden on health care systems by providing early support for healthy behaviors among adults at increased risk for T2D. However, ensuring continued engagement with digital solutions is a challenge impacting the expected effectiveness. Objective We aimed to investigate the longitudinal usage patterns of a digital healthy habit formation intervention, BitHabit, and the associations with changes in T2D risk factors. Methods This is a secondary analysis of the StopDia (Stop Diabetes) study, an unblinded parallel 1-year randomized controlled trial evaluating the effectiveness of the BitHabit app alone or together with face-to-face group coaching in comparison with routine care in Finland in 2017-2019 among community-dwelling adults (aged 18 to 74 years) at an increased risk of T2D. We used longitudinal data on usage from 1926 participants randomized to the digital intervention arms. Latent class growth models were applied to identify user engagement trajectories with the app during the study. Predictors for trajectory membership were examined with multinomial logistic regression models. Analysis of covariance was used to investigate the association between trajectories and 12-month changes in T2D risk factors. Results More than half (1022/1926, 53.1%) of the participants continued to use the app throughout the 12-month intervention. The following 4 user engagement trajectories were identified: terminated usage (904/1926, 46.9%), weekly usage (731/1926, 38.0%), twice weekly usage (208/1926, 10.8%), and daily usage (83/1926, 4.3%). Active app use during the first month, higher net promoter score after the first 1 to 2 months of use, older age, and better quality of diet at baseline increased the odds of belonging to the continued usage trajectories. Compared with other trajectories, daily usage was associated with a higher increase in diet quality and a more pronounced decrease in BMI and waist circumference at 12 months. Conclusions Distinct long-term usage trajectories of the BitHabit app were identified, and individual predictors for belonging to different trajectory groups were found. These findings highlight the need for being able to identify individuals likely to disengage from interventions early on, and could be used to inform the development of future adaptive interventions. Trial Registration ClinicalTrials.gov NCT03156478; https://clinicaltrials.gov/ct2/show/NCT03156478 International Registered Report Identifier (IRRID) RR2-10.1186/s12889-019-6574-y

Remotely Conducted App-Based Intervention for Cardiovascular Disease and Diabetes Risk Awareness and Prevention: Single-Group Feasibility Trial

“…About half of those who signed up found the messages helpful [ 33 ]. As opposed to our study findings, Lavikainen et al [ 34 ] found in their app-based study for T2DM prevention that older people were more likely to engage with the app [ 34 ]. The authors reported that only those who intensely interacted with the app achieved noteworthy changes in lifestyle-related risk factors.…”

“…The authors reported that only those who intensely interacted with the app achieved noteworthy changes in lifestyle-related risk factors. These active users were more likely to have already had a better diet, higher levels of physical activity, and lower stress levels at baseline [ 34 ]. Leung et al [ 35 ], in their study of an app-based intervention for T2DM risk, showed that app users who received a high risk of developing T2DM significantly improved their daily vegetable intake and physical activity over 2 years but not their smoking behavior or alcohol consumption.…”

Engagement with a nationally-implemented digital behaviour change intervention: Usage patterns over the 9-month duration of the National Health Service Digital Diabetes Prevention Programme

“…Engagement with the NHS-DDPP in the present study follows a similar usage pattern seen in trials of digital diabetes prevention programmes, including patterns of attrition ( Harjumaa et al, 2020 ; Lavikainen et al, 2022 ) and the extent and duration of which users engage with different intervention features ( Block et al, 2015 ). Drawing direct comparisons with previous interventions studied in trials are somewhat problematic due to differences in intervention dosage.…”

“…Randomised controlled trials have assessed user engagement of digital behaviour change interventions to prevent T2DM over six ( Block et al, 2015 ; Harjumaa et al, 2020 ) and 12 months ( Lavikainen et al, 2022 ; Moin et al, 2018 ; Painter et al, 2020 ; Toro-Ramos et al, 2020 ; Sepah et al, 2017 ). Crucially, programme engagement was linked with reductions in fasting glucose and HbA1c ( Block et al, 2015 ), increased physical activity ( Batten et al, 2022 ), higher increase in diet quality ( Lavikainen et al, 2022 ) and decreased BMI or weight loss ( Lavikainen et al, 2022 ; Moin et al, 2018 ; Toro-Ramos et al, 2020 ; Sepah et al, 2017 ; Batten et al, 2022 ). One study analysed usage data from a digital programme designed to support self-management of T2DM, which was integrated into routine care in four Clinical Commissioning Groups in London, UK ( Poduval et al, 2018 ).…”

Efficacy of a New Low-Protein Multimedia Diet App for PKU

“…No existing UK apps provide information on food suitability for PKU, and none have been validated by a healthcare organisation or certified by a recognised body. However, studies in other health and medical conditions have demonstrated that apps can improve adherence compared with traditional interventions, such as written educational information [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ].…”