TY  - JOUR
AU  - Hietbrink, Eclaire A G
AU  - Oude Nijeweme-d’Hollosy, Wendy
AU  - Middelweerd, Anouk
AU  - Konijnendijk, Annemieke A J
AU  - Schrijver, Laura K
AU  - ten Voorde, Anouk S
AU  - Fokkema, Elise M S
AU  - Laverman, Gozewijn D
AU  - Vollenbroek-Hutten, Miriam M R
PY  - 2023
DA  - 2023/7/28
TI  - A Digital Coach (E-Supporter 1.0) to Support Physical Activity and a Healthy Diet in People With Type 2 Diabetes: Acceptability and Limited Efficacy Testing
JO  - JMIR Form Res
SP  - e45294
VL  - 7
KW  - eHealth
KW  - type 2 diabetes
KW  - physical activity
KW  - nutrition
KW  - lifestyle change
KW  - acceptability
KW  - limited efficacy
KW  - formative evaluation
KW  - mobile phone
AB  - Background: A healthy lifestyle, including regular physical activity and a healthy diet, is increasingly part of type 2 diabetes (T2D) management. As many people with T2D have difficulty living and maintaining a healthy lifestyle, there is a need for effective interventions. eHealth interventions that incorporate behavior change theories and tailoring are considered effective tools for supporting a healthy lifestyle. The E-Supporter 1.0 digital coach contains eHealth content for app-based eHealth interventions and offers tailored coaching regarding physical activity and a healthy diet for people with T2D. Objective: This study aimed to assess the acceptability of E-Supporter 1.0 and explore its limited efficacy on physical activity, dietary behavior, the phase of behavior change, and self-efficacy levels. Methods: Over a span of 9 weeks, 20 individuals with T2D received daily motivational messages and weekly feedback derived from behavioral change theories and determinants through E-Supporter 1.0. The acceptability of the intervention was assessed using telephone-conducted, semistructured interviews. The interview transcripts were coded using inductive thematic analysis. The limited efficacy of E-Supporter 1.0 was explored using the Fitbit Charge 2 to monitor step count to assess physical activity and questionnaires to assess dietary behavior (using the Dutch Healthy Diet index), phase of behavior change (using the single-question Self-Assessment Scale Stages of Change), and self-efficacy levels (using the Exercise Self-Efficacy Scale). Results: In total, 5 main themes emerged from the interviews: perceptions regarding remote coaching, perceptions regarding the content, intervention intensity and duration, perceived effectiveness, and overall appreciation. The participants were predominantly positive about E-Supporter 1.0. Overall, they experienced E-Supporter 1.0 as a useful and easy-to-use intervention to support a better lifestyle. Participants expressed a preference for combining E-Supporter with face-to-face guidance from a health care professional. Many participants found the intensity and duration of the intervention to be acceptable, despite the coaching period appearing relatively short to facilitate long-term behavior maintenance. As expected, the degree of tailoring concerning the individual and external factors that influence a healthy lifestyle was perceived as limited. The limited efficacy testing showed a significant improvement in the daily step count (z=−2.040; P=.04) and self-efficacy levels (z=−1.997; P=.046) between baseline and postintervention. Diet was improved through better adherence to Dutch dietary guidelines. No significant improvement was found in the phase of behavior change (P=.17), as most participants were already in the maintenance phase at baseline. Conclusions: On the basis of this explorative feasibility study, we expect E-Supporter 1.0 to be an acceptable and potentially useful intervention to promote physical activity and a healthy diet in people with T2D. Additional work needs to be done to further tailor the E-Supporter content and evaluate its effects more extensively on lifestyle behaviors. 
SN  - 2561-326X
UR  - https://formative.jmir.org/2023/1/e45294
UR  - https://doi.org/10.2196/45294
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37505804
DO  - 10.2196/45294
ID  - info:doi/10.2196/45294
ER  -