Engagement with the BitHabit Digital Lifestyle Intervention and Changes in Type 2 Diabetes Risk Factors: A Secondary Analysis of a Randomized Controlled Trial (Preprint)
Authors: Liedes Hilkka , Mattila Elina , Honka Anita , Absetz Pilvikki , Aittola Kirsikka , Manninen Suvi , Lintu Niina , Schwab Ursula , Eloranta Aino-Maija , Umer Adil , Tilles-Tirkkonen Tanja , Männikkö Reija , Ruotsalainen Ilona , van Gils Mark , Lindström Jaana , Lakka Timo , Pihlajamäki Jussi , Vuorinen Anna-Leena 
Published: June 2023

BACKGROUND

Digital behavior change interventions (DBCI) may provide scalable and cost-effective means to support lifestyle improvements and thus help prevent type 2 diabetes (T2D). The DBCIs require some minimum amount of engagement to evoke health benefits. However, sufficient amount and type of engagement, i.e., effective engagement, is not completely understood.

OBJECTIVE

We aimed to describe user engagement with a habit-formation-based multimodal DBCI, the BitHabit app, and analyze the associations between user engagement and changes in risk factors for T2D.

METHODS

This study was a secondary analysis of the Stop Diabetes (StopDia) study which evaluated effectiveness of the BitHabit app in a 12-month randomized controlled trial in a Finnish population at an increased risk of T2D. We included 963 participants receiving only the BitHabit app. To characterize user engagement from various perspectives, we defined 25 use metrics from the BitHabit log data and utilized user experience ratings after one to two months of use as a subjective measure of engagement. We evaluated the associations between user engagement and changes in diet quality, physical activity, waist circumference, BMI, fasting plasma glucose (FPG), and two-hour plasma glucose in the oral glucose tolerance test (2h PG) with Spearman partial correlation coefficients (ρ) and linear regression.

RESULTS

Mean age of the participants was 55.1 (SD 9.9) years, 78% (755/963) were female, and mean BMI was 31.0 (SD 5.4) kg/m2. The BitHabit app was used on a median of 40 (IQR 12–71) days during the study period. The percentage of active users per study week was approximately 50% or higher until the last study month. Active app use during the first month, positive user experience ratings after one to two months of use, and active app use and frequent performances of healthy habits during the whole study period were weakly associated with improvements in the diet quality (ρ=0.08–0.17, P<.05). Some statistically significant, although weaker, associations were also found between different use metrics and changes in waist circumference and BMI. A high intensity use was required to achieve improvements in the risk factors for T2D. E.g., 100 days with physical activity related habit performances was associated with 0.7 cm decrease in waist circumference (P<.003). None of the use metrics was associated with changes in FPG or 2h PG.

CONCLUSIONS

This study demonstrated that the BitHabit app was acceptable and usable. The active app use during the first month and the whole study period and positive user experience ratings were weakly associated with beneficial changes in the risk factors for T2D, especially in the diet quality. However, achieving the improvements required a high intensity use.

CLINICALTRIAL

ClinicalTrials.gov NCT03156478

INTERNATIONAL REGISTERED REPORT

RR2-10.1186/s12889-019-6574-y