Liver Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne, United Kingdom.
J Med Internet Res. 2021 Jan 15;23(1):e20491. doi: 10.2196/20491.
Nonalcoholic fatty liver disease (NAFLD) is linked to excessive calorie consumption, physical inactivity, and being overweight. Patients with NAFLD can halt or decelerate progression and potentially reverse their condition by changing their lifestyle behavior. International guidelines recommend the use of lifestyle interventions; however, there remains a discordance between published guidelines and clinical practice. This is primarily due to a lack of NAFLD-specific interventions to support weight loss and improve liver function.
This study aims to use intervention mapping to systematically develop a digital intervention to support patients with NAFLD to initiate and maintain changes in their dietary and physical activity behavior to promote weight loss.
Intervention mapping consisted of 6 steps: step 1 involved a needs assessment with primary and secondary health care professionals (HCPs) and patients with NAFLD; step 2 involved identification of the social cognitive determinants of change and behavioral outcomes of the intervention; step 3 involved linking social cognitive determinants of behavioral outcomes with behavior change techniques to effectively target dietary and physical activity behavior; step 4 involved the development of a prototype digital intervention that integrated the strategies from step 3, and the information content was identified as important for improving knowledge and skills from steps 1 and 2; step 5 involved the development of an implementation plan with a digital provider of lifestyle behavior change programs to patients with NAFLD using their delivery platform and lifestyle coaches; and step 6 involved piloting the digital intervention with patients to obtain data on access, usability, and content.
A digital intervention was developed, consisting of 8 modules; self-regulatory tools; and provision of telephone support by trained lifestyle coaches to help facilitate behavioral intention, enactment, and maintenance. A commercial provider of digital lifestyle behavior change programs enrolled 16 patients with NAFLD to the prototype intervention for 12 consecutive weeks. A total of 11 of the 16 participants successfully accessed the intervention and continued to engage with the content following initial log-in (on average 4 times over the piloting period). The most frequently accessed modules were welcome to the program, understanding NAFLD, and food and NAFLD. Goal setting and self-monitoring tools were accessed on 22 occasions (4 times per tool on average). A total of 3 out of 11 participants requested access to a lifestyle coach.
Intervention mapping provided a systematic methodological framework to guide a theory- and evidence-informed co-design intervention development process for patients and HCPs. The digital intervention with remote support by a lifestyle coach was acceptable to patients with NAFLD and feasible to deliver. Issues with initial access, optimization of information content, and promoting the value of remote lifestyle coach support require further development ahead of future research to establish intervention effectiveness.
非酒精性脂肪性肝病（NAFLD）与过量热量摄入、身体活动不足和超重有关。通过改变生活方式行为，NAFLD 患者可以阻止或减缓疾病进展，并有可能逆转病情。国际指南建议使用生活方式干预；然而，发表的指南与临床实践之间仍然存在不一致。这主要是由于缺乏专门针对 NAFLD 的干预措施来支持减肥和改善肝功能。
本研究旨在使用干预映射系统地开发一种数字干预措施，以支持 NAFLD 患者启动和维持饮食和身体活动行为的改变，以促进减肥。
干预映射包括 6 个步骤：第 1 步涉及与初级和二级医疗保健专业人员（HCP）和 NAFLD 患者进行需求评估；第 2 步涉及确定干预措施的社会认知决定因素和行为结果；第 3 步涉及将行为结果的社会认知决定因素与行为改变技术联系起来，以有效针对饮食和身体活动行为；第 4 步涉及开发一个原型数字干预措施，该措施整合了第 3 步的策略，并且信息内容被确定为提高知识和技能的重要内容，这些知识和技能来自第 1 步和第 2 步；第 5 步涉及制定一个实施计划，由生活方式行为改变计划的数字提供商为 NAFLD 患者使用他们的交付平台和生活方式教练提供；第 6 步涉及对患者进行数字干预措施的试点，以获取关于访问、可用性和内容的数据。
开发了一个数字干预措施，包括 8 个模块；自我监管工具；以及通过经过培训的生活方式教练提供电话支持，以帮助促进行为意向、实施和维持。一家数字生活方式行为改变计划的商业提供商为 16 名 NAFLD 患者注册了原型干预措施，连续 12 周。16 名参与者中有 11 名成功访问了干预措施，并在首次登录后继续参与内容（平均在试点期间访问 4 次）。访问最多的模块是欢迎加入计划、了解 NAFLD、食物和 NAFLD。目标设定和自我监测工具被访问了 22 次（平均每个工具 4 次）。共有 3 名 11 名参与者要求获得生活方式教练的支持。
干预映射为患者和 HCP 提供了一个系统的方法框架，以指导基于理论和证据的共同设计干预措施的发展过程。带有生活方式教练远程支持的数字干预措施可以被 NAFLD 患者接受，并且可以进行交付。在进行未来研究以确定干预措施的有效性之前，还需要进一步解决初始访问、优化信息内容和促进远程生活方式教练支持的价值等问题。
