A text messaging approach to behavioural change, tailored using the transtheoretical model, in the primary prevention of type 2 diabetes mellitus in Asian Indians

Abstract

Landmark diabetes prevention trials have shown that lifestyle modification is effective in preventing type 2 diabetes (T2D). In general, information technology with short message service (SMS) and interventions based on behavioral theories of individualized motivation are more effective than non-tailored intervention. The Transtheoretical Model (TTM) is a combination of behavioral theory and stage-based theory. We used TTM-tailored healthy lifestyle and motivating SMS messages as an intervention strategy in a 2-year prospective randomized controlled diabetes prevention trial with two groups (control n=266: intervention n=271) of men with impaired glucose tolerance. The main objectives were: 1. To study the utility and acceptability of TTM-based SMS in reducing the incidence of T2D. 2. To analyse the change in TTM stages in the study groups in lifestyle factors (diet and physical activity practices) with respect to incidence of diabetes at the end of the study. 3. To analyse the effects of TTM tailored SMS intervention on quality of life and general health and diabetes awareness. Evaluation tools included: 1.TTM stages of change inventory for diet and physical activity practices. 2. SMS acceptability questionnaire. 3. WHOQOL-BREF (quality of life) questionnaire. 4. General health and diabetes awareness questionnaire. Questionnaires 1 and 2 were study-specific and developed by the candidate whereas 3 and 4 were standardized. Dietary and physical activity questionnaires had been used in previous diabetes prevention studies in India. The TTM-based SMS intervention reduced the incidence of T2D (50 [18%] intervention group; 73 [27%], control group (absolute risk reduction 9%)). Significant differences in TTM stage were observed in the intervention group (p<0.05) at six and twenty-four months for dietary practices. Significant differences (p<0.05) were observed in physical activity practices only at six months. SMS helped improve quality of life. Significant improvement (p<0.001) was observed in general health awareness and diabetes awareness in the intervention group at the end of the study. The TTM-based SMS intervention was associated with reduced incidence of T2D. The intervention helped improve dietary habits. It also helped improve QOL and general health and diabetes awareness level.