JMIR Publications

ABSTRACT

Background:

Individuals of South Asian origin are at increased risk of developing type 2 diabetes mellitus (T2DM) compared to other ethnic minority groups. There is a need to develop interventions to address, and reduce, this heightened risk.

Objective:

We undertook formative work to develop a culturally adapted diet and physical activity text message intervention to prevent T2DM for women of Pakistani origin living in Scotland.

Methods:

We used a stepwise approach that was informed by the 6SQuID framework and consisted of gathering evidence through literature review and focus groups (Step 1), development of a programme theory for the intervention (Step 2) and finally developing the content of the text messages and an accompanying delivery plan (Step 3).

Results:

In Step 1, we reviewed 12 articles and identified three key themes describing factors impacting on diet and physical activity in the context of T2DM prevention: knowledge on ways to prevent T2DM including through diet and physical activity; cultural, social and gender norms; and perceived level of control and sense of inevitability over developing T2DM. The key themes to emerge from the three focus groups with a total of 25 women were: the need for interventions to focus on ‘friendly encouragement’, ‘companionship’, and ‘focus on the individual’ and also for the text-messages to ‘set achievable goals’ and ‘provide information on cooking healthy meals’. We combined the findings of the focus groups and literature review to create 13 guiding principles for developing culturally adapted text-messages. In Step 2, we developed a programme theory, which specified the main determinants of change that our text-messages should aim to enhance: knowledge and skills; sense of control; goal setting and planning behaviour; peer support; and norms and beliefs guiding the behaviour. In Step 3, we used both the intervention programme theory and guiding principles to develop a set of 73 text-messages aimed at supporting healthy diet and 65 text-messages supporting increasing physical activity.

Conclusions:

We present a theory-based approach to developing a culturally adapted diet and physical activity text-message intervention to prevent T2DM for women of Pakistani origin living in Scotland. This work outlines an approach which also may be applicable to the development of interventions for other ethnic minority populations in diverse settings. There is now a need to build on this formative work and undertake a feasibility trial of a text message-based diet and physical activity intervention to prevent T2DM for Pakistani women in Scotland.