Designing Mobile Phone Text Messages Using the Behavior Change Wheel Framework to Influence Food Literacy in Adults With Type 2 Diabetes in Kenya: Protocol for a Systematic Development Study

Moses Mokaya; Florence Kyallo; Peter Yiga; Janna Lena Koole; Tessy Boedt; Roman Vangoitsenhoven; Christophe Matthys

doi:10.2196/48271

Designing Mobile Phone Text Messages Using the Behavior Change Wheel Framework to Influence Food Literacy in Adults With Type 2 Diabetes in Kenya: Protocol for a Systematic Development Study

JMIR Res Protoc. 2023 Dec 4:12:e48271. doi: 10.2196/48271.

Authors

Moses Mokaya^{1

2}, Florence Kyallo¹, Peter Yiga³, Janna Lena Koole², Tessy Boedt², Roman Vangoitsenhoven^{2

4}, Christophe Matthys²

Affiliations

¹ Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
² Experimental and Clinical Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium.
³ Mildmay Research Centre, Kampala, Uganda.
⁴ Department of Endocrinology, University Hospitals, Leuven, Belgium.

PMID: 38048150
PMCID: PMC10728794
DOI: 10.2196/48271

Abstract

Background: The worldwide prevalence of type 2 diabetes (T2D) has increased in the past decade, and it is projected to increase by 126% by 2045 in Africa. At the same time, mobile phone use has increased in Africa, providing a potential for innovative mobile health interventions to support diabetes care.

Objective: This study aimed to apply the Behavior Change Wheel (BCW) framework to develop text messages to influence food literacy in adults with T2D in urban Kenya.

Methods: The 8 steps of the BCW framework guided the development of text messages: (1) Define the problem in behavioral terms; (2) select target behaviors; (3) specify the target behaviors based on who needs to perform the behaviors, what needs to change, and when, where, how often, and with whom; (4) identify what needs to change; (5) identify intervention functions; (6) select policy categories; (7) select behavior change techniques (BCTs); and (8) select the mode of delivery. Recent exploratory studies in Kenya and other low- and middle-income countries provided information that was used to contextualize the intervention.

Results: In step 1, the behavioral problem was defined as unhealthy dietary patterns among adults with T2D. In step 2, based on a qualitative study in the target population, the target behavior was selected to be evaluation of reliable sources of information, and selection and preparation of healthy food. In step 3, unhealthy dietary patterns were selected. In step 4, 10 domains of the Theoretical Domains Framework were identified, and in step 5, 5 intervention functions were linked to the domains and unhealthy dietary patterns were specified. In step 6, communication and regulations were identified as policy categories, while in step 7, 9 BCTs were selected from the Behavior Change Technique Taxonomy version 1. In step 8, the most suitable mode of delivery was determined to be mobile text messages. A total of 36 mobile text messages were developed based on the 9 BCTs.

Conclusions: This study shows the step-by-step application of the BCW framework to develop mobile text messages to influence food literacy in adults with T2D.

International registered report identifier (irrid): RR1-10.2196/48271.

Keywords: Africa; Behavior Change Wheel; adults; behavior; behavior change techniques; care; diabetes; glycemic control; low-income populations; mHealth; mobile health; mobile phone; support; support care; type 2 diabetes.

©Moses Mokaya, Florence Kyallo, Peter Yiga, Janna Lena Koole, Tessy Boedt, Roman Vangoitsenhoven, Christophe Matthys. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 04.12.2023.