A feasibility study using motivational interviewing and a smartphone application to promote physical activity (+Stay-Active) for women with gestational diabetes

Ralph Smith; Rebecca Gould; Yvonne Kenworthy; Nerys Astbury; Iwan Smith; Jacqueline Birks; Paul Bateman; Jane E Hirst; Susan Jebb; Moscho Michalopoulou; Richard Pulsford; Cristian Roman; Mauro Santos; Nicola Wango; Amy Wire; Lucy Mackillop

doi:10.1186/s12884-024-06508-w

A feasibility study using motivational interviewing and a smartphone application to promote physical activity (+Stay-Active) for women with gestational diabetes

BMC Pregnancy Childbirth. 2024 May 14;24(1):360. doi: 10.1186/s12884-024-06508-w.

Authors

Ralph Smith¹, Rebecca Gould², Yvonne Kenworthy³, Nerys Astbury⁴, Iwan Smith⁵, Jacqueline Birks⁶, Paul Bateman⁴, Jane E Hirst^{2

7

8}, Susan Jebb⁴, Moscho Michalopoulou⁴, Richard Pulsford⁹, Cristian Roman¹⁰, Mauro Santos¹⁰, Nicola Wango², Amy Wire¹¹, Lucy Mackillop^{2

7}

Affiliations

¹ Oxford University Hospitals NHS Foundation Trust, Oxford, UK. Ralph.Smith@ouh.nhs.uk.
² Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
³ Cardiovascular Clinical Research Facility, University of Oxford, Oxford, UK.
⁴ Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
⁵ Independent Researcher, Oxford, UK.
⁶ Centre for Statistics in Medicine, University of Oxford, Oxford, UK.
⁷ Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.
⁸ The George Institute for Global Health, Imperial College London UK, London, UK.
⁹ Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
¹⁰ Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK.
¹¹ Independent Researcher, Patient Representative, Oxford, UK.

Abstract

Background: Physical activity (PA) interventions have an encouraging role in gestational diabetes mellitus (GDM) management. Digital technologies can potentially be used at scale to support PA. The aim of this study was to assess the feasibility and acceptability of + Stay-Active: a complex intervention which combines motivational interviewing with a smartphone application to promote PA levels in women with GDM.

Methods: This non-randomised feasibility study used a mixed methods approach. Participants were recruited from the GDM antenatal clinic at Oxford University Hospitals. Following baseline assessments (visit 1) including self-reported and device determined PA measurements (wrist worn accelerometer), women participated in an online motivational interview, and then downloaded (visit 2) and used the Stay-Active app (Android or iOS). Women had access to Stay-Active until 36 weeks' gestation, when acceptability and PA levels were reassessed (visit 3). The primary outcome measures were recruitment and retention rates, participant engagement, and acceptability and fidelity of the intervention. Secondary outcome measures included PA levels, app usage, blood glucose and perinatal outcomes. Descriptive statistics were performed for assessments at study visits. Statistics software package Stata 14 and R were used.

Results: Over the recruitment period (46 weeks), 114 of 285 women met inclusion criteria and 67 (58%) enrolled in the study. Mean recruitment rate of 1.5 participants/clinic with 2.5 women/clinic meeting inclusion criteria. Fifty-six (83%) received the intervention at visit 2 and 53 (79%) completed the study. Compliance to accelerometer measurement protocols were sufficient in 78% of participants (52/67); wearing the device for more than 10 h on 5 or more days at baseline and 61% (41/67) at 36 weeks. There was high engagement with Stay-Active; 82% (55/67) of participants set goals on Stay-Active. Sustained engagement was evident, participants regularly accessed and logged multiples activities on Stay-Active. The intervention was deemed acceptable; 85% of women rated their care was satisfactory or above, supported by written feedback.

Conclusions: This combined intervention was feasible and accepted. Recruitment rates were lower than expected. However, retention rates remained satisfactory and participant compliance with PA measurements and engagement was a high. Future work will explore the intervention's efficacy to increase PA and impact on clinical outcomes.

Trial registration: The study has received a favourable opinion from South Central-Hampshire B Research Ethics Committee; REC reference: 20/SC/0342. ISRCTN11366562.

Keywords: Gestational diabetes mellitus; Physical activity; Smartphone applications.

MeSH terms

Adult
Diabetes, Gestational* / psychology
Diabetes, Gestational* / therapy
Exercise* / psychology
Feasibility Studies*
Female
Health Promotion / methods
Humans
Mobile Applications*
Motivational Interviewing* / methods
Pregnancy
Prenatal Care / methods
Smartphone*