JMIR Publications

ABSTRACT

Background:

Adopting a healthy diet is one of the cornerstones of Type 2 diabetes (T2D) management. Apps are increasingly being used in diabetes self-management, but most studies to date focus on assessing their impact in terms of weight loss or glycaemic control, with limited evidence on the behavioural factors influencing app use to change dietary habits.

Objective:

The main objectives of this study are to assess the enablers and barriers to adopt a healthier diet using the GRO Health app, in two T2D patient groups (recent and long-standing diagnosis patients), and to identify behaviour change techniques (BCTs) to enhance enablers and overcome barriers.

Methods:

Two semi-structured qualitative interview studies were conducted; the first study took place between June and July 2021with a sample of 8 recently diagnosed (less than 12 months) T2D participants, while the second study was conducted between May and June 2022, and included 15 long-standing diagnosed (more than 18 months) participants. In both studies, topic guides were informed by the COM-B model and the Theoretical Domains Framework (TDF). Transcripts were analysed using a combined deductive framework and inductive thematic analysis approach. The Behaviour Change Wheel (BCW) framework was applied to identify appropriate BCTs that could be used in future iterations of apps for patients with diabetes. Themes were compared between the patient groups.

Results:

The present study identified similarities and differences between patient groups in terms of enablers and barriers to adopt a healthier diet using an app. The main enablers for recently diagnosed patients included the acquired knowledge about T2D diets and skills to implement these, while the main barriers were the difficulty to decide which app features to use and limited cooking skills. On the other hand, for long-standing patients, the main enablers included knowledge validation provided by the app, along with app elements to help self-regulate food intake; while the main barriers were the limited interest paid to the content provided or limited skills engaging with apps in general. Both groups reported more enablers than barriers to perform the target behaviour when using the app, coinciding in most of the enablers and barriers encountered. In consequence, BCTs were selected to address key barriers in both groups such as simplifying the information hierarchy in the app interface, including tutorials demonstrating how to use the app features in detail, and redesigning the landing page of the app to guide users towards these tutorials.

Conclusions:

Recently diagnosed and long-standing T2D patients encounter similar enablers, and slightly different barriers, when using an app to adopt a healthier diet. In consequence, the development of app-based approaches to adopt a healthier diet should account for these similarities and differences within patient segments, to reduce barriers to perform the target behaviour. Clinical Trial: Ethical approval was granted for both studies by University College London’s Departmental Research Ethics Committee (20027/001 and 22417.001). Personal identifiers were removed, and data were stored securely.