Intervention
belly breath, prediabetes, Hypertension, T2DM, TCM
DISEASE, HYPERTENSION, PREDIABETES
An expert team that included nursing researchers, TCM doctors, Western medicine doctors, and app developers was formed to guide the development of the intervention app. The team decided that the content embedded in the app would be developed in accordance with the DPP [The mHealth app (both the ordinary and TCM versions) included four modules: health diary, health education, milestone, and chatroom. The “health diary” tracked the participant’s weight, BMI, blood sugar level, dietary diary, and PA over time. “Health education” provided information about specific topics such as learning about prediabetes, Dietary Approaches to Stop Hypertension (DASH) diet, and PA. The TCM mHealth app additionally included health education topics on body constitution, meridian energy, and advice on a body constitution–based diet (such as foods to avoid and foods that are recommended) and PA such as videos, pictures, and descriptive illustrations of types of Qigong (ie, Baduanjin and belly breath). A text message was sent to the participants to remind them to read the topics every week. Milestones were added for the participants to review their goals so that they could make adjustments to reach their monthly goals. For example, if the participants set a goal of an FPG level of 60-99 mg/dL, when this goal was achieved, a window would pop up to show the achievement. The participants could also check bar and line charts over 1 week or 1 month to compare the discrepancy between the actual and desired values as well as actual and ideal behaviors at different time points so that they could adjust their expected goal as needed.In the “chatroom,” personal and group chat rooms were set up using the LINE app (Naver Corp, Gyeonggi Province, South Korea). The researchers sent text messages to the participants in the personal chat room, provided feedback on the results, and encouraged participants to share their experiences in the group chat room. The participants collected virtual gold by completing questionnaires and quizzes and by achieving the set goals. The participants could use the virtual gold to claim actual prizes from the researchers. Gamification elements were added to encourage engagement with the mHealth app. Screenshots and descriptions of the ordinary and TCM mHealth apps are presented in The participants in the TCM and ordinary mHealth app groups received a face-to-face education session on how to use the mHealth app and create a user account. Both mHealth app groups received information about prediabetes and evidence-based methods to decrease the possibility of progression to T2DM (eg, moderate-intensity PA of ≥150 minutes/week, DASH diet, and disease health education). The TCM mHealth app group additionally received body constitution and The researchers monitored logins and log file analysis at least once every week at the mHealth app backend. If the participants did not use the app, complete the diary, or watch health education, additional text messages were sent to the participants. The CONSORT-EHEALTH guidelines [