A Mobile Phone-Based Program to Promote Healthy Behaviors Among Adults With Prediabetes Who Declined Participation in Free Diabetes Prevention Programs: Mixed-Methods Pilot Randomized Controlled Trial
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Abstract
BACKGROUND: Despite evidence that Diabetes Prevention Programs (DPPs) can delay or prevent progression to type 2 diabetes mellitus (T2DM), few individuals with prediabetes enroll in offered programs. This may be in part because many individuals with prediabetes have low levels of autonomous motivation (ie, motivation that arises from internal sources) to prevent T2DM. OBJECTIVE: This study aims to examine the feasibility and acceptability of a mobile health (mHealth) intervention designed to increase autonomous motivation and healthy behaviors among adults with prediabetes who previously declined participation free DPPs. In addition, the study aims to examine changes in autonomous motivation among adults offered 2 versions of the mHealth program compared with an information-only control group. METHODS: In this 12-week, parallel, 3-arm, mixed-methods pilot randomized controlled trial, participants were randomized to (1) a group that received information about prediabetes and strategies to prevent T2DM (control); (2) a group that received a mHealth app that aims to increase autonomous motivation among users (app-only); or (3) a group that received the app plus a physical activity tracker and wireless-enabled digital scale for self-monitoring (app-plus). Primary outcome measures included rates of intervention uptake (number of individuals enrolled/number of individuals assessed for eligibility), retention (number of 12-week survey completers/number of participants), and adherence (number of device-usage days). The secondary outcome measure was change in autonomous motivation (measured using the Treatment Self-Regulation Questionnaire), which was examined using difference-in-difference analysis. Furthermore, we conducted postintervention qualitative interviews with participants. RESULTS: ). No significant differences were observed in adherence rates between app-only and app-plus participants (43 days vs 37 days; P=.34). Among all participants, mean autonomous motivation measures were relatively high at baseline (6.0 of 7.0 scale), with no statistically significant within- or between-group differences in follow-up scores. In qualitative interviews (n=15), participants identified reasons that they enjoyed using the app (eg, encouraged self-reflection), reasons that they did not enjoy using the app (eg, did not consider personal circumstances), and strategies to improve the intervention (eg, increased interpersonal contact). CONCLUSIONS: Among individuals with prediabetes who did not engage in free DPPs, this mHealth intervention was feasible and acceptable. Future work should (1) examine the effectiveness of a refined intervention on clinically relevant outcomes (eg, weight loss) among a larger population of DPP nonenrollees with low baseline autonomous motivation and (2) identify other factors associated with DPP nonenrollment, which may serve as additional potential targets for interventions. TRIAL REGISTRATION: ClinicalTrials.gov NCT03025607; https://clinicaltrials.gov/ct2/show/NCT03025607 (Archived by WebCite at http://www.webcitation.org/73cvaSAie).
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Management of incomplete outcome data was assessed as high risk of bias in four studies.
“The management of incomplete outcome data was assessed as being at high risk of bias in four studies [49,73,90,95].”
From Fitbit-based interventions for healthy lifestyle outcomes: systematic review and meta-analysis (2020) · cites this paper as [49]
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- Authors
- Griauzde, D., Kullgren, J. T., Liestenfeltz, B., Ansari, T., Johnson, E. H., Fedewa, A., Saslow, L. R., Richardson, C., & Heisler, M.
- Affiliations
- University of Michigan (US)
- Corresponding author
- Heisler, Michele
- ORCID
- Venue
- JMIR mHealth and uHealth
- Publisher
- JMIR Publications Inc.
- Published
- 2019-01-09
- Volume
- 7
- Issue
- 1
- Pages
- e11267
- ISSN
- 2291-5222 (ISSN-L)
- PMC
- PMC6329413
- OpenAlex
- W2890418948
- Cited by
- 58
- References
- 37
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 6 · 2023: 9 · 2022: 14 · 2021: 5 · 2020: 6 · 2019: 2
- FWCI
- 4.96
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR mhealth and uhealth (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- U.S. Department of Veterans Affairs (IK2 HX001517)
- Robert Wood Johnson Foundation
- Patrick and Catherine Weldon Donaghue Medical Research Foundation
- Health Services Research and Development
- National Institute of Diabetes and Digestive and Kidney Diseases (DK107456, K01DK107456, P30DK092926, P30DK020572)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- prediabetes, type 2 diabetes prevention, mobile health intervention, autonomous motivation, treatment self-regulation, wearable activity trackers, digital scale, self-monitoring, intervention feasibility and acceptability, app adherence, health behavior, mobile application, interpersonal contact, self-reflection
- MeSH terms
- Adult, Diabetes Mellitus, Female, Health Promotion, Humans, Male, Middle Aged, Motivation, Pilot Projects, Prediabetic State, Surveys and Questionnaires, Cell Phone
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