Title : Theory-driven animated videos for diabetes self-management: Content and appearance validation through a delphi study

Background: Type 2 Diabetes Mellitus (T2DM) is among the most prevalent non-communicable chronic conditions worldwide and requires the sustained adoption of self-care practices, including healthy dietary habits, regular physical activity, adherence to pharmacological treatment, and effective stress management. Although digital technologies have increasingly been incorporated into diabetes care, their primary focus has been on medication adherence, diabetic foot prevention, and the identification of barriers to self-care, with limited attention given to fostering self-reflection and behavioural change. Educational technologies informed by behavioural science may offer valuable opportunities to enhance self-management and strengthen self-efficacy among individuals living with T2DM.

Objective: To validate the content and appearance of animated educational videos designed to support self-care among people with T2DM in primary healthcare settings.

Methods: A methodological study was undertaken to develop and validate an educational technology using a two-round Delphi process. Four animated videos were produced based on the Transtheoretical Model of Behaviour Change and principles of health communication. Fourteen experts participated in the first Delphi round and eleven in the second, comprising nurses and communication specialists selected according to established expertise criteria. An adapted version of the Suitability Assessment of Materials instrument was employed. Content validity was assessed using the Content Validity Index (CVI) and the Content Validity Coefficient (CVC), with values ≥0.80 considered acceptable. Internal consistency was evaluated using Cronbach’s alpha coefficient, adopting a minimum threshold of 0.70.

Results: During the first Delphi round, the videos achieved high levels of agreement regarding their communicative, aesthetic and pedagogical suitability. CVI values ranged from 0.928 to 1.000, while CVC values varied between 0.750 and 0.929. Expert feedback primarily concerned linguistic clarity, comprehensibility of dialogue, narration pace, accessibility features, visual design and motivational elements. Following revision, the second Delphi round demonstrated greater consensus among participants. All videos achieved a CVI of 1.000 across all evaluated domains, while CVC values ranged from 0.91 to 1.00, indicating excellent validity in relation to language, illustrations, layout, cultural relevance and motivational content. Internal consistency also improved, with Cronbach’s alpha reaching 0.750 for Video 1 and 0.856 for Video 2. For Videos 3 and 4, Cronbach’s alpha could not be estimated because all evaluators provided identical ratings, reflecting complete consensus.

Conclusions: Beyond demonstrating robust evidence of content and appearance validity, this study underscores the potential of theory-informed and culturally responsive educational technologies to support diabetes self-management. The integration of behaviour change theory, audiovisual communication strategies and the primary healthcare context of Brazil’s Unified Health System (SUS) offers a scalable and contextually relevant model for promoting self-care and supporting behaviour change among people living with chronic conditions.

Elen Ferraz Teston, PhD, RN, is a nurse and public health specialist with expertise in chronic disease management and family health. She holds a PhD in Nursing from the State University of Maringá, Brazil, and completed a postdoctoral fellowship at Loughborough University, United Kingdom. She worked as a Family Health Nurse. Currently, she serves as Professor of Nursing at the Federal University of Mato Grosso do Sul (UFMS), Brazil, where she teaches at both undergraduate and graduate levels. Her research focuses on chronic conditions, self-management, health education, behavioural change, and primary health care.