There was a strong Diabetes Prevention Research Group presence at this year’s North American Society for the Psychology of Sport and Physical Activity (NASPSPA) Annual Conference in Kona, Hawaii. Learn more about our presentations, below.

Making the ‘MOST’ out of your mHealth intervention: How to develop behaviour change interventions using the Multiphase Optimization Strategy.

MacPherson, M., Merry, K., Locke, S., Jung, M.E.

With thousands of health and fitness mHealth interventions on the market, people struggle to choose an appropriate intervention. The lack of evidence-based mHealth may be due to limited research on intervention development and continued use of traditional research methods for mHealth evaluation. The Multiphase Optimization Strategy (MOST) is a 3 phase development framework which highlights not only intervention effectiveness, but also affordability, scalability, and efficiency (EASE), all factors necessary to developing mHealth interventions that will be used in practice. MOST Phase I highlights the importance of formative intervention development, which is often overlooked and rarely published. MOST Phase I aims to identify candidate intervention components, create a conceptual model, and define an optimization objective; however, the framework does not provide robust guidance on how to conduct quality Phase I research: what steps can be taken to identify intervention components, develop the conceptual model, and achieve intervention EASE with the implementation context in mind. To advance the applicability of MOST within the field of behaviour change science, this work provides an exemplar for how to develop an mHealth intervention. Specifically, we provide an example of how to achieve MOST Phase I goals by outlining the formative development of a text messaging intervention within a diabetes prevention program. Based on these experiences, recommendations are proposed for future researchers to conduct formative research on mHealth interventions with implementation in mind. Given its considerable reach, mHealth has the potential to positively impact public health by decreasing implementation costs and improving accessibility. MOST is well-suited for the efficient development and optimization of mHealth interventions. By using an implementation-focused lens and outlining the steps in developing an mHealth intervention using MOST Phase I, this work can guide future intervention developers towards maximizing the impact of mHealth outside of the research laboratory.

Examining the delivery of motivational interviewing and behavior change techniques in an mHealth exercise intervention for adults with type 2 diabetes.

Cranston, K. D., MacPherson, M. M., Dineen, T. E., McManus, A., Cocks, M., Low, J., Hesketh, K., & Jung, M. E.

The primary focus on efficacy within physical activity interventions impedes implementation outside of the research context. P-values and effect sizes alone do not provide necessary information on how an intervention might be translated into a different context. Comprehensive reporting of active ingredients within an intervention, coupled with intervention fidelity must be addressed at the early stages of trial design to improve implementation. The purpose of this work was to code active intervention components (behaviour change techniques [BCTs] and motivational interviewing [MI] techniques) used within MOTIVATE T2D and examine the extent to which coaches implement the intervention as intended. MOTIVATE T2D is an ongoing randomized pilot study assessing if mobile health technology can improve exercise adherence among individuals with type 2 diabetes. Exercise coaches meet one-on-one with participants in both an exercise counselling control group and an exercise counselling plus mobile health group. Coaches received brief MI training and were provided with session scripts to ensure consistency between groups. Three independent reviewers coded the BCTs and MI techniques in all session scripts. The reviewers then coded a random selection of audio recordings of each of the sessions delivered by the exercise coaches. Session scripts contained 3-14 BCTs and 4-11 MI techniques. Audio recordings contained 3-7 BCTs and 4-11 MI techniques that were in the scripts, and 2-4 BCTs and 1-3 MI techniques that were not in the scripts. To determine the effectiveness of the MOTIVATE T2D pilot study, delivery fidelity must be critically considered. Before progressing to a randomized controlled trial, changes to the scripts and coach training can be made to help improve delivery fidelity. Broadly, comprehensive reporting and adequate fidelity can enable more accurate interpretation of research findings, thus allowing for successful interventions to be more accurately and easily implemented into different contexts.

Move better to feel better: A mixed-methods exploration of the impact of an mHealth app on perceptions of functional movement and physical fitness.

Stork, M. J., McCreary, S., Bean, C., & Jung, M. E.

movr is an mHealth app that has been shown to enhance functional movement and physical fitness by prescribing physical training based on personalized movement assessments. movr’s app usability and impact on perceptions of physical functioning are unknown. The purpose of this study was to explore participants’ receptivity to the movr app and examine how using the app impacted perceptions of functional movement and physical fitness. Forty-eight healthy adults (24 women, 24 men; Mage: 24 ± 5 years) were randomly assigned to 8 weeks of using the movr app (n = 24) or 8 weeks waitlist control (n = 24). A concurrent embedded mixed-methods design was used. The quantitative component consisted of self-reported measures of physical activity enjoyment (PACES) and satisfaction with physical fitness (SPF). The qualitative component consisted of one-on-one semi-structured interviews among a random sub-sample of 15 participants in the movr group. Measures were taken, and interviews were conducted, pre- and post-intervention. Mixed repeated-measures ANOVAs revealed no changes in PACES for either group (ps > .05). Only a significant main effect of time was found for SPF (p = .02), such that scores increased pre- to post-intervention in the movr group (p = .01), but not in the control group (p = .45). Using a codebook thematic analysis, five overarching themes were identified. Three themes were linked to app usability (perceived benefits of app use, challenges, recommendations) and two themes were linked to perceived impact on functioning (physical, psychological). The movr app was well received and positively impacted participants’ perceptions of functional movement and physical fitness (e.g., flexibility, strength). Such findings showed that movr improved perceptions of physical functioning over an 8-week period and provided new insights about the usability and accessibility of the app. It appears that movr is a user-friendly tool that may be used to enhance perceptions (and measures) of functional movement and physical fitness among healthy adults.

Can a brief equity, diversity and inclusion module increase kinesiology students’ empathetic awareness of people who experience weight or race biases?

Sim, J., Cranston, K., & Jung, M.E.

Many individuals with overweight and obesity or from racialized groups experience stigma and bias from healthcare practitioners. Small Steps for Big Changes (SSBC) is a diabetes prevention program designed to empower individuals at risk of type 2 diabetes to make diet and exercise changes in their lives. It is important to train SSBC coaches on equity, diversity, and inclusion (EDI) to reduce the biases they may hold towards SSBC clients. This study investigated whether a brief EDI module could increase kinesiology students’ (a population representative of SSBC coaches) empathetic awareness of people who experience weight and/or race biases.

Participants were recruited through online postings, classroom visits, and email lists. Participants were randomly divided into four groups: EDI-weight, non-EDI-weight, EDI-race, and non-EDI-race. The non-EDI groups were used as a manipulation check. Empathetic awareness
was measured using the empathetic awareness subscale of the Scale of Ethnocultural Empathy and then adapted to fit the weight scenario. The two EDI groups completed the brief SSBC EDI module, and the non-EDI groups watched a neutral video. Empathetic awareness was measured before and after watching either the EDI module or neutral video. The EDI-weight group reported significantly higher mean empathetic awareness to overweight individuals’ postmodule (M = 5.64, SD = 0.65) compared to pre (M = 5.19, SD = 0.76, p = 0.024). There was no difference in empathetic awareness towards racialized individuals from pre (M= 4.91, SD = 1.01) to post module (M = 4.91, SD = 0.82, p = 1.0). These results suggest that a brief EDI module can increase kinesiology students’ empathetic awareness towards people who experience weight biases.

E-learning in diabetes prevention: Examining the effectiveness of an online training program for diabetes prevention coaches.

Grieve, N. J., Cranston, K. D., & Jung, M. E.

E-learning platforms have been shown to be an effective mode for teaching content and skills to health professionals, however less is known within the context of training diabetes prevention coaches. This study aimed to examine the effectiveness of an online coach training course within Small Steps for Big Changes (SSBC). SSBC is a community-based diabetes prevention program run in partnership with the YMCA. SSBC guides adults with prediabetes through exercise and counselling sessions using a motivational interviewing (MI) approach to help empower healthy lifestyle modifications and prevent type 2 diabetes (T2D). This program requires specific training for SSBC coaches (ie., YMCA staff) to counsel clients. Originally, an in-person training workshop was held to train SSBC coaches; however, this process logistically limits training opportunities and program scale-up. As such, an online course to deliver training to SSBC coaches was developed, and effectiveness was determined using pre- and post-training questionnaires assessing knowledge of T2D, MI and SSBC content. Incoming SSBC coaches completed an asynchronous 7-module e-learning course that consisted of relevant content on how to guide a SSBC client through the program. These modules covered SSBC-specific content, MI skills and knowledge, and general T2D information. These modules were followed by a virtual mock client session for coaches to practice skills and apply their leaning. MI knowledge (M1=4.00, SD1=1.63, M2=6.14, SD2=0.90; P < 0.05), and SSBC content knowledge (M1=5.00, SD1=1.82, M2=8.29, SD2=0.95; P < 0.05) significantly increased from pre- to post-training. Increases in diabetes knowledge did not reach statistical significance (M1=7.43, SD1=1.90, M2=8.43, SD2=0.79; P= 0.11). This study demonstrates promising results for e-learning in the context of novice SSBC coaches and can be adapted to other diabetes prevention coaching contexts. This online coach training will allow for SSBC to train more coaches, expand to locations across Canada, and ultimately reach more adults living with prediabetes.