Date

April 2010

Document Type

Dissertation

Degree Name

Ph.D.

Institution

Oregon Health & Science University

Abstract

Background: Cardiovascular disease (CVD) has become the leading cause of mortality and morbidity among middle-aged women in Thailand. A preponderance of evidence supports the conclusion that physical inactivity is a major risk factor for CVD. Despite increasing support for the benefits of physical activity (PA), some middle-aged women in urban areas still report a low frequency of participation in regular exercise or moderate PA. Pender’s health promotion model (1996) offers a guide for exploring the complex bio-psycho-social processes that motivate an individual to engage in behaviors directed towards the enhancement of his or her health. Among Thai women, exercise participation was found to be significantly associated with the perception of benefits from PA, barriers to PA, self-efficacy, and social support for exercise. The principle of motivational interviewing (MI) as a proven method to increase positive health behaviors was used to understand and increase women’s physical activity. Purposes: The purpose of this study was to test whether a motivational interviewing-based health coaching program (MI-BHCP) would be feasible, practical, and effective in a program for promoting physical activity among Thai working women as opposed to an education-only approach using a health education program (HEP) in their workplace. Methods: Fifty-one working women at a large workplace in Bangkok, Thailand were randomly assigned to either 10 weeks of MI-BHCP or HEP. A mixed-methods ANOVA was used to test if women in the MI-BHCP would have a greater change in their PA. The changes in their psycho-social factors including perceived benefits and barriers to be physically active, perceived social support, and perceived self-efficacy to overcome barriers over four time measures (baseline, week 8, week 13, and week 36) were also evaluated. Thematic analysis was used on the qualitative data collected at week 13, which related to their experience gained while participating in MI-BHCP. Results: At baseline, 61% of the participants from both groups reported low PA. Their total minutes for PA and their perceived benefits positively associated with their perceived social support (r= .29, p<.05; r= .38, p < .01). Their perceived self-efficacy also positively associated with their perceived benefits (r= .46, p< .01) and perceived social support from friends and family (r= .37, p< .01; r= .35, p< .05). Their perceived barriers were negatively associated with their total minutes for PA (r=-.31, p< .05) and their perceived benefits (r= -.32, p< .05). Analysis of the primary outcome revealed no statistical changes in the total minutes for PA across four time points related to the two different coaching styles. The interaction of coaching style and the use of the pedometer had a small effect on the total minutes for PA across three time points (F (1, 24) = 1.64, p= .21, ω[superscript 2]=.01). Participants in MI-BHCP who used the pedometer reported higher total minutes for PA at the endpoint than did the participants who used the pedometer in the HCP. The coaching styles only moderately affected the number of walking steps over time, F (2, 26) = .76, p= .05, ω[superscript 2]=.10, with the number of steps of participants in MI-BHCP being higher than the number of the HEP participants at the endpoint. Only the increase of walking steps over times of participants in both groups was statistically significant, F (2, 26) = 4.85, p= .02, ω[superscript 2]=.07. The findings also showed some small effect of MI-BHCP on the increase of perceived benefit (F (2, 80) = 1.44, p= .24, ω[superscript 2]=.01) and the decrease of perceived barriers (F (1.8, 71.85) = 1.90, p= .24, ω[superscript 2]=.05). The results of the participants in MIBHCP group were higher than those of the participants in HEP over time even though these effects were not statistically significant. The perceived social support of participants in both groups was statistically increased over time (F (2, 80) = 3.40, p= .04, ω[superscript 2]=.05) with their perception of social support at the endpoint being higher than at baseline. The qualitative data also showed that participants in MI-BHCP clearly perceived the benefits accrued from participating in MI, and as a result of these perceived benefits, their motivation to be physically active increased. The results affirmed that MI is an appropriate coaching style for use in promoting healthy behaviors at the workplace in Thailand. Implication: The data clearly revealed the need to promote physical activity among middle-age Thai working women. The findings support the conclusion that MI can be appropriately used to increase self-efficacy, perceived benefits, and social support as well as to decrease perceived barriers to activity in working women.

Identifier

doi:10.6083/M4WS8R73

School

School of Nursing

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