Background Type 2 diabetes (T2D) is a public health pandemic disproportionately affecting low- and middle-income countries. The purpose of this formative research was to adapt evidence-based diabetes self-management education programs to the context of Seguro Popular clinics in Mexico. A theory-based mHealth (pictorial text messaging) component was developed. Method Our formative research and development of the program protocol consisted of six phases: (1) interviews and focus groups with stakeholders on the challenges to T2D management, curriculum content needs, and the use of mHealth as a supplement to a DSME program; (2) review of the theoretical underpinning, curriculum, and interactive strategies of four evidence-based DSME programs and modification to meet the needs of adults with T2D and systems of care in Mexico City; (3) development of theory-based illustrated text messages; (4) evaluation of text messaging acceptability and access in adults with T2D via focus groups; (5) development of program manual; and (6) development of a training program for health care providers. Results The ¡Sí, Yo Puedo Vivir Sano Con Diabetes! included 7 group-based weekly lessons; simple, interactive content; weekly empowerment messages; video novellas; group activities; and goal setting. Adaptations to the cultural context of Mexico included content/activities on diabetes etiology (addressing cultural misconceptions), nutrition (indigenous foods and plate method), self-blood glucose monitoring, and diabetes-related stress/coping. We used the Health Action Process Approach to guide the text message development, which posits that adoption, initiation, and maintenance of health behaviors require the development of intentions, plans, coping, and self-efficacy. Our final text message bank consisted of 181 messages. There were approximately 20-30 messages for each process of behavior change (e.g., action planning, maintenance self-efficacy) and 30 messages for each content topic (e.g., eating healthy, physical activity). There were 96 messages that were illustrated. Training materials were also developed. Discussion We used a systematic approach, collaboration with stakeholders, and a well-established behavior change theory to develop an evidence-based intervention to an international context and system of care. Collectively, this process has the potential to enhance the feasibility, acceptability, and efficacy of the program.

中文翻译：

---

制定糖尿病自我管理+移动医疗计划：为墨西哥低收入环境中的试点研究定制干预措施。

背景 2 型糖尿病 (T2D) 是一种公共卫生流行病，对低收入和中等收入国家影响尤为严重。这项形成性研究的目的是使循证糖尿病自我管理教育计划适应墨西哥 Seguro 大众诊所的背景。开发了基于理论的 mHealth（图形文本消息传递）组件。方法 我们对项目协议的形成性研究和开发包括六个阶段：(1) 与利益相关者就 T2D 管理挑战、课程内容需求以及使用移动医疗作为 DSME 项目的补充进行访谈和焦点小组；(2) 回顾理论基础、课程、四个基于证据的 DSME 计划的互动策略和修改，以满足墨西哥城成人 T2D 和护理系统的需求；(3) 基于理论的图解文本消息的开发；(4) 通过焦点小组评估成人 T2D 短信的接受度和使用情况；(5) 程序手册的制定；(6) 制定医疗保健提供者培训计划。结果 ¡Sí, Yo Puedo Vivir Sano Con 糖尿病！包括每周 7 节小组课程；简单的互动内容；每周赋权信息；视频中篇小说；团体活动；和目标设定。针对墨西哥文化背景的调整包括糖尿病病因学（解决文化误解）、营养（本土食品和餐盘法）、自我血糖监测以及糖尿病相关压力/应对的内容/活动。我们使用健康行动过程方法来指导短信开发，该方法认为健康行为的采用、发起和维持需要制定意图、计划、应对和自我效能。我们最终的短信库包含 181 条短信。每个行为改变过程（例如，行动计划、维持自我效能）大约有 20-30 条消息，每个内容主题（例如，健康饮食、体育活动）有 30 条消息。共有 96 条消息带有插图。还编写了培训材料。讨论 我们使用系统方法、与利益相关者的合作以及完善的行为改变理论来开发针对国际背景和护理系统的循证干预措施。总的来说，