Randomised controlled trial of an internet delivered physical activity intervention for individuals with Type 2 diabetes

INTERVENTION: The intervention group will be enrolled in a 12‐week online physical activity intervention. The interventions website is developed based on a theoretical framework (Theory of planned behaviour) and self‐management principles. Participants are asked to regularly visit the intervention website over the 12 week period, however the number of times they access the website and the amount of time they spend on the website is left entirely to their own discretion. During this 12 weeks through the website participants will be able to access weekly education modules, view a library of resources, be able to self‐monitor behaviours (view graphs and progress) and participate in discussion forums. In relation to self‐monitoring behaviour's participants and will be asked to record self‐care behaviours such as physical activity, blood glucose and blood pressure daily and weight weekly. Additionally, participants can set weekly physical activity goals for which they will receive feedback based on their physical activity progress. However, although participants are encouraged through weekly email reminder to make use of all areas of the website, the areas accessed and the utilisation of these tools is left up to the participants discretion. CONDITION: Effectiveness of internet delivered physical activity interventions Type 2 diabetes PRIMARY OUTCOME: Self‐reported physical activity behaviour was the primary outcome measure and was measured using the long form International Physical Activity Questionnaire (IPAQ). The IPAQ has been shown to be a valid and reliable instrument to measure physical activity among adults at a population level (Craig, et al., 2003) and has previously shown to be sensitive enough to detect behaviour change in intervention research (Spittaels, De Bourdeaudhuij, Brug, et al., 2007; Spittaels, De Bourdeaudhuij, & Vandelanotte, 2007). The IPAQ assess the frequency (days) and duration (minutes) of physical activity across five main domains: occupational, transportation, household, leisure time and sitting time. The frequency and duration of time spent in physical activity can be calculated to produce domain specific scores for walking, moderate and vigorous intensity activity. INCLUSION CRITERIA: Participants were deemed eligible to participate if they met the following criteria; a) diagnosed with Type II diabetes; b) available access to internet and email; c) the ability to read and understand English; d) above 18 years of age; e) meet criteria on physical activity readiness questionnaire (PAR‐Q); e) currently not receiving diabetes education and f) not meeting the national physical activity guidelines (national guidelines state that people should accumulate at least 150 minutes moderate physical activity per week). Potential participants who indicated any contraindications as determined by the PAR‐Q were required to obtain consent from their general practitioner prior to participating in the study. SECONDARY OUTCOME: Program satisfaction was measured for participants in the intervention group to examine overall website satisfaction and usefulness of various program features. The survey has been adapted from the Health‐eSteps (Steele, et al., 2007a) and Diabetes NetPLAY (Liebreich, et al., 2009) and was completed at the 12‐week post‐intervention follow‐up. The questionnaire contains 17 items measured using a 5 point Likert scale that ranges from 'strongly agree' to 'strongly disagree' in addition to three open ended questions for participants to record likes/dislikes and recommendations. The questionnaire assesses satisfaction, usability and usefulness of various website components including, online logbooks, goal‐setting, education modules, feedback and email reminders. Quality of life was measured using the SF‐12 which measures the overall physical (PHS) and mental health status (MHS) of individuals (Ware, Kosinski, & Keller, 1996). The SF‐12 is a short version of the SF‐36 and contains 12 questions that can be answered within a shorter time frame (Burdine, Felix, Abel, Wiltraut, & Musselman, 2000). The SF‐12 asks questions across a number of dimensions, including; physical functioning, physical health, emotional health, physical pain, psychological well‐being and health perception (Ware, et al., 1996). The sum of these scores provides a physical component and mental health component summary score used as a norm based standardised score (Ware, Kosinski, & Keller, 1998). The SF‐12 has previously been used in individuals with Type II diabetes (McKay, et al., 2002) and has been proven to be a valid and reliable measure of quality of life (Ware, et al., 1996). Secondary outcomes included a measure of physical activity beliefs according to the TPB, quality of life and satisfaction with the intervention. Physical activity beliefs were measured according to the specifications for the TPB (Ajzen, 1988). This TPB questionnaire has previously proven to be useful in identifying physical activity beliefs in the Type II diabetes population and has shown good internal consistency (Davies, et al., 2010). The first section consisted of four questions each for intention, subjective norm and perceived behavioural control. Each question was measured on a 7‐point Likert scale and were randomised throughout. The second section consisted of questions to measure attitudes towards the behaviour using a 12 item semantic differential scale. Website usage as described by the number of times participants logged onto the website. Sections of the website visited and self‐monitoring of behaviours were also recorded for website usage.