Promoting nonexercise physical activity in type 2 diabetics: perceived behaviour change needs and implementation of mHealth intervention (Preprint)

Abstract

BACKGROUND Physical activity (PA) has an important role in the prevention and treatment of type 2 diabetes (T2D). Interventions with mobile-based technology (mHealth) seem promising in PA promotion but their behavioural foundation is often vague, and the implementation is seldom reported. OBJECTIVE This paper examines perceived behaviour change needs and implementation of mHealth approach in increasing nonexercise PA in T2 diabetics. METHODS A three-arm mHealth intervention was conducted in primary care to promote daily walking and other nonexercise PA in T2 diabetics. Information on perceived behaviour change needs was collected with a modified COM-B questionnaire before the intervention from a separate sample of T2 diabetics (n=25) and at the intervention baseline (n=116). Implementation evaluation focused on the fidelity and acceptability of the main arm of the mHealth intervention (n=39). The 6-month intervention included 24-hour accelerometer-use, smartphone application providing cloud-computed personal feedback on accelerometer-measured PA, PA leaflet, YouTube video on walking, and individual counseling with three face-to-face sessions and four telephone contacts. Data on fidelity was accumulated during the intervention through participant-specific counseling cards and cloud computing. Data on acceptability was collected with a questionnaire in the end of the intervention. Data were mostly analyzed descriptively. RESULTS The responses of theT2 diabetics pointed out three items in capability and two items in motivation, which stood out as perceived behaviour change needs. Moreover, the main intervention arm showed good fidelity and acceptability although some challenges were also experienced especially in cloud-computed feedback and accelerometer-application use. CONCLUSIONS The findings on behaviour change needs call for additional research since no comparable studies were found. Also, the explanatory value of COM-B model and psychometric properties of COM-B questionnaire in T2 diabetics' nonexercise PA deserve further attention. Based on the findings on fidelity and acceptability the main intervention arm seems applicable to clinical practice. However, the challenges discovered underscore the importance of pre-testing technology-based approaches in interventions promoting PA in T2D population. CLINICALTRIAL ClinicalTrials.gov NCT04587414