Adaptation and Feasibility Study of a Digital Health Program to Prevent Diabetes among Low-Income Patients: Results from a Partnership between a Digital Health Company and an Academic Research Team

Table 1

Examples of content and language modification to adapt online lessons in the Omada program to fit literacy levels and cultural relevance associated with low-SES patients in a large safety net clinic.

Original content		⁢Adapted content		Adaptation
Quote	Readability index	Quote	Readability index
Proteins are the building blocks of muscle and tissue, making them essential to growth and healing. They support immune function, and are used to make hormones and enzymes. Protein is also a backup source of energy when carbohydrates aren’t available. When it comes to eating protein, lean sources are great for your health	6.0	Protein builds muscles and tissue, and helps you grow and heal. Your body also uses protein as fuel when it runs out of carbs. Low-fat proteins are great for you	1.8	Improve understandability by using fewer scientific terms
Listening to music while you walk, waiting to read a favorite magazine or watch a guilty-pleasure TV show until you’re on the stationary bike, or inviting your funniest friend to join you can turn exercise into something to look forward to	18.2	Listen to your favorite music while you walk, or invite a friend to join you. This can make exercise something to look forward to	7.2	Emphasize exercises that do not require significant financial investments
“Finally, pay attention to the circumstances and environments that inspire you to stay healthy, and soak up as much of that inspiration as you can. Playing sports, perfecting a new yoga pose, spending time in nature, being around kids, reading about people who overcome illness against all odds... Whatever inspires you, embrace that activity and plan to do it more often	10.6	Find the things that inspire you to stay healthy and use them to keep you on track. Maybe it’s playing sports or being around kids. Maybe you enjoy spending time in nature or learning a new dance. Find what drives you, use it to stay inspired, and plan to do it more often	1.8	Emphasize sources of motivation and activities that are accessible regardless of income level
There’s one more impressive stat about the DPP that you should know: 75% of the people who participated in the lifestyle program and met their first weight-loss goal, kept that weight off for three years. In comparison, only 5% of people who lose weight on traditional diets do the same	9.2	One more great thing about the program: people didn’t just lose weight, but they kept the weight off. 3 out of 4 people kept the weight off for 3 years. With a regular diet, only 1 out of 20 people are able to keep the weight off	3.8	Improve understandability by simplifying numerical concepts

While the entire lessons were on average at 5th-grade reading level, a few excerpts within a lesson could be at a higher SMOG index for readability based on the length of a sentence or the number of 3-syllable words.