Evaluation of the WARIFA App and Its Impact on Healthy Lifestyle

Degree of achievement of a self-defined goal by the participants (selected among: increase consumption on fruit and vegetables, increase physical activity, reduce alcohol consumption, stop smoking, reduce number of weekly hypoglycaemic episodes, or improve sun protective behaviours).

It will be measured on a Likert scale, with scores ranging from 1 ('well below expectations') to 10 ('well above expectations').

Number of times users access the app (number of times per day). Direct adherence.

Time spent using the app (number of hours per day). Direct adherence.

Assessment of the regularity with which users record information related to healthy habits, healthy eating and physical activity. Direct adherence.

The validated App Behaviour Change Scale (ABACUS). Attitudinal/Behavioural Change. The ABACUS scale was designed to measure the potential behavior change of apps. It consists of 21 items grouped into 4 categories: knowledge and information (5 items), goals and planning (3 items), feedback and monitoring (7 items), and actions (6 items). Each item represents a behavior change technique, and its inclusion in the app is rated dichotomously (behavior change technique not included = 0 or included = 1). Higher score means more potential behavioural change of apps.

Assessment of changes in diet quality (changes in consumption of fruits, vegetables, processed foods…). Diary recording of fruit, vegetable, and processed meat consumption will be used. Attitudinal/Behavioural Change.

Data collected through a compatible smartwatch (number of steps) will be recorded. Attitudinal/Behavioural Change.

Diary records of tobacco consumption will be used (number of cigarettes per day). Attitudinal/Behavioural Change.

Diary records of alcohol consumption will be used (Number of units of alcoholic beverages per day). Attitudinal/Behavioural Change.

sun habits questionnaire score wil be used. Attitudinal/Behavioural Change

Daily record of sunscreen use. Attitudinal/Behavioural Change

The continuous glucose monitor data from participants will be used (number of hypoglycaemic events). Biomedical outcomes

Diary records of manually recorded hypoglycaemic events (number of hypoglycaemic events). Biomedical outcomes.

Will be measured in venous blood. Unit of measurement: %. Biomedical outcomes.

Glucose Management Indicator in the last 14 days. Unit of measurement: %. Biomedical outcome

Average glucose in the last 14 days. Unit of measurement: mg/dl. Biomedical outcomes.

Times in glucose range for the last 14 days, measured by the participants' glucose sensor. Unit of measurement: %. Biomedical outcomes.

Total cholesterol, measured through a venous blood sample. Unit of measurement: mg/dl. Biomedical outcomes.

HDL cholesterol, measured through a venous blood sample. Unit of measurement: mg/dl. Biomedical outcomes.

LDL cholesterol, measured through a venous blood sample. Unit of measurement: mg/dl. Biomedical outcomes.

Non-HDL cholesterol, measured through a venous blood sample. Unit of measurement: mg/dl. Biomedical outcomes.

Muscle mass. Measured by impedanciometry. Unit of measurement: Kg. Biomedical outcomes.

Fat mass. Measured by impedanciometry. Unit of measurement: Kg. Biomedical outcomes.

Weight of each participant. Unit of measurement: Kg. Biomedical outcomes

Height of each participant. Unit of measurement: cm. Biomedical outcomes

Circumference of abdomen. Unit of measurement: cm. Biomedical outcomes

Circumference of the calf. Unit of measurement: cm. Biomedical outcomes

Functional test, using a dynamometer in each participant's hand. Unit of measurement: Kg. Biomedical outcomes

Measured by plicometer in the posterior region of the upper arm (triceps area). Unit of measurement: mm. Biomedical outcomes.

Functional test, which measures the time taken to stand up and sit down from a chair 5 times. Unit of measurement: seconds. Biomedical outcomes.

The EQ-5D questionnaire will be used for the group from the general population. Quality of Life and Wellbeing. Questionnaire with two distinct parts. The first part contains five health dimensions (mobility, self-care, activities of daily living, pain/discomfort and anxiety/depression). For each dimension of the EQ-5D, severity levels are coded: 1 if the answer choice is 'no (I have) problems'; 2 if the answer choice is 'some or moderate problems'; and 3 if the answer choice is 'many problems'. The higher the score, the worse the health dimension.

The second part of the EQ-5D is a scale from 0 to 100. On this scale, the individual should mark the point that best reflects their assessment of their overall health status, with 0 being the lowest assessment of their health status and 100 being the best.

The "Vida con Diabetes tipo 1" (ViDa1) questionnaire will be used for the group of individuals with T1D. Quality of Life and Wellbeing.

The ViDa1 has 34 items that are grouped into 4 different dimensions: interference with life, self-care, well-being and worry about the disease. It is a questionnaire that can be self-administered with a Likert-type response format in which a total score per subscale is obtained.

Interference with life: (items 1 - 12), self-care (13 - 23), well-being (24 - 29) and worry about illness (30 - 34). Each item is scored from 1 'strongly disagree' to 5 'strongly agree'. For correction, the scores obtained in each subscale are added together. Items 12, 23 and 27 are reversed for correct interpretation.

Assessment of new knowledge about healthy habits. The European Health Literacy Survey will be used. Knowledge and Attitudes.

The questionnaire consists of 16 questions that classify the degree of difficulty perceived by the participant in each task or situation as: 1 'very easy', 2 'easy', 3 "difficult", 4 'very difficult' or 5 'don't know/no answer'.

For measuring diabetes self-management behaviours, we will use the Summary of Diabetes Self-Care Activities (SDSCA). Knowledge and Attitudes.

Is a brief self-report questionnaire of diabetes self-management that includes items assessing the following aspects of the diabetes regimen. It consists of 11 items that addresses different areas of self-care present in people with Diabetes Mellitus, such as diet, physical activity, medication, self-testing of capillary glycaemia and smoking. It presents a response scale from 0 to 7, depending on the number of days that the person has carried out a certain behaviour in the last week. The smoking item has a dichotomous response scale.

The lower the score, the lower the adherence of the person with MD to favourable self-care behaviours. The questionnaire has no cut-off point, so each item must be assessed individually.

Usability scale (SUS) will be used. Satisfaction and feedback.

The SUS scale is a 10-item questionnaire scored on a 5-point Likert-type scale from 1 (strongly disagree) to 5 (strongly agree). It is arranged to alternate between positive and negative statements to avoid habitual bias from the respondent. The score contribution for the odd items (the positive statements) is the scale position minus 1 and the contribution for the even items (the negative statements) is 5 minus the scale position. The overall score is calculated from the sum of all item scores multiplied by 2.5, with the overall score ranging from 0 to 100. A system with a score above 85 is considered to have excellent usability, whereas a system with a score between 68 and 84 is considered to have good usability.

The mHealth App Usability Questionnaire (MAUQ) will be used. Satisfaction and feedback.

It assesses the ease of use, interface, satisfaction and usefulness of mHealth applications for end users. Consists of 18 items, with 7 response options for each item, ranging from 1 "strongly disagree" to 7 "strongly agree".