Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Dec 1, 2020
Date Accepted: Mar 19, 2021
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
A Smartphone App (TRIANGLE) to Change Cardiometabolic Risk Behaviors in Women Following Gestational Diabetes Mellitus: Intervention Mapping approach
ABSTRACT
Background:
Gestational diabetes mellitus (GDM) is the most common complication during pregnancy and associated with an increased risk for the development of cardiometabolic diseases following delivery. Behavioral interventions can reduce this risk, yet current interventions and their delivery channels fail to meet the needs of new mothers. Mobile health (mHealth) may solve this problem.
Objective:
The aim of this project was to plan and develop a theory- and evidence-based mHealth intervention to change cardiometabolic risk behavior in women following GDM that meets the women’s expected standards of commercial health apps.
Methods:
The Intervention Mapping steps 1 to 4 structured the systematic planning and development of the mHealth program described in this paper. Steps 1 and 2 led to a theory- and evidence-based logic model of change for cardiometabolic health. Based on this model, the prevention program was designed (step 3) and produced in cooperation with industrial partners (step 4) to ensure a high technological standard of the resulting smartphone app for the iPhone. Step 4 included a user study with women post-GDM once a beta-version of the app (“TRIANGLE”) was available. The user study comprised two test rounds of 1 week (n = 5) and 4 weeks (n = 6), respectively. The tests involved validated questionnaires on user acceptance, user logs, and think alouds with semi-structured interviews.
Results:
The novel TRIANGLE app is among the first self-paced smartphone apps for individual habit change in the three lifestyle areas physical activity, nutrition, and psychosocial wellbeing. The three core features of a challenge system, human coaching, and a library address 11 behavioral determinants with 39 behavior change methods to support lifestyle change. Participants in the user study showed a high acceptance and a high perceived impact of the TRIANGLE app on their health behavior. Participants tested the app regularly and suggested some improvements. We adapted the TRIANGLE app according to the insights from the user study before the full TRIANGLE program production.
Conclusions:
The Intervention Mapping approach was feasible to plan and develop an innovative and scalable smartphone solution for women post-GDM. The resulting TRIANGLE intervention has the potential to support behavior change for cardiometabolic disease prevention. Yet, the app needs further refinement and testing in clinical trials. Intervention Mapping steps 5 (implementation plan) and 6 (evaluation plan) may support the integration of the TRIANGLE intervention into routine care. Clinical Trial: trial registration: drks.de DRKS00012736
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