Participation of individuals with type 2 diabetes in a behavioural e-health lifestyle intervention in Denmark: A feasibility study

Background

Behavioural lifestyle interventions can support type 2 diabetes (T2D) self-management; however, participation and adherence rates are often low. This feasibility study examined characteristics of individuals with T2D who were willing or unwilling to participate in, complete, and adhere to a personalised e-health behavioural lifestyle intervention in a general practitioner (GP) setting.

Method

Nurses at two Danish GP setting invited patients with T2D to participate in a one-year smartphone-based intervention. Patient characteristics were obtained from Danish health registers, GP records, and previously collected data. The personalized intervention included three face-to-face consultations (at baseline, 2 months, and 12 months) to set personal goals and measure weight, height, waist, and hip circumferences. Physical and mental health were assessed using the SF-12v1 survey. All other support and interactions occurred via app. Adherence to the app usage was evaluated by tracking logins, messages sent, and response times during the first and final three months of the intervention.

Results

Of the 63 eligible individuals with T2D, 20 (31.7 %) agreed to participate. Those who were willing to participate were predominantly men (75 %), younger (median age 57 years [IQR 52; 66] vs. 65 years [IQR: 57; 73]), had a longer duration of diabetes (6.6 years [2.9; 8.2] vs. 5.5 years [3.7; 7.0], higher fasting glucose levels (8.5 mmol/L [6.8; 10.4] vs. 7.9 mmol/L [7.1; 9.3]), and lower mental component scores (48.8 [38.5; 52.0] vs. 54.7 [47.3; 58.7]) compared to those unwilling. Of 20 individuals who were willing to participate, 13 (65 %) completed the intervention. After 2 months their mental component scores were 47.4 (40.6; 50.5), compared to 31.5 (31.5; 45.8) among those who dropped out. Additionally, completers demonstrated more consistent app usage, whereas app engagement among dropouts declined significantly over the first two months.

Conclusion

Willingness to participate in the behavioural intervention among individual with T2D was modest. Those willing to participate and completed the intervention were more often men, had better mental health, and showed higher app engagement than dropouts. These findings underscore the need for personalized strategies to improve participation and adherence in e-health lifestyle interventions.