title: Stages of change for physical activity and dietary habits in persons with type 2 diabetes included in a mobile health intervention: the Norwegian study in RENEWING HEALTH.
abstract: OBJECTIVE
  The aim of this study was to investigate stages of change for physical activity and dietary habits using baseline data from persons with type 2 diabetes included in a mobile health intervention. We examined the associations between stages of change for physical activity change and dietary change, and between stages of change for each behavior and individual characteristics, health-related quality of life, self-management, depressive symptoms, and lifestyle.
  
  
  METHODS
  We examined 151 persons with type 2 diabetes with an glycated hemoglobin (HbA1c) level ≥7.1%, aged ≥18 years at baseline of a randomized controlled trial, before testing a mobile app with or without health counseling. Stages of change were dichotomized into 'pre-action' and 'action'. Self-management was measured using the Health Education Impact Questionnaire (heiQ) where a higher score reflects increased self-management, and health-related quality of life was measured with the Short-Form-36 (SF-36). Logistic regression modeling was performed.
  
  
  RESULTS
  The median HbA1c level was 7.9% (7.1-12.4), 90% were overweight or obese, and 20% had ≥3 comorbidities. 58% were in the preaction stage for physical activity change and 79% in the preaction stage for dietary change. Higher scores of self-management were associated with an increased chance of being in the action stage for both dietary change and physical activity change. Higher body mass index was associated with an 8% reduced chance of being in the action stage for physical activity change (OR 0.92, 95% CI 0.86 to 0.99).
  
  
  CONCLUSIONS
  Being in the action stage was associated with higher scores of self-management, crucial for type 2 diabetes. Over half of the participants were in the preaction stage for physical activity and dietary change, and many had a high disease burden with comorbidities and overweight.
  
  
  BACKGROUND
  NCT01315756.
authors.affiliation: Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, Oslo, Norway; Faculty of Medicine, Department of Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: Heidi
authors.initials: H
authors.lastname: Holmen
authors.affiliation: Faculty of Medicine, Department of Health Sciences , Institute of Health and Society, University of Oslo , Oslo , Norway.
authors.forename: Astrid
authors.initials: A
authors.lastname: Wahl
authors.affiliation: Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, Oslo, Norway; Faculty of Medicine, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: Astrid
authors.initials: A
authors.lastname: Torbjørnsen
authors.affiliation: Faculty of Medicine, Department of General Practice , Institute of Health and Society, University of Oslo , Oslo , Norway.
authors.forename: Anne Karen
authors.initials: AK
authors.lastname: Jenum
authors.affiliation: Faculty of Health Sciences, Department of Nursing and Health Promotion , Oslo and Akershus University College of Applied Sciences , Oslo , Norway.
authors.forename: Milada Cvancarova
authors.initials: MC
authors.lastname: Småstuen
authors.affiliation: Faculty of Health Sciences, Department of Nursing and Health Promotion , Oslo and Akershus University College of Applied Sciences , Oslo , Norway.
authors.forename: Lis
authors.initials: L
authors.lastname: Ribu
keywords: Behavioral Change; Self-Management; Technology and Diabetes; Type 2 Diabetes