An SMS text message-based type 2 diabetes prevention program for Hispanic adolescents with obesity: Qualitative co-design process

Authors: SOLTERO, ERICA - Children'S Nutrition Research Center (CNRC); LOPEZ, CALLIE - Children'S Nutrition Research Center (CNRC); MIHAIL, SANDRA - Baylor College Of Medicine; HERNANDEZ, AYLEEN - Baylor College Of Medicine; MUSAAD, SALMA - Children'S Nutrition Research Center (CNRC); O'CONNOR, TERESIA - Children'S Nutrition Research Center (CNRC); Thompson, Deborah - Debbe

Submitted to: JMIR Formative Research
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/9/2023
Publication Date: 8/2/2023
Citation: Soltero, E.G., Lopez, C., Mihail, S., Hernandez, A., Musaad, S.M., O'Connor, T.M., Thompson, D.J. 2023. An SMS text message-based type 2 diabetes prevention program for Hispanic adolescents with obesity: Qualitative co-design process. JMIR Formative Research. 7. Article e46606. https://doi.org/10.2196/46606.
DOI: https://doi.org/10.2196/46606

Interpretive Summary: As the use of technology continues to grow in society, the use of digital health interventions has also grown. Interventions that leverage technology may be particularly promising for today's youth given that they have been exposed to technology from a younger age and are the highest users of text and social media communication. Engaging youth as co-collaborators can increase the reach and engagement of digital health interventions by informing the design and development of the program to be tested. The purpose of this study was to use a co-design process to develop Fit24, a 12-week goal-setting Fitbit and text-messaging intervention alongside Hispanic adolescents with obesity. Youth completed in-depth interviews to identify barriers and facilitators of physical activity and sleep, desired behavior change techniques, and preferences for receiving goal-setting assistance and feedback. Information gleaned from interviews was used to develop a bank of text messages that were reviewed and evaluated by panels of research experts and youth. Participants also provided guidance on the implementation of the intervention by informing the team on the desired frequency and timing of text messaging, their cell phone access, family data plans, and shared information on family rules about texting. The texts and program that was developed from this study will be further evaluated in a randomized pilot study assessing feasibility, acceptability, and preliminary efficacy. The co-design process used in this study provides a framework for future research aimed at developing text-message based strategies to reach high-risk youth.

Technical Abstract: This study aimed to use a co-design process to inform the development of SMS text messages that promote healthy physical activity (PA) and sleep behaviors among Hispanic adolescents with obesity. The co-design framework uses multiple methods across several phases. Self-determination theory and a literature review of SMS text message–based interventions guided the background and research phases. In the co-design phase, Hispanic adolescents (n=20) completed in-depth interviews to identify barriers and facilitators of PA and sleep, preferences for ways to emphasize key self-determination theory constructs (autonomy, competence, and relatedness), and suggestions for making SMS text message content engaging. In the design and content phase, interview findings were used to develop initial SMS text messages, which were then evaluated in the early evaluation phase by experts (n=6) and adolescents (n=6). Feedback from these panels was integrated into the SMS text message content during refinement. The background phase revealed that few SMS text message–based interventions have included Hispanic adolescents. Common barriers and facilitators of activity and sleep as well as preferences for ways in which SMS text messages could provide autonomy, competence, and relatedness support were identified in the co-design phase. The youths also wanted feedback about goal attainment. Suggestions to make SMS text messages more engaging included using emojis, GIFs, and media. This information informed an initial bank of SMS text messages (N=116). Expert review indicated that all (116/116, 100%) SMS text messages were age and culturally appropriate; however, some (21/116, 18.1%) did not adequately address youth-identified barriers and facilitators of PA and sleep, whereas others (30/116, 25.9%) were not theoretically adherent. Adolescents reported that SMS text messages were easy to understand (116/116, 100%), provided the support needed for behavior change (103/116, 88.8%), and used mostly acceptable language (84/116, 72.4%). Feedback was used to refine and develop the final bank of 125 unique text messages. Using a co-design process, a theoretically grounded, appealing, and relevant bank of SMS text messages promoting healthy PA and sleep behaviors to adolescents was developed. The SMS text messages will be further evaluated in a pilot study to assess feasibility, acceptability, and preliminary efficacy. The co-design process used in this study provides a framework for future studies aimed at developing SMS text message–based strategies among high-risk adolescents.