Effect of using mobile phone communication on dietary management of Type 2 Diabetes Mellitus patients in Kenya
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Cited by 3 publications
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Designing Mobile Phone Text Messages Using the Behavior Change Wheel Framework to Influence Food Literacy in Adults With Type 2 Diabetes in Kenya: Protocol for a Systematic Development Study
Background The worldwide prevalence of type 2 diabetes (T2D) has increased in the past decade, and it is projected to increase by 126% by 2045 in Africa. At the same time, mobile phone use has increased in Africa, providing a potential for innovative mobile health interventions to support diabetes care. Objective This study aimed to apply the Behavior Change Wheel (BCW) framework to develop text messages to influence food literacy in adults with T2D in urban Kenya. Methods The 8 steps of the BCW framework guided the development of text messages: (1) Define the problem in behavioral terms; (2) select target behaviors; (3) specify the target behaviors based on who needs to perform the behaviors, what needs to change, and when, where, how often, and with whom; (4) identify what needs to change; (5) identify intervention functions; (6) select policy categories; (7) select behavior change techniques (BCTs); and (8) select the mode of delivery. Recent exploratory studies in Kenya and other low- and middle-income countries provided information that was used to contextualize the intervention. Results In step 1, the behavioral problem was defined as unhealthy dietary patterns among adults with T2D. In step 2, based on a qualitative study in the target population, the target behavior was selected to be evaluation of reliable sources of information, and selection and preparation of healthy food. In step 3, unhealthy dietary patterns were selected. In step 4, 10 domains of the Theoretical Domains Framework were identified, and in step 5, 5 intervention functions were linked to the domains and unhealthy dietary patterns were specified. In step 6, communication and regulations were identified as policy categories, while in step 7, 9 BCTs were selected from the Behavior Change Technique Taxonomy version 1. In step 8, the most suitable mode of delivery was determined to be mobile text messages. A total of 36 mobile text messages were developed based on the 9 BCTs. Conclusions This study shows the step-by-step application of the BCW framework to develop mobile text messages to influence food literacy in adults with T2D. International Registered Report Identifier (IRRID) RR1-10.2196/48271
Designing Mobile Phone Text Messages Using the Behavior Change Wheel Framework to Influence Food Literacy in Adults With Type 2 Diabetes in Kenya: Protocol for a Systematic Development Study
Background The worldwide prevalence of type 2 diabetes (T2D) has increased in the past decade, and it is projected to increase by 126% by 2045 in Africa. At the same time, mobile phone use has increased in Africa, providing a potential for innovative mobile health interventions to support diabetes care. Objective This study aimed to apply the Behavior Change Wheel (BCW) framework to develop text messages to influence food literacy in adults with T2D in urban Kenya. Methods The 8 steps of the BCW framework guided the development of text messages: (1) Define the problem in behavioral terms; (2) select target behaviors; (3) specify the target behaviors based on who needs to perform the behaviors, what needs to change, and when, where, how often, and with whom; (4) identify what needs to change; (5) identify intervention functions; (6) select policy categories; (7) select behavior change techniques (BCTs); and (8) select the mode of delivery. Recent exploratory studies in Kenya and other low- and middle-income countries provided information that was used to contextualize the intervention. Results In step 1, the behavioral problem was defined as unhealthy dietary patterns among adults with T2D. In step 2, based on a qualitative study in the target population, the target behavior was selected to be evaluation of reliable sources of information, and selection and preparation of healthy food. In step 3, unhealthy dietary patterns were selected. In step 4, 10 domains of the Theoretical Domains Framework were identified, and in step 5, 5 intervention functions were linked to the domains and unhealthy dietary patterns were specified. In step 6, communication and regulations were identified as policy categories, while in step 7, 9 BCTs were selected from the Behavior Change Technique Taxonomy version 1. In step 8, the most suitable mode of delivery was determined to be mobile text messages. A total of 36 mobile text messages were developed based on the 9 BCTs. Conclusions This study shows the step-by-step application of the BCW framework to develop mobile text messages to influence food literacy in adults with T2D. International Registered Report Identifier (IRRID) RR1-10.2196/48271
BACKGROUND The global prevalence of type 2 diabetes has risen alarmingly in the past decade in sub-Saharan 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 design and develop a mHealth intervention to optimize glycaemic control in adults with type 2 diabetes in urban Kenya METHODS The three stages of the BCW that include understanding the behaviour identifying the intervention options and identifying content and implementations 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, characterized 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. A total of 36 mobile text messages were developed based on nine behaviour change techniques. CONCLUSIONS We developed a mHealth guided by the step-by-step BCW framework while using evidence from the target population. We, therefore, created contextualized intervention components and applied behaviour change techniques that were used to design mobile text messages to optimize glycaemic control for adults with type 2 diabetes in LMICs. The effectiveness of this intervention will be tested in a proof-of-concept study in the target population
Using mHealth and Food Literacy to Optimize Glycaemic Control in Adults with Type 2 Diabetes in Kenya: An Exploratory Trial (Preprint)
BACKGROUND The prevalence of Type 2 Diabetes (T2D) is increasing at alarming rates in Low- and Middle-Income Countries (LMICs), including Kenya. OBJECTIVE The objective of this study is to optimize glycaemic control in adults with T2D in Kenya using mHealth by improving food literacy METHODS We conducted an exploratory trial in adults with T2D in two rural hospitals in Kenya. Participants were randomly selected from two hospitals. Each hospital was assigned to the mHealth intervention or control group. Participants in the intervention group received mobile text messages through a bulk SMS API (Short Message Service Application Programming Interface). Participants in the control group received monthly appointment reminders (= attention control). Participants in both groups continued receiving routine standard of care. Baseline and endline data were collected through face-to-face sessions. The primary endpoint was glycated haemoglobin (HbA1c). Secondary outcomes were food literacy and Fasting blood glucose. Intention-to-treat analyses were performed using linear mixed models. RESULTS A total of 84 participants were recruited; 42 were assigned to the intervention group and 42 to the control group. A total of 57 (67.8%) participants (intervention: 29, control: 28) completed the study. After 12 weeks, univariate analysis showed that HbA1c remained stable in both groups. The difference with baseline measurement in the intervention group was 0.43% [from 10.02% (SD ±3.01) to 10.45% (SD ±3.22), P=.250] compared to 0.80% [from [10.62 (±3.35) to 11.42 (±3.25), P=.414]] in the control group. After multiple linear modelling, with age and education as random factors, the overall intervention effect for HbA1c was 0.19% (95% CI -0.82; 2.21) P=.846. For food literacy, the intervention group had a higher non-significant mean score after 12 weeks [53.5% (SD ±9.2) to 60.7% (±8.3), P=.012] compared to the control group [58.7% (±9.3) to 59.9% (±11.2), P=.767]. Fasting blood glucose did not significantly change. CONCLUSIONS Although this study did not provide evidence on the effect of glycaemic control through food literacy for adults with Type 2 Diabetes, a focus on food literacy to improve dietary quality is still needed given its significant potential on dietary behaviour. Future research should pay attention to active patient involvement in the design and development of mHealth interventions, tracking behaviour and patient-centred outcomes, involving healthcare workers, and having a bi-directional approach. CLINICALTRIAL www.ClinicalTrials.gov (NCT05013294)
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