Development and Qualitative Evaluation of the E-Supporter: A Text-Based Intervention to Support Physical Activity and Healthy Nutrition in People with Type 2 Diabetes Mellitus

Purpose: Text-based interventions are considered as an effective and relatively simple technology for health promotion purposes. The E-Supporter is a text-based (SMS and e-mail) lifestyle coaching intervention to encourage physical activity and healthy nutrition in people with Type 2 Diabetes Mellitus (T2DM). This study aimed to develop and qualitatively evaluate the first E-Supporter version tailored to the Stages of Change and self-efficacy levels.
Methods: The development of the E-Supporter was based on scientific evidence, theory and experts input. Furthermore, 13 diabetes experts participated in two focus groups to evaluate the E-Supporter on readability, relevance and correctness of the provided information. Lastly, the E-Supporter was evaluated in a field test of 9 weeks by 20 people with T2DM. Participants wore a Fitbit for measuring physical activity and kept a food diary for assessing eating behavior. Besides, participants received two text messages per day and one email weekly. At the end of the nine-weeks, telephone interviews were conducted to assess the E-Supporter on perceived effectiveness, ease of use and content quality. The interview transcripts were inductively coded, clustered and sorted into general themes.
Findings: A total of 279 SMS messages and 9 email formats were discussed in the focus groups of which 208 SMS messages were approved immediately, 56 messages were adapted before approval, 15 messages were excluded and minor textual adjustments were made to all email formats. The final version of the E-Supporter consisted of 264 informational and motivational SMS-messages (103 targeting physical activity and 161 targeting nutrition) tailored to the Stages of Change and 9 email formats containing feedback on behavior based on Fitbit and food diary data tailored to self-efficacy levels. Participants were predominantly positive about E-Supporter; they thought that the E-supporter can support them in achieving a better lifestyle and experienced high ease of use. Both the content of messages and e-mails were appreciated, even though most participants preferred the e-mails because they were perceived as more personal.
Conclusions: Based on the first positive evaluation results, we expect the E-Supporter to be a useful intervention to promote physical activity and healthy nutrition in people with T2DM.