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PA interventions & the re-aim framework

Terms in this set (31)

Motivational interviewing
• Counseling technique that provides people with the opportunity to talk about and resolve their feelings so they can move forward with change

• Counselor role → help client strengthen intrinsic motivation for change
• Expressions of empathy
• Development of discrepancy
• Rolling with resistance
• Supporting self-efficacy
MI definitions
• MI is a client-centered, counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. (Rollnick & Miller,1995).
• MI is a collaborative, person-centered form of guiding to elicit and strengthen motivation for change (2009)
• Client must have high importance, high confidence, readiness "I want to" "I believe I can," "I think it's important" → MI can help
MI Empathy
Ability to identify with another person and understand his/her feelings
-allows the client to feel accepted and understood
-key to building an environment where client is comfortable opening up
MI discrepancy
• Client must become aware of the discrepancy between their current behavior and their broader goals
• What are your goals for ___?
• What are you doing in your life to direct you towards those goals?
• Is your current lifestyle promoting or hindering your progress?

• Achieving goals = FOCUS!!!!
• Related to empathy
MI resistance
• Never directly oppose or argue with client who resists change
• "You're right, it is really hard to start exercising"

• Talk on change must come from the client.
• After discussing discrepancies, allow THEM to come up with a list of changes to reach their goals

• Do NOT use a scare tactic on the client!!!! Why?
• Creates a stronger resistance and possibly avoidance of PA
MI self-efficacy
• Increase self-efficacy by targeting the four sources
• Past performance
• Vicarious experiences
• Social persuasion
• Physiological/affective states
O
A
R
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Open-ended questions
Affirmation
Reflective listening
Summary Statements
Open-Ended Questions
Cannot be answered with "yes" or "no"
• Designed to elicit more information
• Usually begin with "What" "How" "Why" or "Tell me about"
Affirmations
• Confirming understanding of the underlying meaning of the conversation (nodding, uh huh, tell me more)
• Statements recognizing client's strengths
• Rapport Builders
3. Reflective Listening
• Truly listening to what is said
• Elicits more information and critical details
• Clarifies that you understood what the other person meant
• Involves restating or reflecting what the other person said, often elaborating slightly
• Rule of thumb - client talks more than you do
Summary Statements
• An important and special type of reflective listening
• Allow you to integrate information gathered and make sure that you're not missing things
• Enhances individual's perception that you are listening and understand
• Most effective when using individual's own words
MI strategies
• Build Motivation: Change ruler
• How important is it for you to ____ on a 0-10 scale (0= not at all important;10= extremely important)?
• How confident would you say you are, that if you decided to ____ you could do it? 0-10 scale

• Strengthen Confidence - Use ruler
• Confidence ruler: Why are you____ and not 10? What would it take for you to go from ____ to (a high number)
• Strategies: Review past success, Personal strengths & supports, Brainstorm , Reframe, Hypothetical change
Goal of information intervention approaches
• Provide information on the benefits of PA
• Arouse fear or concern about risks of inactivity
• Increase awareness of opportunities for PA
• Explain techniques to overcome barriers to activity
• Provide strategies to overcome negative attitudes toward activity
Types of Informational Intervention Approaches
• Mass Media Campaigns
• Provide people with information about PA through newspapers, billboards, TV, podcasts, websites, social media, etc.
• Insufficient evidence of effectiveness when used as a stand-alone intervention

• Community-Wide Campaigns
• Engage different community members and organizations in the development and delivery of information aimed at increasing PA
• Recommended

• Point-of-Decision Prompts
• Motivational cues delivered at points where people must choose between physically active and inactive options
• Recommended
Developing Maximally Effective Informational Interventions
• Adapt physical activity messages for the population
• Emphasize the benefits, rather than the risks, of exercise
• Make sure benefits are specific to the target population
• Provide simple but detailed "How to" information for starting an activity program
Behavioral Intervention Approaches
1. Recognizing cues and opportunities for PA
2. Developing strategies to maintain activity levels
3. Learning to recognize and manage situations that can sabotage activity plans
4. Developing strategies to prevent relapse to a sedentary lifestyle
Behavioral Intervention Approaches include
• Teach and use behavioral skills to help initiate and maintain physical activity
• Behavioral interventions typically include counseling/coaching:
• One-on-one
• Group setting
• Telephone
• Email
• Online
Behavioral Intervention Approaches types
• Goal-setting (SMART Goals)
• Developing action plans
• Self-monitoring
• Relapse prevention
• Plan for lapses (cognitive restructuring)
Social Intervention Approaches
• Exercise groups
• Buddy systems
• Group support systems
• Telephone & e-mail support systems
• Social Networking
Environmental/Policy Intervention Approaches
• Street-scale urban design and land use policies
• Recommended
• Community-scale urban design and land use policies
• Recommended
• Creation of or enhanced access to places for physical activity combined with informational outreach activities
• Recommended
• Transportation and travel policies/practices
• Insufficient evidence

Social Ecological Model
Research vs. Real World
• Research study participants are different from the general population.
• People must volunteer to participate
• Likely have more motivation
• Research staff delivering an intervention have more time, expertise, and motivation to deliver the intervention.
• Many interventions may not be feasible to deliver in the real world

Interventions that work in the environment of the randomized clinical control trial are often ineffective in real-world settings
RE-AIM - what is it?
• A framework for evaluating the public health impact of physical activity promotion interventions

• Deals with issues related to the intervention's impact in real-world settings and the translation of research to practice
Dimensions of RE-AIM
5 Dimensions to examine the impact of an intervention:

Individual level
• Reach
• Efficacy/Effectiveness
Setting level
• Adoption
• Implementation
Individual and setting
• Maintenance
Reach
• Individual Level
• The proportion of individuals who participate compared with those who don't

• Questions:
• What percentage of potentially eligible participants...
• were excluded?
• took part?
• how representative were they?
Efficacy/Effectiveness
• Individual Level
• The impact of an intervention on PA and other health outcomes, including negative effects, quality of life, and economic outcomes

• Questions:
• What impact did the intervention have on...
• All participants who began the program
• On intermediate and primary outcomes?
• On positive and negative (unintended) outcomes, including QoL?

• KEY → If the intervention is not effective, then all other components of the RE-AIM framework become irrelevant
Adoption
• Setting level
• The proportion of settings and intervention providers who are willing to initiate a PA promotion program

• Questions:
• What percentage of settings...
• Were excluded?
• Participated?
• How representative were they?
Implementation
• Setting/Agent level
• Implementation refers to the provider's dependability to the various elements of an intervention's protocol, including consistency of delivery as intended and the time and cost of the intervention 39

• Questions:
• To what extent were the various intervention components delivered as intended (in the protocol)?
• Especially when conducted by different (non-research) staff members in applied settings?
Maintenance
• Individual & Setting Level
• The extent to which a PA promotion program or policy becomes part of the routine practices and policies

• Questions:
• Individual level:
• Long-term effects (minimum 6-12 months following intervention)?
• Attrition rate, were dropouts representative, and how did attrition impact conclusions about effectiveness?

• Setting level:
• Extent of different intervention components continued or institutionalized?
• How was the original program modified?
RE-AIM model
Public Health Impact of hypothetical evidence-based intervention after taking into account the RE-AIM dimensions
...
Putting it all together: RE-AIM at work
• Tom designed a program for teenagers to become more active. He initially conducted it in a controlled setting at the local high school, and is now evaluating its effectiveness in community fitness facilities.
• First he assesses reach. He finds out there are 200 teens in his community. There are 12 members in the program. 12/200 = 6%
• Next he examines the efficacy. Teenagers in the program have doubled their minutes of PA per week since starting the program!

• Next, he assesses the number of fitness centers that have adopted his program. Three centers are offering it. • Next, he watched staff implementing the intervention, and finds that they are not doing it quite as he intended (accurate info, enthusiastic, etc.) • Last, the program has been on-going for several weeks and the teens are struggling to maintain high levels of PA • What was good? How can Tom improve his intervention?
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