title: Development of a fully automated, web-based, tailored intervention promoting regular physical activity among insufficiently active adults with type 2 diabetes: integrating the I-change model, self-determination theory, and motivational interviewing components.
abstract: BACKGROUND
  Type 2 diabetes is a major challenge for Canadian public health authorities, and regular physical activity is a key factor in the management of this disease. Given that fewer than half of people with type 2 diabetes in Canada are sufficiently active to meet the recommendations, effective programs targeting the adoption of regular physical activity (PA) are in demand for this population. Many researchers argue that Web-based, tailored interventions targeting PA are a promising and effective avenue for sedentary populations like Canadians with type 2 diabetes, but few have described the detailed development of this kind of intervention.
  
  
  OBJECTIVE
  This paper aims to describe the systematic development of the Web-based, tailored intervention, Diabète en Forme, promoting regular aerobic PA among adult Canadian francophones with type 2 diabetes. This paper can be used as a reference for health professionals interested in developing similar interventions. We also explored the integration of theoretical components derived from the I-Change Model, Self-Determination Theory, and Motivational Interviewing, which is a potential path for enhancing the effectiveness of tailored interventions on PA adoption and maintenance.
  
  
  METHODS
  The intervention development was based on the program-planning model for tailored interventions of Kreuter et al. An additional step was added to the model to evaluate the intervention's usability prior to the implementation phase. An 8-week intervention was developed. The key components of the intervention include a self-monitoring tool for PA behavior, a weekly action planning tool, and eight tailored motivational sessions based on attitude, self-efficacy, intention, type of motivation, PA behavior, and other constructs and techniques. Usability evaluation, a step added to the program-planning model, helped to make several improvements to the intervention prior to the implementation phase.
  
  
  RESULTS
  The intervention development cost was about CDN $59,700 and took approximately 54 full-time weeks. The intervention officially started on September 29, 2014. Out of 2300 potential participants targeted for the tailored intervention, approximately 530 people visited the website, 170 people completed the registration process, and 83 corresponded to the selection criteria and were enrolled in the intervention.
  
  
  CONCLUSIONS
  Usability evaluation is an essential step in the development of a Web-based tailored intervention in order to make pre-implementation improvements. The effectiveness and relevance of the theoretical framework used for the intervention will be analyzed following the process and impact evaluation. Implications for future research are discussed.
authors.affiliation: Interdisciplinary Group of Health Applied Research, Nursing Department, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.
authors.forename: Michel
authors.identifier: http://orcid.org/0000-0003-4058-7363
authors.initials: M
authors.lastname: Moreau
authors.forename: Marie-Pierre
authors.identifier: http://orcid.org/0000-0002-0782-5457
authors.initials: MP
authors.lastname: Gagnon
authors.forename: François
authors.identifier: http://orcid.org/0000-0002-8976-5362
authors.initials: F
authors.lastname: Boudreau
keywords: I-Change Model; Internet; World Wide Web; behavior modification; computer-tailoring; eHealth; motivational interviewing; physical activity; self determination; tailoring; type 2 diabetes mellitus