Shopping for healthy habits: Design and 4-month usage of an Internet-based lifestyle intervention to prevent type 2 diabetes (Preprint)

Marja Harjumaa (Corresponding Author), Pilvikki Absetz, Miikka Ermes, Elina Mattila, Reija Männikkö, Tanja Tilles-tirkkonen, Niina Lintu, Ursula Schwab, Adil Umer, Juha Leppänen, Jussi Pihlajamäki

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Background: Prevalence of type 2 diabetes is rapidly increasing and is now almost 10% in the adult population. Research has shown it can be prevented through lifestyle changes, but sustainable and scalable lifestyle intervention models are still lacking. Habit-based approaches offer an underutilized opportunity to induce long term behavior changes.
Objective: The purpose of this study is to describe an Internet-based lifestyle intervention for people at risk for type 2 diabetes targeted to support formation of healthy habits and to explore the usage behavior during the first four months of a randomized controlled trial.
Methods: The BitHabit intervention app was created in a collaborative process between medical and nutrition scientists, behavior scientists and computer scientists, and its feasibility was tested with end-users. The intervention was based on Self-Determination Theory and habit theories, with the design and functionalities aimed to provide similar user experience as online shopping. The app offers 489 simple, contextualized behavioral suggestions, triggered by daily life activities. Users can browse, inspect and select them, report their performances on a daily basis, and reflect on their own activities. Users can also get reminders, information on other users’ activities and information on the prevention of type 2 diabetes. An unblended parallel Randomized Controlled Trial (RCT) was carried out incorporated in the primary health care system to evaluate the effectiveness of the app in comparison to routine care. Usage behavior of the app is reported for the first four months of the trial based on the log data of the participants, who were 18-70 year-old community-dwelling adults at an increased risk for type 2 diabetes. Participants attracted by varied means of community mobilization were recruited using a digital risk-screening tool provided through the project’s web site.
Results: Altogether 3 271 participants were recruited online of which 2909 were eligible to participate in the RCT. The participants were randomized using a computerized randomization system to the control group (n=971), the Internet-based intervention (n=967) and the Internet-based intervention with face-to-face group counseling (n=971). Intervention groups were combined for the analysis. Mean age of the control group was 55.0 years and intervention groups 55.1 years. 80.9% of the control group and 79.5% of the intervention group participants were women. 99.5% of the participants logged in to the app at least once, 98.6% of them selected at least one habit, and 94.9% reported at least one habit performance. During the four months use the median number of usage days was 17 (IQR 10-30). The median number of sessions was 20 (IQR 11-36). The median session duration was 1.8 minutes (IQR 0.7-3.8) and the median total usage time was 69 minutes (IQR 33-146). Altogether, 782 939 performances were reported during the first 4 months.
Conclusions: The results demonstrate that Internet-based lifestyle interventions can be delivered to large user groups. Citizens have technological capabilities to adopt such solutions, and with recruitment based on risk screening, high level of engagement with the intervention can be reached. Clinical Trial: Identifier: NCT03156478
Original languageEnglish
JournalJMIR Diabetes
Publication statusSubmitted - 29 Feb 2020
MoE publication typeA1 Journal article-refereed

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    Harjumaa, M., Absetz, P., Ermes, M., Mattila, E., Männikkö, R., Tilles-tirkkonen, T., Lintu, N., Schwab, U., Umer, A., Leppänen, J., & Pihlajamäki, J. (2020). Shopping for healthy habits: Design and 4-month usage of an Internet-based lifestyle intervention to prevent type 2 diabetes (Preprint). Manuscript submitted for publication.