Research explores behaviour change techniques for diabetes self-management mobile apps

In a study published in The Lancet, a research team sought to identify which behaviour change techniques work best for diabetes self-management mobile apps, with the findings indicating that self-monitoring of behaviour as a behaviour change technique and taking medication as a target behaviour were both associated with improved metabolic outcomes.

Contextually, the study notes the importance of self-management for diabetes but acknowledges that sustained enactment of effective self-management for diabetes “remains challenging” as it requires engagement in “diverse behavioural activities” throughout life, such as a regular exercise schedule, monitoring health, following medication regimens and consistently adapting diet. Digital tech has “created unparalleled opportunities to constantly assess and modify health behaviours,” the researchers suggest, “utilising technologies such as computer programs, mobile apps and wearable devices to encourage behaviour change”.

To conduct their analyses, the researchers identified 57 randomised controlled trials published until November 2023 from four separate sources. The team were looking for the mean difference in HbA1c levels between baseline and follow-up as the main outcome variable.

Overall, the study found that “apps are effective in improving glycaemic control in patients with diabetes”; in particular, the data indicated “gradual improvement in app performance peaking around the nine-month time point, followed by a decrease in effectiveness thereafter”. Improvements in HbA1c were noted to have associated with individual BCTs, with self-monitoring of behaviour “explaining greatest amount of heterogeneity”.

The authors expand on this point: “Our results confirm that actively tracking individual parameters and data using DBCIs (digital behaviour change interventions) can enable patients to take control of their condition and enhance emotional investment, a crucial component of self-management. Based on our analyses, self-monitoring emerges as a more effective strategy compared to passive sensing, which captures data about a person without requiring any extra effort on their part, confirming the importance of self-reporting when DBCIs are intended to support behaviour change.

Another element reported to have a “statistically significant impact” was user involvement being a highlighted development feature in the digital tech solution, with interventions that had incorporated user involvement in their design exhibiting improved glycaemic control. This finding “warrants careful consideration”, the researchers note, as it emphasises that “inability to navigate the practical challenges in implementing user-centred design may limit its beneficial impact.

Citation: Which behaviour change techniques work best for diabetes self-management mobile apps? Results from a systematic review and meta-analysis of randomised controlled trials. Rosanna Tarricone, Francesco Petracca, Liv Svae, Maria Cucciniello, Oriana Ciani: