Assessing the feasibility and acceptability of a Health Action Process Approach physical activity and sedentary behavior self-guided workbook in rural adults with Type 2 diabetes

Abstract

[EMBARGOED UNTIL 8/1/2023] Physical inactivity and increased amounts of time spent sedentary pose a significant health risk for adults with Type 2 diabetes (T2DM); increasing physical activity (PA) and reducing sedentary behavior can improve diabetes outcomes. Rural adults are disproportionately affected by T2DM and experience barriers to diabetes self- management resources creating a disparate health situation. Mobile health technology interventions can improve health outcomes and are a resource which can bridge barriers in access to diabetes self-management resources in rural populations. However, little research has been conducted in rural populations delivering a PA and sedentary behavior change intervention using mobile health technology strategies. There is a dearth of rigorously developed and evaluated mobile health technology interventions for rural adults with T2DM, making it difficult to understand the appropriateness for rural adults, mechanisms of behavior change, and validity of outcomes derived. This dissertation study evaluated the feasibility and safety, acceptability, and preliminary effects of a novel Health Action Process Approach model guided PA and sedentary behavior intervention for rural adults with T2DM. This study found that the intervention was acceptable and appropriate for rural adults. Feasibility data collected provided evidence for intervention refinement. A moderate significant effect size was detected post-intervention for increased leisure-time self-reported PA (r = .48, p = .04). Large non-significant effect sizes were observed post-intervention for reduction in sedentary time spent using a computer (r = .51, p = .11) and watching television (r = .59, p = .06). Detected effect sizes suggest the intervention impacted PA and sedentary behaviors as intended and warrant future evaluation as a fully powered study to evaluate intervention efficacy is larger, more diverse samples. With future research and the transition of evidence to a mobile health technology platform, health disparities in a vulnerable rural population with T2DM could be improved, resulting in positive health outcomes and reductions in chronic disease burden.