Effect of a health-education program using motivational interviewing on oral health behavior and self-efficacy in pregnant women: a randomized controlled trial

Oral health problems are common among pregnant women. The objective of this study was to examine the effectiveness of motivational interviewing (MI) as a behavior-change technique to enhance self-efficacy and oral health among pregnant women. A randomized controlled trial was conducted with 112 pregnant Iranian women. Women in the intervention group received an education program on oral health using MI during two face-to-face sessions, along with routine health education (two 1-h lectures on oral health changes and needs during pregnancy presented as a lecture by an oral health technician over a 2-wk period). Those in the control group received two 1-h lectures on oral health changes and needs during pregnancy. Oral health behaviors, oral health self-efficacy, and general self-efficacy, were assessed, along with gingival and dental health from baseline to the 3-month follow-up. Analysis of covariance was used to determine differences between intervention and control groups. Scores for both general and specific self-efficacy and for healthy behaviors increased in the intervention group, whereas there was no significant change within controls from baseline to follow-up. Between-group analyses also indicated a significant difference in the scores for self-efficacy and behavior favoring the intervention group. Scores on the gingival inflammation index decreased, as did the number of decayed teeth in the intervention group relative to the control group. The number of filled teeth increased significantly in the intervention group. Health education interventions using MI techniques may help to improve oral health-related self-efficacy and behaviors among pregnant women.

Maintaining the Outcomes of a Successful Weight Gain Prevention Intervention in Mid-Age Women: Two Year Results from the 40-Something Randomized Control Trial

Despite the life stage of menopause being identified as a high risk for weight gain, there are few obesity prevention interventions for this target group, and no evidence on maintenance of intervention effects after intervention support is withdrawn. In the 40-Something Randomized Controlled Trial (RCT) (ACTRN12611000064909), a five-consultation health professional (dietitian and exercise physiologist) obesity prevention intervention, using motivational interviewing principles (MI) over 12 months, achieved significantly greater weight loss than a self-directed intervention (SDI) (tailored written material) in 54 non-obese (body mass index (BMI): 18.5-29.9 kg/m2), premenopausal women (44-50 years). The aim of the current paper is to report on whether the intervention effects were maintained at two years. Anthropometric, biochemical and health behavior data were collected at baseline, 12 months (end of intervention) and 24 months (end of maintenance period). Forty participants (22 = MI, 18 = SDI) who completed all measures to 12 months were invited to participate in the monitoring phase and 30 (MI = 16, SDI = 14) consented. The primary outcome of weight at 24 months was assessed using intention to treat principles (n = 54), adjusting for baseline weight. The MI group had a significantly lower weight at 24 months (64.6 kg, 95% CI: 63.2, 66.6, p = 0.015) compared with the SDI group (67.3 kg, 95% CI: 65.7, 68.8), and the secondary outcomes of percentage body fat and waist circumference were also significantly lower in the MI group. The low-intensity, health professional weight control intervention utilizing MI principles was more efficacious in maintaining a significant weight loss compared to a self-directed intervention, and both were successful in preventing obesity.

Participation in physical activities for children with cerebral palsy: feasibility and effectiveness of physical activity on prescription

Background

Children with cerebral palsy (CP) are less physically active and more sedentary than other children which implies risk factors for their physical and mental health. Physical activity on prescription (PAP) is an effective intervention to promote a lifestyle change towards increased physical activity in adults in general. Knowledge is lacking about the use of PAP in children with CP. Therefore, the aim of this study was to evaluate the feasibility of PAP for children with CP and its effectiveness on participation in physical activity and sedentary behaviour.

Methods

Eleven children with CP, aged 7-11 years, participated in PAP, consisting of a written agreement between each child, their parents and the physiotherapist and based on Motivational Interviewing (MI), Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS). Individual goals, gross motor function and physical activity were assessed at baseline, at 8 and/or 11 months using COPM, GAS, logbooks, Gross Motor Function Measure (GMFM-66), physical activity questionnaires, physical activity and heart rate monitors and time-use diaries. At 8 and 11 months the feasibility of the intervention and costs and time spent for the families and the physiotherapist were evaluated by questionnaires.

Results

The intervention was feasible according to the feasibility questionnaire. Each child participated in 1-3 self-selected physical activities during 3-6 months with support from the physiotherapist, and clinically meaningful increases from baseline of COPM and GAS scores were recorded. Being physically active at moderate-vigorous levels varied between less than 30 and more than 240 minutes/day, and the median for the whole group was 84 minutes/day at baseline and 106 minutes/day at 8 months.

Conclusions

The intervention PAP seems to be feasible and effective for children with CP, involving both every day and organised physical activities to promote an active lifestyle through increased participation, motivation, and engagement in physical activities. Further research of PAP is needed, preferably in a long term randomised controlled trial and including health economic analysis to show costs and benefits.

Trial Registration

ISRCTN76366356, retrospectively registered.

Can a relatively low-intensity intervention by health professionals prevent weight gain in mid-age women? 12-Month outcomes of the 40-Something randomised controlled trial

BACKGROUND

Weight gain in perimenopausal women results in increased visceral adipose tissue, leading to metabolic syndrome and associated comorbidities. Despite a high prevalence of weight gain at this life stage, interventions to prevent menopausal obesity are lacking.

AIM

To test the effectiveness of an intervention delivered by health professionals using a motivational interviewing (MI) counselling style in preventing weight gain in non-obese (body mass index (BMI) 18.5 and 29.9 kg m(-2)) women in late premenopause.

METHODS

In a randomised controlled trial, 54 women (mean (s.d.) age 47.3 (1.8) years; BMI 25.1 (2.4) kg m(-2)) who had menstruated within the preceding 3 months were randomly assigned to an MI intervention (n=28) (five health professional MI counselling sessions) or a self-directed intervention (SDI) (print materials only) (n=26). The primary outcome, body weight (kg) and secondary outcomes (blood lipids, glucose, body fat %, lean mass % and waist circumference) were measured at baseline and postintervention (12 months), and intention-to-treat analysis was conducted.

RESULTS

Forty women completed all measures and adhered to all protocols. The weight at 12 months for the MI group of 65.6 kg (95% CI: 64.5; 66.8) was significantly different (P=0.034) from the SDI group of 67.4 kg (95% CI: 66.2; 68.6). When stratified by baseline BMI category, the MI group lost significantly more weight (-2.6 kg; 95% CI: -3.9; -1.2) than the SDI group (-0.1 kg; 95% CI: -1.2; 1.0, P=0.002) for the healthy weight women. The overweight women lost weight regardless of the intervention group, with no between-group difference (-3.5 kg; 95% CI: -6.1, -1.0 and -2.3; 95% CI: -4.1, -0.5, P=0.467).

CONCLUSION

This relatively low-intensity intervention, incorporating MI into health professional counselling, not only effectively prevented weight gain but also achieved significant weight loss and decreased diastolic blood pressure. Further refinements are required to optimise outcomes for overweight women.

An evaluation of training for lay providers in the use of Motivational Interviewing to promote academic achievement among urban youth

This study examined training outcomes for lay service providers who participated in a Motivational Interviewing (MI) training program designed to help increase intrinsic motivation and academic achievement among urban low-income and minority youth. Seventeen lay academic advisors received 16 hours of training in MI. Two, two-hour booster sessions plus five, two- hour weekly group supervision sessions were conducted with lay advisors over a period of seven months. One-hundred percent of lay advisors (n =17) participated in all training, booster sessions and assessments. Seventy-one percent of lay advisors (n=12) completed all group supervision sessions and submitted tapes for review. MI training was associated with increased knowledge of MI principles among lay service providers; increased proficiency in responding to simulated clients in an MI consistent style; increased use of MI adherent behaviors in sessions with real clients and maintenance of high motivation to use MI from pretest to posttest. Although lay advisors increased their knowledge of MI, further training is required for advisors to increase competence in delivering MI. Overall, Implications for using MI in the context of school-based settings is discussed.

The 40-Something randomized controlled trial to prevent weight gain in mid-age women

Background

Obesity prevention is a major public health priority. Despite the health risks associated with weight gain, there has been a distinct lack of research into effective interventions to prevent, rather than treat, obesity particularly at high risk life stages such as menopause in women. This paper describes the rationale for and design of a 2-year randomized controlled trial (RCT) (the 40-Something Study) aimed at testing the feasibility and efficacy of a relatively low intensity intervention designed to achieve weight control in non-obese women about to enter the menopause transition.

Methods and design

The study is a parallel-group RCT consisting of 12 months of intervention (Phase 1) and 12 months of monitoring (Phase 2). Non-obese pre-menopausal healthy females 44–50 years of age were screened, stratified according to Body Mass Index (BMI) category (18.5-24.9 and 25–29.9 kg/m²) and randomly assigned to one of two groups: motivational interviewing (MI) intervention (n = 28), or a self-directed intervention (SDI) (control) (n = 26). The MI intervention consisted of five consultations with health professionals (four with a Dietitian and one with an Exercise Physiologist) who applied components of MI counselling to consultations with the women over a 12 month period. The SDI was developed as a control and these participants received print materials only. Outcome measures were collected at baseline, three, 12, 18 and 24 months and included weight (primary outcome), waist circumference, body composition, blood pressure, plasma markers of metabolic syndrome risk, dietary intake, physical activity and quality of life. Analysis of covariance will be used to investigate outcomes according to intervention type and duration (comparing baseline, 12 and 24 months).

Discussion

The 40-Something study is the first RCT aimed at preventing menopausal weight gain in Australian women. Importantly, this paper describes the methods used to evaluate whether a relatively low intensity, health professional led intervention will achieve better weight control in pre-menopausal women than a self-directed intervention. The results will add to the scant body of literature on obesity prevention methods at an under-researched high-risk life stage, and inform the development of population-based interventions.

Trial registration

ACTRN12611000064909