JMIR Publications

ABSTRACT

Background:

Digital health interventions may offer a scalable way to prevent type 2 diabetes (T2D) by providing early support for healthy behaviors among adults at increased risk for T2D with minimal burden to health systems. However, ensuring continued engagement with digital solutions is a challenge impacting on the expected effectiveness.

Objective:

We aimed to identify the BitHabit healthy lifestyle app user engagement trajectories, to examine predictors of trajectories, and to investigate association between the identified trajectories and 12-month changes in risk factors in adults at increased risk for T2D.

Methods:

An unblended parallel one-year randomized controlled trial was carried out to evaluate the effectiveness of the app or the app together with face-to-face group coaching in comparison with routine care in Finland in 2017‒2019 among 18- to 74-year-old community-dwelling adults at an increased risk of T2D. This is a secondary analysis using longitudinal data from 1926 participants randomized into the digital intervention arms. Latent class growth models were applied to identify user engagement trajectories with the app during 11-months. Predictors for trajectory membership were examined with multinomial logistic regression models. Analysis of covariance was utilized to investigate association between trajectories and 12-month changes in T2D risk factors.

Results:

Mean age of the 1926 participants was 55.2 (SD 10.0) years and 79.7% were women. Four user engagement trajectories were identified: terminated usage (46.9%), weekly usage (38.0%), twice weekly usage (10.8%), and daily usage (4.3%). Active app use during the first month, higher net promoter score after the first 1‒2 months of use, older age, and better quality of diet at baseline increased the odds of not belonging to the terminated usage trajectory. Compared with other trajectories, daily usage was associated with higher increase in diet quality and more pronounced decrease in BMI and waist circumference at 12 months compared with other trajectories.

Conclusions:

More than half of the participants continued to use the app throughout the 12-month intervention. Initial user engagement and experience during the first month of the intervention, and baseline diet quality predicted long-term user engagement. Most beneficial changes in risk factors were observed among those with daily app use throughout the study. These findings could be used in further developments aiming to predict response and adapt interventions for persons at risk of disengagement, or to identify persons who will benefit the most from the app usage. Clinical Trial: ClinicalTrials.gov NCT03156478; https://clinicaltrials.gov/ct2/show/NCT03156478