• Ja

• Ja

Lifestyle modification is essential in the management of type 2 diabetes (T2D), yet long-term adherence remains challenging. eHealth offers opportunities to support self-management through monitoring and tailored guidance. This thesis explores how eHealth strategies can be dynamically tailored to promote healthy lifestyles in people with T2D and how such strategies can be embedded in diabetes care.

Chapter 2 examined views on the current and future role of lifestyle counseling in secondary T2D care through interviews with diabetes nurses. Nurses regarded lifestyle support as integral to care but reported barriers such as limited lifestyle expertise, time constraints, unclear guidelines, and difficulties related to patient motivation. Their counseling often focused on raising awareness and giving brief advice rather than providing intensive coaching. Although eHealth was not yet widely integrated, nurses recognized its potential to complement care and strengthen self-management.

Chapters 3–5 focused on the development and evaluation of E-Supporter, a dynamically tailored lifestyle intervention. Chapter 3 described its systematic development, grounded in behavioral theory and user needs. Tailoring was based, among others, on personal goals, progress, and barriers to achieving lifestyle goals. Chapter 4 showed that the intervention was acceptable and perceived as supportive in a nine-week feasibility study, with exploratory improvements in steps, self-efficacy, and diet. Chapter 5 explored a just-in-time adaptive intervention (JITAI) delivered via ecological momentary assessments (EMAs). Participants appreciated context-relevant messages but differed in how personalized and helpful the support felt, underscoring the need for more individualized tailoring content and intensity.

Chapter 6 synthesized 61 dynamically tailored eHealth interventions for chronic disease. Tailoring most often targeted physical activity and diet, with increasing attention to contextual and emotional factors. Although many interventions were theory-based and showed within-group improvements, evidence for superiority over controls remained limited. Stronger methodological rigor is needed to unlock their full potential.

Chapter 7 integrates these findings, highlighting three key insights: tailoring should be multidimensional; eHealth can bridge clinical care and daily life; and methodological progress requires transparency, interoperability, and reuse of intervention components.

Overall, this thesis provides a foundation for designing and implementing dynamically tailored eHealth to support sustainable lifestyle change in T2D care.

• Uploading his/her dissertation and additional information the author agrees with publication on this website. The author should in advance obtain permission from any other copyright holders for publication on this site.