JMIR Publications

ABSTRACT

Background:

Despite recommendations that physical activity be a major component of treatment for adolescents with obesity and prediabetes or type 2 diabetes, physical activity is especially low in this population.

Objective:

To obtain end-user feedback on text message content and to assess acceptability of a planned text messaging intervention with financial incentives to motivate youth with prediabetes or type 2 diabetes to increase physical activity

Methods:

Adolescents with overweight or obesity and prediabetes or type 2 diabetes who attended a large academic pediatric endocrinology clinic were recruited to participate in group interviews (2-4/group) via videoconferencing. Participants were asked to share their thoughts about use of text messages and financial incentives to remind and motivate individuals like themselves to be more physically active. They rated and provided feedback on specific messages to be used in a clinical trial. To explore attitudes about the use of financial incentives for physical activity, participants were asked about their personal experience with rewards to motivate behavior change, as well as their anticipated reactions to rewards provided for goal attainment (gain-framing) versus provided and then taken away if a goal was not met (loss-framing). Interviews were conducted by two trained facilitators and an observer/recorder. Content analysis was used to explore themes.

Results:

Focus groups were completed in 20 participants (11 female; 15 type 2 diabetes/5 prediabetes) of mean age 15 years (range 12-18) and body mass index range of 32-52 kg/m2 (>95th percentile for age/sex). The majority were Non-Hispanic Black (70%), and 2 were Hispanic (10%). Fifty-three percent (n=8) of participants with type 2 diabetes were prescribed insulin. All agreed that text messages would serve as good reminders to be physically active, and there was strong consensus about the need for short messages. Favorable content included references to what they will likely to be doing when the messages are sent (e.g., homework, watching television), as well as messages that were encouraging or informative. Specific physical activity suggestions were rated favorably, but participants differed in the perceived utility of including links to exercise videos. Attitudes about financial incentives varied, with approximately half reporting that loss-framed incentives could be highly motivating in order to avoid the frustration of loss.

Conclusions:

Adolescents with obesity and diabetes or prediabetes endorsed support for text messages that are short, encouraging, and informative for physical activity promotion. Participants were familiar with the concept of rewards for behavior change, but only half expected that loss-framed incentives would be motivating. A text messaging intervention employing financial incentives to motivate youth with prediabetes or type 2 diabetes to be more physically active is theoretically acceptable, but the impact on actual activity level in this population requires prospective evaluation in a clinical trial.