Evaluation and Refinement of a Bank of SMS Text Messages to Promote Behavior Change Adherence Following a Diabetes Prevention Program: Survey Study (Preprint)

Abstract

BACKGROUND Text messaging presents a low-cost and far-reaching modality which can be used to augment existing diabetes prevention programs and improve long-term diet and exercise behaviour change adherence. To date, little research has been published regarding the process of text message content development. Understanding how interventions are developed is necessary to evaluate their evidence base, and to guide implementation of effective and scalable mHealth interventions in public health initiatives and in future research. OBJECTIVE This paper describes the development and refinement of a bank of text messages targeting diet and exercise behaviour change to be implemented following a diabetes prevention program. METHODS A bank of 124 theory-based text messages was developed using the Behaviour Change Wheel and linked to active intervention components (behaviour change techniques OR BCTs). The Behaviour Change Wheel is a theory-based framework which provides structure to intervention development, and can guide the use of evidence-based practices in behaviour change interventions. Once messages were written, 18 individuals who either took part in a diabetes prevention program or were a diabetes prevention coach evaluated the messages on their clarity, utility, and relevance using a 5-point Likert scale. Messages were refined according to participant feedback and re-coded to have an accurate representation of BCTs in the final bank. RESULTS Seventy-six messages (61%) were edited, four were added, and 8 were removed based on participant scores and feedback. Of the 76 messages edited, 43 received minor word choice and grammar alterations while retaining their original BCT code; the remaining 33 (plus the four newly written messages) were re-coded by a reviewer trained in BCT identification. CONCLUSIONS This study outlines the process used to develop and refine a bank of text messages to be implemented following a diabetes prevention program. This resulted in a bank of 120 theory-based, user-informed text messages which 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 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.