The Effect of Nurse-led Motivational Interviewing Based on the Trans-theoretical Model
Condition: Older Adult; Motivational Interviewing; Physical Activity; Nursing Caries
Study type: Interventional

Summary: 
      Older adults constitute the age group that leads the most sedentary life in society and is
      mostly affected by physical inactivity.

      This study was conducted to determine how nurse-led Motivational Interviewing (MI) based on
      the Trans-Theoretical Model (TTM) affected promoting physical activity in older adults.

      A randomised controlled trial. The population of this trial was composed of seniors aged
      between 65 and74 living in a family health center area in Yozgat, Turkey (N=1630). The study
      sample, estimated via power analysis (d=0.30; 1-β=0.80; α=0.05), constituted 117 older adults
      (Intervention Group (IG) n=58; Control Group (CG) n=59) who met the inclusion criteria. The
      data were gathered via a questionnaire, TTM-Scales, Physical Activity Scale for Elderly
      (PASE), KATZ-ADL by an independent researcher who was blinded to the study groups. A
      pedometer (JP-600) for each senior was used to calculate the average weekly step counts. The
      data were analyzed via IBM-SPSS version 23.0. Descriptive statistics, student's t-test,
      paired-samples t-test, Mann Whitney-U, the Wilcoxon Sign, Friedman, Pearson chi-square, and
      Fisher-Freeman-Halton exact tests were used to analyze the data. Cohen's d and dz formulas
      were used to calculate the effect sizes.

      MI sessions were held every two weeks in IG. No intervention was applied in CG. Significant
      progress was found in the change stages of IG compared to CG. The mean of step counts was
      significant in favour of IG, and the effect size was d=0.641. PASE total score increased
      significantly in IG, and the effect size was dz=0.202.

      This trial indicated that after the TTM-based MI, the change stages of the older adults
      improved, and their exercising behaviours promoted. In conclusion, TTM and MI are recommended
      to be used by the nurses toimprove healthy lifestyle behaviours in older adults, and studies
      to increase physical activity levels in this population should be conducted for a longer
      period, and studies with larger sample groups are recommended.
    

Detailed description: 
      This randomised controlled study was carried out in a Family Health Centre (FHC) region in
      Turkey between April and November 2019.

      The population of the study consisted of older adults aged 65 to 74 years residing in the
      related FHC region (n=1630). First, their records were examined, and those (n=881), who were
      determined to meet the inclusion criteria [19] based on these records, were called up and
      invited to the FHC. The sample size was calculated to be at least 90 individuals (d=0.30;
      1-β=0.80; α=0.05). Considering the possibility of the participants' withdrawal from the
      study, all 117 older adults, who met the inclusion criteria in the population and agreed to
      participate, were included in the study (Intervention Group n=58; Control Group n=59). Figure
      1 shows the Consort Flow Diagram of the study.

      After stratifying according to age (65-69, 70-74), gender, and stage of exercise change
      (contemplation and pre-contemplation stage), the stratified simple randomisation procedure
      was used. No researcher and participant blindness were performed. The randomisation procedure
      was conducted via the R programming language version 3.5 (https://cran.r-project.org ) by an
      independent statistician to prevent selection bias. The data were collected and recorded by
      an independent researcher who was trained by the researcher and did not know the groups. The
      statistics were performed by an independent statistician.

      The data were collected using the personal information form, the TTM scales (the Exercise
      Stages of Change Scale, the Exercise Processes of Change Scale, the Decisional BalanceScale
      for Exercise, and the Exercise Self-efficacy Scale), the PASE, the KATZ Activities of Daily
      Living (ADL) Scale, and a pedometer.

      TTM-based MI and Information Guidelines for Gaining Exercise Behaviour were prepared by the
      researcher within the scope of the relevant literature.

      The guideline was used after consulting five experts in the field of nursing who have
      research on TTM.

      A preliminary application was conducted between September 2018 and January 2019. Filling the
      forms took about 30 minutes. Preliminary motivational interviews were conducted by the
      researcher and were recorded. Two experts supervised the records and gave feedback. The
      individuals who participated in the preliminary session were not included in the study.

      An independent research assistant trained by the researcher collected the data in the FHC via
      the face-to-face interview method, and the researcher conducted motivational interviews
      (face-to-face and on the phone) between April and November 2019.

      In the present study, an effort was made to help the IG to realize the dilemmas of
      individuals in the precontemplation stage about exercising, and individuals in the
      contemplation stage to produce their own solutions. In this direction, techniques such as
      decision balance, importance, and trust technique were applied, thus enabling them to reveal
      their feelings, thoughts, and reactions regarding the benefits/harms of doing/not doing
      exercise. They were supported to raise awareness about the consequences and solutions of the
      causes.

      Face-to-face motivational interviews lasted for an average of 30 minutes. After the MI, the
      exercise information guideline prepared by the researcher and the TTM-based MI guideline
      according to the stages were given to the older adults. During the MI, a form prepared by the
      researcher was used to note the content of the interview. At the end of MI, the next
      appointment was planned. In addition, the older adults were given a chart prepared by the
      researcher to note their walk.

      On the other hand, the phone-based motivation interviews lasted an average of five to seven
      minutes. Before the telephone interview, it was determined which stage of change the older
      adult was in. Then a motivational interview was held according to the stage.

      The CG was only followed up at the beginning and end of the study, no intervention was made.
      The CG received standard care. Although the family health staff do not give routine and
      standard training about the benefits of exercising in the FHC to the elderly, they give
      information when necessary.
    

Intervention name(s): Intervention motivational interview group
Intervention type(s): Behavioral
Intervention description(s): Motivational interviewing (MI) a client-centered, goal-oriented method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. Motivational interviewing is underpinned by a series of principles that emphasise a collaborative therapeutic relationship in which the autonomy of the patient is respected and the patient's intrinsic resources for change are elicited by the therapist.
In the present study, an effort was made to help the IG to realize the dilemmas of individuals in the precontemplation stage about exercising, and individuals in the contemplation stage to produce their own solutions. In this direction, techniques such as decision balance, importance, and trust technique were applied, thus enabling them to reveal their feelings, thoughts, and reactions regarding the benefits/harms of doing/not doing exercise. They were supported to raise awareness about the consequences and solutions of the causes.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: older adult; motivational interviewing; Transtheoretical model; physical activity; nursing