1,721,031 research outputs found
Is the Small Changes programme clinically effective for adults who are obese?
Full text linkThis thesis concerns the treatment of (N=148) male and female clients in a weight management programme: Small Changes the thesis compares treatment as usual with a new approach using motivational interviewing. Firstly a preface sets out the historical context of Small Changes and how it developed and was originally funded before the aims of the thesis and the detail encompassed in each chapter are set out. Following this an introduction chapter presents the key constructs and theories surrounding motivational interviewing. This leads into study 1, a systematic review addressing the question: What should be included in a comprehensive weight management programme? The conclusion to this question is a mixture of input from: nutrition and exercise expertise combined with a clear behavioural approach, measures that encompass important clinical parameters, other than just weight, and sufficient length of follow-up post treatment. This conclusion forms the basis of the study 2 literature review which focusses on the contribution of motivational interviewing for affecting exercise and nutrition behaviours with the aim of improving weight management outcomes. The literature review leads into the methodology for study 2 which outlines the measures used, the follow-up period and the detail of what was done in study 2; sufficiently clearly for others to replicate what was done. From this chapter a separate results chapter reveals the statistical results for the outcome measures included in study 2. The discussion chapter then follows and focusses on the interpretation, critique and analysis of the results and relates these back to the literature presented in the literature review for study 2. Finally conclusions and short-comings of the study 2 investigation are explored and further research considerations made
Developing theory in motivational interviewing: academic and practitioner perspectives from MICBT integration
Full text linkMotivational Interviewing (MI) and Cognitive Behaviour Therapy (CBT) are both
evidence based psychosocial interventions. Motivational interviewing has not
sought to develop its own comprehensive theory (Miller & Rollnick, 2012)
although it has developed hypotheses on why MI works. This project has looks
at what an integration of these two approaches can tell us about motivational
interviewing’s theory, hypothesised mechanisms of action and efficacy. It has set
out to examine and explore existing theory through qualitative research. This
included Semi structured interviews with researchers and practitioners who are
experts in the integration of MI and CBT (MICBT). Their views and existing
literature were used develop understanding about MI efficacy. A critical realist
philosophical framework and Theoretical Thematic analysis was used to explore
and test MI theory. A number of themes around hypothesised mechanisms and
MI theory emerged from both sets of participants. These included psychological
safety, alliance, responding to resistance, acceptance, compassion and positive
emotion. A relational rather than a technical practice was emphasised and the
theory relating to that observed. Theory around Power, its negative and positive
operation in people’s lives arose frequently; as did hypothesised mechanisms
relating to power differentials and MI as a ‘power yielding’ approach. Building on
insights from evolutionary theory, links were made to a more detailed
consideration of the effects of social context on research, practice and the ability
of individuals to make change. This project challenges a narrow-individualised
approach to research and intervention, emphasising the need to take into account
the effects of social inequality and individual social circumstances.
The project has illustrated some of the reality of translating theory into real-world
practice and suggests expanding MI theory so that it is more contextualised. The
centrality of understanding power and power structures may be a useful addition
to an understanding of why MI works. An increased awareness of social context
and its impacts raise questions about how individual and societal level
interventions could work together to improve health behaviour change. Finally, a
number of suggestions for future research are made, including that individualised
interventions need to be evaluated in real-world services, with direct consultation
of and involvement of service users
An exploration of childhood obesity treatment interventions to enhance their long-term effectiveness.
Full text linkChildhood obesity is a major public health concern. Recent data suggests although childhood obesity prevalence rates appear to be slowing, they are still unacceptably high (Health Survey for England, 2010). To establish a downward trend in childhood obesity rates, effective treatment options are vital. To date, multi-component treatment interventions (MCTIs) incorporating a physical activity, healthy eating and behavioural component and encouraging family involvement appear to be the most promising approach to treat childhood obesity. However, no firm conclusion can be made regarding the sustainability of treatment outcomes (i.e. behavioural & weight related outcomes) (Luutikhuis et al., 2009). This thesis contributed to the evidence base regarding the sustainability of treatment outcomes from MCTIs; considered stakeholder views in the intervention design process and provided an insight into treatment recipient's reasons for attrition from MCTIs.To critically examine the evidence base, Study 1 provided a systematic review of childhood obesity treatment interventions. Results revealed gaps in the evidence in terms of how best to maintain treatment outcomes. Furthermore the study highlighted a need to better consider stakeholder views in intervention design and to fully report treatment fidelity (TF). In Study 2, a qualitative inquiry explored stakeholder perspectives towards childhood obesity treatment and the maintenance of treatment outcomes. Results revealed incongruence between treatment recipients (i.e. parents & children) and treatment deliverers (i.e. health professionals). Treatment recipients suggested they required ongoing support to maintain treatment outcomes. Conversely, treatment deliverers suggested ongoing support is unrealistic and MCTIs should create autonomous individuals who feel confident in their ability to maintain treatment outcomes. Implications included the need to consider maintenance strategies that promote autonomous motivations and perceived competence for behavioural changes in participants with the aim of improving weight maintenance following MCTIs.In light of stakeholder views in Study 2, Study 3A detailed a pilot study to test the efficacy of a maintenance intervention underpinned by Self Determination Theory (Deci & Ryan, 1985; 2000) and that integrated Motivational Interviewing (Miller & Rollnick, 1991; 2002) and cognitive behavioural strategies to improve the sustainability of behavioural and weight related outcomes following a MCTI. A secondary aim of Study 3A was to evaluate TF. Findings supported the potential importance of autonomous motivation and perceived competence in enhancing the maintenance of behavioural and weight related changes. Furthermore this study highlighted a need to explore participants' reasons for attrition from MCTIs. Study 3B provided a qualitative exploration of parents and children's reasons for attrition from MCTIs. Findings underlined the complexity of attrition with several psychological and motivational reasons appearing as the driving source for attrition. Study implications included the need to consider individual families' needs within MCTIs, targeting parents and children's motivations for maintaining a healthy lifestyle and weight differently. The collective implications of the four studies included the need for stakeholders to be involved at all levels of design, implementation and evaluation of MCTIs, the need to assess and report all aspects of TF and the need for MCTIs to develop families' perceived competence and autonomous motivations for health behaviour changes in order to improve the sustainability of weight related outcomes
Understanding successful physical activity behaviour change using a grounded theory methodology
No full textResearch evidence highlights regular physical activity (PA) as an increasingly important
factor in the prevention of a variety of chronic diseases. Consequently, encouraging
people to make PA related lifestyle changes is an everyday challenge faced by health
professionals in primary and secondary health care settings. Although a number of
intervention strategies have been developed and implemented, research evidence
presents only limited support for their efficacy. While short-term changes may be
achievable using current intervention strategies, long-term change (i.e. maintenance)
appears much more difficult to achieve.
Although many public health interventions are developed without explicit reference to
theory, evidence suggests that the explicit use of theory will significantly improve the
chances of effectiveness (Nutbeam & Harris, 2004). As no existing theoretical models
are specifically intended to account for PA behaviour change, a number of pre-existing
theoretical frameworks have been adopted to explain PA participation. This thesis
reviews the existing body of theoretical literature in exercise psychology alongside
conducting a systematic review (Study 1) of interventions based on the Transtheoretical
Model (TTM). As a result, the theoretical depth or explanatory quality of existing
models and theories is called into question, when applied to a PA context and specific
phenomena such as long-term PA behaviour change.
After reflecting on the debate surrounding different epistemological viewpoints and
theoretical perspectives, applications of an alternative theory generating research
approach (the Grounded Theory Methodology: GTM) are explored and evaluated. As a
result, in light of the considerable epistemological debate that surrounds GTM, study 2
of this thesis focuses explicitly on methodological issues within exercise psychology. A
critical review of applications of GTM within exercise psychology is conducted. Results
reveal that many existing studies.demonstrate a poor understanding of GTM and/or fail
to present an adequate account of the research process.
Ultimately the results of study 2 provide valuable implications for study 3 of this thesis,
which adopts GTM to develop an ecologically valid explanatory model of long-term PA
behaviour change. Twenty-one adult participants (9 male, 12 female), aged between 38
and 62 years, were recruited from a countywide PA referral scheme. All participants
had made long-term, positive changes to their PA habits. Participants contributed to 25
in-depth interviews. All sampling and analytical procedures were dictated by the key
tenets of GTM and a constructivist theoretical stance. To assist with the GTM process,
the software package QSR-NVivo was used throughout. A grounded theory of longterm
PA behaviour change is presented in the form of a multidimensional explanatory
model. The model identifies a number of observed cognitive processes, which appear
central to PA behaviour change and maintenance. The underlying mechanisms
responsible for these are also highlighted. Results are discussed with specific emphasis
on literature surrounding value theories, core beliefs and the introduction of prominent
clinical psychology and psychotherapy approaches within exercise psychology. Finally,
implications for theory development and applied practice are highlighted and directions
for future research suggested
The development, delivery and evaluation of a physical activity maintenance intervention.
Full text linkThe number of adults living with chronic health conditions and co-morbidities (e.g., diabetes and depression) is expected to rise by 2035 resulting in significant health and social care challenges (Department of Health, 2012). Supporting people with long-term conditions into better physical and mental health is a public health priority (NICE, 2009). One common approach used to manage or prevent a range of chronic health conditions is physical activity (PA). Evidence supports the short-term effects of PA interventions but a decline in PA levels occurs after an intervention ends (Foster, et al., 2012). Considering the lack of long-term effectiveness of interventions, this thesis explored the active ingredients of PA maintenance (e.g., determinants and behaviour change techniques [BCTs]) through the development, delivery and evaluation of a theory-based PA maintenance intervention. The intervention was developed using intervention mapping principles (Bartholomew, Parcel, Kok, & Gottlieb, 2006). A scoping review explored the intervention components, theories, determinants and BCTs for PA maintenance across at least six months in clinical populations. Multiple theories, determinants and BCTs were found meaning the important components for intervention development were inconclusive. Research gaps were identified, which was addressed through a qualitative study (Study 1). Study 1 investigated the determinants and strategies for successful and unsuccessful maintenance in completers of physical activity referral schemes (PARS). Determinants included: congruence between outcome expectations, experiences and values; social support; and, overcoming barriers. Multiple cognitive-behavioural strategies for PA, condition management and coping were identified, including self-monitoring and pacing. Recommendations included interventions to adopt a person-centred integrative approach, such as motivational interviewing (Miller & Rollnick, 2013) and cognitive-behavioural techniques (MI-CB; Naar-King et al., 2013; Hogden et al., 2012).A RCT pilot study was conducted (Study 2a) to test the efficacy and feasibility of the MI-CB intervention within a PARS setting. The MI-CB group maintained PA at six months post-PARS and enhanced barrier self-efficacy and physical outcome experiences but not social support, coping strategies or BMI compared to usual care. The intervention was largely feasible and generated excellent adherence rates (95%). A treatment fidelity (TF) framework was adopted (Study 2b) assessing fidelity of design, training, delivery, receipt and enactment (Bellg et al., 2004). Results indicated that the intervention provider was not proficient in delivering all MI-CB components (e.g., complex reflections). The findings suggested that on-going supervision was needed to ensure practitioner competence. The contrast between low fidelity to MI-CB delivery and intervention efficacy suggested other variables influenced intervention effectiveness, such as therapeutic alliance, intervention receipt and enactment. Outcomes from this thesis confirm that PA maintenance is a complex process in adults with chronic health conditions, involving multiple theoretical determinants and strategies. A large scale trial is warranted to compare the efficacy of MI-CB to single approaches, such as MI and CBT
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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