Thesis

Exploring, through an integrative systematic review, qualitative study and mixed methods study, the integration of activity trackers into clinical care to support physical activity and reduce sedentary behaviour in adults diagnosed with or at risk of type 2 diabetes

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Awarding institution
  • University of Strathclyde
Date of award
  • 2025
Thesis identifier
  • T17559
Person Identifier (Local)
  • 202191997
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Abstract
  • Background The rising prevalence of Type 2 diabetes (T2D) is strongly linked to insufficient physical activity and high sedentary behaviour. Consumer activity trackers may support behaviour change, but their integration into clinical care has been inconsistent. The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance) provides a structured lensto evaluate their potential for real-world impact. Aim This thesis examined how activity trackers can be integrated into T2D clinical care using the RE-AIM framework to identify barriers, enablers, and recommendations across research, patient, and healthcare system perspectives. Methods A three-study mixed-methods programme was undertaken. An integrative systematic review assessed the extent to which RE-AIM dimensions were reported in chronic disease interventions using activity trackers. A qualitative study explored patient and healthcare professional perspectives on tracker use within T2D care. A pragmatic mixed-methods study embedded Fitbit devices into the NHS Weigh to Go programme, evaluating quantitative outcomes alongside qualitative feedback from participants and staff. Results Across studies, Reach was constrained by low awareness and cost barriers but improved when free devices were provided. Effectiveness was supported by personalised feedback and integration with existing care but limited by technical issues. Adoption was hampered by poor promotion and staff uncertainty. Implementation required clear protocols and training, while inconsistent device performance undermined fidelity. Maintenance was challenged by short-term engagement and limited long-term support structures. Quantitative findings demonstrated significant short-term increases in step counts, but sustainability was weak. Conclusion Using the RE-AIM framework, this thesis shows that activity trackers can be feasibly integrated into T2D care, but impact depends on systematically addressing gaps across all five dimensions. Recommendations include enhancing awareness and access, embedding personalised feedback, training healthcare staff, establishing governance protocols, and ensuring long-term support. These findings highlight both the promise of trackers for diabetes care and the need for structured, system-wide integration strategies.
Advisor / supervisor
  • Kirk, Alison
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