Harnessing Technology to Develop a Just-in-Time Adaptive Intervention to Promote Physical Activity in Adolescents with Type 2 Diabetes

About This Grant

PROJECT SUMMARY/ABSTRACT The incidence of youth-onset type 2 diabetes (T2D) is on the rise, with a 95% escalation rate since 2001, and a staggering 77% increase during the COVID-19 pandemic. Regular physical activity is a cornerstone of T2D treatment. Yet, physical activity engagement is alarmingly low among youth with T2D, and effective interventions are lacking. Dr. Gutierrez-Colina’s long-term career objective is to improve health outcomes for youth with T2D by developing state-of-the-art mobile health (mHealth) interventions that provide personalized support for T2D self-management. The goal of this K23 proposal is to develop a novel just-in-time adaptive intervention (JITAI) that integrates dissemination and implementation science with real-time assessments of physical activity barriers and facilitators to deliver tailored strategies for promoting physical activity in adolescents with T2D. In Aim 1, a sequential exploratory design will be used to identify time-varying factors (e.g., motivation, fatigue, self- regulation) that influence physical activity engagement in adolescents with T2D. Qualitative interviews with N=18 T2D stakeholders will be conducted to gather in-depth feedback about physical activity barriers and facilitators. Qualitative findings will be integrated into the development of a 2-week ecological momentary assessment protocol designed to examine daily temporal associations between real-world barriers/facilitators and physical activity in the daily lives of N=25 adolescents with T2D. In Aim 2, the intervention components of a physical activity JITAI (e.g., personalized text messages, tailoring variables) will be co-developed with an advisory board of adolescents and caregivers. Intervention development will draw from dissemination and implementation science frameworks, as well as the “Capability, Opportunity, and Motivation (COM-B) Model,” a well-established theory of health behavior change. The JITAI will target activity barriers/facilitators related to Capability, Opportunity, and Motivation and deliver tailored support at the right time, in the right dose, and only when needed. In Aim 3, a sequential factorial experimental design will be used to pilot a 28-day micro-randomized trial of the physical activity JITAI with N=30 adolescents. Study feasibility and acceptability will be evaluated through usability surveys and post-intervention end-user interviews. Findings will generate critical data to inform an R01 application focused on a full-scale micro-randomized trial to optimize the physical activity JITAI. The proposed K23 research and career development plan will be supported by an outstanding mentorship team and a rich research environment at Colorado State University and the University of Colorado/Children's Hospital Colorado. Completion of the K23 training goals in (1) qualitative/mixed methods, (2) JITAI intervention development with an emphasis on dissemination and implementation science, and (3) the design and evaluation of micro- randomized clinical trials will equip Dr. Gutierrez-Colina with essential expertise in digital interventions and the rigorous methods involved in their evaluation. This training will directly support her successful transition to an independent research career focused on advancing personalized digital interventions for youth with T2D.