*Result*: Co-Designing a Multimodal Physical Activity Intervention for Individuals With Young-Onset Type 2 Diabetes (18-40 Years) in China.
Title:
Co-Designing a Multimodal Physical Activity Intervention for Individuals With Young-Onset Type 2 Diabetes (18-40 Years) in China.
Authors:
Zhao X; Division of Care for Long Term Conditions, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK., Forbes A; Division of Care for Long Term Conditions, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK., Ghazaleh HA; Division of Care for Long Term Conditions, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK., Cheng L; School of Nursing, Faculty of Medicine, Sun Yat-sen University, Guangzhou, China., Guo X; Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China., Duaso M; Division of Care for Long Term Conditions, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.
Source:
Health expectations : an international journal of public participation in health care and health policy [Health Expect] 2026 Feb; Vol. 29 (1), pp. e70580.
Publication Type:
Journal Article
Language:
English
Journal Info:
Publisher: Wiley Country of Publication: England NLM ID: 9815926 Publication Model: Print Cited Medium: Internet ISSN: 1369-7625 (Electronic) Linking ISSN: 13696513 NLM ISO Abbreviation: Health Expect Subsets: MEDLINE
Imprint Name(s):
Original Publication: Oxford, UK : Wiley, c1998-
MeSH Terms:
References:
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Y. Li, D. Teng, X. Shi, et al., “Prevalence of Diabetes Recorded in Mainland China Using 2018 Diagnostic Criteria From the American Diabetes Association: National Cross Sectional Study,” BMJ 369 (2020): m997.
D. J. Magliano, J. W. Sacre, J. L. Harding, E. W. Gregg, P. Z. Zimmet, and J. E. Shaw, “Young‐Onset Type 2 Diabetes Mellitus — Implications for Morbidity and Mortality,” Nature Reviews Endocrinology 16 (2020): 321–331.
J. Xie, M. Wang, Z. Long, et al., “Global Burden of Type 2 Diabetes in Adolescents and Young Adults, 1990‐2019: Systematic Analysis of the Global Burden of Disease Study 2019,” BMJ 379 (2022): e072385.
Q. Meng, A. Mills, L. Wang, and Q. Han, “What Can We Learn From China's Health System Reform?,” BMJ 365 (2019): l2349.
N. Lascar, J. Brown, H. Pattison, A. H. Barnett, C. J. Bailey, and S. Bellary, “Type 2 Diabetes in Adolescents and Young Adults,” Lancet Diabetes & Endocrinology 6 (2018): 69–80.
S. Misra, C. Ke, S. Srinivasan, et al., “Current Insights and Emerging Trends in Early‐Onset Type 2 Diabetes,” Lancet Diabetes & Endocrinology 11 (2023): 768–782.
J. A. Kanaley, S. R. Colberg, M. H. Corcoran, et al., “Exercise/Physical Activity in Individuals With Type 2 Diabetes: A Consensus Statement From the American College of Sports Medicine,” Medicine & Science in Sports & Exercise 54 (2022): 353–368.
W. Wang, “Interpretation of the Diabetes Prevention and Control Action of the Healthy China Initiative 2019‐2030,” China CDC Weekly 2 (2020): 143–145.
X. Zhao, A. Forbes, H. A. Ghazaleh, et al., “Interventions and Behaviour Change Techniques for Improving Physical Activity Level in Working‐Age People (18–60 Years) With Type 2 Diabetes: A Systematic Review and Network Meta‐Analysis,” International Journal of Nursing Studies 160 (2024): 104884.
J. Valabhji, E. Barron, D. Bradley, et al., “Early Outcomes From the English National Health Service Diabetes Prevention Programme,” Diabetes Care 43 (2020): 152–160.
C. Zhang and P. Gong, “Healthy China: From Words to Actions,” Lancet Public Health 4 (2019): e438–9.
S. R. Mortensen, P. L. Kristensen, A. Grøntved, M. Ried‐Larsen, C. Lau, and S. T. Skou, “Determinants of Physical Activity Among 6856 Individuals With Diabetes: A Nationwide Cross‐Sectional Study,” BMJ Open Diabetes Research & Care 10 (2022): e002935.
G. Robert, L. Locock, O. Williams, J. Cornwell, S. Donetto, and J. Goodrich, Co‐Producing and Co‐Designing. Cambridge University Press, 2022, https://doi.org/10.1017/9781009237024.
G. Robert, S. Donetto, and O. Williams, “Co‐designing Healthcare Services with Patients,” in The Palgrave Handbook of Co‐Production of Public Services and Outcomes. Springer International Publishing, 2021), 313–333.
D. Lee, P. Feiertag, and L. Unger, “Co‐Production, Co‐Creation or Co‐Design of Public Space? A Systematic Review,” Cities 154 (2024): 105372.
C. Carswell, P. A. Coventry, J. V. E. Brown, et al., “Development of a Supported Self‐Management Intervention for People With Severe Mental Illness and Type 2 Diabetes: Theory and Evidence‐Based Co‐Design Approach,” Journal of Medical Internet Research 25 (2023): e43597.
A. E. Shriane, S. A. Ferguson, G. Rigney, et al., “Healthy From the Start: Co‐Designing Sleep, Nutrition and Physical Activity Resources for Young Shiftworkers—Novel Implementation and Evaluation,” Health Expectations 27 (2024): e70063, https://doi.org/10.1111/hex.70063.
P. G. Rowe, Design Thinking. MIT Press, 1991.
X. Zhao, M. Duaso, H. A. Ghazaleh, L. Cheng, and A. Forbes, “Effectiveness of Interventions for Improving Physical Activity Level in Working‐Age People (Aged 18–60 Years) With Type 2 Diabetes: A Systematic Review and Meta‐Analysis,” Lancet 402 (2023): S97.
X. Zhao, M. Duaso, H. A. Ghazaleh, X. Guo, and A. Forbes, “Barriers and Facilitators to Physical Activity in People With Young‐Onset (Aged 18‐40 Years) Type 2 Diabetes: A Qualitative Study,” Journal of Clinical Nursing 34 (2025): 2386–2399.
E. Racine, F. Riordan, E. Phillip, G. Flynn, S. McHugh, and P. M. Kearney, “It Just Wasn't Going to Be Heard’: A Mixed Methods Study to Compare Different Ways of Involving People With Diabetes and Health‐Care Professionals in Health Intervention Research,” Health Expectations 23 (2020): 870–883.
D. T. Campbell and D. W. Fiske, “Convergent and Discriminant Validation by the Multitrait‐Multimethod Matrix,” Psychological Bulletin 56 (1959): 81–105.
S. Michie, M. M. van Stralen, and R. West, “The Behaviour Change Wheel: A New Method for Characterising and Designing Behaviour Change Interventions,” Implementation Science 6 (2011): 42, https://doi.org/10.1186/1748-5908-6-42.
D. Morgan, Focus Groups as Qualitative Research. SAGE Publications, Inc, 1997, https://doi.org/10.4135/9781412984287.
N. Amir, “Teacher's Toolkit: A Simple Sketch Tool to Foster Creativity in a Science Context,” Science Scope 45 (2021): 68–70.
S. Donetto, P. Pierri, V. Tsianakas, and G. Robert, “Experience‐Based Co‐Design and Healthcare Improvement: Realizing Participatory Design in the Public Sector,” Design Journal 18 (2015): 227–248.
V. Braun and V. Clarke, “Using Thematic Analysis in Psychology,” Qualitative Research in Psychology 3 (2006): 77–101.
I. Korstjens and A. Moser, “Series: Practical Guidance to Qualitative Research. Part 4: Trustworthiness and Publishing,” European Journal of General Practice 24 (2018): 120–124.
E. Guba and Y. S. Lincoln, Naturalistic Inquiry. Sage Publications, 1985).
T. Sumsion, “The Delphi Technique: An Adaptive Research Tool,” British Journal of Occupational Therapy 61 (1998): 153–156.
F. P. Gittinger, M. Lemos, J. L. Neumann, et al., “Interrater Reliability in the Assessment of Physiotherapy Students,” BMC Medical Education 22 (2022): 186.
X. Zhao, G. C. Feng, S. H. Ao, and P. L. Liu, “Interrater Reliability Estimators Tested Against True Interrater Reliabilities,” BMC Medical Research Methodology 22 (2022): 232.
C. Ozemek, A. Bonikowske, J. Christle, and P. Gallo, ACSM's Guidelines for Exercise Testing and Prescription. Wolters Kluwer Health, 2025. 12th ed.
H. Rouvinen, K. Jokiniemi, M. Sormunen, and H. Turunen, “Internet Use and Health in Higher Education Students: A Scoping Review,” Health Promotion International 36 (2021): 1610–1620.
V. Hohberg, R. Fuchs, M. Gerber, D. Künzler, S. Paganini, and O. Faude, “Blended Care Interventions to Promote Physical Activity: A Systematic Review of Randomized Controlled Trials,” Sports Medicine ‐ Open 8 (2022): 100.
X. Zhao, Q. Liu, X. Guo, X. Hu, and L. Cheng Serial Mediation Roles of Empowerment and Self‐Care Activities Connecting Health Literacy, Quality of Life, and Glycemic Control in People With Type 2 Diabetes. Worldviews Evid Based Nurs 2023; published online Oct 19, https://doi.org/10.1111/wvn.12684.
H. Ishikawa, T. Takeuchi, and E. Yano, “Measuring Functional, Communicative, and Critical Health Literacy Among Diabetic Patients,” Diabetes Care 31 (2008): 874–879.
S. Michie, M. Richardson, M. Johnston, et al., “The Behavior Change Technique Taxonomy (v1) of 93 Hierarchically Clustered Techniques: Building An International Consensus for the Reporting of Behavior Change Interventions,” Annals of Behavioral Medicine 46 (2013): 81–95.
K. R. Garstang, P. C. Jackman, L. C. Healy, S. B. Cooper, and D. Magistro, “What Effect Do Goal Setting Interventions Have on Physical Activity and Psychological Outcomes in Insufficiently Active Adults? A Systematic Review and Meta‐Analysis,” Journal of Physical Activity and Health 21 (2024): 541–553.
L. J. Beselt, M. H. McDonough, J. Hewson, and C. Din, “Social Support and Social Barriers for Participating in Group Physical Activity Among Older Women Living Alone,” Qualitative Research in Sport, Exercise and Health 15 (2023): 819–834.
Y. Li, D. Teng, X. Shi, et al., “Prevalence of Diabetes Recorded in Mainland China Using 2018 Diagnostic Criteria From the American Diabetes Association: National Cross Sectional Study,” BMJ 369 (2020): m997.
D. J. Magliano, J. W. Sacre, J. L. Harding, E. W. Gregg, P. Z. Zimmet, and J. E. Shaw, “Young‐Onset Type 2 Diabetes Mellitus — Implications for Morbidity and Mortality,” Nature Reviews Endocrinology 16 (2020): 321–331.
J. Xie, M. Wang, Z. Long, et al., “Global Burden of Type 2 Diabetes in Adolescents and Young Adults, 1990‐2019: Systematic Analysis of the Global Burden of Disease Study 2019,” BMJ 379 (2022): e072385.
Q. Meng, A. Mills, L. Wang, and Q. Han, “What Can We Learn From China's Health System Reform?,” BMJ 365 (2019): l2349.
N. Lascar, J. Brown, H. Pattison, A. H. Barnett, C. J. Bailey, and S. Bellary, “Type 2 Diabetes in Adolescents and Young Adults,” Lancet Diabetes & Endocrinology 6 (2018): 69–80.
S. Misra, C. Ke, S. Srinivasan, et al., “Current Insights and Emerging Trends in Early‐Onset Type 2 Diabetes,” Lancet Diabetes & Endocrinology 11 (2023): 768–782.
J. A. Kanaley, S. R. Colberg, M. H. Corcoran, et al., “Exercise/Physical Activity in Individuals With Type 2 Diabetes: A Consensus Statement From the American College of Sports Medicine,” Medicine & Science in Sports & Exercise 54 (2022): 353–368.
W. Wang, “Interpretation of the Diabetes Prevention and Control Action of the Healthy China Initiative 2019‐2030,” China CDC Weekly 2 (2020): 143–145.
X. Zhao, A. Forbes, H. A. Ghazaleh, et al., “Interventions and Behaviour Change Techniques for Improving Physical Activity Level in Working‐Age People (18–60 Years) With Type 2 Diabetes: A Systematic Review and Network Meta‐Analysis,” International Journal of Nursing Studies 160 (2024): 104884.
J. Valabhji, E. Barron, D. Bradley, et al., “Early Outcomes From the English National Health Service Diabetes Prevention Programme,” Diabetes Care 43 (2020): 152–160.
C. Zhang and P. Gong, “Healthy China: From Words to Actions,” Lancet Public Health 4 (2019): e438–9.
S. R. Mortensen, P. L. Kristensen, A. Grøntved, M. Ried‐Larsen, C. Lau, and S. T. Skou, “Determinants of Physical Activity Among 6856 Individuals With Diabetes: A Nationwide Cross‐Sectional Study,” BMJ Open Diabetes Research & Care 10 (2022): e002935.
G. Robert, L. Locock, O. Williams, J. Cornwell, S. Donetto, and J. Goodrich, Co‐Producing and Co‐Designing. Cambridge University Press, 2022, https://doi.org/10.1017/9781009237024.
G. Robert, S. Donetto, and O. Williams, “Co‐designing Healthcare Services with Patients,” in The Palgrave Handbook of Co‐Production of Public Services and Outcomes. Springer International Publishing, 2021), 313–333.
D. Lee, P. Feiertag, and L. Unger, “Co‐Production, Co‐Creation or Co‐Design of Public Space? A Systematic Review,” Cities 154 (2024): 105372.
C. Carswell, P. A. Coventry, J. V. E. Brown, et al., “Development of a Supported Self‐Management Intervention for People With Severe Mental Illness and Type 2 Diabetes: Theory and Evidence‐Based Co‐Design Approach,” Journal of Medical Internet Research 25 (2023): e43597.
A. E. Shriane, S. A. Ferguson, G. Rigney, et al., “Healthy From the Start: Co‐Designing Sleep, Nutrition and Physical Activity Resources for Young Shiftworkers—Novel Implementation and Evaluation,” Health Expectations 27 (2024): e70063, https://doi.org/10.1111/hex.70063.
P. G. Rowe, Design Thinking. MIT Press, 1991.
X. Zhao, M. Duaso, H. A. Ghazaleh, L. Cheng, and A. Forbes, “Effectiveness of Interventions for Improving Physical Activity Level in Working‐Age People (Aged 18–60 Years) With Type 2 Diabetes: A Systematic Review and Meta‐Analysis,” Lancet 402 (2023): S97.
X. Zhao, M. Duaso, H. A. Ghazaleh, X. Guo, and A. Forbes, “Barriers and Facilitators to Physical Activity in People With Young‐Onset (Aged 18‐40 Years) Type 2 Diabetes: A Qualitative Study,” Journal of Clinical Nursing 34 (2025): 2386–2399.
E. Racine, F. Riordan, E. Phillip, G. Flynn, S. McHugh, and P. M. Kearney, “It Just Wasn't Going to Be Heard’: A Mixed Methods Study to Compare Different Ways of Involving People With Diabetes and Health‐Care Professionals in Health Intervention Research,” Health Expectations 23 (2020): 870–883.
D. T. Campbell and D. W. Fiske, “Convergent and Discriminant Validation by the Multitrait‐Multimethod Matrix,” Psychological Bulletin 56 (1959): 81–105.
S. Michie, M. M. van Stralen, and R. West, “The Behaviour Change Wheel: A New Method for Characterising and Designing Behaviour Change Interventions,” Implementation Science 6 (2011): 42, https://doi.org/10.1186/1748-5908-6-42.
D. Morgan, Focus Groups as Qualitative Research. SAGE Publications, Inc, 1997, https://doi.org/10.4135/9781412984287.
N. Amir, “Teacher's Toolkit: A Simple Sketch Tool to Foster Creativity in a Science Context,” Science Scope 45 (2021): 68–70.
S. Donetto, P. Pierri, V. Tsianakas, and G. Robert, “Experience‐Based Co‐Design and Healthcare Improvement: Realizing Participatory Design in the Public Sector,” Design Journal 18 (2015): 227–248.
V. Braun and V. Clarke, “Using Thematic Analysis in Psychology,” Qualitative Research in Psychology 3 (2006): 77–101.
I. Korstjens and A. Moser, “Series: Practical Guidance to Qualitative Research. Part 4: Trustworthiness and Publishing,” European Journal of General Practice 24 (2018): 120–124.
E. Guba and Y. S. Lincoln, Naturalistic Inquiry. Sage Publications, 1985).
T. Sumsion, “The Delphi Technique: An Adaptive Research Tool,” British Journal of Occupational Therapy 61 (1998): 153–156.
F. P. Gittinger, M. Lemos, J. L. Neumann, et al., “Interrater Reliability in the Assessment of Physiotherapy Students,” BMC Medical Education 22 (2022): 186.
X. Zhao, G. C. Feng, S. H. Ao, and P. L. Liu, “Interrater Reliability Estimators Tested Against True Interrater Reliabilities,” BMC Medical Research Methodology 22 (2022): 232.
C. Ozemek, A. Bonikowske, J. Christle, and P. Gallo, ACSM's Guidelines for Exercise Testing and Prescription. Wolters Kluwer Health, 2025. 12th ed.
H. Rouvinen, K. Jokiniemi, M. Sormunen, and H. Turunen, “Internet Use and Health in Higher Education Students: A Scoping Review,” Health Promotion International 36 (2021): 1610–1620.
V. Hohberg, R. Fuchs, M. Gerber, D. Künzler, S. Paganini, and O. Faude, “Blended Care Interventions to Promote Physical Activity: A Systematic Review of Randomized Controlled Trials,” Sports Medicine ‐ Open 8 (2022): 100.
X. Zhao, Q. Liu, X. Guo, X. Hu, and L. Cheng Serial Mediation Roles of Empowerment and Self‐Care Activities Connecting Health Literacy, Quality of Life, and Glycemic Control in People With Type 2 Diabetes. Worldviews Evid Based Nurs 2023; published online Oct 19, https://doi.org/10.1111/wvn.12684.
H. Ishikawa, T. Takeuchi, and E. Yano, “Measuring Functional, Communicative, and Critical Health Literacy Among Diabetic Patients,” Diabetes Care 31 (2008): 874–879.
S. Michie, M. Richardson, M. Johnston, et al., “The Behavior Change Technique Taxonomy (v1) of 93 Hierarchically Clustered Techniques: Building An International Consensus for the Reporting of Behavior Change Interventions,” Annals of Behavioral Medicine 46 (2013): 81–95.
K. R. Garstang, P. C. Jackman, L. C. Healy, S. B. Cooper, and D. Magistro, “What Effect Do Goal Setting Interventions Have on Physical Activity and Psychological Outcomes in Insufficiently Active Adults? A Systematic Review and Meta‐Analysis,” Journal of Physical Activity and Health 21 (2024): 541–553.
L. J. Beselt, M. H. McDonough, J. Hewson, and C. Din, “Social Support and Social Barriers for Participating in Group Physical Activity Among Older Women Living Alone,” Qualitative Research in Sport, Exercise and Health 15 (2023): 819–834.
Grant Information:
Public Engagement Small Grant from King's College London; 202108440151 King's - China Scholarship Council PhD Scholarship
Contributed Indexing:
Keywords: co‐design; design thinking; intervention development; physical activity; type 2 diabetes; young adults
Entry Date(s):
Date Created: 20260204 Date Completed: 20260206 Latest Revision: 20260223
Update Code:
20260223
PubMed Central ID:
PMC12868930
DOI:
10.1111/hex.70580
PMID:
41635131
Database:
MEDLINE
*Further Information*
*Background: A limited number of physical activity programmes exist for Chinese people with young-onset (18-40 years) type 2 diabetes amid its rising global prevalence. This study aims to develop a multimodal intervention for improving physical activity levels for individuals with young-onset type 2 diabetes using co-design.
Methods: The development process included three stages. Stage 1 involved synthesising the findings of a review of existing physical activity interventions and a qualitative study of exercise experiences of young adults with type 2 diabetes. This generated a list of candidate intervention elements and behaviour change techniques to inform the co-design process. Stage 2 involved the development of animated trigger films, using findings from stage 1, to present the physical activity experiences of people with young-onset type 2 diabetes. In stage 3, a series of co-design workshops engaging relevant stakeholders were conducted, utilising the outputs from the previous two stages and aligning with the Design Thinking theory.
Results: Twenty-five participants (12 young adults with type 2 diabetes, 12 healthcare professionals, and one family member) attended co-design workshops to develop the intervention. The co-design process resulted in a logic model for a tailored programme-IPAYD (Improving Physical Activity in people with Young-onset type 2 Diabetes). This programme integrates behaviour change techniques across four elements: individualised goal setting and planning, exercise monitoring, a peer support forum, and educational resources. An eHealth platform was preferred to deliver the programme, incorporating one-to-one consultations and optional group sessions to enhance social support and social interaction.
Conclusions: Through stakeholder engagement in a co-design process, this study makes a novel and much-needed contribution to developing a physical activity intervention for Chinese people with young-onset type 2 diabetes.
Patient and Public Contribution: An advisory group of six Chinese young people with type 2 diabetes met online and communicated through a project-focused WeChat group. They contributed to the animated film scripts, the topic guide of the workshops, the design of the intervention materials, and how to conduct the workshops to align with Chinese culture.
(© 2026 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)*