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Open Access 01-12-2021 | Diabetes Prevention | Research article

A digital lifestyle behaviour change intervention for the prevention of type 2 diabetes: a qualitative study exploring intuitive engagement with real-time glucose and physical activity feedback

Authors: Maxine E. Whelan, Francesca Denton, Claire L. A. Bourne, Andrew P. Kingsnorth, Lauren B. Sherar, Mark W. Orme, Dale W. Esliger

Published in: BMC Public Health | Issue 1/2021

Abstract

Background

Mobile health technologies have advanced to now allow monitoring of the acute physiological responses to lifestyle behaviours. Our aim was to explore how people engaged with real-time feedback on their physical activity and glucose levels over several weeks.

Methods

Semi-structured interviews with 26 participants (61.5% female, 56.6 years) at moderate-to-high risk of developing type 2 diabetes were conducted. Interviews were completed after participants took part in an intervention comprising a flash glucose monitor (Freestyle Libre) and a physical activity monitor (Fitbit Charge 2). Purposive sampling ensured representation of ages, genders and group allocations.

Results

Inductive thematic analysis revealed how individuals intuitively used, interpreted and acted on feedback from wearable technologies. Six key themes emerged: triggers of engagement with the technologies, links between behaviour and health, lack of confidence, changes to movement behaviours, changes to diet and barriers to lifestyle behaviour change.

Conclusions

Our findings demonstrate that accessing behavioural and physiological feedback can increase self-awareness of how lifestyle impacts short-term health. Some participants noticed a link between the feedback presented by the two devices and changed their behaviour but many did not. Training and educational support, as well as efforts to optimize how feedback is presented to users, are needed to sustain engagement and behaviour change. Extensions of this work to involve people with diabetes are also warranted to explore whether behavioural and physiological feedback in parallel can encourage better diabetes self-management.

Trial registration

ISRCTN Registry, ISRCTN17545949, 12/05/2017, prospectively registered.

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Chatterjee S, Khunti K, Davies MJ. Type 2 diabetes. Lancet. 2017. https://doi.org/10.1016/S0140-6736(17)30058-2.

J. Tuomilehto, J. Lindström, J. Eriksson.- … E. J. of, and U. 2001, “Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance,” Mass Med Soc, 2002;344(18):1343–1350.

J. Lindstrom, P. Ilanne-Parikka, M. Peltonen, and S. A. Lancet, “Finnish Diabetes Prevention Study G. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes,” 2006.

Li G, 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 (London, England). 2008;371(9626):1783–9. https://doi.org/10.1016/S0140-6736(08)60766-7.CrossRef

Barron E, Clark R, Hewings R, Smith J, Valabhji J. Progress of the healthier you: NHS diabetes prevention Programme: referrals, uptake and participant characteristics: Diabet Med; 2018. https://doi.org/10.1111/dme.13562.

Penn L, et al. NHS Diabetes Prevention Programme in England: Formative evaluation of the programme in early phase implementation. BMJ Open. 2018;8(2). https://doi.org/10.1136/bmjopen-2017-019467.

Meskó B, Drobni Z, Bényei É, Gergely B, Győrffy Z. Digital health is a cultural transformation of traditional healthcare. mHealth. 2017;3:38. https://doi.org/10.21037/mhealth.2017.08.07.CrossRefPubMedPubMedCentral

Michie S, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46(1):81–95. https://doi.org/10.1007/s12160-013-9486-6.CrossRefPubMed

Dombrowski SU, Sniehotta FF, Avenell A, Johnston M, Maclennan G, Araújo-Soares V. Identifying active ingredients in complex behavioural interventions for obese adults with obesity-related co-morbidities or additional risk factors for co-morbidities: a systematic review. Taylor Fr. 2010;6(1):7–32. https://doi.org/10.1080/17437199.2010.513298.CrossRef

10.

S. Michie, C. Abraham, C. Whittington, J. Mcateer, and S. Gupta, “IDENTIFYING EFFECTIVE TECHNIQUES Effective techniques in healthy eating and physical activity interventions: A meta-regression.” Accessed 06 Oct 2020. Available: https://psycnet.apa.org/record/2009-20990-006.

11.

Mamykina L, Smaldone AM, Bakken SR. Adopting the sensemaking perspective for chronic disease self-management. J Biomed Inform. 2015;56:406–17. https://doi.org/10.1016/j.jbi.2015.06.006.CrossRefPubMedPubMedCentral

12.

O’Donoghue T, Rabin M. The economics of immediate gratification. J Behav Decis Mak. 2000;13(2):233–50. https://doi.org/10.1002/(SICI)1099-0771(200004/06)13:2<233::AID-BDM325>3.0.CO;2-U.CrossRef

13.

Weber BJ, Chapman GB. Playing for peanuts: why is risk seeking more common for low-stakes gambles? Organ Behav Hum Decis Process. 2005;97(1):31–46. https://doi.org/10.1016/j.obhdp.2005.03.001.CrossRef

14.

Nelson LA, Coston TD, Cherrington AL, Osborn CY. Patterns of User Engagement with Mobile- and Web-Delivered Self-Care Interventions for Adults with T2DM: A Review of the Literature. Curr Diab Rep. 2016;16(7):1–20. https://doi.org/10.1007/s11892-016-0755-1 Current Medicine Group LLC 1.CrossRef

15.

Kumar S, et al. Mobile health technology evaluation: the mHealth evidence workshop. Am J Prev Med. 2013;45(2):228–36. https://doi.org/10.1016/j.amepre.2013.03.017.CrossRefPubMedPubMedCentral

16.

O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245–51. https://doi.org/10.1097/ACM.0000000000000388.CrossRefPubMed

17.

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Heal Care. 2007;19(6):349–57. https://doi.org/10.1093/intqhc/mzm042.CrossRef

18.

Whelan ME, Kingsnorth AP, Orme MW, Sherar LB, Esliger DW. Sensing interstitial glucose to nudge active lifestyles (SIGNAL): feasibility of combining novel self-monitoring technologies for persuasive behaviour change. BMJ Open. 2017;7(10):e018282. https://doi.org/10.1136/bmjopen-2017-018282.CrossRefPubMedPubMedCentral

19.

Gray LJ, et al. The Leicester risk assessment score for detecting undiagnosed type 2 diabetes and impaired glucose regulation for use in a multiethnic UK setting. Diabet Med. 2010;27(8):887–95. https://doi.org/10.1111/j.1464-5491.2010.03037.x.CrossRefPubMed

20.

Bonde D. Qualitative interviews: when enough is enough; 2013.

21.

Ruckenstein M. Visualized and interacted life: personal analytics and engagements with data doubles. Societies. 2014;4(1):68–84. https://doi.org/10.3390/soc4010068.CrossRef

22.

Mathew R, Gucciardi E, De Melo M, Barata P. Self-management experiences among men and women with type 2 diabetes mellitus: A qualitative analysis. BMC Fam Pract. 2012;13. https://doi.org/10.1186/1471-2296-13-122.

23.

Malpass A, Andrews R, Turner KM. Patients with type 2 diabetes experiences of making multiple lifestyle changes: a qualitative study. Patient Educ Couns. 2009;74(2):258–63. https://doi.org/10.1016/j.pec.2008.08.018.CrossRefPubMed

24.

Evans JMM, Mackison D, Swanson V, Donnan PT, Emslie-Smith A, Lawton J. Self-monitoring among non-insulin treated patients with type 2 diabetes mellitus: patients’ behavioural responses to readings and associations with glycaemic control. Diabetes Res Clin Pract. 2013;100(2):235–42. https://doi.org/10.1016/j.diabres.2013.03.005.CrossRefPubMed

25.

Jones MI, et al. Patients’ experiences of self-monitoring blood pressure and self-titration of medication: the TASMINH2 trial qualitative study. Br J Gen Pract. 2012;62(595):e135–42. https://doi.org/10.3399/bjgp12X625201.CrossRefPubMed

26.

Hallberg I, Ranerup A, Kjellgren K. Supporting the self-management of hypertension: patients’ experiences of using a mobile phone-based system. J Hum Hypertens. 2016;30(2):141–6. https://doi.org/10.1038/jhh.2015.37.CrossRefPubMed

27.

Morton K, et al. Using digital interventions for self-management of chronic physical health conditions: a meta-ethnography review of published studies. Patient Educ Couns. 2017;100(4):616–35. https://doi.org/10.1016/j.pec.2016.10.019.CrossRefPubMed

28.

Ong WM, Chua SS, Ng CJ. Barriers and facilitators to self-monitoring of blood glucose in people with type 2 diabetes using insulin: a qualitative study. Patient Prefer Adherence. 2014;8:237–46. https://doi.org/10.2147/PPA.S57567.CrossRefPubMedPubMedCentral

29.

Hortensius J, Kars MC, Wierenga WS, Kleefstra N, Bilo HJ, van der Bijl JJ. Perspectives of patients with type 1 or insulin-treated type 2 diabetes on self-monitoring of blood glucose: a qualitative study. BMC Public Health. 2012;12(1):167. https://doi.org/10.1186/1471-2458-12-167.CrossRefPubMedPubMedCentral

30.

Horner GN, Agboola S, Jethwani K, Tan-McGrory A, Lopez L. Designing Patient-Centered Text Messaging Interventions for Increasing Physical Activity Among Participants With Type 2 Diabetes: Qualitative Results From the Text to Move Intervention. JMIR mHealth uHealth. 2017;5(4):e54. https://doi.org/10.2196/mhealth.6666.CrossRefPubMedPubMedCentral

31.

Peel E, Douglas M, Lawton J. Self monitoring of blood glucose in type 2 diabetes: longitudinal qualitative study of patients’ perspectives. Br Med J. 2007;335(7618):493–6. https://doi.org/10.1136/bmj.39302.444572.DE.CrossRef

32.

D. UK, “Five million people at high risk of type 2 diabetes | Diabetes UK,” 2015. https://www.diabetes.org.uk/about_us/news/-five-million-people-at-high-risk-of-type-2-diabetes Accessed 17 Aug 2020.

33.

Liao Y, Basen-Engquist KM, Urbauer DL, Bevers TB, Hawk E, Schembre SM. Using continuous glucose monitoring to motivate physical activity in overweight and obese adults: a pilot study. Cancer Epidemiol Biomark Prev. 2020;29(4):761–8. https://doi.org/10.1158/1055-9965.EPI-19-0906.CrossRef

34.

Ehrhardt N, Al Zaghal E. Behavior Modification in Prediabetes and Diabetes: Potential Use of Real-Time Continuous Glucose Monitoring. J Diabetes Sci Technol. 2019;13(2):271–5. https://doi.org/10.1177/1932296818790994 SAGE Publications Inc.CrossRefPubMed

35.

Schembre SM, et al. Just-in-Time Feedback in Diet and Physical Activity Interventions: Systematic Review and Practical Design Framework. J Med Internet Res. 2018;20(3):e106. https://doi.org/10.2196/jmir.8701.CrossRefPubMedPubMedCentral

36.

DeSmet A, De Bourdeaudhuij I, Chastin S, Crombez G, Maddison R, Cardon G. Adults’ preferences for behavior change techniques and engagement features in a mobile app to promote 24-hour movement behaviors: Cross-sectional survey study. J Med Internet Res. 2019;21(12):e15707. https://doi.org/10.2196/15707.CrossRef

37.

Korkiakangas E, Taanila AM, Keinänen-Kiukaanniemi S. Motivation to physical activity among adults with high risk of type 2 diabetes who participated in the Oulu substudy of the Finnish diabetes prevention study. Health Soc Care Community. 2011;19(1):15–22. https://doi.org/10.1111/j.1365-2524.2010.00942.x.CrossRefPubMed

38.

Kelly S, Martin S, Kuhn I, Cowan A, Brayne C, Lafortune L. Barriers and Facilitators to the Uptake and Maintenance of Healthy Behaviours by People at Mid-Life: A Rapid Systematic Review. PLoS One. 2016;11(1):e0145074. https://doi.org/10.1371/journal.pone.0145074.CrossRefPubMedPubMedCentral

Title: A digital lifestyle behaviour change intervention for the prevention of type 2 diabetes: a qualitative study exploring intuitive engagement with real-time glucose and physical activity feedback
Authors: Maxine E. Whelan
Francesca Denton
Claire L. A. Bourne
Andrew P. Kingsnorth
Lauren B. Sherar
Mark W. Orme
Dale W. Esliger
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Diabetes Prevention
Type 2 Diabetes
Published in: BMC Public Health / Issue 1/2021
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-020-09740-z

At a glance: The STEP trials

Springer Medicine

A digital lifestyle behaviour change intervention for the prevention of type 2 diabetes: a qualitative study exploring intuitive engagement with real-time glucose and physical activity feedback

Abstract

Background

Methods

Results

Conclusions

Trial registration

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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