Interview participant characteristics.

Physical activity is a core aspect of type 2 diabetes (T2DM) self-management, but most Saudi adults do not meet physical activity recommendations and there are no culturally tailored interventions to promote physical activity in Saudi adults with T2DM. This study is a prospective single-centre, single-arm feasibility study of a mobile SMS text messaging intervention with a nested qualitative study. The aim was to explore the feasibility and acceptability of ActiveText@T2D, a 6-week theory-based mobile text messaging intervention to promote physical activity in people with T2DM in Saudi Arabia. Intervention development was informed by the Behaviour Change Wheel (BCW) framework and COM-B model. ActiveText@T2D consisted of 2 one-way SMS text messages per week, for 6 weeks. All participants were offered the intervention and assessed at baseline (Time 0: T0) and 3-month follow-up (Time 1: T1). Data collection included feasibility outcomes (recruitment and retention), clinical outcomes (body mass index and glycaemic control from clinic records at T0), and self-reported outcomes (self-efficacy, physical activity, and barriers to exercise at T0, T1). Qualitative interview data (n = 19) were collected at T1 with 11 patients (7 male, 4 female, mean age 54.5 years) and 8 female nurses (mean age 31.8 years). Quantitative data were analysed descriptively, qualitative data were analysed thematically. Of 98 participants approached, 62 were eligible, and 52 consented (84% participation rate; 23 women, 29 men; mean age 54.82 years), 44 (85%) completed baseline measures and received the intervention. Thirty-nine participants completed follow-up measures (75% retention to T1). All outcome measures were sensitive to change: The Arabic version of the CDC Barriers to Being Active Quiz (BBAQ), The Arabic version of Exercise Self-Efficacy scale (ESE-A), The Arabic International Physical Activity Questionnaire (A-IPAQ). Patients and healthcare professionals perceived the intervention to be broadly acceptable. Qualitative findings identified three overarching themes: “use of text messaging as a health intervention”, “engagement with physical activity” and “instilling knowledge about physical activity and diabetes control”. This study demonstrates the feasibility and acceptability of ActiveText@T2D, a theory-based culturally tailored SMS text messaging intervention, to Saudi adult patients with T2DM and healthcare professionals involved in their care. The next step would be a full-scale definitive randomised controlled trial to assess the effectiveness and cost-effectiveness of ActiveText@T2D.
Protocol registration: Protocols.io, DOI: dx.doi.org/10.17504/protocols.io.261ger217l47/v1 (registered on 08.01.2025).