Case Report The Online Big Blue Test for Promoting Exercise: Health, Self-Efficacy, and Social Support Beni Go ´mez-Zu ´n ˜iga, PhD, 1 Modesta Pousada, PhD, 1 Manny M. Hernandez, MEng, 2 Sheri Colberg, PhD, 3 Elia Gabarro ´n, BSc, 4 and Manuel Armayones, PhD 1 1 Department of Psychology, Open University of Catalunya, IN3, Barcelona, Spain. 2 Diabetes Hands Foundation, Berkeley, California. 3 Human Movement Sciences Department, Old Dominion University, Norfolk, Virginia. 4 Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway. Abstract Background: Recent articles have documented the influence of self-efficacy and social support on exercising. Simulta- neously, insulin use is also related to the perception of self- efficacy and social support in patients with diabetes. We combine these two ideas through the Big Blue Test experience in a social networking site and propose to analyze whether a change in blood sugar levels after completion of the Big Blue Test and insulin use are related to the perception of self- efficacy and social support in patients with diabetes. Mate- rials and Methods: To undergo the Big Blue Test, 3,926 participants voluntarily joined the Diabetes Hands Founda- tion. Responses were analyzed using descriptive analysis. Results: The participants who reduced their blood glucose after exercise the least were those with lower self-efficacy and also with lower perceived social support. There seems to have been no relationship between changes in blood sugar level and the explicit intention of doing exercise in the future. Insulin- dependent participants demonstrated a lower perception of self-efficacy and social support than non–insulin-dependent participants. Conclusions: Change in blood glucose level or being insulin-dependent or not do not explain completely a health behavior such as exercise. Hence, self-efficacy and social support have an impact on behavioral change such as exercise to become a habit in people with diabetes, and this experience through a social networking site is an important tool for this behavioral change. For exercise to become a habit in people with diabetes, it is necessary to consider not only the crucial physiological variables, but also those psychological variables that clearly have an impact on behavioral change. Key words: e-health, behavioral health, technology, home health monitoring Introduction I n a chronic disease such as diabetes, responsibility for the daily management of the illness shifts from the healthcare professional to the individual with the disease and their immediate environment. In this shift, the individual with diabetes becomes the main actor, and it is necessary for him or her to develop a diverse skillset to maintain a satisfactory quality of life. 1 Consistent with the aim of empowering people with dia- betes, the Big Blue Test (BBT) is a program launched through the Internet and linked with World Diabetes Day. The objec- tive of the BBT is to raise awareness of the importance of physical activity in managing diabetes. In fact, the importance of physical activity to the proper management of diabetes is supported by data cited in several recent studies. 2,3 A participant in the BBT voluntarily signs up for the pro- gram and follows four steps: 1. Tests his or her blood sugar 2. Performs a physical activity during a 14-min interval 3. Tests his or her blood sugar again 4. Shares his or her experience by collecting his or her own data and answering some questions through the Web (the questions are described in the Procedure section). The BBT is run by the Diabetes Hands Foundation, a non- profit organization that since 2008 has developed different programs aimed at people affected by diabetes. The theoretical models that have been developed to explain how people can become active agents of their own health have used the intention (the motivation) as the main predictor of health behavior or change behavior. But, very often, intention of making a change in behavior is not the best predictor of real change. Intention needs to be supplemented by other factors that can facilitate its translation into action. 4 More recent models emphasize the importance of self-efficacy as a key variable in explaining how people can take control over their behavior. Perceived self-efficacy refers to a person’s confi- dence in his or her abilities to perform required actions and achieve desired results. Applied to the field of health, 852 TELEMEDICINE and e-HEALTH OCTOBER 2015 DOI: 10.1089/tmj.2014.0158