A Low-Intensity Mobile Health Intervention With and Without Health Counseling for Persons With Type 2 Diabetes, Part 1: Baseline and Short-Term Results From a Randomized Controlled Trial in the Norwegian Part of RENEWING HEALTH

Torbjørnsen, Astrid; Jenum, Anne Karen; Småstuen, Milada Cvancarova; Årsand, Eirik; Holmen, Heidi; Wahl, Astrid Klopstad; Ribu, Lis

doi:10.2196/mhealth.3535

Cited by 117Mobile Health and mHealth ApplicationsDiabetes Management and EducationDiabetes Management and Research

A Low-Intensity Mobile Health Intervention With and Without Health Counseling for Persons With Type 2 Diabetes, Part 1: Baseline and Short-Term Results From a Randomized Controlled Trial in the Norwegian Part of RENEWING HEALTH

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Torbjørnsen, Astrid, Jenum, Anne Karen, Småstuen, Milada Cvancarova, Årsand, Eirik, Holmen, Heidi, Wahl, Astrid Klopstad, Ribu, Lis·2014·JMIR mHealth and uHealth

DOI 10.2196/mhealth.3535PMC PMC4275473

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Abstract

BACKGROUND: Self-management support for people with type 2 diabetes is essential in diabetes care. Thus, mobile health technology with or without low-intensity theory-based health counseling could become an important tool for promoting self-management. OBJECTIVES: The aim was to evaluate whether the introduction of technology-supported self-management using the Few Touch Application (FTA) diabetes diary with or without health counseling improved glycated hemoglobin (HbA1c) levels, self-management, behavioral change, and health-related quality of life, and to describe the sociodemographic, clinical, and lifestyle characteristics of the participants after 4 months. METHODS: A 3-armed randomized controlled trial was conducted in Norway during 2011-2013. In the 2 intervention groups, participants were given a mobile phone for 1 year, which provided access to the FTA diary, a self-help tool that recorded 5 elements: blood glucose, food habits, physical activity, personal goal setting, and a look-up system for diabetes information. One of the intervention groups was also offered theory-based health counseling with a specialist diabetes nurse by telephone for 4 months from baseline. Both intervention groups and the control group were provided usual care according to the national guidelines. Adults with type 2 diabetes and HbA1c ≥7.1% were included (N=151). There were 3 assessment points: baseline, 4 months, and 1 year. We report the short-term findings after 4 months. HbA1c was the primary outcome and the secondary outcomes were self-management (Health Education Impact Questionnaire, heiQ), behavioral change (diet and physical activity), and health-related quality of life (SF-36 questionnaire). The data were analyzed using univariate methods (ANOVA), multivariate linear, and logistic regression. RESULTS: Data were analyzed from 124 individuals (attrition rate was 18%). The groups were well balanced at baseline. There were no differences in HbA1c between groups after 4 months, but there was a decline in all groups. There were changes in self-management measured using the health service navigation item in the heiQ, with improvements in the FTA group compared to the control group (P=.01) and in the FTA with health counseling group compared with both other groups (P=.04). This may indicate an improvement in the ability of patients to communicate health needs to their health care providers. Furthermore, the FTA group reported higher scores for skill and technique acquisition at relieving symptoms compared to the control group (P=.02). There were no significant changes in any of the domains of the SF-36. CONCLUSIONS: The primary outcome, HbA1c, did not differ between groups after 4 months. Both of the intervention groups had significantly better scores than the control group for health service navigation and the FTA group also exhibited improved skill and technique acquisition.

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Users’ preferences and design recommendations to promote engagements with mobile apps for diabetes self-management: Multi-national perspectives
Adu, M. D., Malabu, U. H., Malau‐Aduli, A. E. O., & Malau‐Aduli, B. S. (2018) · PLoS ONE · doi:10.1371/journal.pone.0208942 · Cited by 76 · see citing works
User Engagement With Smartphone Apps and Cardiovascular Disease Risk Factor Outcomes: Systematic Review
Spaulding, E. M., Marvel, F. A., Piasecki, R. J., Martin, S. S., & Allen, J. K. (2021) · JMIR Cardio · doi:10.2196/18834 · Cited by 70 · see citing works
Characterizing Active Ingredients of eHealth Interventions Targeting Persons With Poorly Controlled Type 2 Diabetes Mellitus Using the Behavior Change Techniques Taxonomy: Scoping Review
Kebede, M. M., Liedtke, T. P., Möllers, T., & Pischke, C. R. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7135 · Cited by 69 · see citing works
Development features and study characteristics of mobile health apps in the management of chronic conditions: a systematic review of randomised trials
Cucciniello, M., Petracca, F., Ciani, O., & Tarricone, R. (2021) · npj Digital Medicine · doi:10.1038/s41746-021-00517-1 · Cited by 73 · see citing works
Exploring app features with outcomes in mHealth studies involving chronic respiratory diseases, diabetes, and hypertension: a targeted exploration of the literature
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Mobile Diabetes Intervention Study of Patient Engagement and Impact on Blood Glucose: Mixed Methods Analysis
Quinn, C. C., Butler, E. C., Swasey, K. K., Shardell, M. D., Terrin, M. L., Barr, E. A., & Gruber‐Baldini, A. L. (2018) · JMIR mhealth and uhealth · doi:10.2196/mhealth.9265 · Cited by 61 · see citing works
Effectiveness of internet-based interventions on glycemic control in patients with type 2 diabetes: meta-analysis of randomized controlled trials
Shen, Y., Wang, F., Zhang, X., Zhu, X., Sun, Q., Fisher, E., & Sun, X. (2018) · Journal of Medical Internet Research · doi:10.2196/jmir.9133 · Cited by 54 · see citing works
The Effectiveness of Telemedicine Solutions for the Management of Type 2 Diabetes: A Systematic Review, Meta-Analysis, and Meta-Regression
Hangaard, S., Laursen, S. H., Andersen, J. D., Kronborg, T., Vestergaard, P., Hejlesen, O., & Udsen, F. W. (2023) · Journal of Diabetes Science and Technology · doi:10.1177/19322968211064633 · Cited by 55 · see citing works
Stages of change for physical activity and dietary habits in persons with type 2 diabetes included in a mobile health intervention: the Norwegian study in RENEWING HEALTH
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App-technology to increase physical activity among patients with diabetes type 2 the diacert-study, a randomized controlled trial
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Blended Interventions to Change Behavior in Patients With Chronic Somatic Disorders: Systematic Review
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Smartphones and Apps to Control Glycosylated Hemoglobin (HbA1c) Level in Diabetes: A Systematic Review and Meta-Analysis
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Acceptability of an mHealth App Intervention for Persons With Type 2 Diabetes and its Associations With Initial Self-Management: Randomized Controlled Trial
Torbjørnsen, A., Småstuen, M. C., Jenum, A. K., Årsand, E., & Ribu, L. (2018) · JMIR mhealth and uhealth · doi:10.2196/mhealth.8824 · Cited by 44 · see citing works
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Efficacy of a Mobile Social Networking Intervention in Promoting Physical Activity: Quasi-Experimental Study
Tong, H. L., Coiera, E. W., Tong, W., Wang, Y., Quiroz, J. C., Martin, P. B., & Laranjo, L. (2019) · JMIR mhealth and uhealth · doi:10.2196/12181 · Cited by 39 · see citing works
Effectiveness of technology-based psychosocial interventions on diabetes distress and health-relevant outcomes among type 2 diabetes mellitus: A systematic review and meta-analysis
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Investigating the behavioural effects of a mobile-phone based home telehealth intervention in people with insulin-requiring diabetes: Results of a randomized controlled trial with patient interviews
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Assessment of short and long-term outcomes of diabetes patient education using the health education impact questionnaire (HeiQ)
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Wearable Devices for Supporting Chronic Disease Self-Management: Scoping Review
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The Service User Technology Acceptability Questionnaire: Psychometric Evaluation of the Norwegian Version
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Validity of the Model for Assessment of Telemedicine: A Delphi study
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Internet-Based Lifestyle Intervention to Prevent Type 2 Diabetes Through Healthy Habits: Design and 6-Month Usage Results of Randomized Controlled Trial
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Making robust decisions about the impact of health education programs: Psychometric evaluation of the Health Education Impact Questionnaire (heiQ) in diverse patient groups in Norway
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Appropriation of Mobile Health for Diabetes Self-Management: Lessons From Two Qualitative Studies
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Analysing mHealth usage logs in RCTs: Explaining participants’ interactions with type 2 diabetes self-management tools
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Blended Care Interventions to Promote Physical Activity: A Systematic Review of Randomized Controlled Trials
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Mobile Health Technology (mDiab) for the Prevention of Type 2 Diabetes: Protocol for a Randomized Controlled Trial
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Using the RE-AIM framework to evaluate internal and external validity of mobile phone–based interventions in diabetes self-management education and support
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Innovative strategies to improve diabetes outcomes in disadvantaged populations
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Digital health and management of chronic disease: A multimodal technologies typology
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Patients’ attitudes towards mobile health in Singapore: a cross-sectional study
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Telemonitoring and Health Counseling for Self-Management Support of Patients With Type 2 Diabetes: A Randomized Controlled Trial
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Strategies to Overcome Therapeutic Inertia in Type 2 Diabetes Mellitus: A Scoping Review
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Analysis of Effectiveness and Psychological Techniques Implemented in mHealth Solutions for Middle-Aged and Elderly Adults with Type 2 Diabetes: A Narrative Review of the Literature
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Structure and Characteristics of Diabetes Self-management Applications: A Systematic Review of the Literature
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People with type 2 diabetes struggling for self‐management: A part study from the randomized controlled trial in RENEWING HEALTH
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The Use of SMS Text Messaging to Improve the Hospital-to-Community Transition in Patients With Acute Coronary Syndrome (Txt2Prevent): Results From a Pilot Randomized Controlled Trial
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An integrative review and theoretical examination of chronic illness mHealth studies using the Middle‐Range Theory of Self‐care of Chronic Illness
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Assessing the Effectiveness of Digital Health Behavior Strategies on Type 2 Diabetes Management: Systematic Review and Network Meta-Analysis
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“The effectiveness of these strategies may stem from their ability to comprehensively influence the patient’s lifestyle and behavioral habits, thereby promoting the achievement of treatment goals [73,79,94].”
The Key Digital Tool Features of Complex Telehealth Interventions Used for Type 2 Diabetes Self-Management and Monitoring With Health Professional Involvement: Scoping Review
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Effect of Multimodal App-Based Interventions on Glycemic Control in Patients With Type 2 Diabetes: Systematic Review and Meta-Analysis
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Application of the National Institute for Health and Care Excellence Evidence Standards Framework for Digital Health Technologies in Assessing Mobile-Delivered Technologies for the Self-Management of Type 2 Diabetes Mellitus: Scoping Review
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Consideration of inequalities in effectiveness trials of mHealth applications – a systematic assessment of studies from an umbrella review
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Designing socially acceptable mHealth technologies for Parkinson's disease self-management
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Measuring the Effects of Sharing Mobile Health Data During Diabetes Consultations: Protocol for a Mixed Method Study
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Social Cognitive Theories and Electronic Health Design: Scoping Review
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Telehealth in patient care by advanced practice nurses: a systematic review
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A Continuous Aerobic Resistance Exercise Protocol for Concussion Rehabilitation Delivered Remotely via a Mobile App: Feasibility Study
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Mobile application intervention to promote self-management in insulin-requiring type 1 and type 2 diabetes individuals: protocol for a mixed methods study and non-blinded randomized controlled trial
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Comparison of three meta-analytic methods using data from digital interventions on type 2 diabetes
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SELF-MANAGEMENT IN PERSONS WITH LIMB LOSS: A SYSTEMATIC REVIEW
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An integrative review of chronic illness mHealth self-care interventions: Mapping technology features to patient outcomes
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The Impact of Mobile Health Use on the Self-care of Patients With Type 2 Diabetes: Protocol for a Randomized Controlled Trial
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Food Intake REstriction for Health OUtcome Support and Education (FIREHOUSE) Protocol: A Randomized Clinical Trial
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Psychotherapeutic Interventions for Type 2 Diabetes Mellitus
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L’avenir des Silver Tech
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Telemedicine for Diabetes in Norway
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Corresponding Author:
Torbjørnsen, A., Anne, M., Jenum, K., Milada, P., Cvancarova Småstuen, M., Års, P. E., Holmen, P. H., Astrid, M., Wahl, K., Ribu, L., et al. (2016)
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A Mobile Health Intervention for Self-Management and Lifestyle Change for Persons With Type 2 Diabetes, Part 2: One-Year Results From the Norwegian Randomized Controlled Trial RENEWING HEALTH
Holmen, H., Torbjørnsen, A., Wahl, A. K., Jenum, A. K., Småstuen, M. C., Årsand, E., & Ribu, L. (2014) · JMIR mHealth and uHealth · doi:10.2196/mhealth.3882 · Cited by 294 · see citing works
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Low-Intensity Self-Management Intervention for Persons With Type 2 Diabetes Using a Mobile Phone-Based Diabetes Diary, With and Without Health Counseling and Motivational Interviewing: Protocol for a Randomized Controlled Trial
Ribu, L., Holmen, H., Torbjørnsen, A., Wahl, A. K., Grøttland, A., Småstuen, M. C., Elind, E., Bergmo, T. S., Breivik, E., & Årsand, E. (2013) · JMIR Research Protocols · doi:10.2196/resprot.2768 · Cited by 45 · see citing works
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Telemonitoring and Health Counseling for Self-Management Support of Patients With Type 2 Diabetes: A Randomized Controlled Trial
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Efficacy of a Mobile Health–Based Behavioral Treatment for Lifestyle Modification in Type 2 Diabetes Self-Management: Greenhabit Randomized Controlled Trial
Ruiz-León, A. M., Casas, R. M., Castro‐Barquero, S., Alfaro-González, S., Radeva, P. I., Sacanella, E., Casanovas-Garriga, F., Pérez-Gesalí, A., & Estruch, R. (2024) · Journal of Medical Internet Research · doi:10.2196/58319 · Cited by 31 · see citing works

Authors: Torbjørnsen, A., Jenum, A. K., Småstuen, M. C., Årsand, E., Holmen, H., Wahl, A. K., & Ribu, L.
Affiliations: OsloMet – Oslo Metropolitan University (NO)
University Hospital of North Norway (NO)
University of Oslo (NO)
Corresponding author: Torbjørnsen, Astrid
ORCID: Torbjørnsen, Astrid
Jenum, Anne Karen
Årsand, Eirik
Holmen, Heidi
Wahl, Astrid Klopstad
Ribu, Lis
Venue: JMIR mHealth and uHealth
Publisher: JMIR Publications Inc.
Published: 2014-12-11
Volume: 2
Issue: 4
Pages: e52
ISSN: 2291-5222 (ISSN-L)
DOI: 10.2196/mhealth.3535
PMC: PMC4275473
OpenAlex: W2160865185
Cited by: 117
References: 53
Citations by year: 2026: 3 · 2025: 4 · 2024: 7 · 2023: 4 · 2022: 11 · 2021: 18 · 2020: 11 · 2019: 14 · 2018: 15 · 2017: 14 · 2016: 8 · 2015: 7 · 2014: 1
FWCI: 18.11
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)
NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
Funders: Høgskolen i Oslo og Akershus
Norges Forskningsråd
Diabetesforbundet
Akershus Universitetssykehus
Topics: Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords: type 2 diabetes, mobile health, diabetes self-management, health counseling, HbA1c, telephone counseling, health-related quality of life, dietary behavior, physical activity, health system navigation, self-management support, HbA1c reduction, behavior change, goal setting, dietary habits, patient-provider communication

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A Low-Intensity Mobile Health Intervention With and Without Health Counseling for Persons With Type 2 Diabetes, Part 1: Baseline and Short-Term Results From a Randomized Controlled Trial in the Norwegian Part of RENEWING HEALTH

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