| Background:Although studies have proved that behavior change intervention can delay and prevent type 2 diabetes among individuals with prediabetes, there were barriers on promoting the traditional face-to-face intervention on a large scale to meet the needs of many individuals for the consuming of time and cost. More and more researchers carried behavior internet intervention to overcome these barriers. The effectiveness and compliance were still not ideal for the absence of theory-based internet intervention. It is necessary to discuss the effectiveness and compliance of theory-based behavior internet intervention and related theory-based intervention strategies.Aim:(1) To construct a behavior internet intervention model for people with prediabetes based on literature review and analysis with behavior theories, intervention technology/strategies, and the perspective of individuals with prediabetes towards condition appraisals and experience. (2) To cooperate with information technology professionals to construct the behavior intervention web portal following the opions of experts from the experts meeting. (3) To preliminarily validate the effect of implementation of the behavior internet intervention model.Method:This study has three parts:Part one, based on literature review and analysis, and the perspective of individuals with prediabetes towards condition appraisals and experience, the model was initially developed. Semi-structured interviews were conducted to 11 individuals with prediabetes to ascertain the appraisal and the experience of people with prediabetes. Other structured interviews were carried to 62 individuals with prediabetes to investigate their usage of internet and furtherly verify the feasibility of internet behavior intervention among people with prediabetes. Part two, the behavior intervention web portal was constructed under the cooperation of information technology professionals. Then 8 experts from different professional areas verified the main function, delivery methods and intervention contents of the model and the web portal. Part three, a pilot study of behavior internet intervention was conduct among 57 individuals with prediabetes, who were divided randomly into intervention group (n=30) and control group (n=27). Intervention group received a 3 months behavior internet intervention. TTM constructs, dietry behavior, execise behavior, understanding the knowledge of diabetes and the attitudes towards diabetes were compared between two groups at baseline and after 3 months intervention. The control group received the same intervention for 3 months after waiting for 3 months. The aforementioned indicators were reevaluated after 6 months for both groups.Result:(1) Part one:after analyzing, comparing and synthesizing multiple behavior theories and behavior intervention technologies/strategies, the Transtheoretical Model was selected as the theory basis to construct initially a behavior intervention framework and finally develop a behavior internet intervention model for individuals with prediabetes, applied with the Transtheoretical Model-based behavior intervention technologies/strategies and common implementation of online intervention methods. The model emphasized four main modules:Implementation environment that is the characteristics of individuals with prediabetes; Treatment included autonomous study and communicative functions; the Transtheoritical Model based Intervention Mechanism; Outcome focusing on behaviors and measurements of prediabetes. The results of the interview indicated that people with prediabetes were under inadequate treatment. Individuals in different stage of change should receive stage-target intervention strategies and personalized and effective-communicated intervention. The second interview showed the authority and accuracy of the intervention contents, the privacy of users, and multiple communicate methods are key points in internet intervention design. (2) Part two:three modules of evaluation, intervention and database were developed to achieve the functions of the model through web portal to collect and save data, and deliver intervention. Experts mainly suggested taking actions on encouraging users to use the web portal, improving the behavior compliance of the individuals, and assuring the correct communicate comtents among individuals. These priorities on behavior internet intervention provided supplementary directions for further intervention implemention. (3) Part three:totally 50 individuals finished the whole intervention and data collection, including 26 individuals in intervention group and 24 in control group at 3 months after intervention. By intention-to-treat analysis, the significant difference was showed in the distribution of the stages of change pre and post intervention among intervention group, who moved forward to higher stages (P<0.05). The significant difference of stages of change was not found in control group (P>0.05). After intervention, the value between the two groups were found significant differences on pros, the dimension of decisional balance, reducing the energy intake, the dimension of diet self-efficacy, execise self-efficacy, dietary and execise behavior, and understanding the knowledge of diabetes (P<0.05). While there were no significant differences between intervention group and control group on processes of change, the cons, the dimension of decisional balance, and the attitudes towards diabetes (P>0.05). Totally 44 individuals finished the whole intervention and data collection, including 23 individuals in intervention group and 21 in control group at 6 months after intervention. The significant difference was showed in the distribution of the stages of change pre and post intervention in both groups, who moved forward to higher stages (P<0.05). The significant difference was also found in both groups on all of the aforementioned indicators (P<0.05). Twenty-six individuals in intervention group, who completed the first 3 months intervention,23 individuals in intervention group, who completed the last 3 months intervention, and 21 individuals in control group, who completed the 3 months intervention, totally logined in the portal respectively for 352 person-time (10-27 person-time/person),379 person-time (11-26 person-time/person) and 342 person-time (12-28 person-time/person), with average 1.13 times per person per week (0.83-2.25 times/person/week),1.37 times (0.92-2.17 times/person/week) and 1.36 times (1.00-2.33 times/person/week), and with the average study time of 15 minites (5-15 minites),10 minites (5-20 minites) and 15 minites (5-30 minites) respectively.Conclusion:After the preliminary discussion, the behavior internet intervention based on TTM theory is suitable for application in individuals with prediabetes, with the significance of improvement on physiological indicators, clinical indicators, dietary and execise behavior, while the effect of long-time intervention need to be tested by prolonging the period of intervention and follow-up. This web portal established on the basis of the model can be easy to use by medical staffs or related health educators to provide intervention for people with prediabetes to change and improve their life behavior and then delay or prevent the incidence of type 2 diabetes. |
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