PMID- 30626566 OWN - NLM STAT- MEDLINE DCOM- 20200129 LR - 20230502 IS - 2291-5222 (Print) IS - 2291-5222 (Electronic) IS - 2291-5222 (Linking) VI - 7 IP - 1 DP - 2019 Jan 9 TI - A Mobile Phone-Based Program to Promote Healthy Behaviors Among Adults With Prediabetes Who Declined Participation in Free Diabetes Prevention Programs: Mixed-Methods Pilot Randomized Controlled Trial. PG - e11267 LID - 10.2196/11267 [doi] LID - e11267 AB - BACKGROUND: Despite evidence that Diabetes Prevention Programs (DPPs) can delay or prevent progression to type 2 diabetes mellitus (T2DM), few individuals with prediabetes enroll in offered programs. This may be in part because many individuals with prediabetes have low levels of autonomous motivation (ie, motivation that arises from internal sources) to prevent T2DM. OBJECTIVE: This study aims to examine the feasibility and acceptability of a mobile health (mHealth) intervention designed to increase autonomous motivation and healthy behaviors among adults with prediabetes who previously declined participation free DPPs. In addition, the study aims to examine changes in autonomous motivation among adults offered 2 versions of the mHealth program compared with an information-only control group. METHODS: In this 12-week, parallel, 3-arm, mixed-methods pilot randomized controlled trial, participants were randomized to (1) a group that received information about prediabetes and strategies to prevent T2DM (control); (2) a group that received a mHealth app that aims to increase autonomous motivation among users (app-only); or (3) a group that received the app plus a physical activity tracker and wireless-enabled digital scale for self-monitoring (app-plus). Primary outcome measures included rates of intervention uptake (number of individuals enrolled/number of individuals assessed for eligibility), retention (number of 12-week survey completers/number of participants), and adherence (number of device-usage days). The secondary outcome measure was change in autonomous motivation (measured using the Treatment Self-Regulation Questionnaire), which was examined using difference-in-difference analysis. Furthermore, we conducted postintervention qualitative interviews with participants. RESULTS: Overall, 28% (69/244) of eligible individuals were randomized; of these, 80% (55/69) completed the 12-week survey. Retention rates were significantly higher among app-plus participants than participants in the other 2 study arms combined (P=.004, chi(2)). No significant differences were observed in adherence rates between app-only and app-plus participants (43 days vs 37 days; P=.34). Among all participants, mean autonomous motivation measures were relatively high at baseline (6.0 of 7.0 scale), with no statistically significant within- or between-group differences in follow-up scores. In qualitative interviews (n=15), participants identified reasons that they enjoyed using the app (eg, encouraged self-reflection), reasons that they did not enjoy using the app (eg, did not consider personal circumstances), and strategies to improve the intervention (eg, increased interpersonal contact). CONCLUSIONS: Among individuals with prediabetes who did not engage in free DPPs, this mHealth intervention was feasible and acceptable. Future work should (1) examine the effectiveness of a refined intervention on clinically relevant outcomes (eg, weight loss) among a larger population of DPP nonenrollees with low baseline autonomous motivation and (2) identify other factors associated with DPP nonenrollment, which may serve as additional potential targets for interventions. TRIAL REGISTRATION: ClinicalTrials.gov NCT03025607; https://clinicaltrials.gov/ct2/show/NCT03025607 (Archived by WebCite at http://www.webcitation.org/73cvaSAie). CI - (c)Dina Griauzde, Jeffrey T. Kullgren, Brad Liestenfeltz, Tahoora Ansari, Emily H Johnson, Allison Fedewa, Laura R Saslow, Caroline Richardson, Michele Heisler. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 09.01.2019. FAU - Griauzde, Dina AU - Griauzde D AUID- ORCID: 0000-0002-2260-0299 AD - Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States. AD - University of Michigan Medical School, Ann Arbor, MI, United States. AD - Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States. FAU - Kullgren, Jeffrey T AU - Kullgren JT AUID- ORCID: 0000-0001-6269-5707 AD - University of Michigan School of Dentistry, Ann Arbor, MI, United States. FAU - Liestenfeltz, Brad AU - Liestenfeltz B AUID- ORCID: 0000-0001-9203-5881 AD - University of Michigan School of Nursing, Ann Arbor, MI, United States. FAU - Ansari, Tahoora AU - Ansari T AUID- ORCID: 0000-0003-0789-8696 AD - University of Michigan School of Public Health, Ann Arbor, MI, United States. FAU - Johnson, Emily H AU - Johnson EH AUID- ORCID: 0000-0003-2133-4950 AD - University of Michigan Medical School, Ann Arbor, MI, United States. FAU - Fedewa, Allison AU - Fedewa A AUID- ORCID: 0000-0002-4727-4290 AD - University of Michigan School of Dentistry, Ann Arbor, MI, United States. FAU - Saslow, Laura R AU - Saslow LR AUID- ORCID: 0000-0003-3991-3205 AD - University of Michigan School of Nursing, Ann Arbor, MI, United States. FAU - Richardson, Caroline AU - Richardson C AUID- ORCID: 0000-0002-1945-6046 AD - University of Michigan Medical School, Ann Arbor, MI, United States. AD - Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States. FAU - Heisler, Michele AU - Heisler M AUID- ORCID: 0000-0002-6889-2063 AD - University of Michigan Medical School, Ann Arbor, MI, United States. AD - Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States. AD - University of Michigan School of Dentistry, Ann Arbor, MI, United States. AD - University of Michigan School of Public Health, Ann Arbor, MI, United States. LA - eng SI - ClinicalTrials.gov/NCT03025607 GR - IK2 HX001517/HX/HSRD VA/United States GR - K01 DK107456/DK/NIDDK NIH HHS/United States GR - P30 DK020572/DK/NIDDK NIH HHS/United States GR - P30 DK092926/DK/NIDDK NIH HHS/United States PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20190109 PL - Canada TA - JMIR Mhealth Uhealth JT - JMIR mHealth and uHealth JID - 101624439 SB - IM MH - Adult MH - Cell Phone/*trends MH - Diabetes Mellitus/prevention & control/psychology MH - Female MH - Health Promotion/methods/*standards MH - Humans MH - Male MH - Middle Aged MH - Motivation MH - Pilot Projects MH - Prediabetic State/psychology/*therapy MH - Surveys and Questionnaires PMC - PMC6329413 OTO - NOTNLM OT - autonomous motivation OT - behavioral change OT - mHealth OT - mobile phone OT - prediabetes OT - prevention OT - type 2 diabetes mellitus COIS- Conflicts of Interest: DG, BL, TA, EHJ, AF, CR, and MH declare that they have no conflicts of interest. JTK has received consulting fees from SeeChange Health and HealthMine, and a speaking honorarium from AbilTo, Inc. EDAT- 2019/01/11 06:00 MHDA- 2019/01/11 06:01 PMCR- 2019/01/09 CRDT- 2019/01/11 06:00 PHST- 2018/06/09 00:00 [received] PHST- 2018/09/10 00:00 [accepted] PHST- 2018/08/23 00:00 [revised] PHST- 2019/01/11 06:00 [entrez] PHST- 2019/01/11 06:00 [pubmed] PHST- 2019/01/11 06:01 [medline] PHST- 2019/01/09 00:00 [pmc-release] AID - v7i1e11267 [pii] AID - 10.2196/11267 [doi] PST - epublish SO - JMIR Mhealth Uhealth. 2019 Jan 9;7(1):e11267. doi: 10.2196/11267.