Participants (n=12) were recruited through social media posts (via Facebook and Twitter). Recruitment inclusion criteria included adults aged 18+ years, diagnosed with type 2 diabetes, residing in the United Kingdom, and able to read and write in English. Exclusion criteria included any other type of disease not listed in the inclusion criteria and any people aged out with the defined age bracket. The study participant information sheet and consent form were uploaded into the secure Qualtrics survey system. A link to this form was emailed to participants and their consent was recorded by indicating “yes” on the Qualtrics consent form. Once consent was received, participants were emailed a link to a baseline questionnaire on the Qualtrics system. This questionnaire gathered demographics, educational level, activity tracker use, and who if anyone provides physical activity advice within the person’s clinical care.

Participants (n=9) were recruited through university contacts (via email) and social media posts (via Facebook and “X”). Recruitment criteria included adults aged 18+ years, residing in the United Kingdom, and experience of type 2 diabetes health care or physical activity for health. The study participant information sheet and consent form were uploaded into the secure Qualtrics survey system. A link to this form was emailed to participants and their consent was recorded. Once consent was received, a link to a questionnaire on the Qualtrics survey system to collect information on demographic and job role characteristics was emailed to participants.

Initially, participant numbers were set at 15 for each group (type 2 diabetes participants and health care professionals). Data saturation was undertaken using the “stopping criterion” [15]. Participant interview saturation was reached when no new codes were identified [16]. All consented participants were retained with none dropping out.

One-to-one interviews were conducted with all participants. A semistructured interview schedule was prepared to focus on the 5 RE-AIM dimensions of reach, effectiveness, adoption, implementation, and maintenance. Interviews were conducted either over the telephone or via the secure Zoom conferencing platform. Each interview was recorded via a secure encrypted dictaphone. An abductive interview technique was used which started with the main RE-AIM dimension and worked down into the participants’ lived experiences in more detail [17]. Each interview was later transcribed verbatim from the dictaphone recording.

NVivo 12 (Lumivero) software was used to manage the data and support the thematic analysis. All transcribed interviews were uploaded into this platform. A thematic analysis plan was developed which incorporated the 6-stage process recommended by Braun and Clarke [18]. The 6-stages are data familiarization (repeated reading of the transcripts), initial coding (identification of words or sentences connected to the analysis), initial development of themes (combining of codes into themes), review of identified themes, naming, and finalization of themes and preparation of the final journal article. The thematic analysis was conducted by the lead author (WH) and cross-checked by the 3 coauthors (AK, ML, and XJ). Differences in thematic and code names or meanings were resolved via discussion between these 3 researchers and the lead author.

The majority of adults diagnosed with type 2 diabetes stated that they were not aware of the My Diabetes My Way platform and that it had not been discussed during consultations with a health care professional. For those registered on the platform, only one was aware of the ability to upload the Fitbit data into the system.

Health care professionals discussed awareness of the My Diabetes My Way platform and the ability to upload Fitbit data into the system. The majority of health care professionals were aware of the platform but none knew that users could upload the Fitbit data.

Awareness of the benefits of tracking physical activity through activity trackers was discussed. Adults diagnosed with type 2 diabetes suggested that these devices would provide the user and health care professionals with an accurate indication of an individual’s physical activity.

Health care professionals discussed the benefits of using activity trackers in clinical care. The ability to monitor a patient’s physical activity and provide appropriate advice and support was identified as the main benefit.

Awareness of the benefits of using activity trackers to improve the health of users was explored. Adults diagnosed with type 2 diabetes stated that these devices could increase user’s physical activity and reduce sedentary behavior which would improve the health of the individual.

Health care professionals discussed the benefits to a patient’s health if activity trackers were used in the clinical care of adults diagnosed with type 2 diabetes. Improved health was highlighted as the main benefit which would reduce the need for medical treatment.

Adults diagnosed with type 2 diabetes discussed how clinical care providers could gain access to activity trackers. It was suggested that these devices could be prescribed by the health care provider and used as part of a patient’s treatment plan.

Health care professionals discussed how patients could access an activity tracker as part of their clinical care. It was suggested that these devices could be prescribed by a health care professional.

Access to the My Diabetes My Way platform was discussed during interviews with adults diagnosed with type 2 diabetes. It was suggested that accessibility could be improved by a health care professional providing clear guidance and instructions on how to register for this service, especially for people with limited information technology skills.

Health care professionals discussed the digital literacy barriers that may prevent a patient from accessing and using information technology as part of their clinical care. It was suggested that those with limited digital skills and confidence in using technology would need support and training.

Adults diagnosed with type 2 diabetes discussed the costs with respect to purchasing an activity tracker. The majority of those interviewed said they would pay for a device if it was to form part of their type 2 diabetes care. If prescribed by a health care professional, the cost would be covered by the NHS though some suggested that with stretched budgets this may not be possible.

Health care professionals discussed the cost of purchasing an activity tracker. It was suggested that those who can afford the device should pay for it. If bought by the health care provider in bulk, the cost could be reduced for the patient. For those on a limited budget, the activity tracker could be prescribed.

Adults diagnosed with type 2 diabetes discussed the costs associated with internet access. Those interviewed stated that they had to pay an internet provider for home access and that would be required to access their activity tracker data and the My Diabetes My Way platform. It was suggested that those on low incomes may need financial support to access the internet at home.

Health care professionals discussed the cost implications of accessing the internet. It was suggested that those on limited incomes may need support with the costs. Poor internet coverage in rural areas could also increase access costs and make it difficult for people in these locations to use technology in clinical care.

Adults diagnosed with type 2 diabetes discussed the costs associated with purchasing digital technology. They indicated that either a smartphone or computer would be needed to access activity tracker data and the My Diabetes My Way website. For those on low incomes, such devices could be prescribed by the NHS.

Health care professionals discussed the costs associated with purchasing digital technology. It was highlighted that for patients to upload activity tracker data into the My Diabetes My Way platform they would need to have either a smartphone or computer. Patients on lower incomes may need support with the cost of these items.

Adults diagnosed with type 2 diabetes discussed the cost implications with respect to health care staff if activity trackers are used as part of type 2 diabetes treatment. The main costs identified included staff training and staff time.

Health care professionals discussed the costs associated with being health care professionals. The main costs identified were staff time and training.

Adults diagnosed with type 2 diabetes discussed the promotion of the My Diabetes My Way platform and how this could be signposted. Awareness of the system was low and it was indicated that better signposting by health care professionals was required. Suggested methods of communication were face-to-face consultations, posters in health service clinics, leaflets, SMS text messages, telephone calls, and emails.

Health care professionals discussed the promotion of My Diabetes My Way and the ability to upload activity tracker data into the system. It was suggested that signposting should be the responsibility of the health care provider and make all staff aware. Promotion should be undertaken during face-to-face consultations between the patient and health care professional. Staff could be made aware during team meetings and work emails.

Adults diagnosed with type 2 diabetes discussed the importance of the knowledge and credibility of health care staff when promoting the use of technology in clinical care. In recommending such technology, the health care staff should understand how it works, the benefits, and the ability to fully support the patient.

Health care professionals discussed the importance of health care professionals being credible and knowledgeable of any technology promoted. It was suggested that health care staff would need appropriate training to gain a full understanding before discussing and promoting information technology to a patient.

Adults diagnosed with type 2 diabetes discussed the advice and support patients may require when using an activity tracker or the My Diabetes My Way platform. The main advice focused on individuals who possess low information technology skills and confidence in using such systems. Further advice in relation to exercise and physical activity was suggested.

Health care professionals discussed the advice patients may require to support them when using an activity tracker and the My Diabetes My Way platform as part of their type 2 diabetes treatment. The suggested advice included how best to access and use the technology.

Adults diagnosed with type 2 diabetes discussed the additional support they would need to compliment the use of activity trackers as part of their type 2 diabetes care. The majority stated that being prescribed a gym referral would motivate them to be more physically active.

Health care professionals discussed the prescription of gym referrals to support the use of activity trackers in clinical care. The majority of health care professionals stated that prescribed gym referrals were already used to support adults diagnosed with type 2 diabetes. Some suggested that the gym referral through an exercise professional should incorporate an input about activity trackers.

Adults diagnosed with type 2 diabetes discussed the support patients may need to interpret the data collected on an activity tracker. It was suggested that health care professionals with knowledge of exercise and activity trackers should conduct the interpretation and communicate this to the patient.

Health care professionals discussed the support patients would need to interpret the data collected from the activity tracker. It was suggested that this support would be best delivered by a qualified health care professional with knowledge of physical activity and exercise.

Adults diagnosed with type 2 diabetes discussed the support in the form of educational packages that could be developed and deployed to assist patients to use activity trackers and the My Diabetes My Way platform effectively. It was suggested that the packages could be delivered online or booklet or face-to-face educational class.

Health care professionals discussed patient support in the form of educational packages. It was suggested that these packages could be self-read or delivered in a classroom setting.

Adults diagnosed with type 2 diabetes discussed how feedback from activity tracker data could be communicated and by who. The majority suggested the feedback should be delivered during a face-to-face consultation with a health care professional. Some proposed that when activity data was uploaded into the My Diabetes My Way platform the system interpreted the information and provided immediate feedback and advice.

Health care professionals discussed how best feedback from technology can be communicated to the patient. It was suggested that in the majority of cases this would be best served during face-to-face consultations. With respect to the My Diabetes My Way platform, participants proposed that the system analyzes the uploaded Fitbit data and provides feedback directly to the patient.

Adults diagnosed with type 2 diabetes discussed how data collected from an activity tracker and interpreted should be personalized for the user during the feedback process. This should take into account the patients’ medical history and understanding of physical activity.

Health care professionals discussed the personalization of data obtained through technology. It was suggested that as each patient has differing needs and goals the collected data should be personalized for the individual.

Adults diagnosed with type 2 diabetes discussed the motivational aspect of using data from technology in clinical care. Some suggested that activity trackers could motivate users to be more physically active. Before there, use participants said that users must be motivated to engage with the technology.

Health care professionals discussed how activity trackers could act as a motivational tool for patients. For this to be effective, it was highlighted that the patient would need to engage with the intervention for this to be successful.

Adults diagnosed with type 2 diabetes discussed who should manage the data obtained from activity trackers and stored on the My Diabetes My Way platform. All suggested that a health care professional such as the patient’s doctor, practice nurse, and diabetes nurse should have responsibility for managing the storage and use of the data.

Health care professionals discussed the management of any data collected from patients. It was suggested that this must follow national guidelines and policies for health care organizations. Such data should be managed by the local health authority.

Adults diagnosed with type 2 diabetes discussed the available activity tracker functions. For those with knowledge of these devices, the preferred functions were daily steps, distance moved, challenges, and sleep.

Health care professionals discussed the main activity tracker functions that could be used to support patients. The main functions identified were steps, physical activity intensity, distance walked, and stairs climbed.