Abstract
Purpose: To determine whether the use of motivational interviewing (MI) to inform parents that their young child was overweight enhanced their engagement in a family-based intervention compared to feedback delivered via best practice care (BPC). In addition, this thesis aimed to examine what parents recall, understand, and experience from the feedback process.
Methods: 1093 families of children aged 4-8 years were recruited from primary and secondary care to participate in a BMI screening health check. Anthropometric measurements were taken by trained measurers while parents completed a comprehensive questionnaire to assess demographic characteristics, their child’s lifestyle behaviors (e.g., amount of physical activity, television time, fruit and vegetable intake) feeding practices, warmth/hostility towards the child, parental concern about overweight and parental perception of their child’s weight. Parents of overweight children (BMI >85th percentile) were randomised to receive feedback regarding their childs’ weight status via MI or BPC. Parents of children <85th percentile were given best practice care feedback and had no further involvement in the study. Parents of overweight children (≥85th percentile; n = 271) participated in a follow-up interview approximately two weeks later and repeated aspects of the screening questionnaire and a semi-structured interview to assess parental recall, understanding and experience of the feedback session. All interviews were audio-taped and transcribed for coding purposes.
Results: Uptake into the intervention was high with 76% of families agreeing to participate, with no significant difference in uptake between the two feedback conditions (% difference 6.6 (95% CI -2.9, 16.0). There were no significant differences in measures of harm or lifestyle behaviors after feedback between the two conditions, with the exception of those who received MI feedback being more autonomously motivated to make lifestyle changes at follow-up (difference 0.18: 95% CI 0.00 to 0.35). Virtually every parent (94%) remembered that their child was overweight but far less (50%) could explain what that actually meant in terms of their child’s health. Interestingly, overall recall was higher in parents who received feedback via BPC feedback (difference 0.47; 95% CI 0.05 to 0.88), but understanding of the health implications was significantly higher in those receiving MI (difference 0.14, 95% CI 0.01 to -0.27, P = 0.02). Mothers who were more educated (0.79; 95% CI 0.30 to 1.28), and those who found the feedback useful (0.20; 95% CI 0.05, 0.36) had higher recall scores. Most parents (79%) described their experience of the feedback session as positive and 88% of parents positively rated the traffic light BMI charts, indicating that they were a simple and clear visual way to present their child’s BMI information. Significantly more parents who received their child’s weight status via MI rated the feedback as empathetic (P=0.004) and autonomy supportive (P=0.02) but more also rated it as uncomfortable (P=0.002) compared with those who received feedback via BPC. More parents from the MI condition were ambivalent about the information after feedback (% difference 11.8, 95% CI 1.5 to 22, P=0.026), while more parents from the BPC condition accepted the message that their child was overweight (% difference 16.1, 95% CI 4.0 to -28.0, P=0.008). However, the most important predictor of parental acceptance of the information was a positive experience of feedback (OR 2.91, 95% CI 1.57 to 5.40, P<0.001). While, the majority of parents did not discuss the weight results with their children (88%), and tended to explain the study and any family changes in the context of family health, 18% told their children the weight information. Some parents told their child conflicting information or discussed information in front of children using potentially inappropriate terms such as being “fat” and a small number (n = 12) of parents reported that their child was concerned about the information they had been told.
Conclusions: The current study suggests that while MI for feedback did not offer significant benefits over BPC with regard to intervention engagement, lifestyle behaviour change and recall and understanding of the information, one session of MI led to more self-determined motivation which is thought to influence long-term behavioural changes. The observation that parents remain uncertain about the implications of their child being overweight, even after an individualised 30 minute interactive session, has significant implications for how this information is given to parents, particularly within the context of adding weight screening to routine care. Our findings suggest that rather than using a specific approach (MI or BPC) in managing weight discussions, the fundamental characteristics of the interaction are that it needs to be non-judgmental and empathetic to promote acceptance of the information. Our results also suggest that it is important for health practitioners to consider what information children will hear in a consultation, either directly or via later discussion with parents. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12609000749202