Accepted for/Published in: JMIR Research Protocols
Date Submitted: Apr 17, 2023
Date Accepted: Oct 10, 2023
Food literacy in adults with type 2 diabetes in Kenya: designing mobile phone text messages using the Behaviour Change Wheel framework.
ABSTRACT
Background:
The global prevalence of type 2 diabetes (T2D) has increased in the past decade, and it is projected to increase by 126% in 2045 in Africa. At the same time, mobile phone use has increased in Africa, providing a potential for innovative mobile health (mHealth) interventions to support diabetes care.
Objective:
This study aimed to apply the Behaviour Change Wheel (BCW) to develop text messages to influence food literacy in adults with T2D in urban Kenya
Methods:
The three stages of the BCW which include: Stage 1 understanding the behaviour; Stage 2 identifying the intervention options and Stage 3 identifying content and implementation options, guided the development of this mHealth intervention. Recent preparatory studies from low- and middle-income countries (LMICs) provided information that was used to contextualize the three stages of intervention development.
Results:
Stage 1 revealed unhealthy eating patterns, characterised by low intake of fruits and vegetables and larger portion sizes of carbohydrates, as the key behaviour problem. In Stage 2, target options to optimize glycaemic control were identified and related to food literacy components, including nutrition information, food selection, meal preparation and eating. In Stage 3, text messages were selected as the delivery mode. The text messages were developed through three sub-steps that included (a) linking identified intervention function to relevant Kenyan and international guidelines and recommendations for a healthy diet; (b) structuring guideline content to relevant BCT; (c) gain or loss framing of the text message. A total of 36 mobile text messages were developed based on nine behaviour change techniques.
Conclusions:
This study shows the step-by-step application of the BCW framework and evidence from the target population to design mobile text messages to influence food literacy in adults with T2D in Kenya. The effectiveness of this intervention will be tested in an exploratory trial in the target population.
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