A Digital Coach (E-Supporter 1.0) to Support Physical Activity and a Healthy Diet in People With Type 2 Diabetes: Acceptability and Limited Efficacy Testing

Background: A healthy lifestyle, including regular physical activity and a healthy diet, is increasingly part of type 2 diabetes (T2D) management. Since many people with T2D have difficulty living and maintaining a healthy lifestyle, there is a need for effective interventions. eHealth interventions that incorporate behavior change theories and tailoring are considered effective tools to support a healthy lifestyle. The E-Supporter 1.0 contains eHealth content for app-based eHealth interventions and offers tailored coaching regarding physical activity and a healthy diet for people with T2D.

Objective: The objective was to assess the acceptability of the E-Supporter 1.0 and explore its limited efficacy on (1) physical activity, (2) dietary behavior, (3) lifestyle goal achievement, (4) the phase of behavior change, and (5) self-efficacy levels.

Methods: Twenty people with T2D received motivational messages and feedback from the E-Supporter 1.0 for 9 weeks. The acceptability of our intervention was assessed using telephone-conducted semi-structured interviews. Interview transcripts were coded using inductive thematic analysis. The limited efficacy of the E-Supporter 1.0 was explored using the Fitbit Charge 2 to monitor step count to assess activity and questionnaires to assess dietary behavior (using the Dutch Healthy Diet index), phase of behavior change (using the Single-question Self-Assessment Scale Stages of Change), and self-efficacy levels (using the Exercise Self-Efficacy Scale).

Results: Participants were predominantly positive about the E-Supporter 1.0. Overall, they experienced the E-Supporter 1.0 as a useful and easy-to-use intervention to support a better lifestyle. As expected, the degree of tailoring was experienced as too limited. The limited efficacy testing showed a significant improvement in daily step count (Z=-2.040, P = .041) and self-efficacy levels (Z=-2.220, P = .026) between baseline and post-intervention. Diet was improved through better adherence to Dutch dietary guidelines. No significant improvement was found in the phase of behavior change (P = .157).

Conclusions: Based on the first positive results, we expect the E-Supporter 1.0 to be a potentially useful intervention to promote physical activity and a healthy diet in people with T2D. Additional work needs to be done to further develop the E-Supporter to improve the degree of tailoring and to evaluate its effects more extensively on lifestyle behaviors.