Accepted for/Published in: JMIR Formative Research
Date Submitted: Jul 8, 2025
Date Accepted: Dec 18, 2025
Promoting non-exercise physical activity in patients with type 2 diabetes: perceived behaviour change needs and implementation of mHealth intervention
ABSTRACT
Background:
Physical activity (PA) has an important role in the prevention and treatment of type 2 diabetes (T2D). Interventions with mobile-based technology (mHealth) seem promising in PA promotion but their behavioural framework is often vague, and the implementation is seldom reported.
Objective:
This paper examines perceived behaviour change needs and implementation of mHealth approach in increasing non-exercise PA in patients with T2D.
Methods:
A three-arm mHealth intervention was conducted in primary care to promote daily walking and other non-exercise PA in patients with T2D. Information on perceived behaviour change needs was collected with a modified COM-B questionnaire before the intervention from a separate sample of patients with T2D (n=25) and at the intervention baseline (n=119). Implementation evaluation focused on the fidelity and acceptability of the main arm of the mHealth intervention (n=39). The 6-month intervention included 24-hour accelerometer use, smartphone application providing cloud-computed personal feedback on accelerometer-measured PA, a PA leaflet, a YouTube video on walking, and individual counseling with three face-to-face sessions and four telephone contacts. Data on fidelity was accumulated during the intervention through participant-specific counseling cards and cloud computing. Data on acceptability was collected with a questionnaire at the end of the intervention. Data analysis was mainly descriptive.
Results:
The participants' responses revealed three items in capability and two in motivation, which stood out as perceived behaviour change needs. Moreover, the main intervention arm showed good fidelity and acceptability, although some challenges were also experienced especially in cloud-computed feedback and accelerometer-application use.
Conclusions:
The findings on behaviour change needs call for additional research since no comparable studies were found. Also, the explanatory value of the COM-B model and psychometric properties of the COM-B questionnaire concerning the non-exercise PA of patients with T2D deserve further attention. Based on the findings on fidelity and acceptability the main intervention arm seems applicable to clinical practice. However, the challenges discovered underscore the importance of pre-testing technology-based approaches in interventions promoting PA in patients with T2D. Clinical Trial: ClinicalTrials.gov NCT04587414
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