Motivation to Change Lifestyle Habits in Youth With Obesity
Condition: Pediatric Obesity; Motivational Interviewing
MeSH terms: Obesity; Pediatric Obesity
Study type: Observational

Summary: 
      Approximately one-third of Canadian children have excess weight, putting them at increased
      risk of type 2 diabetes, cardiovascular disease, bone and joint problems, and some forms of
      cancer. Because current therapies for managing obesity have modest success, there is a need
      to develop and test innovative strategies to enhance pediatric weight management. Using a
      novel interview designed to measure motivation to change lifestyle habits, interviewers will
      conduct separate and structured 1-on-1 interviews with youth with obesity and parents. By
      applying principles of motivational interviewing, trained interviewers will ask youth and
      their parents about their motivation to change lifestyle habits related to diet and physical
      activity. Subsequently, interview data will be used to examine predictors of
      clinically-meaningful outcomes over time, including changes in weight status, lifestyle
      habits, health care utilization, and attrition. The investigators will also measure a number
      of variables related to weight management, including dietary intake, physical activity,
      anthropometry, and psychosocial health.
    

Detailed description: 
      The Readiness and Motivation Interview for Families (RMI-Family) was created as a structured
      interview for assessing youth and parent motivation (and within family member agreement)
      regarding lifestyle changes in pediatric weight management.

      The RMI-Family was modeled on the Readiness and Motivation Interview (RMI), which was
      developed originally for use in the management of eating disorders (e.g., anorexia nervosa)
      and emerged as a 'gold standard' approach to assessing treatment motivation in that
      population. The RMI-Family was based on the tenets of motivational interviewing (MI), a
      directive, client-centered, and empirically-supported clinical approach to helping
      individuals resolve ambivalence about change across a range of lifestyle behaviours,
      including smoking, substance abuse, as well as diet and physical activity.

      Participants will be recruited and enrolled into the study after being referred for pediatric
      weight management within Alberta Health Services, the governmental authority responsible for
      providing health care in the province of Alberta, Canada. Interviews will be completed
      following referral and before youth and parents initiative pediatric weight management. Each
      youth and parent will complete the RMI-Family (interview duration: 60 - 90 minutes) at
      baseline, 6-, and 12-months post-baseline. Individual (i.e., youth or parent) and
      family-level (i.e., across youth and parent) responses to interview questions will be scored,
      as will aspects of interview administration (e.g., fidelity to motivational interviewing
      tenets).

      Families (youth+parent) will also complete the following questionnaires at baseline, 6- and
      12-months follow-up:

        1. Behavior Assessment System for Children-Third Edition (BASC-3)

        2. Behavior Rating Inventory of Executive Function-Second Edition (BRIEF 2)

        3. Emotion Regulation Questionnaire (ERQ)

        4. Coping with Children's Negative Response Scale (CCNES)

        5. Marlowe-Crowne Social Desirability Scale (MC-SDS)

        6. Motivation to Change Rulers (Readiness to change lifestyle habits)

        7. Waterloo Eating Behaviour Questionnaire (WEB-Q)

        8. Dutch Eating Behaviour Questionnaire (DEBQ)

      Physical activity will be measured for youth over a 7-day period using accelerometry, which
      will provide estimates of total movement time (and movement intensity) and sleep. Data
      regarding demography (e.g., gender, date of birth), anthropometry (e.g., height, weight),
      health services utilization (e.g., number of clinic appointments, length of appointments),
      and program attrition will be retrieved from medical records.

      To ensure research team members who administer the RMI-Family interview adhere to principles
      of motivational interviewing (MI) (e.g., express and show empathy, roll with resistance,
      support autonomy, take curious and non-judgmental approach), the investigators implemented a
      number of training procedures before the study launched in fall, 2017. First, as background,
      all interviewers received and reviewed a package of information and resources (including
      sample videos) regarding MI, which covered a range of theoretical and practical issues.
      Second, all interviewers completed practice interviews using the RMI-Family with friends or
      colleagues that were audio-recorded for their own practice and self-reflection. Third,
      interviewers completed and audio-recorded 2 - 3 formal interviews (youth and parent
      versions), which were subsequently reviewed and evaluated by senior research team members
      with advanced training and expertise in psychology, counseling, and MI. Interviewers received
      feedback (both positive and constructive) about their interviews; when deemed necessary,
      interviewers completed additional interviews to build competence and skill, which were also
      reviewed by senior team members until they were confident that a similar and high level of
      proficiency was achieved by all interviewers.

      To ensure interviewers maintain a high level of competence in administering the RMI-Family
      interview, all youth and parent interviews will be recorded (audio only) over the course of
      this study. After each interviewer completes 5 interviews, he/she will submit a
      randomly-selected interview for review by research team members to ensure implementation
      fidelity. To assess fidelity, the investigators will use the Motivational Interviewing
      Supervision and Training Scale (MISTS), which provides a behavioural count of interviewers'
      skills consistent with the principles of MI and assess the quality and fidelity with which
      the interview is administered. Subsequently, interviewers and reviewers will discuss issues
      related to clinical interactions and conversations; this formative approach is designed to
      optimize adherence to the MI interviewing practices over the course of the study.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Youth with obesity (BMI ≥97th percentile) and their parents. The study will be conducted at
        multiple sites within Alberta Health Services, including those families referred to and
        enrolled in multidisciplinary weight management clinics (Pediatric Centre for Weight and
        Health [PCWH]) at the Stollery Children's Hospital (Edmonton, AB) and Alberta Children's
        Hospital (Calgary, AB) and outpatient nutrition counseling for pediatric weight management
        (Edmonton, AB). The outpatient nutrition counseling occurs within clinic space at the PCWH
        in Edmonton, AB.
      
Keywords: Obesity; Pediatric; Parent; Family; Motivational Interviewing; Lifestyle; Health Behavior