A qualitative evaluation of a novel mHealth physical activity intervention with just-in-time prompts in people living with prediabetes and type 2 diabetes

Background : Physical inactivity and prolonged sitting are major risk factors for prediabetes and type 2 diabetes (T2DM). Despite this, individuals with prediabetes and T2DM often face challenges in maintaining adequate physical activity. The ENERGISED trial aimed to address this by using a mobile health (mHealth) intervention combining wearable Fitbit devices, just-in-time context-sensitive text messages, and telephone counselling, tailored to the needs of individuals with prediabetes and T2DM. This study aimed to explore participants' experiences with the intervention to inform future improvements and broader implementation. Methods : A qualitative study was conducted using semi-structured telephone interviews with 27 participants (20 with T2DM and 7 with prediabetes, aged 42-80 years) from the intervention arm of the ENERGISED trial. The interviews examined motivations for engagement, perceived benefits, and barriers to adherence. Thematic analysis was used to identify key themes related to the intervention's components and participants' behaviour changes. Results : Participants generally reported high satisfaction with the intervention. Key motivators included a sense of responsibility for personal health and the use of Fitbit devices, which facilitated self-monitoring and accountability. Telephone counselling reinforced these behaviours by providing external support. Perceptions of text messages were mixed, but just-in-time prompts to interrupt sitting were positively received. Conclusions : The ENERGISED program demonstrated that mHealth tools, particularly wearables and personalised support, can aid lifestyle changes in prediabetes and T2DM. Refining just-in-time text messages to better align with participant needs could further enhance outcomes. These findings are key for improving future mHealth interventions to increase physical activity and reduce sedentary behaviour in individuals with prediabetes and T2DM.