A culturally adapted diet and physical activity text message intervention to prevent Type 2 diabetes mellitus for women of Pakistani origin living in Scotland: formative study

Krasuska, M., Davidson, E. M., Beune, E., Jenum, A. K., Gill, J. M.R. , Stronks, K., van Valkengoed, I. G.M., Diaz, E. and Sheikh, A. (2023) A culturally adapted diet and physical activity text message intervention to prevent Type 2 diabetes mellitus for women of Pakistani origin living in Scotland: formative study. JMIR Formative Research, 7, e33810. (doi: 10.2196/33810) (PMID:37713245) (PMCID:PMC10541642)

Abstract

Background: Individuals of South Asian origin are at an increased risk of developing type 2 diabetes mellitus (T2DM) compared with other ethnic minority groups. Therefore, there is a need to develop interventions to address, and reduce, this heightened risk. Objective: We undertook formative work to develop a culturally adapted diet and physical activity text message intervention to prevent T2DM for women of Pakistani origin living in Scotland. Methods: We used a stepwise approach that was informed by the Six Steps in Quality Intervention Development framework, which consisted of gathering evidence through literature review and focus groups (step 1), developing a program theory for the intervention (step 2), and finally developing the content of the text messages and an accompanying delivery plan (step 3). Results: In step 1, we reviewed 12 articles and identified 3 key themes describing factors impacting on diet and physical activity in the context of T2DM prevention: knowledge on ways to prevent T2DM through diet and physical activity; cultural, social, and gender norms; and perceived level of control and sense of inevitability over developing T2DM. The key themes that emerged from the 3 focus groups with a total of 25 women were the need for interventions to provide “friendly encouragement,” “companionship,” and a “focus on the individual” and also for the text messages to “set achievable goals” and include “information on cooking healthy meals.” We combined the findings of the focus groups and literature review to create 13 guiding principles for culturally adapting the text messages. In step 2, we developed a program theory, which specified the main determinants of change that our text messages should aim to enhance: knowledge and skills, sense of control, goal setting and planning behavior, peer support, and norms and beliefs guiding behavior. In step 3, we used both the intervention program theory and guiding principles to develop a set of 73 text messages aimed at supporting a healthy diet and 65 text messages supporting increasing physical activity. Conclusions: We present a theory-based approach to develop a culturally adapted diet and physical activity text message intervention to prevent T2DM for women of Pakistani origin living in Scotland. This study outlines an approach that may also be applicable to the development of interventions for other ethnic minority populations in diverse settings. There is now a need to build on this formative work and undertake a feasibility trial of a text message–based diet and physical activity intervention to prevent T2DM for women of Pakistani origin living in Scotland.

• Item Type: Articles
• Additional Information: This study was funded by the Health Programme 2014-2020 from the European Union grant HP-PJ-2014 (InPreSD—Innovative Prevention Strategies for type 2 Diabetes in South Asians Living in Europe).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Gill, Professor Jason
• Authors: Krasuska, M., Davidson, E. M., Beune, E., Jenum, A. K., Gill, J. M.R., Stronks, K., van Valkengoed, I. G.M., Diaz, E., and Sheikh, A.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: JMIR Formative Research
• Publisher: JMIR Publications
• ISSN: 2561-326X
• ISSN (Online): 2561-326X
• Copyright Holders: Copyright © 2023 ©Marta Krasuska, Emma M Davidson, Erik Beune, Anne Karen Jenum, Jason MR Gill, Karien Stronks, Irene GM van Valkengoed, Esperanza Diaz, Aziz Sheikh
• First Published: First published in JIMR Formative Research 7:e33810
• Publisher Policy: Reproduced under a Creative Commons licence