Participatory development of an mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED)

Abstract

Background: The escalating global prevalence of type 2 diabetes and prediabetes presents a major public health challenge. Physical activity plays a critical role in managing (pre)diabetes; however, adherence to physical activity recommendations remains low. The ENERGISED trial was designed to address these challenges by integrating mHealth tools into the routine practice of general practitioners, aiming for a significant, scalable impact in (pre)diabetes patient care through increased physical activity and reduced sedentary behaviour.

Methods: The mHealth intervention for the ENERGISED trial was developed according to the mHealth development and evaluation framework, which includes the active participation of (pre)diabetes patients. This iterative process encompasses four sequential phases: (a) conceptualisation to identify key aspects of the intervention; (b) formative research including two focus groups with (pre)diabetes patients (n = 14) to tailor the intervention to the needs and preferences of the target population; (c) pre-testing using think-aloud patient interviews (n = 7) to optimise the intervention components; and (d) piloting (n = 10) to refine the intervention to its final form.

Results: The final intervention comprises six types of text messages, each embodying different behaviour change techniques. Some of the messages, such as those providing interim reviews of the patients' weekly step goal or feedback on their weekly performance, are delivered at fixed times of the week. Others are triggered just in time by specific physical behaviour events as detected by the Fitbit activity tracker: for example, prompts to increase walking pace are triggered after 5 min of continuous walking; and prompts to interrupt sitting following 30 min of uninterrupted sitting. For patients without a smartphone or reliable internet connection, the intervention is adapted to ensure inclusivity. Patients receive on average three to six messages per week for 12 months. During the first six months, the text messaging is supplemented with monthly phone counselling to enable personalisation of the intervention, assistance with technical issues, and enhancement of adherence.

Conclusions: The participatory development of the ENERGISED mHealth intervention, incorporating just-in-time prompts, has the potential to significantly enhance the capacity of general practitioners for personalised behavioural counselling on physical activity in (pre)diabetes patients, with implications for broader applications in primary care.

Keywords: Behaviour change techniques; Fitbit; Just-in-time adaptive intervention (JITAI); Participatory development; Phone counselling; Primary care; Self-regulation theory; Text messages; Walking; Wearables.

Fig. 1

A sample of the weekly report of a patient’s Fitbit syncing pattern. The vertical green lines represent individual Fitbit syncs. The compact green area signifies regular syncing (approx. every 15 min). The hatched area marks time periods from 4 to 8 pm when just-in-time Stand Up text messages are triggered. This specific patient would be classified as Group B: irregular syncing, mostly in the afternoon and during weekends, probably only when connected to the Wi-Fi at home. Despite the irregular sync, the patient would likely receive several just-in-time Stand Up messages per week (assuming she spent 30 min sitting), but hardly any just-in-time Walk Faster messages. Hence, her classification as Group B, which receives adapted Walk Faster messages independent of Fitbit data