JMIR Publications

ABSTRACT

Background:

Clinical trials have shown that type 2 diabetes (T2D) is preventable by lifestyle interventions targeted at high-risk people. Nevertheless, large-scale implementation of risk identification followed by preventive interventions has proven to be challenging. Specifically, recruitment of participants into preventive interventions is an important but often overlooked part of the intervention process.

Objective:

This study compares the reach and yield of different communication channels to engage people at increased risk of T2D to fill in a digital screening questionnaire and to express their willingness to participate in a T2D prevention study, with emphasis on how to reach those most at risk.

Methods:

We established an interactive and stepwise online T2D risk-screening tool with automated feedback according to T2D risk level and, for those who were eligible, an invitation to participate in the Stop Diabetes (StopDia) prevention intervention study conducted in primary health care. The risk estimate was given based on the Finnish Diabetes Risk Score (FINDRISC), self-reported history of repeatedly measured high blood glucose concentration, or, among women, previous gestational diabetes. A communication strategy involving several channels was created to invite people to fill in the StopDia online screening tool, and respondents were classified into 11 categories based on the channel through which they reported having heard about StopDia. Demographic characteristics of respondents reached via different communication channels were compared using variance analysis. Logistic regression was used to study the respondents’ likelihood of progressing through the risk screening steps.

Results:

A total of 33 399 persons started filling in the StopDia online screening tool. Of them, 85% completed the test and named at least one channel as the communication channel as the source of information about StopDia. Altogether 26 167 persons filled in sufficient information to obtain the risk estimate. Of them, 53% were at increased risk, 30% were men, and 40% had low or middle education level. The most often mentioned channels were workplace (n=6 817), social media or Internet (n=6 712), and newspapers (n=4 784). The proportion of individuals at increased risk was the highest among those reached via community pharmacies (68%) and health care (64%). The communication channel that reached the largest percentage of interested and eligible persons (34%) was relative or friend. Health care (54%) and radio or TV (46%) reached the largest proportion of people with lower education.

Conclusions:

Communication channels that reach large number of people such as social media and newspapers that reach large number of people were the most effective channels in identifying people at risk. Personalized approaches increased the engagement of men and less-educated people. Community pharmacies and health care services reached people with particularly high T2D risk. Thus, recruitment channels should be selected and modified based on the intended target group. Clinical Trial: Name of registry: Clinicaltrials.gov URL of registry: https://clinicaltrials.gov/ct2/show/NCT03156478?term=NCT03156478&draw=2&rank=1 Trial number: NCT03156478