{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:21:25Z","timestamp":1784308885895,"version":"3.55.0"},"reference-count":47,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"NHMRC Investigator Grant","award":["GNT1174886"],"award-info":[{"award-number":["GNT1174886"]}]},{"name":"USDA NIFA Hatch Project","award":["MICL02798"],"award-info":[{"award-number":["MICL02798"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Telemed Telecare"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Behavioural changes targeting diet and physical activity to achieve weight loss are considered the cornerstones of metabolic dysfunction-associated steatotic liver disease (MASLD) management. Digital health interventions effectively address barriers in accessing such lifestyle interventions particularly for persons in remote and regional communities that have high rates of MASLD and limited access to healthcare. This research uses co-design methodology to inform the development of a multimodal, digital lifestyle intervention for individuals with MASLD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Over 20 months (May 2023-January 2025), an iterative co-design process guided by the Double Diamond framework-\n                      <jats:italic toggle=\"yes\">discover, define, develop, deliver-<\/jats:italic>\n                      was implemented. Twenty-seven adults (\u226518 years) from Alfred Health, Australia participated in one-on-one interviews to explore insights and perspectives during the\n                      <jats:italic toggle=\"yes\">\n                        <jats:underline>discover<\/jats:underline>\n                      <\/jats:italic>\n                      phase. This included people with MASLD (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 10; 50% female; mean age: 63.6 years), and healthcare professionals (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 17; 59% female; mean age: 37.1 years) [dietitians (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 5), exercise professionals (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 6) and hepatologists\/clinicians (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 6)], representing a range of ethnic backgrounds. Key themes were synthesised using a reflexive thematic analysis employing a data-driven, inductive approach during the\n                      <jats:italic toggle=\"yes\">define<\/jats:italic>\n                      phase. The\n                      <jats:italic toggle=\"yes\">develop<\/jats:italic>\n                      phase led to actionable suggestions, and final feedback was sought from participants in the\n                      <jats:italic toggle=\"yes\">deliver<\/jats:italic>\n                      phase.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Interviews identified barriers and facilitators that influenced participant engagement and adherence to the digital intervention, highlighting the need for an evidence-based, personalised and holistic approach during the\n                      <jats:italic toggle=\"yes\">discover<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">define<\/jats:italic>\n                      phases. Five key themes emerged: i) content relevance and adaptability, ii) personalisation, iii) social and community, iv) barriers and facilitators, and v) website interface design. The\n                      <jats:italic toggle=\"yes\">develop<\/jats:italic>\n                      phase focused on refining the intervention based on participant feedback and\n                      <jats:italic toggle=\"yes\">deliver<\/jats:italic>\n                      phase encompassed finalising the digital intervention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This iterative co-design process identified the needs and preferences of individuals with MASLD for a multimodal, digital lifestyle intervention. This research will guide a holistic, tailored approach with culturally appropriate resources and community engagement, piloted to assess feasibility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1357633x251366098","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T06:43:07Z","timestamp":1755672187000},"page":"465-478","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Co-design of a digital health lifestyle intervention for adults with metabolic dysfunction-associated steatotic liver disease"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5671-4817","authenticated-orcid":false,"given":"Surbhi","family":"Sood","sequence":"first","affiliation":[{"name":"Deakin University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart K","family":"Roberts","sequence":"additional","affiliation":[{"name":"Alfred Health"},{"name":"Monash University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Scott","sequence":"additional","affiliation":[{"name":"Deakin University"},{"name":"Monash University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5357-2721","authenticated-orcid":false,"given":"Shelley E","family":"Keating","sequence":"additional","affiliation":[{"name":"The University of Queensland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9607-202X","authenticated-orcid":false,"given":"Sze-Yen","family":"Tan","sequence":"additional","affiliation":[{"name":"Deakin University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"George","sequence":"additional","affiliation":[{"name":"The University of Sydney and Westmead Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Kiss","sequence":"additional","affiliation":[{"name":"Deakin University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9897-1598","authenticated-orcid":false,"given":"Robin M","family":"Daly","sequence":"additional","affiliation":[{"name":"Deakin University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W","family":"Dunstan","sequence":"additional","affiliation":[{"name":"Deakin University"},{"name":"Baker Heart and Diabetes Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin M","family":"Tucker","sequence":"additional","affiliation":[{"name":"Michigan State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena S","family":"George","sequence":"additional","affiliation":[{"name":"Deakin University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/egastro-2023-100005"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.15009"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.52189"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1584.2011.01188.x"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/liv.15264"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/jhn.13069"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2013.02.012"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-023-01918-w"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/nbu.12707"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11325-022-02767-z"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.3390\/nu16020282"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.12809\/hkmj235152"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.5535\/arm.23090"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12961-020-0528-9"},{"key":"e_1_3_3_16_2","unstructured":"Dawda P Knight A. 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