Effects of a Mobile Phone-Based Health Behavior Modification Program on Health Outcomes in Overweight Community-Dwellers with Prediabetes

Abstract

Introduction Prediabetes is a major public health problem both globally and in Thailand, particularly given the increasing prevalence of prediabetes. With current technological advancements, the use of social media as a tool for health behavior modification represents an important strategy for promoting care and support for prediabetes within primary care settings. 

Objectives The objectives of this study were: 1) to compare the mean blood glucose, body weight, body mass index, and waist circumference in the experimental group before and after participating in the program; 2) to compare the mean blood glucose, body weight, body mass index, and waist circumference between the experimental and comparison groups after the program; and 3) to compare the proportion of participants who achieved normal status between the experimental and comparison groups.

Design This study employed a quasi-experimental design with two groups, pre- and post-test. The researchers developed a mobile phone-based health behavior modification program that applied the 3-Self approach: self-efficacy, self-regulation, and self-care. The program was structured according to the PROMISE Model, which comprises: Positive reinforcement (P), emphasizing encouragement through positive feedback; Result-based management (R), focusing on outcome-oriented strategies; Optimize (O), fostering optimism; Motivation (M), promoting sustained behavioral modification; Individual or Client-centered approach (I), tailoring interventions to the specific health problems and needs of participants; and Self-esteem (SE), enhancing personal value and confidence.

Methodology The study participants consisted of 70 overweight adults aged 35–59 years in Surat Thani Province who had prediabetes. Participants were selected using simple random sampling based on the following inclusion criteria: 1) adults aged 35–59 years with no history of diabetes, hypertension, or dyslipidemia; 2) a history or prior record of fasting blood glucose levels between 100–125 mg/dL after at least 8 hours of fasting; 3) a body mass index (BMI) ≥ 23 kg/m²; 4) ownership and ability to use a mobile phone with internet access and application functionality; 5) ability to communicate, read, and understand Thai; and 6) willingness to participate in the study. Participants were assigned to the experimental and comparison groups (35 per group) through matched pairs. The sample size was determined using power analysis with the G*Power program. Research instruments included: 1) the mobile phone-based health behavior modification program, 2) a handbook for transitioning from prediabetes to normal status, 3) role model video clips, 4) a personal information record form, 5) a blood glucose meter, 6) a weighing scale and stadiometer, and 7) a measuring tape. Data collection was conducted between March and May 2025. Data were analyzed using descriptive statistics, Chi-square test, Independent t-test, Paired t-test, and Z-test.

Results The mean age of participants in the experimental and comparison groups was 49.31 years (SD = 7.16) and 51.26 years (SD = 7.18), respectively. Most participants had completed secondary education (60.00% and 48.57%, respectively), and the majority reported no first-degree relatives with diabetes (60.00% and 85.71%, respectively). After participating in the program, the experimental group demonstrated a statistically significant decrease in mean fasting blood glucose from baseline (M = 108.49 mg/dL, SD = 16.15) to after the program (M = 98.86 mg/dL, SD = 7.83; t = 4.410, p < .001). Similarly, the comparison group showed a significant decrease in mean fasting blood glucose (M = 102.49 mg/dL, SD = 5.58) compared with baseline (M = 106.69 mg/dL, SD = 5.49; t = 5.209, p < .001). After the program, the experimental group also exhibited significant lower in mean body weight (M = 69.17 kg, SD = 11.79 vs. M = 70.57 kg, SD = 12.28; t = 4.663, p < .001), body mass index (M = 27.63 kg/m2, SD = 3.78 vs. M = 28.35 kg/m², SD = 3.69; t = 5.046, p < .001), and waist circumference (M = 88.91 cm, SD = 9.93 vs. M = 91.11 cm, SD = 11.33; t = 2.427, p = .021). However, no statistically significant differences were observed between the experimental and comparison groups in these outcomes. When examining the proportion of participants who transitioned from prediabetes to normal status, the experimental group (77.14%) had a significantly higher proportion than the comparison group (51.43%; Z = 5.040, p = .025).

Recommendations Community nurse practitioners and public health personnel can adopt the program developed in this study, which integrates social media as a tool to promote health behavior modification for diabetes prevention among prediabetes in the community.