JMIR Publications

ABSTRACT

Background:

A healthy lifestyle, including regular physical activity and a healthy diet, is becoming increasingly important in the treatment of chronic diseases. eHealth interventions that incorporate Behavior Change Techniques (BCTs) and dynamic tailoring strategies could effectively support a healthy lifestyle. The E-Supporter 1.0 is an eCoach designed to support physical activity and a healthy diet in people with Type 2 Diabetes mellitus (T2D).

Objective:

To describe the systematic development of the E-Supporter 1.0.

Methods:

Our systematic design process consisted of 3 phases. The definition phase included the selection of the target group and formulation of intervention objectives, and the identification of behavioral determinants based on which Behavior Change Techniques (BCTs) were selected to apply in the intervention. In the development phase, intervention content was developed by specifying tailoring variables, intervention options and decision rules. In the last phase, the E-Supporter 1.0 was evaluated by means of a usability test among 9 people with T2D to assess intervention usage and acceptability.

Results:

The main intervention objectives were to stimulate light to moderate-vigorous of physical activities or adherence to the Dutch dietary guidelines in people with T2D. The selection of behavioral determinants was informed by the Health Action Process Approach (HAPA) and theories explaining behavior maintenance. BCTs were included to address relevant behavioral determinants (e.g., action control, self-efficacy, and coping planning). Development of the intervention resulted in 3 types of intervention options, consisting of motivational messages, behavioral feedback, and tailor-made supportive exercises. Based on If-Then rules, intervention options could be tailored to, among others, type of behavioral goal, and (barriers for) goal achievement. Data on these variables could be collected using app data, activity tracker data and daily Ecological Momentary Assessments (EMAs). Usability testing revealed that user experiences were predominantly positive, despite some problems in the fixed delivery of content.

Conclusions:

The systematic development approach resulted in a theory-based and dynamically tailored eCoach. Future work should focus on expanding intervention content to other chronic conditions and lifestyle behaviors, enhancing the degree of tailoring, and evaluating intervention effects on acceptability, use and (cost)effectiveness.