Changing diet and physical activity behaviour in type 2 diabetes

Cradock, Kevin
The aim of this thesis was to design an artefact to support diet and physical activity behaviour change in people with type 2 diabetes. The first step was to identify behaviour change techniques (BCTs) in diet and physical activity interventions in type 2 diabetes management. A systematic review identified 13 studies which identified four BCTs from 46 identified associated with clinically significant reductions in HbA1c: ‘instruction on how to perform a behaviour’, ‘behavioural practice/rehearsal’, ‘demonstration of the behaviour’ and ‘action planning’ in addition to the intervention features ‘supervised physical activity’, ‘group sessions’, ‘contact with an exercise physiologist’, ‘contact with an exercise physiologist and a dietitian’, ‘baseline HbA1c >8%’ and interventions of greater frequency and intensity. Initial weight loss and reductions in HbA1c diminished over time. A second systematic review and meta-analysis looking at exclusively diet BCTs in type 2 diabetes management was carried out. 54 studies were identified which included 42 different BCTs, four of which were associated with clinically significant reductions in HbA1c: ‘feedback on behaviour’, ‘problem solving’, ‘adding objects to the environment’, ‘social comparison’ and the intervention feature ‘use of theory’. Meta-analyses showed that studies that changed behaviour by controlling the diet environment were more successful than studies that changed behaviour by instructing the participant as to what to do. The first phase of the design process began with an exploration of the lives and experiences of participants with type 2 diabetes using design probes. Participants identified barriers, facilitators and ideas associated with their diet and physical activity behaviours. Thematic analysis identified themes of the food environment, mental health, work schedule, planning, social support, cravings, economic circumstances and energy associated with diet behaviour with similar themes identified for physical activity as well as themes of physical health, weather, motivation and the physical environment. The second phase of this design process explored the barriers, facilitators and ideas identified in the design probes in greater depth in focus groups and generative exercises and following this process a Lifestyle Planner based intervention was designed. The designed Lifestyle Planner intervention targeted diet, water consumption and mental health and included a Preparatory Workbook, one-to-one action planning and a Lifestyle Planner. The Lifestyle Planner diet intervention was evaluated with four participants over 12 weeks and results showed improvements in mental health, weight loss and positive participant feedback, suggesting the need for further testing and potential adaption to a smartphone app.
NUI Galway
Publisher DOI
Attribution-NonCommercial-NoDerivs 3.0 Ireland