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. 2021 Aug 13;11(8):1585-1595.
doi: 10.1093/tbm/ibab058.

Using the behavior change wheel to develop text messages to promote diet and physical activity adherence following a diabetes prevention program

Megan M MacPherson  1 , Kaela D Cranston  1 , Sean R Locke  2 , Jessica E Bourne  3 , Mary E Jung  1
Affiliations

Using the behavior change wheel to develop text messages to promote diet and physical activity adherence following a diabetes prevention program

Megan M MacPherson et al. Transl Behav Med. .

Abstract

Improving diet and physical activity (PA) can reduce the risk of developing type 2 diabetes (T2D); however, long-term diet and PA adherence is poor. To impact population-level T2D risk, scalable interventions facilitating behavior change adherence are needed. Text messaging interventions supplementing behavior change interventions can positively influence health behaviors including diet and PA. The Behavior Change Wheel (BCW) provides structure to intervention design and has been used extensively in health behavior change interventions. Describe the development process of a bank of text messages targeting dietary and PA adherence following a diabetes prevention program using the BCW. The BCW was used to select the target behavior, barriers and facilitators to engaging in the behavior, and associated behavior change techniques (BCTs). Messages were written to map onto BCTs and were subsequently coded for BCT fidelity. The target behaviors were adherence to diet and PA recommendations. A total of 16 barriers/facilitators and 28 BCTs were selected for inclusion in the messages. One hundred and twenty-four messages were written based on selected BCTs. Following the fidelity check a total of 43 unique BCTs were present in the final bank of messages. This study demonstrates the application of the BCW to guide the development of a bank of text messages for individuals with prediabetes. Results underscore the potential utility of having independent coders for an unbiased expert evaluation of what active components are in use. Future research is needed to demonstrate the feasibility and effectiveness of resulting bank of messages.

Keywords: Diet; Exercise; Health behavior; Health promotion; Healthy lifestyle; Prediabetic state; Text messaging.

Plain language summary

Making changes to one’s physical activity and diet can reduce future risk of developing type 2 diabetes. That being said, making life-long changes to complex behaviors such as diet or physical activity is easier said than done. Text messages can be used to improve long-term diet and physical activity changes; however, it can be difficult to identify what should be said in a text message to nudge those behaviors. To improve utility and reduce cost of sending unnecessary messages, theory should be used in developing text messaging content. The current study used the Behavior Change Wheel to develop a library of text messages that can be used to improve diet and physical activity in individuals who have taken part in an effective community-based diabetes prevention program. The Behavior Change Wheel guides researchers to develop real-world interventions based on evidence and theory. Overall, we created a library of 124 theory-based messages which can be further tested following a diabetes prevention program.

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Figures

None
Graphical abstract
Fig 1 |
Fig 1 |
The Behavior Change Wheel. Reproduced with permission from Michie S, Atkins L, West R. (2014) The Behavior Change Wheel: A Guide to Designing Interventions. London: Silverback Publishing. www.behaviorchangewheel.com.
Fig 2 |
Fig 2 |
Diagram of BCTs identified in the literature and screened for inclusion.
Fig 3 |
Fig 3 |
Final bank of messages coded by a blind reviewer for BCTs and discrepancies from original codes.
See this image and copyright information in PMC

References

    1. Anja B, Laura R. The cost of diabetes in Canada over 10 years: applying attributable health care costs to a diabetes incidence prediction model. Health Promot Chronic Dis Prev Can Res Policy Pract. 2017;37:49. - PMC - PubMed
    1. Tunceli K, Bradley CJ, Nerenz D, Williams LK, Pladevall M, Elston Lafata J. The impact of diabetes on employment and work productivity. Diabetes Care. 2005;28(11):2662–2667. - PubMed
    1. Knowler WC, Barrett-Connor E, Fowler SE, et al. ; Diabetes Prevention Program Research Group . Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403. - PMC - PubMed
    1. Li G, Zhang P, Wang J, et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet. 2008;371(9626):1783–1789. - PubMed
    1. Lindström J, Louheranta A, Mannelin M, et al. ; Finnish Diabetes Prevention Study Group . The Finnish Diabetes Prevention Study (DPS): lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care. 2003;26(12):3230–3236. - PubMed

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