Jennie E. Hancox

Motivating the unmotivated: how can health behavior be changed in those unwilling to change?

Author(s): Hardcastle, Sarah J; Hancox, Jennie; Hattar, Anne; Maxwell-Smith, Chloe; Thogersen-Ntoumani, Cecilie; Hagger, Martin S

The effects of training group exercise class instructors to adopt a motivationally adaptive communication style.

Drawing from self‐determination theory (Deci & Ryan, 2002), we developed and tested an intervention to train fitness instructors to adopt a motivationally adaptive communication style when interacting with exercisers. This was a parallel group, two‐arm quasi‐experimental design. Participants in the intervention arm were 29 indoor cycling instructors (n = 10 for the control arm) and 246 class members (n = 75 for the control arm). The intervention consisted of face‐to‐face workshops, education/information video clips, group discussions and activities, brainstorming, individual planning, and practical tasks in the cycling studio. Instructors and exercisers responded to validated questionnaires about instructors’ use of motivational strategies and other motivation‐related variables before the first workshop and at the end of the third and final workshop (4 months later). Time × arm interactions revealed no significant effects, possibly due to the large attrition of instructors and exercisers in the control arm. Within‐group analyses in the intervention arm showed that exercisers’ perceptions of instructor motivationally adaptive strategies, psychological need satisfaction, and intentions to remain in the class increased over time. Similarly, instructors in the intervention arm reported being less controlling and experiencing more need satisfaction over time. These results offer initial promising evidence for the positive impact of the training.

Adherence support strategies for exercise interventions in people with mild cognitive impairment and dementia: A systematic review

Exercise-based therapy may improve health status for people with Mild Cognitive Impairment (MCI) or dementia but cannot work without adherence, which has proven difficult. This review aimed to evaluate strategies to support adherence among people with MCI or Dementia and was completed in Nottingham/UK in 2017. A narrative synthesis was used to investigate the effectiveness or usefulness of adherence support strategies. Fifteen adherence support strategies were used including theoretical underpinning (programmes based on behavior change theories), individual tailoring, worksheets and exercise booklets, goal setting, phone calls or reminders, newsletters, support to overcome exercise barriers, information, adaptation periods, individual supervision, support for clinicians, group setting, music, accelerometers/pedometers and emphasis on enjoyable activities. Music was the only strategy that was investigated in a comparative design but was found to be effective only for those who were generally interested in participating in activities. A wide range of adherence support strategies are being included in exercise interventions for people with MCI or dementia, but the evidence regarding their effectiveness is limited.

An intervention to train group exercise class instructors to adopt a motivationally adaptive communication style: a quasi-experimental study protocol

Introduction: According to self-determination theory (SDT), individuals in position of authority can have a powerful impact on the motivation of the individuals they instruct via the type of communication style they use. This paper describes (a) the rationale for and development of an SDT-based motivation communication training package for group exercise instructors and (b) the design and protocol for an intervention study to evaluate the implementation of this intervention. Methods and analysis: Fifty indoor cycling class instructors will be assigned to either an intervention group (n = 25) or a control group (n = 25). Over a 10-week period, instructors in the intervention group will complete a multiphase SDT-based communication training programme. The evaluation package will comprise qualitative and quantitative assessments of the motivationally relevant features of the class environment as well as motivation and well-being variables, undertaken by both exercise class members and instructors. Baseline quantitative data collection will take place up to one month prior to the start of the intervention and be re-administered within one month following the end of the intervention period. Quantitative data will be analysed using multilevel growth modelling. Follow-up semi-structured interviews with instructors and exercise class members will be conducted four to six weeks following the end of the intervention to explore perceptions of the training programme. All interviews will be analysed using inductive thematic analysis. Ethics and dissemination: The study has been granted ethical approval from Curtin University Ethics Board. The findings of the study will be disseminated through peer-reviewed journals and conference presentations. Trial Registration: ANZCTR.org.au: ACTRN12615000036516.

Putting self-determination theory into practice: application of adaptive motivational principles in the exercise domain

Abstract Grounded in self-determination theory (SDT), and in the group exercise context, this qualitative study explored: (1) instructors’ experiences of operationalising motivational strategies following participation in an SDT-based training programme, (2) exercisers’ views on instructors use of motivational strategies and any impact on exercisers’ basic psychological needs and motivation and (3) the challenges and facilitators reported by instructors when implementing motivation strategies in practice. Thirteen indoor group cycling instructors and 15 exercisers, who had been regularly attending a group cycling class taught by one of the instructors, participated in semi-structured interviews. Ten instructors also completed self-reflective diaries detailing their experiences of implementing the need-supportive strategies. Data were analysed using the Framework Method and coding was performed using an abductive reasoning approach. Analysis revealed specific examples of ‘how to’ operationalise motivation strategies within group exercise settings. Challenges to implementation included: the structured nature of the group exercise class, initiating meaningful one-to-one conversations, phrasing instructions in a need-supportive way, and breaking old habits. Facilitators to implementation included establishing a connection with exercisers and understanding SDT. Findings are discussed in relation to the theoretical, practical and research implications. The findings of the present study could potentially be used to improve the design and training content of SDT-based training programmes in group exercise contexts and other similar group activity settings within sport and healthcare settings.

Promoting activity, independence and stability in early dementia and mild cognitive impairment (PrAISED): development of an intervention for people with mild cognitive impairment and dementia:

This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless, they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is an understanding of how to develop an intervention for people with mild cognitive impairment and dementia to promote their independence, stability, and physical activity. Introduction: Older adults with dementia are at a high risk of falls. Standard interventions have not been shown to be effective in this patient population potentially due to poor consideration of dementia-specific risk factors. An intervention is required that addresses the particular needs of older people with dementia in a community setting. Methods: We followed guidelines for the development of an intervention, which recommend a structured approach considering theory, evidence and practical issues. The process used 15 information sources. Data from literature reviews, clinician workshops, expert opinion meetings, patient-relative interviews, focus groups with people with dementia and clinicians, a cross-sectional survey of risk factors, a pre-post intervention study and case studies were included. Data were synthesized using triangulation to produce an intervention suitable for feasibility testing. Practical consideration of how an intervention could be delivered and implemented were considered from the outset. Results: Elements of the intervention included individually tailored, dementia-appropriate, balance, strength and dual-task exercises, functional training, and activities aimed at improving environmental access, delivered using a motivational approach to support adherence and long-term continuation of activity. We focussed on promoting safe activity rather than risk or prevention of falls. Conclusion: We used a systematic process to develop a dementia-specific intervention to promote activity and independence while reducing falls risk in older adults with mild dementia.

Development of and adherence to a computer-based gamified environment designed to promote health and wellbeing in older people with mild cognitive impairment.

BACKGROUND The older population of Europe is increasing and there has been a corresponding increase in long term care costs. This project sought to promote active ageing by delivering tasks via a tablet computer to participants aged 65-80 with mild cognitive impairment. OBJECTIVES An age-appropriate gamified environment was developed and adherence to this solution was assessed through an intervention. METHODS The gamified environment was developed through focus groups. Mixed methods were used in the intervention with the time spent engaging with applications recorded supplemented by participant interviews to gauge adherence. There were two groups of participants: one living in a retirement village and the other living separately across a city. RESULTS The retirement village participants engaged in more than three times the number of game sessions compared to the other group possibly because of different social arrangements between the groups. CONCLUSION A gamified environment can help older people engage in computer-based applications. However, social community factors influence adherence in a longer term intervention.

Suitability of the Perceived Motivational Climate in Sport Questionnaire-2 for Dance Research: A Think Aloud Approach

The Perceived Motivational Climate in Sport Questionnaire-2 (PMCSQ-2) adapted for dance has been employed in a variety of dance settings. However, the content validity of the measure and the relevance of particular subscales (e.g., Intra-Team Member Rivalry) have been questioned. Thus, the aims of this study were twofold: first, to examine the content validity of the PMCSQ-2 and identify problematic items and the nature and frequency of such problems experienced by dancers completing the measure; and second, to determine whether the content of task-involving and ego-involving climates, as captured in the subscales of the PMCSQ-2, are relevant and meaningful in dance contexts. Think aloud interviews were conducted with 21 dancers (10 male, 11 female) representing diverse types and levels of dance experience. The interviews were transcribed verbatim and segmented into text related to each item in the PMCSQ-2. Each participants responses were individually analyzed, with the nature and frequency of problems encountered recorded in relation to five potential causes: errors in understanding, interpretation, retrieval, judgment, and responding. Think aloud interviews revealed that 72% of the participant responses presented no problem, indicating that the measure has an acceptable degree of content validity. However, the findings highlight a number of potentially problematic areas that warrant further attention. Implications for the interpretation of previous research and the conduct of future research employing the PMCSQ-2 in dance as well as other achievement contexts (e.g., sport) are discussed.