Lay Summary Making changes to one’s physical activity and diet can reduce future risk of developing type 2 diabetes. That being said, making life-long changes to complex behaviors such as diet or physical activity is easier said than done. Text messages can be used to improve long-term diet and physical activity changes; however, it can be difficult to identify what should be said in a text message to nudge those behaviors. To improve utility and reduce cost of sending unnecessary messages, theory should be used in developing text messaging content. The current study used the Behavior Change Wheel to develop a library of text messages that can be used to improve diet and physical activity in individuals who have taken part in an effective community-based diabetes prevention program. The Behavior Change Wheel guides researchers to develop real-world interventions based on evidence and theory. Overall, we created a library of 124 theory-based messages which can be further tested following a diabetes prevention program.

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Background SMS text messaging is a low-cost and far-reaching modality that can be used to augment existing diabetes prevention programs and improve long-term diet and exercise behavior change adherence. To date, little research has been published regarding the process of SMS text message content development. Understanding how interventions are developed is necessary to evaluate their evidence base and to guide the implementation of effective and scalable mobile health interventions in public health initiatives and in future research. Objective This study aims to describe the development and refinement of a bank of SMS text messages targeting diet and exercise behavior change to be implemented following a diabetes prevention program. Methods A bank of 124 theory-based SMS text messages was developed using the Behaviour Change Wheel and linked to active intervention components (behavior change techniques [BCTs]). The Behaviour Change Wheel is a theory-based framework that provides structure to intervention development and can guide the use of evidence-based practices in behavior change interventions. Once the messages were written, 18 individuals who either participated in a diabetes prevention program or were a diabetes prevention coach evaluated the messages on their clarity, utility, and relevance via survey using a 5-point Likert scale. Messages were refined according to participant feedback and recoded to obtain an accurate representation of BCTs in the final bank. Results 76/124 (61.3%) messages were edited, 4/124 (3.2%) were added, and 8/124 (6.5%) were removed based on participant scores and feedback. Of the edited messages, 43/76 (57%) received minor word choice and grammar alterations while retaining their original BCT code; the remaining 43% (33/76, plus the 4 newly written messages) were recoded by a reviewer trained in BCT identification. Conclusions This study outlines the process used to develop and refine a bank of SMS text messages to be implemented following a diabetes prevention program. This resulted in a bank of 120 theory-based, user-informed SMS text messages that were overall deemed clear, useful, and relevant by both individuals who will be receiving and delivering them. This formative development process can be used as a blueprint in future SMS text messaging development to ensure that message content is representative of the evidence base and is also grounded in theory and evaluated by key knowledge users.

IntroductionGlobal rates of type 2 diabetes (T2D) are on the rise and there is a need for both effective and replicable interventions to decrease this incidence. Systematic reviews highlight the efficacy of diet and exercise interventions in decreasing T2D risk; however, no review to date provides clear information regarding intervention details (eg, what is delivered, by whom, to whom, when, and mode of delivery). This paper outlines the protocol for a scoping review summarising intervention characteristics of diet and exercise programmes for individuals at risk for T2D. From the included studies and through the use of the Template for Intervention Description and Replication (TIDieR), the scoping review that results from this protocol paper will provide a narrative analysis of how diabetes prevention programmes are being reported and implemented.MethodsA comprehensive search strategy is outlined to identify studies within Medline, CINAHL, PsycINFO, EMBASE and SPORTDiscus. The search strategy will include terms relating to diet and exercise interventions and diabetes risk. To determine eligible studies, predefined inclusion and exclusion criteria will be used independently by two review authors. To be included, studies must be delivering a diet and/or exercise intervention among adults who have been identified as at risk for developing T2D with an outcome related to diabetes prevention. Data extraction of those studies that meet inclusion criteria will be guided by the TIDieR).Ethics and disseminationEthical approval is not required as this review will be using previously collected data. Review findings will be presented at scientific conferences and published in a peer-reviewed journal.

Background: Motivational interviewing is an effective counselling style for changing lifestyle behaviours. Few studies have examined brief motivational interviewing training for non-healthcare practitioners to deliver motivational interviewing-informed health programs. The purpose of this study was to pilot a brief motivational interviewing workshop on non-healthcare practitioners to deliver a community-based diabetes prevention program. Methods: This pilot study used convenience sampling to obtain seven participants naïve to motivational interviewing who wanted to become diabetes prevention program coaches. Participants attended a two-day motivational interviewing workshop, were then shadowed by an expert coach delivering the diabetes prevention program, and finally, were shadowed by an expert coach and received feedback. The primary outcome was whether coaches were able to maintain a level of at least client-centered motivational interviewing skills for the six months post-training, as assessed by the Motivational Interviewing Competency Assessment (MICA). Two independent coders used the MICA to assess a random selection of participants’ audio recordings of interactions between with diabetes prevention program clients. One session for each client in coaches’ first six months post-training was coded. Motivational interviewing-competency scores were generated using MICA scores for six months. Results: Coaches were 25B2 years old, 71% female, and 43% had less than a bachelor’s degree. Mean motivational interviewing-competency was at a level of client-centered (total MICA score of 3.3a0.24) over six months. The majority (71%) of all sessions were client-centered for all of the MICA categories. Conclusions: This pilot study offers preliminary evidence that non-healthcare practitioners attending a brief motivational interviewing training were able to deliver a client-centered level of motivational interviewing in a community-based diabetes prevention program up to six months post-training without the use of any booster training sessions. This suggests that the training used within this study may be sufficient to train future non-healthcare practitioner diabetes prevention program coaches in the community.