DEVELOPMENT OF TEXT-MESSAGING TO SUPPORT THE SOUTH AFRICAN DIABETES PREVENTION PROGRAM

Objective: Emerging evidence suggests that the addition of text-messaging to standard healthy lifestyle interventions may improve the outcomes of diabetes prevention programs (DPP). This paper describes the process of developing text-messages for people at risk of developing diabetes in low-resourced communities as part of the South African DPP (SA-DPP). Design and method: The development comprised multiple steps which included nutrition and physical activity experts, who were guided by recommended steps for developing and pre-testing text messaging for health behavior change. The steps included: 1) Message development: 44 nutrition messages and 23 exercise messages were formulated based on the existing SA-DPP curriculum and its formative research; 2) these text messages were evaluated for readability/understandability in terms of content, language, and quality of information through interviews [structured questionnaire conducted telephonically or in-person] with 75 participants from two low-resourced areas; 3) messages not well understood according to the interviews were refined by the expert panel; 4) participants from step 2 who showed the least understanding of the messages participated in three workshops to evaluate the refined text-messages; and 5) the text bank was finalized. Results: Based on the results of the readability survey, 37 of the 69 formulated text messages [24 of the 44 encouraging healthy eating, and 13 of the 23 promoting physical activity] were refined by the expert panel. Focused discussions revealed that participants still had some difficulties with terms such as “variety’’ and “diet’’, and the concept of avoiding certain foods e.g. sugar, sweets, chocolates and salty snacks and eating a “fresh’’ salad with a meal. Thus, a further seven messages were refined considering alternate terminology proposed by the participants. The final text bank includes a total of 67 messages; topics covered are on fruit, vegetables and variety in the diet (n = 15), limiting fat intake (n = 10), avoiding sugar (n = 11), avoiding salt (n = 5), promoting fibre-rich foods (n = 1), messages promoting physical activity (n = 21) and general check-in messages (n = 4). Conclusions: This paper outlines the evidenced-based and participatory process of developing understandable healthy lifestyle text messages to promote and maintain behavior change objectives of participants at risk for developing diabetes.