Title: Developing evidence-based text messages to target diet and physical activity behaviour for people with type 2 diabetes mellitus
Funder: Department of Health and Social Care

Abstract: Background Appropriate diet and levels of physical activity can control weight and reduce the risk of complications for people with Type 2 Diabetes (T2D). Our previous research, developing medication adherence text messages with this population, highlighted that many would welcome greater support to make changes to diet and physical activity behaviours through messages. Text messages have resulted in significant changes to both diet and physical activity in the general population, and reduction in blood glucose levels in those with T2D. However, how these messages are intended to have their effect is not clear, making it hard to improve on previous research. Including defined Behaviour Change Techniques (BCTs) allow researchers to describe how an intervention is designed to have an effect. To have the greatest chance of success, messages need to be acceptable to people with T2D, targeted at specific behaviours and use BCTs with evidence of effectiveness. Aims and Objectives Aim: To develop an acceptable evidence-based text message intervention to change diet and physical activity behaviours, for people with T2D. Objectives: 1) Create text messages to change dietary and physical activity behaviours based on BCTs, 2) assess how well the messages represent the intended BCTs, 3) assess the anticipated acceptability of the messages prior to sending them (to ensure no unacceptable messages are sent) and 4) assess the experienced acceptability of the messages when sent to people with T2D. Methods A staged approach will be taken to develop the messages over 18 months. We have conducted a PPI meeting to plan this research, a consensus meeting (n=14) to prioritise specific target behaviours (e.g. reduce portion size and walk where possible), and identified BCTs with evidence of effectiveness from previous research. We now plan to build on this work in three stages: i) A workshop with people with T2D, behaviour change researchers and health care professionals (n=30) to write messages, then rate them for how well they represent the intended BCTs (objectives 1 and 2). ii) A survey to assess the anticipated acceptability of the messages to people with T2D prior to sending them (n=60) (objective 3), any messages that are not acceptable will be removed. Finally, iii) an experienced acceptability study (n=40) where people with T2D will be recruited through general practices (GPs), receive text messages for 3 months and be interviewed (objective 4). Anticipated impact and dissemination Using evidence-based, acceptable text messages to deliver behaviour change interventions as part of routine care has high reach at low per unit cost. Our previous research has established the feasibility of recruiting GP surgeries and patients to receive text messages and delivering messages at scale and is funding ongoing work to establish potential routes to implementation of messages through GP surgeries and potentially as part of diabetes structured education programmes. This considerably shortens the route to impact as the results of the present research can be incorporated directly into ongoing implementation work and within 1 to 2 years of the present research ending people with T2D could be benefitting from the messages.

Lay abstract: Aim: To develop text messages that help people with type 2 diabetes (T2D) improve their diet and level of physical activity What we know: Following diet and physical activity advice helps to reduce the risk of health problems for people with T2D Just telling people about a healthy diet, or ideal levels of physical activity may not change what someone does day-to-day. Many people need support to change health behaviours Techniques designed to help people change their behaviour, such as setting goals, can help people act Text messages can be sent to large numbers of people, for a low cost For the best chance of success, it is important that the messages are a) acceptable to the people receiving them and b) use techniques to help people to make changes How we re going to achieve our aim: If you ask someone to follow a healthy diet or do more physical activity, you could be asking them to change lots of different behaviours such as eating less sugar or less fat and walking each day. We invited people with T2D, doctors, nurses, dietitians, and researchers to take part in a workshop to work out which behaviours are the most important ones for people with T2D to do. We have also looked at previous research and found techniques that have helped people with T2D change their diet and levels of activity. We will now follow three steps to develop the messages: Thirty people (people with T2D, researchers, dietitians, doctors, and nurses) will take part in an online workshop. They will write messages using the techniques that have worked in previous research to target important behaviours for people with T2D. They will then complete a survey to report whether the messages are good examples of the techniques. Sixty people with T2D will complete a survey to tell us whether they like and understand the messages and how useful they think they would be. Forty people with T2D will receive the messages for 3 months and take part in an interview over the phone to help us understand their experiences. Patient and Public Involvement (PPI) This application has been developed with a PPI group. Our PPI co-applicant and PPI group will be involved in key decisions and review any materials being sent to people with T2D. What we will do with the findings We will explore how these messages can become part of routine NHS care. The findings will be used together with work our team are doing looking at sending out text messages to help people with T2D take their medication. Findings will also be publicised through databases of people interested in research, diabetes charities, community groups, places of worship and publications.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;6.7 PHYSICAL;5.7 PHYSICAL
Health categories: METABOLIC AND ENDOCRINE