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Jeong and Jeong: Development and Evaluation of a Motivational Interviewing Program for Exercise Improvement in Persons with Physical Disabilities
Original Article

J Korean Acad Nurs 2017;47(3):406-419.

Published online: 15 January 2017

DOI: https://doi.org/10.4040/jkan.2017.47.3.406

Development and Evaluation of a Motivational Interviewing Program for Exercise Improvement in Persons with Physical Disabilities

Jeong Hee Jeong1, Ihn Sook Jeong2,

1Department of Nursing, Daedong College, Busan

2College of Nursing, Pusan National University, Yangsan, Korea

Address reprint requests to : Jeong, Ihn Sook College of Nursing, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan 50612, Korea Tel: +82-51-510-8342 Fax: +82-51-510-8308 E-mail: jeongis@pusan.ac.kr

Received 25 January 2017       Revised 22 May 2017       Accepted 22 May 2017

Copyright © 2017 Korean Society of Nursing Science

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The aims of this study were to develop a motivational interviewing program for exercise improvement in persons with physical disabilities and to examine the effect of this motivational interviewing intervention.

Methods

The study employed a nonequivalent control group pretest and posttest design. A total of 62 persons with physical disabilities (30 in the experimental group, 32 in the control group) were recruited from 2 community rehabilitation centers. The experimental group received 8 sessions of a group motivational interviewing program, scheduled once a week, with each session lasting 60 minutes. Test measures were completed before the intervention, immediately after the end of the intervention, 2 weeks later, and 6 weeks after the end of the intervention. Measures included self-efficacy for exercise, decisional balance for exercise, stage of change for exercise, regularity of exercise, exercise maintenance, and independent living ability. Data were analyzed using the c2-test, Fisher's exact test, Independent samples t-test, and repeated measures ANOVA, conducted using IBM SPSS Statistics version 18.

Results

The experimental group showed a significant increase in self-efficacy for exercise (F=50.98, p<.001), benefit (pros) of exercise (F=24.16, p<.001), and independent living ability (F=50.94, p<.001), and a significant decrease in loss (cons) of exercise (F=26.50, p<.001). There were significant differences between the two groups in stages of change for exercise (p<.001), regularity of exercise (p<.001), and exercise maintenance (c2=26.61, p<.001).

Conclusion

The motivational interviewing program has the potential to improve exercise levels in persons with physical disabilities.

Keywords: Disabled persons, Motivational interviewing, Exercise

References

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Table 1.
Program for Group Motivational Interviewing
Session Topics Goals Contents (underlying principles and skills of motivational interviewing)
1 Searching for yourself Understanding the subject Introduction to daily life
Formation of trusting relationships Understanding the impact of daily life on your health
Exploring the stages of change for Choosing the focus you need for your health
exercise Exploring the stages of change for exercise
2 Recognizing both Exploring ambivalence toward exercise Thinking about advantages of exercising and disadvantages of not
sides to exercise Confirming will to change exercise exercising
habits Exposure to ambivalence
Checking your willingness to change exercise habits
3 Thinking about the Creating discrepancy Understanding the discrepancy between your present and your
future Motivation for exercise desired future
Eliciting change talk
4 Whether to change Decisional balance check for changes Judging the pros and cons of exercise
or maintain in exercise habits Eliciting change talk about changes in exercise habits
Motivation for exercise
5 An inner struggle Resolving ambivalence toward exercise Thinking about situations where regular exercise is difficult
Enhancing motivation to change Participating in a role play
exercise habits Exploring how to cope in a tempting situation
6 Supporting Improving self-efficacy for exercise Recalling experience of successful exercise
self-efficacy for Exploring confidence in change Exploring strengths
exercise Confirmation of stages of change for Exploring confidence in exercise
exercise Identifying the stages of change for exercise
7 Future direction Checking the decisional balance of Discussing pros and cons of options to promote exercise
options to promote exercise Checking your willingness to change exercise habits
Confirming will to change exercise
habits
8 Planning change Change plan for regular exercise Building a change plan for regular exercise
and exploring the Final check of importance of and Fill in an importance scale
importance of confidence in change
regular exercise
Table 2.
Homogeneity Test for Participants’ Characteristics at Baseline
Characteristics Categories Exp.(n=30) Cont.(n=32) c2 or t p
n (%) or M±SD n (%) or M±SD
Gender Male 17 (56.7) 17 (53.1) 0.08 .779
Female 13 (43.3) 15 (46.9)
Age (yr) ≤39 1 (3.3) 2 (6.2) 1.21 .572*
40~59 17 (56.7) 14 (43.8)
≥60 12 (40.0) 16 (50.0)
59.50±9.55 59.13±12.44 0.13 .895
Education ≤Elementary 11 (36.6) 9 (28.1) 0.56 .758
Middle 8 (26.8) 9 (28.1)
≥High 11 (36.6) 14 (43.8)
Marital status Yes 22 (73.2) 24 (75.0) 0.22 .881
No 8 (26.8) 8 (25.0)
Economic activity Yes 3 (10.0) 3 (9.4) >.999*
No 27 (90.0) 29 (90.6)
Types of disability Amputation 3 (10.0) 4 (12.5) 0.45 >.999*
Plegia (monoplegia, paraplegia) 19 (63.3) 19 (59.4)
Malfomation and deformity 6 (20.0) 6 (18.7)
Others 2 (6.7) 3 (9.4)
Degree of disability Grade 1 6 (20.0) 4 (12.5) 1.86 .655*
Grade 2 12 (40.0) 10 (31.2)
Grade 3 10 (33.3) 14 (43.8)
Grade 4 2 (6.7) 4 (12.5)
Causes of disability Congenital 2 (6.7) 2 (6.2) 0.16 >.999*
Disease 17 (56.7) 18 (56.3)
Accident 11 (36.6) 12 (37.5)
Length of disability (yr) 31.20±18.27 28.00±20.00 0.66 .514
Perceived importance of exercise 8.23±1.65 8.44±1.76 -0.47 .640
Self-efficacy for exercise 34.93±13.38 37.56±16.51 -0.69 .495
Decisional balance for exercise Benefit (Pros) 18.17±2.89 19.22±2.49 -1.54 .129
Loss (Cons) 13.83±2.79 14.16±3.32 -0.41 .681
Stages of change for exercise Precontemplation 3 (10.0) 3 (9.4) 1.09 .941*
Contemplation 12 (40.0) 13 (40.6)
Preparation 5 (16.6) 3 (9.4)
Action 2 (6.7) 3 (9.4)
Maintenance 8 (26.7) 10 (31.2)
Regularity of exercise Yes 10 (33.3) 13 (40.6) 0.35 .553
No 20 (66.7) 19 (59.4)
Independent living ability 93.60±14.85 96.50±9.73 -0.90 .371

Exp.=experimental group; Cont.=control group.

*Fisher’s exact test.

Table 3.
Effects of Motivational Interviewing Program for Exercise Improvement on Outcome Variables
Variables Time Categories Exp. (n=30) Cont. (n=32) Sources F or c2 p Post-hoc
n (%) or M±SD n (%) or M±SD t (p)
Self-efficacy for exercise Pre 34.93±13.38 37.56±16.51 Group 50.50 <.001
Post 1 59.87±12.34 33.25±15.01 Time 33.04 <.001 7.60 (<.001)
Post 2 65.83±13.11 32.66±14.69 G*T 50.98 <.001 9.36 (<.001)
Post 3 64.86±12.26 36.63±14.86 8.12 (<.001)
Decisional balance for exer rcise
Benefit (Pros) Pre 18.17±2.89 19.22±2.49 Group 18.69 <.001
Post 1 21.13±1.98 18.59±2.91 Time 5.73 .001 4.00 (<.001)
Post 2 21.87±2.11 17.84±2.93 G*T 24.16 <.001 6.23 (<.001)
Post 3 21.20±2.34 17.84±2.57 5.39 (<.001)
Loss (Cons) Pre 13.83±2.79 14.16±3.32 Group 47.32 <.001
Post 1 10.80±2.59 14.94±2.60 Time 7.57 <.001 -6.27 (<.001)
Post 2 10.43±2.51 15.56±2.37 G*T 26.50 <.001 -8.27 (<.001)
Post 3 10.03±2.03 15.16±2.29 -9.31 (<.001)
Differences (Pros-Cons) Pre 4.34±4.33 5.06±4.13 Group 52.02 <.001
Post 1 10.33±3.49 3.66±4.45 Time 10.55 <.001 6.55 (<.001)
Post 2 11.43±3.80 2.28±3.85 G*T 43.64 <.001 9.40 (<.001)
Post 3 11.17±3.82 2.69±3.84 8.72 (<.001)
Stages of change for Post 1 Precontemplation 0 (0.0) 6 (18.8) 37.66 <.001*
exercise Contemplation 0 (0.0) 12 (37.5)
Preparation 1 (3.3) 1 (3.1)
Action 21 (70.0) 2 (6.2)
Maintenance 8 (26.7) 11 (34.4)
Post 3 Precontemplation 0 (0.0) 4 (12.5) 40.17 <.001*
Contemplation 0 (0.0) 15 (46.9)
Preparation 3 (10.0) 5 (15.6)
Action 19 (63.3) 1 (3.1)
Maintenance 8 (26.7) 7 (21.9)
Regularity of exercise Post 1 29 (96.7) 13 (40.6) 22.25 <.001
Post 2 29 (96.7) 11 (34.4) 26.25 <.001
Post 3 27 (90.0) 8 (25.0) 26.61 <.001
Exercise maintenance Post 1~3 (6weeks) 27 (90.0) 8 (25.0) 26.61 <.001
Independent living ability Pre 93.60±14.85 96.50±9.73 Group 31.56 <.001
Post 1 113.77±9.90 91.43±11.02 Time 21.33 <.001 8.37 (<.001)
Post 3 112.93±9.11 93.16±11.03 G*T 50.94 <.001 7.67 (<.001)

Exp.=experimental group; Cont.=control group; G*T=group*time; Post 1=immediately after the end of the intervention; Post 2=2weeks after the end of the intervention; Post 3=6weeks after the end of the intervention.

*Fisher’s exact test.

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