Using Fitbits and Follow-Up to Increase Physical Activity and Prevent Diabetes

Type 2 diabetes mellitus (T2DM) is a major public healthcare problem that continues to increase at an alarming rate around the world, with even more individuals affected by prediabetes. Physical activity, healthy eating, and weight loss are known behavioral modifications. Needs assessment results from a rural primary care clinic and its surrounding public health department revealed that the incidence of T2DM is increasing and healthcare team members lack effective tools to help motivate individuals in making behavioral changes. This is especially challenging in rural America, where obesity rates are higher. The literature supports the use of Fitbits for increasing physical activity and emphasizes the importance of awareness, motivation, and individualized follow-up. The objective of this program was to evaluate the effectiveness and feasibility of using physical activity trackers (Fitbits) and individualized follow-up with coaching strategies as a motivational tool for rural individuals with prediabetes to increase and sustain physical activity as one component of a diabetes prevention program (DPP). The overarching goal was to delay or prevent T2DM in a primary care population. Participants included 13 adults with prediabetes and clinic staff from a rural primary care clinic. Quantitative and qualitative data were collected over six months in two phases (Phase 1: Behavioral Change-Months one to three and Phase 2: Sustainability-Months four to six) from Fitbits, biophysical data, surveys, semi-structured interviews, and field notes. Key findings include that more participants increased their physical activity level by the end of Phase 1 (when there was more healthcare team interaction) than at the end of Phase 2 (when there was less healthcare team interaction). Key points of this program include: (a) increasing physical activity is one component of diabetes prevention, but there needs to be behavioral change and sustainability; (b) healthcare team relatedness matters, but it takes time and effort; (c) rural areas pose challenges, but these challenges can be overcome; and (d) Fitbit costs are less than treating annual care of individuals with diabetes. This DPP suggests that Fitbits and frequent follow-up with individualized coaching strategies by healthcare team members can be a cost-effective motivational tool to increase physical activity among rural individuals with prediabetes. However, feasibility of sustaining this six-month program for participants and in primary care is questionable.