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A digital lifestyle behaviour change intervention for the prevention of type 2 diabetes: a qualitative study exploring intuitive engagement with real-time glucose and physical activity feedback

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posted on 2021-01-18, 15:25 authored by Maxine E Whelan, Francesca Denton, Claire LA Bourne, Andrew KingsnorthAndrew Kingsnorth, Lauren SherarLauren Sherar, Mark W Orme, Dale EsligerDale Esliger
BACKGROUND: Mobile health technologies have advanced to now allow monitoring of the acute physiological responses to lifestyle behaviours. Our aim was to explore how people engaged with real-time feedback on their physical activity and glucose levels over several weeks. METHODS: Semi-structured interviews with 26 participants (61.5% female, 56.6 years) at moderate-to-high risk of developing type 2 diabetes were conducted. Interviews were completed after participants took part in an intervention comprising a flash glucose monitor (Freestyle Libre) and a physical activity monitor (Fitbit Charge 2). Purposive sampling ensured representation of ages, genders and group allocations. RESULTS: Inductive thematic analysis revealed how individuals intuitively used, interpreted and acted on feedback from wearable technologies. Six key themes emerged: triggers of engagement with the technologies, links between behaviour and health, lack of confidence, changes to movement behaviours, changes to diet and barriers to lifestyle behaviour change. CONCLUSIONS: Our findings demonstrate that accessing behavioural and physiological feedback can increase self-awareness of how lifestyle impacts short-term health. Some participants noticed a link between the feedback presented by the two devices and changed their behaviour but many did not. Training and educational support, as well as efforts to optimize how feedback is presented to users, are needed to sustain engagement and behaviour change. Extensions of this work to involve people with diabetes are also warranted to explore whether behavioural and physiological feedback in parallel can encourage better diabetes self-management. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN17545949 , 12/05/2017, prospectively registered.


This work was funded in part by philanthropic support received from the late Dr. the Honorable David Saul. The research was supported by the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre. This work has also been supported in part by the Higher Education Institution Challenge for Patient Supported Quality Improvement and Education in Health and Social Care (funded by the East Midlands Academic Health Science Network) for the involvement of members of the public in research and by Loughborough University School of Sport, Exercise and Health Science for research facilitation funds.



  • Sport, Exercise and Health Sciences

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BMC Public Health






BioMed Central


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This is an Open Access Article. It is published by BioMed Central under the Creative Commons Attribution 4.0 International Licence (CC BY 4.0). Full details of this licence are available at: https://creativecommons.org/licenses/by/4.0/

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Dr Dale Esliger. Deposit date: 16 January 2021

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