University of Twente Student Theses


Development and Evaluation of a Just-in-Time Adaptive eCoach to Encourage Physical Activity and Healthy Nutrition in People with Type 2 Diabetes Mellitus

Hietbrink, E.A.G. (2020) Development and Evaluation of a Just-in-Time Adaptive eCoach to Encourage Physical Activity and Healthy Nutrition in People with Type 2 Diabetes Mellitus.

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Abstract:Background: Type 2 Diabetes Mellitus (T2DM) is a chronic condition with major impact on the health and well-being of individuals. The lifestyle components physical activity and healthy nutrition are core elements in diabetes management. However, adhering to recommendations regarding physical activity and healthy nutrition appears to be challenging for people with T2DM. Tailored lifestyle coaching on personal and environmental factors can increase adherence to lifestyle recommendations. Just-in-time adaptive interventions allow for this tailored support by adapting to an individual's personal state and environment. In previous research, eCoaching modules were developed to support a healthy lifestyle in people with T2DM but these modules were not tailored to an individual's personal state and environment yet. Aim: The aim of this study was to develop and evaluate a just-in-time adaptive eCoaching module to encourage physical activity and healthy nutrition in people with T2DM. Methods: A literature search and online questionnaires were used to identify personal and environmental factors that influence physical activity and healthy nutrition. Subsequently, the information, that was found in literature and assessed with the online questionnaires, was applied to develop an ecological momentary assessment (EMA) questionnaire and coaching messages tailored to personal and environmental factors. Decision points and rules were established in order to complete the design. Eight people with T2DM evaluated the resulting eCoaching module. During this evaluation, participants received two EMA questionnaires and two text messages per day for two weeks. At the end of the evaluation, telephone interviews were conducted to assess the eCoaching module on content, personalization, expected contribution to behavioural change, behaviour use and general appreciation. Results: The questionnaires showed that health benefits, enjoyment of the healthy behaviour, and emotions are key influencing factors for both physical activity and healthy nutrition. Social support, weather conditions and physical discomfort appeared to be important factors that influence physical activity. Personal motivations and environmental barriers seemed to affect healthy dietary habits. An EMA questionnaire was developed to assess eleven dynamic personal and environmental factors at two semirandom times per day. Furthermore, a set of 310 short coaching messages was developed. People with T2DM were predominantly positive about the eCoaching module. They rated the module with an average grade of 8 out of 10. The EMA questionnaire contained relevant instructions, questions and answer options and the burden of the questionnaire was considered low. In general, the content and personalization of the coaching messages were considered satisfactory. In addition, the eCoaching module has the potential to change behaviour. Conclusion: A first version of a just-in-time adaptive eCoach for lifestyle support in people with T2DM was developed and positively evaluated. Nevertheless, personalization can be improved further on personal goals, stages of change, influencing lifestyle factors for specific target groups and current lifestyle.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:01 general works, 44 medicine
Programme:Health Sciences MSc (66851)
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