Participants’ and health care providers’ insights regarding a web-based and mobile-delivered program to improve dietary behaviour among disadvantaged people with type 2 diabetes: Descriptive qualitative study (Preprint)

Abstract

BACKGROUND Healthy eating is a key element of type 2 diabetes (T2D) self-management. Digital interventions offer new avenues to reach broad audiences to promote healthy eating behaviours. However, the acceptance of these interventions by socioeconomically disadvantaged people such as those with lower levels of education, lower income, or ethnic minority groups, has not yet been fully evaluated. OBJECTIVE The objective of this study was to investigate the acceptability and usability of EatSmart, a 12-week, web-based and mobile-delivered healthy eating behaviour change support program, from the perspective of both the intervention participants living with T2D, and Health Care Providers (HCPs) involved with diabetes care. METHODS This study employed a qualitative descriptive design. Sixty disadvantaged adults with T2D, as determined by receipt of either a HealthCare Card or a pension/benefit as the main source of income, were recruited to participate in the program. Data from participants regarding their experiences with and perceptions of the program and longer-term maintenance of any behavioural or attitudinal changes were collected through an online self-report survey with open ended questions administered 12-weeks post-baseline (n=54), and semi-structured telephone interviews administered at 36-weeks post-baseline (n=16). Supplementary semi-structured interviews with six HCPs involved with diabetes care (including endocrinologists, accredited practicing dietitians, and diabetes nurse educators) were also conducted at 36-weeks post-baseline. These interviews aimed to understand providers’ views about successful and unsuccessful elements of EatSmart as a technology-delivered intervention, any concerns or barriers regarding use of these type of interventions, and feedback from their interactions with patients about the intervention’s content, impact, or observed benefits. All data from surveys and interviews were pooled and thematically analysed. RESULTS Our data showed that EatSmart was acceptable to participants and contributed positively to improve food-related behaviours. Most participants mentioned that they enjoyed their experience with EatSmart and expressed high satisfaction with its content and delivery. The educational and motivational content was seen as the most useful parts of the program. Benefits discussed by intervention participants included gaining health knowledge and skills; positive changes in their food purchasing and cooking; and in eating greater quantities and varieties of fruits and vegetables. HCPs also described the intervention as beneficial and persuasive for the target audience and had specific suggestions for future tailoring of such programs. CONCLUSIONS The findings suggested that this digitally-delivered intervention with its supportive educational modules and text messages was generally appealing for both participants and HCPs. This intervention medium shows promise and could feasibly be rolled out on a broader scale to augment usual diabetes care. CLINICALTRIAL Australian New Zealand Clinical Trials Registry, ACTRN12619001111167; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001111167 INTERNATIONAL REGISTERED REPORT RR2-10.2196/19488