Identification and explanation of a research article:
A telephone-only MI to increase Physical Activity in Rural Adults.
A Randomized Controlled Trial.
Sarana Alexander
New York City College of Technology
Nursing Research
NUR 3130-8516
Spring 2012
Researchers perform methodical inquiry to seek understanding or to acquire knowledge about the topic being studied; in an effort to resolve problems, provide evidence for new ideas or just to develop theories. The main purpose of this piece of research was to “evaluate whether a telephone-only motivational interviewing intervention, delivered from one location by a physical activity counselor trained in MI, would increase the physical activity of rural adults in small towns in a broad geographic area.” (Bennett, J., Young, H., Nail, L., Winters-Stone, K, & Hanson, G. 2008)
Motivational interviewing; the interventions used in this study, is a counseling method which uses four general principles namely expressing empathy, self efficacy, rolling with resistance, developing discrepancy between current behavior and desire behaviors. These four principles will help the client to develop behavior change.
The need for this research was basically summarized by this quote, “rural adults have higher rates of chronic illness and physical limitations that might be prevented by increased physical activity”. (Bove & Olsen, 2006; Center on an Agind Society, 2003; kondro, 2006). Therefore the justification for this research is that few studies have been done to help increase regular physical activity in rural environments, even though, “Both rural and urban adults are likely to be inactive, but rural adults have less access to exercise classes or facilities to increase physical activity.” (Bennett, J., Young, H., Nail, L., Winters-Stone, K, & Hanson, G. 2008)
Hence, the researchers performed a RCT, where inactive rural adults who stated that they were ready to increase physical activity were placed into a uncontrolled group (given a pedometer and monthly MI telephone calls) and an controlled group (telephone calls no MI content), then monitored for 6 months. Based on findings of this study, the researchers were able to make specific predictions as to whether this intervention had positive outcomes, through increased physical activity of the participants.
This study used a Quantitative/positivist paradigm because the data is statistical- numerical, empirical, well controlled with very systematic procedures and has deductive reasoning. Participants of this RCT were randomized to two groups using a computer generated randomization list. An intervention was actively introduced to the controlled group, making this study one of Experimental design.
According to Essentials of Nursing Research (2009), “quantitative researchers, often start with a theory or a conceptual model, and through deductive reasoning they will make predictions about how phenomena would behave in the real world if the theory were true.” (Polit & Beck 2009) “This theory is a systematic, abstract explanation of some aspect of reality”. (Polit & Beck 2009) In this research article, the theoretical framework is explicated in the introductory paragraphs.
The theory of this study is explained in paragraph two. Based on studies done recently about urban populations, regular daily physical activity is being encouraged rather than group exercise classes. The rationale is that if one makes the choice to live a certain lifestyle then they’re most likely to adhere to that lifestyle longer, as opposed to being forced. There have been studies utilizing behavior change interventions such as MI for urban adults. MI focuses on the client and helps them to choose how to work on their behavior, without coercion. Hence, the researchers of this study decided to perform the same intervention of MI, except using telephone calls rather than in person MI sessions.
Variables are used in quantitative studies. “Most quantitative researchers seek to understand how or why things vary, and to learn how differences in one variable are related to differences in another.” (Polit & Beck 2009) The question I ask myself is, “is there an intervention/treatment that would cause (independent variable) improvement in outcomes (dependant variable) of the study?”
The Independent variable in this research study is motivational intervention. The dependant variable is behavior change through increased regular physical activity in rural adults, increased self efficacy for exercise, increased stage of change for exercise and also behavior change. The operational variables are the measuring tools or operations that the researcher used to gather information.
To measure physical activity, self reports using the Champs questionnaire for older adults mailed surveys and exercise log were used. For measurement of self efficacy for exercise, the participants had to use a 5-level Likert-type scale and indicate their level of confidence to exercise despite six barriers example bad weather conditions. To measure stage of change for exercise, participants had to select one out of five statements (five stages of readiness) that describes their exercise behavior. This was done at baseline then at 6 months.
With regular physical activities, the difference between both groups over time was not significant. The intervention group saw a significant increase in self efficacy for exercise in comparison to the controlled group. Lastly, the intervention group had a greater increase in stage of change, although not significant, than did the control group. Based on the findings of this research, MI intervention increased the self efficacy for exercise but did not increase physical activity compared with controls.
This research had many limitations, namely seasonal effects (winter), control conditions and length of the intervention. Future studies could now be guided by this research, since the weaknesses of this research could be used to strengthen future ones. For instance, instead of conducting the study in winter, future researchers could have participation through all seasons in order to see the true effect of telephone only MI intervention.
The implication of this study is that, “the traditional approach consisting of an initial in person interview using MI strategies followed by telephone calls is successful at increasing physical activity in formerly inactive adults, however it is less clear whether MI with no in person component can effect behavior change, it did not increase physical acidity in this study.” (Bennett, J., Young, H., Nail, L., Winters-Stone, K, & Hanson, G. 2008)
References
Polit, D. F., & Beck, C. T. (2010). Essential of nursing research: Appraising evidence for nursing practice (7 ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
Bennett, J., Young, H., Nail, L., Winters-Stone, K, & Hanson, G. (2008). A telephone-only motivational intervention to increase physical activity in rural adults. A randomized controlled Trial.
Bove, C.F., & Olson, C. M. (2006). Obesity in low-income rural women: Qualitative insights about physical activity and eating patterns.
Center for an aging society. (2003). Rural and urban health. Retrieved from www.aging-society.org
Kondro, W. (2006). Health of rural Canadians lags behind urban counterparts. Canadian Medical Association Journal, 175, 1195.
