“You Can’t Do It on Your Own”: Experiences of a motivational interviewing intervention on physical activity and dietary behaviour☆

https://doi.org/10.1016/j.psychsport.2011.01.001Get rights and content

Abstract

Objectives

While obesity is on the increase, interventions that seek to change physical activity or dietary behaviour tend to have limited success in the long-term. Consistently effective approaches for facilitating lifestyle change within primary health care settings are yet to be determined. Despite an increase in counselling interventions, little is known about how such interventions are received. The purpose of this study was to explore the experiences of obese patients, following participation in a counselling intervention, in order to identify the influences on behaviour change in relation to physical activity and diet.

Design

A qualitative semi-structured interview study using inductive thematic content analysis.

Methods

Fourteen overweight or obese patients participated in semi-structured interviews that focused on experiences of consultations; current physical activity and eating behaviour; facilitators and barriers to change.

Results

Analysis of the interview transcripts revealed four themes that appeared to account for current lifestyle behaviour: (1) Monitoring and support; (2) Listening support; (3) Motivation and self-regulation; and (4) Barriers.

Conclusions

Extended contact and support were deemed necessary for these patients. Interventions within primary care that are high intensity, with extended contact, and adopt an autonomy-supportive counselling style need development and evaluation. Such interventions should also focus on building self-regulation skills and strategies to overcome potential barriers to weight loss efforts.

Highlights

►Interviewees’ testaments support for the effectiveness of motivational interviewing interventions based on the principles of self-determination theory and self-efficacy based in primary care contexts. ► Social support and continued contact are important to promote changes in physical activity among obese people. ► Development of self-regulation skills are a key mediating factor in the maintenance of physical activity behavioural changes. ► The provision of support from the social agents administering the motivational interviewing intervention were observed to promote increased commitment to the intervention by supporting needs for relatedness.

Section snippets

Aims of the present study and psychological bases for emergent themes

This aims of the present study were to explore the perceptions and experiences of those who received the counselling intervention in order to identify the facilitating and inhibiting factors that influence behaviour change in relation to physical activity and diet. The current approach was inductive rather than deductive, and therefore no specific a priori hypotheses were developed as a basis for the research. However, in recognition that knowledge is never independent of interpretive and

Method

At the conclusion of the six-month counselling intervention, 125 patients (62%) from the counselling group remained in the study. The 18-month data revealed that successes made during the 6-month intervention period were often not sustained in the following year. We therefore wanted to explore the perceptions and experiences of those receiving the intervention and particularly to explore the reasons why some had achieved and maintained success in their weight loss efforts whilst others had not.

Results

Four main themes emerged from the analysis: (1) Monitoring and support; (2) Listening support; (3) Motivation and self-regulation; and (4) Barriers. These themes will be described in detail in the next section. Salient quotes and content from the transcribed interviews will be included to illustrate and substantiate each theme.

Monitoring and support

One of the main emergent themes centred on the need for regular monitoring and support, and this was echoed by those who had been both successful and unsuccessful in making or maintaining lifestyle changes. Theoretically, support and monitoring are important for supporting the need for relatedness, based on a self-determination theory, and also for the development of self-efficacy from social cognitive theory though the provision of feedback. Support and encouragement were deemed necessary by

Listening support

Despite some individuals expressing a need to receive social support and strong encouragement from significant others about their physical activity and diet, a key theme that participants perceived to help them want to change was the style of interaction within the consultations in that it was informal, patient centred, and provided support through listening: “It sort of kick-started me…I just liked the informality of it…it just seemed relaxed…and you didn’t feel as if you were being preached

Motivation and self-regulation

Self-motivation and commitment was a key theme for participants who managed to lose weight in the six months and maintained the changes for the following year. Graham (aged 63) lost a lot of weight at six months and continued to do so up to 18 months after the commencement of the intervention. Although he started the project as an individual thinking about change with a “conscious desire to lose weight” he started walking most days and maintained his walking throughout the intervention and well

Barriers

For some women, lack of social support, in the form of ‘weight loss sabotage’, usually by their husbands or partners, presented a formidable barrier to their weight loss efforts. Gillian (aged 56) provides an illuminating example of ‘sabotage’: “If I don’t have a lot on my plate he gets very upset…he doesn’t like to think that I’m going without, you know and he said if he had wanted to marry a skinny girl he would have”. For Gillian, her main barrier to making progress in the diet and physical

Discussion

The purpose of the present study was to explore the perceptions and experiences of obese patients receiving a counselling intervention using motivational interviewing (MI) to change their physical activity and dietary habits. A primary aim of the study was to identify participants’ perceptions of the factors influencing their behaviour change throughout the course of the intervention in relation to physical activity and diet. A qualitative approach was adopted to capture the range of influences

Conclusion

The present study extends understanding of how obese patients receive face-to-face consultations and the factors influencing behaviour change attempts in relation to physical activity and diet. The findings support current thinking from theoretical perspectives like self-determination theory and social cognitive theory regarding autonomy-supportive social contexts and the priority of including feedback in interventions. Results show first hand the impact of such social environments on an

Acknowledgments

The authors would like to thank the following: (1) Eastbourne Downs Primary Care Trust who provided the funding to support the study; (2) the staff at Princes Park Health Centre; (3) the members of the Trial Steering Group; and (4) the participants who willingly took part in the project.

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    ☆

    It is important to note that we use the terms ‘inductive thematic content analysis’ and its abbreviated form ‘thematic analysis’ interchangeably within the manuscript for ease of reading and economy. It must be stressed that the methodological approach here is one based on the emergence of themes from the analysis of transcribed interview data from interviewees. Although this approach is one that recognizes the possibility of researcher bias, the analysis was not the result of a top-down, deductive approach that applied one or more theoretical paradigms to determining the themes likely to emerge.

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