BACKGROUND: Intensive lifestyle modifications have proved effective in preventing type 2 diabetes mellitus (T2DM), yet the efficiency and effectiveness of these modifications need to be improved. Emerging social media interventions are considered useful in promoting these lifestyles; nevertheless, few studies have investigated the effectiveness of combining them with behavior theory. OBJECTIVE: This study aims to examine the effectiveness of a 6-month mobile-based intervention (DHealthBar, a WeChat applet) combined with behavioral theory compared with a printed intervention in improving dietary behaviors, physical activity, and intention to change these behaviors among populations at high risk for T2DM. METHODS: Participants aged 23 to 67 years were recruited offline in Beijing, China, and were randomized into the intervention group or the control group, which received educational content via DHealthBar or a printed handbook, respectively. Educational materials were culturally tailored recommendations on improving dietary behaviors, physical activity, and intention to change based on the transtheoretical model. Participants in the intervention arm received push notifications twice per week on WeChat and had access to the educational content for the 6-month study period. Participants in the control arm received the same intervention content through printed materials. The outcomes of participants' behavior change, intention to change behavior, and anthropometric characteristics were collected via online measuring tools at baseline, 3 months, and 6 months. RESULTS: In this study, 79 enrolled individuals completed baseline information collection (control n = 38 versus intervention n = 41), and 96% (76/79) completed the 6-month follow-up visit. Attrition rates did not differ significantly between the 2 groups (Chi2[1] = 0.0, p = 0.61). Baseline equivalence was found. Participants in both groups reported a statistically significant decrease in energy intake at the 2 follow-up assessments compared with baseline (3 months, control exp(beta) = 0.83, 95% CI 0.74 to 0.92 versus intervention exp(beta) = 0.76, 95% CI 0.68 to 0.85; 6 months, control exp(beta) = 0.87, 95% CI 0.78 to 0.96 versus intervention exp(beta) = 0.57, 95% CI 0.51 to 0.64). At 6 months, a significantly larger decrease was observed in the intervention group in energy, fat, and carbohydrate intake, accompanied with a significantly larger increase in moderate-intensity physical activity compared with the control group (energy exp(beta) = 0.66, 95% CI 0.56 to 0.77; fat exp(beta) = 0.71, 95% CI 0.54 to 0.95; carbohydrates exp(beta) = 0.83, 95% CI 0.66 to 1.03; moderate-intensity physical activity exp(beta) = 2.05, 95% CI 1.23 to 3.44). After 6 months of the intervention, participants in the intervention group were more likely to be at higher stages of dietary behaviors (exp(beta) = 26.80, 95% CI 3.51 to 204.91) and physical activity (exp(beta) = 15.60, 95% CI 2.67 to 91.04) than the control group. CONCLUSIONS: DHealthBar was initially effective in improving dietary behavior, physical activity, and intention to change these behaviors among populations who were at high risk of developing T2DM, with significant differences in the changes of outcomes over the 6-month intervention period. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2000032323; https://tinyurl.com/y4h8q4uf.

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