Characteristics of behavior change techniques in theory-based self-management education and support interventions for...

This scoping review aimed to inform the development of theory-driven, person-centered digital diabetes self-management education and support (DSME/S) programs for patients with type 2 diabetes.

The Behavioral Education and Support Techniques (BEST) taxonomy, adapted from the Behavior Change Techniques Taxonomy version 1 (BCTTv1), was used to improve clarity and relevance for DSME/S. Theory-based digital DSME/S intervention studies published between 2016 and 2023 and targeting adults aged ≥20 years were included. Studies were selected and data extracted using the Population, Concept, and Context framework. Theoretical foundations and behavior change domains were analyzed through iterative consensus among the research team.

Of 5,181 records, 41 studies met inclusion criteria. Most of the participants in the included studies were over 40 years old. Smartphone app-based interventions predominated, accounting for 36.5%, followed by web-based interventions at 34.2%. The ADCES 7 Self-Care Behaviors framework, which underpins the National Standards for DSME/S, was the most frequently identified framework (n=14, 34%). Shaping Knowledge, Goals and Planning, Social Support, and Monitoring were the most frequently applied behavior change domains, reflecting a stronger emphasis on individual-level capabilities than on contextual or system-level changes. No single theory was consistently associated with positive clinical or behavioral outcomes across studies.

This review identified the theoretical frameworks, behavioral domains and techniques targeted in current digital DSME/S. Future research is needed to evaluate the effectiveness of digital DSME/S interventions across diverse populations and to identify behavior change techniques tailored to specific subgroups, such as individuals with early-onset type 2 diabetes.