Motivation and Readiness in Managing Adolescent Obesity: Treatment Fidelity, Lived Experiences, and Readiness to Change Ruler
Creators: Browne, Nadia E.
Publisher: name: University of Alberta Library
Year: 2024

<p>Background. One in three Canadian children and adolescents are living with obesity, so evidence-based, effective interventions for managing adolescent obesity are critically important. Motivation (i.e., desire and drive for change) and readiness to change (i.e., capability for change) are constructs that are often integrated into the assessment tools and interventions for managing adolescent obesity, but the contribution of these inter-related concepts remain poorly characterized. Health care practitioners need more evidence to help them tailor interventions for managing adolescent obesity, including measuring families’ motivation and readiness, selecting appropriate assessment tools, and gaining a better understanding of adolescents’ lived experiences with obesity.<br>
Objectives. To (i) assess the fidelity, key-elements, and reporting of interventions based on motivational interviewing (MI) for managing adolescent obesity, (ii) understand adolescents’ experiences living with obesity and making behavioural changes, and (iii) evaluate the scores and psychometric properties of the Readiness to Change Ruler in obesity management and predictors of readiness to change at baseline, 6-, and 12-months follow-up in adolescents with obesity and their parents.<br><br>
Methods. This multiple-methods dissertation includes three studies conducted between 2017 and 2022. Study 1 was a scoping review and stakeholder consultation on the application and reporting of MI for the management of adolescent obesity (objective 1). Study 2 was a qualitative study that used interpretative phenomenological analysis and involved one-on-one, semi-structured, virtual interviews with adolescents with obesity enrolled in pediatric obesity management (objective 2). Study 3 was a quantitative study that involved secondary analysis of data from a prospective cohort study to examine the reliability (i.e., internal consistency, levels of agreement) and validity (i.e., construct validity) of the 5-item Readiness to Change Ruler and calculate associations with readiness to change (objective 3).<br>
Results. Study 1 (n=26 studies; n=13 stakeholders) found that MI-based interventions for<br>
managing adolescent obesity had ‘low treatment fidelity’. In addition, there were no studies with ‘high treatment fidelity’ across all five domains — theory, training, implementation, treatment receipt, and treatment enactment. Of the treatment fidelity strategies, fidelity to theory was the most adhered to while treatment enactment was the lowest. In Study 2, adolescents’ (n=7) lived experiences with obesity were related to: (i) emotional reactions during clinical encounters, including positive, neutral, or negative reactions; (ii) fear and apprehension when changing behaviours, particularly fear of failure and motivational readiness to change physical activity, nutrition, and sleep habits; and (iii) behaviour change complications that included unexpected circumstances (e.g., COVID-19 pandemic) and required family involvement and interest. In Study 3, data analyses were conducted with 54 adolescent-parent dyads (n=108 participants). Cronbach’s ⍺ coefficients for the 5-item Readiness to Change Ruler completed by adolescent-parent dyads were ≥0.8 (range: 0.8 to 0.9), indicating good internal consistency at all three time points. In addition, adolescent-parent mean ICCs were ≥0.7 (range: 0.7 to 0.8), suggesting good levels of agreement for the total scale. For construct validity, exploratory factor analysis for the Readiness to Change Ruler identified a one-factor structure (all factor loadings ≥0.3) for adolescents at all three time points and parents at 6- and 12-months follow-up. At baseline, a family history of chronic diseases was positively associated with parents’ readiness to change their adolescents’ behaviours (ꞵ=0.416, p&lt;0.001). <br>
Conclusions. Findings from this dissertation offer valuable insights into motivation and readiness to change for managing adolescent obesity and highlight the importance of reporting treatment fidelity in MI-based interventions, providing tailored health care services, and utilizing an evidenced-based assessment tool. Treatment fidelity is important in the planning, implementation, and evaluation of MI-based interventions for managing adolescent obesity. Adolescents’ lived experiences with obesity revealed varying behavioural changes. This can be attributed to their individual needs, as well as emotions, apprehension, and difficulties with changing behaviours. The 5-item Readiness to Change Ruler provides evidence that it is a reliable and valid measure for assessing readiness to change in adolescents with obesity and their parents. The relationships between sociodemographic variables, personal health history, and readiness to change require further study.</p>