Development of a Fully Automated, Web-Based, Tailored Intervention Promoting Regular Physical Activity Among Insufficiently Active Adults With Type 2 Diabetes: Integrating the I-Change Model, Self-Determination Theory, and Motivational Interviewing Components

“Competence: feeling effective in one’s ongoing interactions with the social environment and experiencing opportunities to exercise and express one’s capacities [63]”

“Autonomy: being the perceived origin or source of one’s own behavior [67]”

“Among them, Social Cognitive Theory [54], Transtheoretical Model [55], Theory of Planned Behavior [56], and Health Belief Model [57] are the most widely used theories and models in tailored interventions targeting PA uptake and maintenance [12,18,19,21,22].”

“Using recent reporting standards in the fields of health behavior change and tailoring [33,34], this paper will therefore try to build on previous research by demonstrating the in-depth development of the Diabète en Forme (DEF) Web-based, tailored intervention targeting adoption and maintenance of regular aerobic PA a…”

“Questions that the research team will seek to answer through this step are (1) through which processes did behavior change occur in participants? (2) how effective was the program in meeting its behavioral objectives? (3) how effective was the program compared to another type of Web-based intervention using a more gen…”

“It is by far the most common type of diabetes and the most widespread worldwide [1,2].”

“…also explore the use of concepts derived from Self-Determination Theory (SDT), a theory focusing on types rather than just amount of motivation [36], and Motivational Interviewing (MI), a counseling approach using a collaborative style of communication for strengthening a person’s own…”

“Another interesting model used in this field is the I-Change Model [58], which can be interpreted as a coherent integration of the ideas of the theories and models mentioned above, combined with other goal-setting theories [59].”

“Among them, Social Cognitive Theory [54], Transtheoretical Model [55], Theory of Planned Behavior [56], and Health Belief Model [57] are the most widely used theories and models in tailored interventions targeting PA uptake and maintenance [12,18,19,21,22].”

“As controlled forms of motivation are expected to sometimes motivate short-term PA behavior but not to sustain its maintenance [51], autonomous motivation is more strongly correlated to PA behavior adoption and maintenance over a long period of time [51,64].”

“This approach has demonstrated its potential to be more effective than more general types of health behavior change interventions, including those targeting PA [12,18,19].”

“Relatedness: feeling connected to others, to caring for and being cared for by those others, to having sense of belongingness both with other individuals and with one’s community [68]”

“In recent years, many reviewers also focused on effective behavior change techniques targeting physical activity [5,12,18,78-82,84].”

“Noar et al discovered that tailored interventions targeting health behavior change are more effective when (1) there are multiple contacts with participants, (2) they include theoretical, behavioral, and demographic constructs, (3) they use more than three constructs for tailored content, and (4) they target construct…”

“However, although evidence suggests this has not yet become an established reality across all countries, education levels, and age categories [12,25], Internet and mobile communication channels could have a greater dissemination potential [13,26].”

“[99,100] (BREQ-2 combined with four more items measuring integrated motivation) 23 Type of motivation”

“The use of information technologies like the Internet is seen as a promising avenue for the development of large scale interventions with behavior change purposes [12-16].”

“As mentioned in previous literature, scientific reporting regarding how health behavior change interventions work is currently lacking when compared to publications examining the effectiveness of these interventions, as incomplete information is provided on their theoretical basis, behavior change techniques employed,…”

“It is by far the most common type of diabetes and the most widespread worldwide [1,2].”

“Although our model resembles previous attempts that integrated more than one model for the prediction of PA behavior change [83,85], it is important to mention that we do not position our model as a new predictive model for behavior change and that it is not an attempt to “reinvent the wheel”.”

“More specifically, practicing regular PA may help to improve glycemic control [5-7], reduce visceral adiposity [7], lower plasma triglycerides [7], and reduce all-cause mortality risk [8].”

“There are several arguments for how we decided to develop our model: (1) the model integrates more possible sociocognitive determinants related to PA behavior among Canadian adults with type 2 diabetes than any other single model [58], (2) the I-Change Model integrates in a coherent manner a majority of ideas from the…”

“In recent years, many reviewers also focused on effective behavior change techniques targeting physical activity [5,12,18,78-82,84].”

“It has also been demonstrated that tailoring can be effective on various communication channels including print-based [20,21], automated phone [22], and Internet, mobile, or offline computer [12,19,22-24].”

“In recent years, many reviewers also focused on effective behavior change techniques targeting physical activity [5,12,18,78-82,84].”

“Motivational session 1 allows participants to select two health-risks associated with type 2 diabetes that they want to avoid, Social support (unspecified) [5,78]”

“Similarly, it is also important to note that some evidence suggests that using multiple theories generally results in less effective interventions compared to the use of a single theory [112], but this trend does not seem to be well supported and other evidence suggests that the use of constructs derived from differen…”

“The contributing factors are (1) intervention targeting only one behavior [19], (2) extensive use of the theoretical framework [19], (3) inclusion of multiple behavior change techniques [19], (4) use of additional methods for interacting with participants (mainly text messages and emails) [19], (5) inclusion of educat…”

“Supporting patients’choices and initiatives [48]”

“As controlled forms of motivation are expected to sometimes motivate short-term PA behavior but not to sustain its maintenance [51], autonomous motivation is more strongly correlated to PA behavior adoption and maintenance over a long period of time [51,64].”

“Another limitation is that behavior maintenance may currently be minimally addressed by the intervention (ie, as a reference, interventions promoting better maintenance normally last more than 24 weeks [118]), while we clearly stated that it was one of our main goals along with PA behavior adoption.”

“The contributing factors are (1) intervention targeting only one behavior [19], (2) extensive use of the theoretical framework [19], (3) inclusion of multiple behavior change techniques [19], (4) use of additional methods for interacting with participants (mainly text messages and emails) [19], (5) inclusion of educat…”

“This approach has demonstrated its potential to be more effective than more general types of health behavior change interventions, including those targeting PA [12,18,19].”

“The method used to execute this step was a first experience for the research team and was based on regular practice in the field of usability evaluation [103,104].”

“Although our model resembles previous attempts that integrated more than one model for the prediction of PA behavior change [83,85], it is important to mention that we do not position our model as a new predictive model for behavior change and that it is not an attempt to “reinvent the wheel”.”

“The integration and applications of SDT and MI have been extensively discussed and encouraged in the PA domain in recent years [44-48].”

“In recent years, many reviewers also focused on effective behavior change techniques targeting physical activity [5,12,18,78-82,84].”

“…integrates more possible sociocognitive determinants related to PA behavior among Canadian adults with type 2 diabetes than any other single model [58], (2) the I-Change Model integrates in a coherent manner a majority of ideas from the most popular theories and models used for tailoring [58,77],…”

“Tailoring, the generation of personalized feedback by a computer program based on prior individual assessment(s) [17], accounts for a large part of research using information technologies in the context of health behavior change.”

“In that sense, SDT, which accounts for a significant body of research on PA behavior motivation (ie, over a hundred papers) [51], may represent a great potential theory for enhancing the performance of more standard tailored interventions [23,51,62].”

“These beliefs are also increasingly supported by evidence [109-111].”

“Research on PA adoption and maintenance increasingly shows the added value of autonomous motivation, an SDT and MI-related construct, to help individuals adopt and, more importantly, maintain regular PA [49-51].”

“(adapted version of GLTEQ) [97,98]: items are number of times/week and minutes/time for vigorous, moderate, and low PA 6 PA behavior I intend to be regularly active in the next month [9]: totally disagree (-3) to totally agree (+3) 3 Intention My plans are to practice physical activities regularly in the next month [9…”

“Diabetes is also the leading cause of various health problems in Canadian adults (eg, blindness, end stage renal disease, and non-traumatic amputation) and increases the risk of hospitalization for different causes compared to individuals not having diabetes [3].”

“This approach has demonstrated its potential to be more effective than more general types of health behavior change interventions, including those targeting PA [12,18,19].”

“The integration and applications of SDT and MI have been extensively discussed and encouraged in the PA domain in recent years [44-48].”

“To verify if the messages adequately support the basic needs of competence, autonomy, and relatedness, participants will be asked to answer an adapted version of the 6-item modified Health Care Climate Questionnaire [102] 1 month after the intervention (first follow-up).”

“However, it is important to note that other fields of research that are less explored in the tailoring field could have further contributed to our evidence basis, such as fields related to message design (eg, the “look and feel” of messages) and message structure (eg, emotional appeals, narrative vs statistical, gain…”

“First, we confirm that the development of a tailored intervention can be quite a complex and time-consuming process, as has been highlighted by previous tailored intervention developers [35,108].”

“Nine articles identifying potential determinants of aerobic PA in adults with type 2 diabetes were found in our qualitative review [9,69-76].”

“In recent years, many reviewers also focused on effective behavior change techniques targeting physical activity [5,12,18,78-82,84].”

“The integration and applications of SDT and MI have been extensively discussed and encouraged in the PA domain in recent years [44-48].”

“Nine articles identifying potential determinants of aerobic PA in adults with type 2 diabetes were found in our qualitative review [9,69-76].”

“We will also explore the use of concepts derived from Self-Determination Theory (SDT), a theory focusing on types rather than just amount of motivation [36], and Motivational Interviewing (MI), a counseling approach using a collaborative style of communication for strengthening a person’s own motivation and commitment…”

“There are several arguments for how we decided to develop our model: (1) the model integrates more possible sociocognitive determinants related to PA behavior among Canadian adults with type 2 diabetes than any other single model [58], (2) the I-Change Model integrates in a coherent manner a majority of ideas from the…”

“Nine articles identifying potential determinants of aerobic PA in adults with type 2 diabetes were found in our qualitative review [9,69-76].”

“But although SDT can provide a few guidelines in the creation of such an environment, this theory has received some criticism regarding its practical use for doing so when compared to MI [46-48,65].”

“In recent years, the use of the I-Change Model in tailored interventions has resulted in long-term positive impacts on PA behavior among adults of various age groups [60,61].”

“Nine articles identifying potential determinants of aerobic PA in adults with type 2 diabetes were found in our qualitative review [9,69-76].”

“However, although evidence suggests this has not yet become an established reality across all countries, education levels, and age categories [12,25], Internet and mobile communication channels could have a greater dissemination potential [13,26].”

“Among them, Social Cognitive Theory [54], Transtheoretical Model [55], Theory of Planned Behavior [56], and Health Belief Model [57] are the most widely used theories and models in tailored interventions targeting PA uptake and maintenance [12,18,19,21,22].”

“Using recent reporting standards in the fields of health behavior change and tailoring [33,34], this paper will therefore try to build on previous research by demonstrating the in-depth development of the Diabète en Forme (DEF) Web-based, tailored intervention targeting adoption and maintenance of regular aerobic PA a…”

“Research on PA adoption and maintenance increasingly shows the added value of autonomous motivation, an SDT and MI-related construct, to help individuals adopt and, more importantly, maintain regular PA [49-51].”

“The use of information technologies like the Internet is seen as a promising avenue for the development of large scale interventions with behavior change purposes [12-16].”

“(adapted version of GLTEQ) [97,98]: items are number of times/week and minutes/time for vigorous, moderate, and low PA 6 PA behavior I intend to be regularly active in the next month [9]: totally disagree (-3) to totally agree (+3) 3 Intention My plans are to practice physical activities regularly in the next month [9…”

“These beliefs are also increasingly supported by evidence [109-111].”

“Wide-reaching and effective PA promotion programs are therefore needed and recommended [3,4,11].”

“We will also explore the use of concepts derived from Self-Determination Theory (SDT), a theory focusing on types rather than just amount of motivation [36], and Motivational Interviewing (MI), a counseling approach using a collaborative style of communication for strengthening a person’s own motivation and commitment…”

“Finally, it should be mentioned that the development of the tailored motivational sessions used the latest research by Friederichs et al on MI-based tailoring [39].”

“Nine articles identifying potential determinants of aerobic PA in adults with type 2 diabetes were found in our qualitative review [9,69-76].”

“Given that Short et al recently published a paper on the development of an evidence-based, tailored print intervention using essentially the same standards and program-planning model as us [35], our paper will add to their work by repeating the procedure for a fully automated, Web-based, tailored intervention.”

“The contributing factors are (1) intervention targeting only one behavior [19], (2) extensive use of the theoretical framework [19], (3) inclusion of multiple behavior change techniques [19], (4) use of additional methods for interacting with participants (mainly text messages and emails) [19], (5) inclusion of educat…”

“Nine articles identifying potential determinants of aerobic PA in adults with type 2 diabetes were found in our qualitative review [9,69-76].”

“To conclude Step 1, it is also important to note that our literature review included three other papers not mentioned so far, which provided insights into common beliefs related to aerobic PA among people with type 2 diabetes [9,90] and aerobic PA preferences among Canadians with type 2 diabetes [84].”

“To conclude Step 1, it is also important to note that our literature review included three other papers not mentioned so far, which provided insights into common beliefs related to aerobic PA among people with type 2 diabetes [9,90] and aerobic PA preferences among Canadians with type 2 diabetes [84].”

“Accordingly, the Public Health Agency of Canada urges the development of new population approaches targeting the delay and reduction of complications associated with type 2 diabetes [3].”

“First, the assessment of development costs was not performed according to a standardized method [116,117] and should be interpreted with caution.”

“First, the assessment of development costs was not performed according to a standardized method [116,117] and should be interpreted with caution.”

“The evolution of Canadian Internet use further suggests that public health organizations should take advantage of this technology to develop and deliver their services [27-29], including services targeting populations with chronic diseases [30].”

“Or, researchers could also try to determine which systems are faster for automating the tailoring process of interventions, whether it be TailorBuilder [91], other similar tailoring systems [113,114], the use of direct computer programming human resources, or other means.”

“The relevance of these post-intentional constructs has previously been demonstrated for health behaviours such as inspecting risks for hereditary cancer [20], physical activity [21], and children’s vaccination uptake by parents [22].”

““Endre” also builds on previous work in the application of MI [32,33] and use of lapse preparation and lapse management [31,34-37].”

“Type 2 diabetes mellitus is a chronic metabolic disease characterized by poor regulation of blood glucose caused by insulin resistance and beta-cell impairment [1,2].”

“The ICM has been successfully used to predict and change lifestyle behaviors in people without diabetes [49–53] and in people living with type 2 diabetes [54,55].”

“A subset of research works is focused on creating personalized healthcare pathways for the management of the disease (9) or tailored intervention plans (10).”

“These were identified in the literature review preceding the development of both interventions [80].”

“, Using ICM, it is also possible to explore factors that have a long-term, positive impact on the acceptance of the physical activity, meaning the effectiveness of the development of the type 2 diabetes intervention at the later stages could be evaluated (Moreau et al., 2015).”

“Previous research [25-27] has reported favorable responses of participants to online motivational interventions for increasing physical activity, although MI in these settings was delivered in a largely automated intervention.”

“Several interventions that were earlier carried out as face-to-face options have now been translated into web-based formats [2 – 4].”

“Researchers have reported an increasing number of diabetic patients using eHealth with potential benefits and risks of diabetes care [8-10].”

“Many types of recent studies extend the system to provide the personalized physical activity and incorporated concepts and techniques from behavior change theories [6].”

“There is still a research gap to examine the effectiveness of online communication systems to support self-care.(40) More studies are needed in this regard.”

“…in Self-Determination Theory (SDT), targeting autonomy, competence, and relatedness (Demetriou & Bachner, 2019; Friederichs et al., 2016; Gillison et al., 2019; Hsu et al., 2013; M. Lee et al., 2017; Lim & Ha, 2019; Ma & Yoo, 2021; Mayo et al., 2022; Moreau et al., 2015; Rocchi et al., 2021).”