mHealth Intervention to Promote Nonexercise Physical Activity in Patients With Type 2 Diabetes: Secondary Analysis and Implementation Study.

Patients with type 2 diabetes identified specific behavior change needs in capability and motivation domains prior to the intervention.

• Behavior change needs were assessed using a modified capability, opportunity, motivation-behavior (COM-B) questionnaire
• Data were collected from a separate sample of patients with T2D (n=25) before the intervention and at intervention baseline (n=119)
• Participants' responses revealed 3 items in capability and 2 in motivation that stood out as perceived behavior change needs
• No comparable studies were found to contextualize the findings on behavior change needs

The main intervention arm demonstrated high fidelity across face-to-face sessions and telephone contacts.

• Face-to-face sessions completed: 112/117 (96%)
• Telephone contacts completed: 145/156 (93%)
• The main intervention arm included 39 participants
• Fidelity data were accumulated during the intervention through counseling cards and cloud computing

Accelerometer use showed moderate mean weekly compliance but with wide variation across the intervention period.

• Mean weekly accelerometer use was 54% across the intervention
• Weekly accelerometer use ranged from 80% to 17% during the intervention
• Participants used 24-hour accelerometers as part of the main intervention arm
• Challenges were experienced especially in cloud-computed feedback and accelerometer-app use

The main intervention arm showed good acceptability as rated by participants on a Likert scale.

• Acceptability was assessed with a questionnaire at the end of the intervention using a Likert scale from 1 to 5
• Mean acceptability scores ranged from 3.8 to 4.8 across items
• Some challenges were also experienced, particularly with cloud-computed feedback and accelerometer-app use
• Data analysis was mainly descriptive

The intervention was a 3-arm mHealth trial conducted in primary care targeting nonexercise physical activity in type 2 diabetes patients.

• The main arm of the intervention (n=39) included 24-hour accelerometer use, a smartphone app with personal feedback, a PA leaflet, a YouTube video on walking, and individual counseling
• Counseling consisted of 3 face-to-face sessions and 4 telephone contacts
• Total intervention baseline sample was n=119
• Implementation evaluation focused on fidelity and acceptability of the main arm

The explanatory value of the COM-B model and the psychometric properties of the COM-B questionnaire were identified as areas requiring further attention.

• A modified COM-B questionnaire was used to assess perceived behavior change needs
• The authors noted that no comparable studies were found for the behavior change needs findings
• The paper calls for additional research on both the COM-B model's explanatory value and the psychometric properties of the COM-B questionnaire
• The behavioral framework of mHealth interventions is described as often vague in the existing literature