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. 2022 May 11;5:60. doi: 10.1038/s41746-022-00606-9

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© The Author(s) 2022

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 1 — Development (a), principles (b) and effect of exposure to the tool (c). a shows the step-wise development of the tool, commencing with longitudinal analyses of psychological factors associated with HbA1c progression in 195 patients with T2D. This was followed by semi-structured interviews on unmet needs in lifestyle management and expectations of a digital lifestyle tool. The tool underwent repeated testing and modification based on feedback from patients and healthcare professionals on content, language, usability, and relevance. b depicts the underlying principles. At each login, participants can choose one of 80 different themes to discover new knowledge and methods. A theme consists of tests to explore current habits, texts with health information and exercises to learn behavior change techniques. At the end of each theme, participants ask a question to themselves on how to act on the content. When returning, they evaluate their activities in daily life and proceed to discover another theme. Users can refine earlier questions or ask new ones, in order to stimulate increased knowledge and self-reflection as they proceed through the tool. c shows the exposure-response relationship. Participants attended quarterly visits during the first year. Exposure to the tool (number of completed themes) and the corresponding change of HbA1c relative to previous visit for each quarterly period during the first year was determined in all participants who used the tool (n = 205). A total of 161 participants used the tool as recommended (biweekly) during at least one quarter. Mean values are shown across all individuals for quarterly periods in which no themes (n = 114 periods), 1–4 themes (n = 228) and at least 5 themes (n = 311), respectively, were completed. Error bars are s.e.m.