Digitally Supported Lifestyle Intervention to Prevent Type 2 Diabetes Through Healthy Habits: Secondary Analysis of Long-Term User Engagement Trajectories in a Randomized Controlled Trial
BackgroundDigital health interventions may offer a scalable way to prevent type 2 diabetes (T2D) with minimal burden on health care systems by providing early support for healthy behaviors among adults at increased risk for T2D. However, ensuring continued engagement with dig...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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JMIR Publications
2022-02-01
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| Series: | Journal of Medical Internet Research |
| Online Access: | https://www.jmir.org/2022/2/e31530 |
| _version_ | 1797735252240629760 |
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| author | Piia Lavikainen Elina Mattila Pilvikki Absetz Marja Harjumaa Jaana Lindström Elina Järvelä-Reijonen Kirsikka Aittola Reija Männikkö Tanja Tilles-Tirkkonen Niina Lintu Timo Lakka Mark van Gils Jussi Pihlajamäki Janne Martikainen |
| author_facet | Piia Lavikainen Elina Mattila Pilvikki Absetz Marja Harjumaa Jaana Lindström Elina Järvelä-Reijonen Kirsikka Aittola Reija Männikkö Tanja Tilles-Tirkkonen Niina Lintu Timo Lakka Mark van Gils Jussi Pihlajamäki Janne Martikainen |
| author_sort | Piia Lavikainen |
| collection | DOAJ |
| description |
BackgroundDigital health interventions may offer a scalable way to prevent type 2 diabetes (T2D) with minimal burden on health care systems by providing early support for healthy behaviors among adults at increased risk for T2D. However, ensuring continued engagement with digital solutions is a challenge impacting the expected effectiveness.
ObjectiveWe aimed to investigate the longitudinal usage patterns of a digital healthy habit formation intervention, BitHabit, and the associations with changes in T2D risk factors.
MethodsThis is a secondary analysis of the StopDia (Stop Diabetes) study, an unblinded parallel 1-year randomized controlled trial evaluating the effectiveness of the BitHabit app alone or together with face-to-face group coaching in comparison with routine care in Finland in 2017-2019 among community-dwelling adults (aged 18 to 74 years) at an increased risk of T2D. We used longitudinal data on usage from 1926 participants randomized to the digital intervention arms. Latent class growth models were applied to identify user engagement trajectories with the app during the study. Predictors for trajectory membership were examined with multinomial logistic regression models. Analysis of covariance was used to investigate the association between trajectories and 12-month changes in T2D risk factors.
ResultsMore than half (1022/1926, 53.1%) of the participants continued to use the app throughout the 12-month intervention. The following 4 user engagement trajectories were identified: terminated usage (904/1926, 46.9%), weekly usage (731/1926, 38.0%), twice weekly usage (208/1926, 10.8%), and daily usage (83/1926, 4.3%). Active app use during the first month, higher net promoter score after the first 1 to 2 months of use, older age, and better quality of diet at baseline increased the odds of belonging to the continued usage trajectories. Compared with other trajectories, daily usage was associated with a higher increase in diet quality and a more pronounced decrease in BMI and waist circumference at 12 months.
ConclusionsDistinct long-term usage trajectories of the BitHabit app were identified, and individual predictors for belonging to different trajectory groups were found. These findings highlight the need for being able to identify individuals likely to disengage from interventions early on, and could be used to inform the development of future adaptive interventions.
Trial RegistrationClinicalTrials.gov NCT03156478; https://clinicaltrials.gov/ct2/show/NCT03156478
International Registered Report Identifier (IRRID)RR2-10.1186/s12889-019-6574-y |
| first_indexed | 2024-03-12T12:56:19Z |
| format | Article |
| id | doaj.art-3d9371372cb541c28544113f0281931c |
| institution | Directory Open Access Journal |
| issn | 1438-8871 |
| language | English |
| last_indexed | 2024-03-12T12:56:19Z |
| publishDate | 2022-02-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | Journal of Medical Internet Research |
| spelling | doaj.art-3d9371372cb541c28544113f0281931c2023-08-28T20:52:39ZengJMIR PublicationsJournal of Medical Internet Research1438-88712022-02-01242e3153010.2196/31530Digitally Supported Lifestyle Intervention to Prevent Type 2 Diabetes Through Healthy Habits: Secondary Analysis of Long-Term User Engagement Trajectories in a Randomized Controlled TrialPiia Lavikainenhttps://orcid.org/0000-0003-3560-8860Elina Mattilahttps://orcid.org/0000-0001-7805-5982Pilvikki Absetzhttps://orcid.org/0000-0002-1047-909XMarja Harjumaahttps://orcid.org/0000-0002-5919-5709Jaana Lindströmhttps://orcid.org/0000-0001-9255-020XElina Järvelä-Reijonenhttps://orcid.org/0000-0002-9346-3340Kirsikka Aittolahttps://orcid.org/0000-0002-6283-7805Reija Männikköhttps://orcid.org/0000-0002-1448-1971Tanja Tilles-Tirkkonenhttps://orcid.org/0000-0002-8268-3401Niina Lintuhttps://orcid.org/0000-0002-5456-1490Timo Lakkahttps://orcid.org/0000-0002-9199-2871Mark van Gilshttps://orcid.org/0000-0002-0029-1771Jussi Pihlajamäkihttps://orcid.org/0000-0002-6241-6859Janne Martikainenhttps://orcid.org/0000-0003-0855-3921 BackgroundDigital health interventions may offer a scalable way to prevent type 2 diabetes (T2D) with minimal burden on health care systems by providing early support for healthy behaviors among adults at increased risk for T2D. However, ensuring continued engagement with digital solutions is a challenge impacting the expected effectiveness. ObjectiveWe aimed to investigate the longitudinal usage patterns of a digital healthy habit formation intervention, BitHabit, and the associations with changes in T2D risk factors. MethodsThis is a secondary analysis of the StopDia (Stop Diabetes) study, an unblinded parallel 1-year randomized controlled trial evaluating the effectiveness of the BitHabit app alone or together with face-to-face group coaching in comparison with routine care in Finland in 2017-2019 among community-dwelling adults (aged 18 to 74 years) at an increased risk of T2D. We used longitudinal data on usage from 1926 participants randomized to the digital intervention arms. Latent class growth models were applied to identify user engagement trajectories with the app during the study. Predictors for trajectory membership were examined with multinomial logistic regression models. Analysis of covariance was used to investigate the association between trajectories and 12-month changes in T2D risk factors. ResultsMore than half (1022/1926, 53.1%) of the participants continued to use the app throughout the 12-month intervention. The following 4 user engagement trajectories were identified: terminated usage (904/1926, 46.9%), weekly usage (731/1926, 38.0%), twice weekly usage (208/1926, 10.8%), and daily usage (83/1926, 4.3%). Active app use during the first month, higher net promoter score after the first 1 to 2 months of use, older age, and better quality of diet at baseline increased the odds of belonging to the continued usage trajectories. Compared with other trajectories, daily usage was associated with a higher increase in diet quality and a more pronounced decrease in BMI and waist circumference at 12 months. ConclusionsDistinct long-term usage trajectories of the BitHabit app were identified, and individual predictors for belonging to different trajectory groups were found. These findings highlight the need for being able to identify individuals likely to disengage from interventions early on, and could be used to inform the development of future adaptive interventions. Trial RegistrationClinicalTrials.gov NCT03156478; https://clinicaltrials.gov/ct2/show/NCT03156478 International Registered Report Identifier (IRRID)RR2-10.1186/s12889-019-6574-yhttps://www.jmir.org/2022/2/e31530 |
| spellingShingle | Piia Lavikainen Elina Mattila Pilvikki Absetz Marja Harjumaa Jaana Lindström Elina Järvelä-Reijonen Kirsikka Aittola Reija Männikkö Tanja Tilles-Tirkkonen Niina Lintu Timo Lakka Mark van Gils Jussi Pihlajamäki Janne Martikainen Digitally Supported Lifestyle Intervention to Prevent Type 2 Diabetes Through Healthy Habits: Secondary Analysis of Long-Term User Engagement Trajectories in a Randomized Controlled Trial Journal of Medical Internet Research |
| title | Digitally Supported Lifestyle Intervention to Prevent Type 2 Diabetes Through Healthy Habits: Secondary Analysis of Long-Term User Engagement Trajectories in a Randomized Controlled Trial |
| title_full | Digitally Supported Lifestyle Intervention to Prevent Type 2 Diabetes Through Healthy Habits: Secondary Analysis of Long-Term User Engagement Trajectories in a Randomized Controlled Trial |
| title_fullStr | Digitally Supported Lifestyle Intervention to Prevent Type 2 Diabetes Through Healthy Habits: Secondary Analysis of Long-Term User Engagement Trajectories in a Randomized Controlled Trial |
| title_full_unstemmed | Digitally Supported Lifestyle Intervention to Prevent Type 2 Diabetes Through Healthy Habits: Secondary Analysis of Long-Term User Engagement Trajectories in a Randomized Controlled Trial |
| title_short | Digitally Supported Lifestyle Intervention to Prevent Type 2 Diabetes Through Healthy Habits: Secondary Analysis of Long-Term User Engagement Trajectories in a Randomized Controlled Trial |
| title_sort | digitally supported lifestyle intervention to prevent type 2 diabetes through healthy habits secondary analysis of long term user engagement trajectories in a randomized controlled trial |
| url | https://www.jmir.org/2022/2/e31530 |
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