促进健康行为改变有助于预防和控制二型糖尿病，但当下的干预实践面临许多挑战，比如干预措施对患者的心理需求关注不足、健康教育忽视了行为改变前期的人群。因此本研究以解释现象学分析作为研究的方法论视角，深入探究糖尿病患者在健康行为改变过程中的心理面貌和面临的真实困境，从而确定设计目标，设计一款促进糖尿病患者采取健康行为改变的移动应用产品。本研究包括三个子研究。研究一对6位早期糖尿病患者进行深度访谈，通过对访谈记录的逐字阅读和双重诠释过程，利用解释现象学分析的方法，得到三个高级主题：患者对自我的认识、行为决策的影响因素和行为维持的影响因素，并从行为改变前的态度和认知、行为决策和行为维持三方面揭示了行为改变困难的内在原因。结果发现，患者在生活压力下倾向于对自身健康状态进行乐观偏差评估，并通过和他人更差的情况比较来缓解自身的焦虑和不安，这种比较直接降低了患者采取行为改变的动机。此外，行为决策受到低自我效能、高期望和家庭角色导致的资源冲突的影响，而行为维持阶段则常伴随着低正反馈、高负反馈和外部归因的挑战。

第二个研究依据研究一结果确定了焦虑型、放纵型、自律型三类用户画像，在确定以挣扎型患者作为目标用户的基础上，定义了8条具体设计目标。并以行为改变轮和福格行为模型作为理论基础，设计了旨在提高糖尿病患者健康行为改变能力、促进做出实际行为改变的移动应用产品“健康启程”。该产品除了具备一般健康行为产品的常见功能外，还设计了可视化身体状态、用户等级制、行为反思和调整等特色功能。该设计通过了SUS可用性测试，得分较高，可用性水平处于可接受范围内。

第三个研究验证了产品设计的有效性。方法是：前测/后测*完整功能组/基础功能组的2*2的混合设计，对26位被试进行了为期一周的干预测验。因变量为运动行为改变评定量表得分，自变量为组别和时间，通过广义估计方程验证效果。结果是：两组的被试在运动行为改变上的整体情况、初始行为改变、参与性对话-优势和行为自信上均有显著的提升。尽管未发现前后测*时间的交互作用，但在数据上呈现了干预组比对照组的提升更多的明显趋势，基于小程序后台收集的用户使用数据，也发现对照组被试比参与组被试有更高的使用持久度和粘性，验证了产品功能在提升目标用户行为自信、激励用户做出实际行为改变的效果。

综上所述，本研究针对糖尿病患者的健康行为改变，首次将质性研究与干预设计相结合，揭示患者的行为改变过程中挣扎、无力的自我和难以克服的挑战，并设计“健康启程”移动应用产品，以挑战系统为核心、身体、等级等多个系统辅助，满足用户行为改变与持续的需求。在未来，可以进一步考虑面向更多地区、年龄段和社会经济地位的患者开展研究，形成对糖尿病患者健康行为改变的全面理解。

Promoting health behavior change can help prevent and control type II diabetes, but the current intervention practice faces many challenges, such as insufficient attention to the psychological needs of patients and health education ignoring the population in the early stage of behavior change. Therefore, this study takes interpretative phenomenological analysis as the research methodological perspective to deeply explore the psychological appearance and real dilemma faced by diabetic patients in the process of health behavior change, so as to determine the design goal and design a mobile application product to promote diabetic patients to adopt health behavior change. This study includes three sub-studies. In this study, a pair of 6 patients with early diabetes were interviewed in depth. Through the process of word-for-word reading and double interpretation of the interview records, three advanced topics were obtained by using the method of interpretative phenomenological analysis: The internal reasons for the difficulty of behavior change were revealed from three aspects: attitude and cognition before behavior change, behavior decision making and behavior maintenance. The results showed that patients under life stress tend to evaluate their own health status with optimism bias, and reduce their anxiety and anxiety by comparing with others' worse situation, which directly reduces the motivation of patients to adopt behavior change. In addition, behavioral decision making is influenced by resource conflicts caused by low self-efficacy, high expectations and family roles, while the behavioral maintenance stage is often accompanied by low positive feedback, high negative feedback and external attribution challenges.

The second study identified three types of user portraits, namely anxious, indulgent and self-disciplined, according to the results of the first study. On the basis of determining struggling patients as the target users, eight specific design goals were defined. Based on the behavioral change wheel and Fogg behavioral model, the mobile application product "Healthy Departure" was designed to improve the ability of diabetes patients to change their health behaviors and promote actual behavior change. In addition to the common functions of general health behavior mobile application products, this product has also designed features such as visualization of body state, user hierarchy, behavior reflection and adjustment. The design passed the SUS usability test with a high score and an acceptable usability level.

The third study validated the effectiveness of the product design. The method is: pre-test/post-test * full function group/core function group of 2*2 mixed design, 26 subjects conducted a one-week intervention test. The dependent variables were motor behavior change rating scale score, and the independent variables were group and time. The effect was verified by generalized estimation equation. The results showed that participants in both groups showed significant improvements in overall status of motor behavior change, initial behavior change, participative conversation-dominance, and behavioral confidence. Although no interaction between pre-test and post-test time was found, the data showed a clear trend of more improvement in the intervention group than in the control group. Based on the user usage data collected in the background of the mini program, it was also found that the control group had higher durability and stickiness than the participants. The effectiveness of product functions in enhancing target users' behavioral confidence and motivating users to make actual behavioral changes was verified.

In summary, aiming at the health behavior change of diabetic patients, this study for the first time combined qualitative research with intervention design to reveal the patients' struggle, powerless self and insurmountable challenges in the process of behavior change, and designed the mobile application product "Healthy Journey", with the challenge system as the core and multiple systems such as body and grade support, to meet the users' behavior change and continuous needs. In the future, further consideration could be given to conducting studies across more regions, age groups, and socioeconomic status to develop a comprehensive understanding of health behavior changes in people with diabetes.