Physical activity counselling : the application of motivational interviewing and brief negotiation

The Department of Culture Media and Sport (2002) set a national target for sport and physical activity (PA) that 70% of the population be reasonably active by 2020. However, the proportion of the population meeting these levels of activity is currently only 30% (DoH, 2004a). There is now unequivocal evidence that the UK population is becoming increasingly inactive leading to increases in premature mortality and illness and disease. There is also clear evidence that increased PA can assist in both the avoidance and management of hypokinetic disease such as CHD and type II diabetes. Part of the health strategy for the UK includes the use of interventions such as PA referral schemes (PARS). Within such schemes specific techniques such as PA counselling are increasingly popular in both community and clinical settings (Tulloch et al., 2006). The aim of the thesis was to examine the context and efficacy of PARS, the prevalence of PA counselling and the levels of competence and consistency applied within empirical studies, and finally an assessment of the efficacy of behaviour change counselling in PARS settings based on Motivational Interviewing (Miller & Rollnick, 2002). The first study provided a systematic review of PA counselling from 1995 to 2006 and examined whether a theoretical framework was applied to each study reporting a PA counselling component and if so, which theory. Furthermore, it assessed the number of studies that report the use of a treatment fidelity framework in order to ensure internal validity of the intervention as well as an assessment of competence of the interventionist. Results indicated the dominant theory to be the transtheoretical model (TTM) and in particular stages of change (a sub-component of TTM). No studies applied a treatment fidelity framework with only 2 from 25 assessing competence of the PA counselling interventionist.Prior to delivering an MI intervention, the second study followed a treatment fidelity framework and assessed the competence of the investigator in delivering MI. This applied validated tools with regards to levels of MI competency and proficiency. Results indicated that the investigator demonstrated proficiency across MI global ratings of empathy and spirit and used commensurate levels of open to closed questions and complex to simple reflections.Having assessed the competency and consistency of the MI intervention Study 3 examined the impact of MI applied to a randomly allocated patient group referred to a PARS by GP's The results of the intervention, as compared to a control group receiving traditional PARS interventions only, were equivocal. Additional measures such as patient 'readiness to change' and 'exercise motivation' were also recorded and it appears from the current study that 'pure' MI is not appropriate for those patients reporting a high level of readiness.The final study assessed the impact of a 2-day training workshop in MI to an experienced PARS officer with little or no previous counselling training. The assessment of competence was carried out using the same measure as Study 2 for comparison. The impact of the training was assessed by applying a similar design to that of Study 3. Competency tests indicated the 2-day training did not create competence and proficiency across all facets of MI though adaptations were recorded. The impact on the patient adherence rates in the PARS was similarly equivocal to the previous study.