This paper aimed to provide evidence on the perceived acceptability of the “MOVEdiabetes” study to POs and participants in the IG. Overall, the majority of the IG participants (who completed the 12 months study period) and all POs were satisfied with the “MOVEdiabetes” study. Additionally, the majority of the participants perceived the programme as appropriate within primary diabetes care in Oman. The fact that this intervention was delivered in a primary care setting may have enhanced intervention implementation and acceptance as this setting has been reported as being effective for PA promotion [15–18]. Primary health care is considered as one of seven best investments by the Global Advocacy for PA.[19, 20] It is therefore reassuring for Omani researchers who may wish to upscale the current study or develop similar PA interventions within diabetes clinical settings.
Opportunities to ask questions and feedback were well received by both the participants and POs. In fact, the information received was perceived as ‘more than necessary’ or ‘far too much’ by more than half of the participants. A future assessment may be needed to explore which aspects of the project require more information.
The communications in the “MOVEdiabetes” study were accessible and flexible throughout the study period. Participants had options for interactive communications with their peers and/or POs through WhatsApp or face to face contacts in the health centres within the scheduled visits to diabetes clinics. This may have initiated a positive social atmosphere for PA support [21]. This feature may have contributed to their willingness to recommend the project to others and to their subjective perceptions of improvements in their PA behaviour. Findings from the literature confirmed the positive effects of psycho-social influences namely self-efficacy and social support on levels of PA [21–26]. However, future studies may consider exploring robust ways for effective and sustainable communications including providing information and feedback in promoting PA in diabetes care.
The intervention components used in the “MOVEdiabetes” study were a practical translation of the recommendations from the formative work carried out to inform the PA intervention design [10, 11]. This study demonstrated that the “MOVEdiabetes” intervention components (face to face personalised PA consultations, pedometer and WhatsApp use) within routine diabetes primary care were satisfactory, appropriate and acceptable by the majority of the participants and POs. However, some participants perceived the longevity, defined as the period of time within which the device (pedometers) was operating well, as ‘very poor’ or ‘poor’ (device stopped working/recording the steps taken/day). Future interventions may consider devices with better quality and longer longevity.
It is notable that the WhatsApp, PA consultations and pedometer use was highly rated by participants. The POs on the other hand, gave more positive ratings for delivering the consultations, pedometers and then WhatsApp use. POs may value clinical based settings for consultations as a normal part of their daily work and may not have time to engage in additional (outside the clinic) communications [4, 27, 28]. This challenge was possibly diluted by the fact that the project was managed by a team of four members in each of the health centres who took turns to give feedback to participants. On the other hand, the participant/patients may have considered the WhatsApp communications as an additional flexible tool to discuss their health condition with their health care providers. This may have facilitated the establishment of a better patient-provider relationship reflected in the high participants’ satisfaction on the opportunities to ask questions and getting answers/feedback reported earlier. The positive effects of using the WhatsApp phone application in promoting PA has been reported in few studies [29]. However, more information is required on the long-term use of phone and text applications on promoting healthy behaviours.
Two research perspectives were identified as challenging by the participants and POs. Firstly, the multiple questionnaires (GPAQ, self-efficacy, social support, general well-being and exit questionnaires) used in this study were viewed as too long and time consuming. However, it is important to note that these were used for research purposes and may not be used within the common routine diabetes clinics. Future simpler versions of those questionnaires may be warranted for service evaluation purposes if these were to be integrated within the routine diabetes primary care. Secondly, delivery of the PA intervention was linked to pre-scheduled visits to diabetes clinics. Due to the dynamic and busy nature of the diabetes primary clinics as reported by the POs, future interventions may test the effectiveness of “stand alone” PA clinics that patients could be referred to vs the integrative “MOVEdiabetes” approach [30]. However, the fact that most participants found coming to the clinic for visits easy, may be attributed to the integrative approach adapted in the current study.
Similar to many studies in nearby countries,[31–33] hot weather was cited as a barrier by responders from the “MOVEdiabetes” study indicating the importance of discussing options for indoor PA and/or weather friendly timings for PA. However, addressing extreme weather conditions in promoting PA is under reported [34, 35].
Finally, participants highlighted the desire for advice on diet as an adjunct to PA and also for similar PA promotion projects to be available for all (the general population). These recommendations are of direct relevance to the National Health Policy Priorities in Oman [36]. To promote the health awareness of the community and establish a culture of healthy lifestyles” [36, 37].
With respect to the POs, qualitative data indicates a desire for more training on PA behaviour change techniques and measurement tools [4]. This may be essential for the continuation of the capacity building activities in PA across health care professions.
Challenges to delivering the intervention by the POs were similar to those reported in the literature e.g. the physical and logistical constraints within the structure of primary health care (e.g. small rooms and lack of space) [3]. Future extension of this project could explore the optimal approaches to re-structure and organise the routine diabetes clinics to make them friendly to PA promotion for both patients and health care providers.
Notably, the interviewer led approach may have discouraged the participant from giving negative comments and more work may be needed to explore views and perceptions using anonymous approaches. Also, the current exit surveys looked at perceptions from the intervention group only; future studies may consider exploring views from the comparison groups too. This would confirm if the perceptions on the study programme were actually different between the study groups e.g. perceptions of changed behaviours