Efficacy of Mobile Instant Messaging-Delivered Brief Motivational Interviewing for Parents to Promote Physical Activity in Pediatric Cancer Survivors: A Randomized Clinical Trial

Abstract

Importance: Physical activity has beneficial effects that mitigate cancer- and treatment-related late effects. However, children who survive cancer are often physically inactive. Brief motivational interviewing may be an effective approach for increasing children's physical activity levels.

Objective: To examine the effects of mobile instant messaging-delivered brief motivational interviewing for parents in promoting regular physical activity in children who have survived cancer.

Design, setting, and participants: An assessor-blinded randomized clinical trial was conducted at 2 Hong Kong pediatric oncology outpatient clinics from March 1, 2019, to January 29, 2021. A total of 161 children who had survived cancer, aged 9 to 16 years, and their parents were randomized (1:1) to an intervention or control group.

Interventions: The intervention group received a 6-month mobile instant messaging-delivered brief motivational interviewing using a strategy menu. Parent-child dyads in both groups received a health advice session and were directed to a physical activity website at baseline.

Main outcomes and measures: The primary outcome was the children's physical activity levels at 12-month follow-up, measured by the Chinese University of Hong Kong: Physical Activity Rating for Children and Youth (total sores: 0-10, higher scores indicate greater physical activity levels). Secondary outcomes were cancer-related fatigue levels, handgrip strength, peak expiratory flow rate, and quality of life. Intention-to-treat analysis was performed.

Results: Of the 161 children included in the study, 93 were boys (57.8%), and the mean (SD) age was 12.4 (2.4) years. Generalized estimating equation analyses showed a significant improvement in outcomes in the intervention group compared with the control group: physical activity levels (group-by-time interaction, 6 months: β = 3.09; 95% CI, 2.65-3.53; P < .001; 12 months: β = 3.91; 95% CI, 3.45-4.36; P < .001), cancer-related fatigue (6 months: β = -5.69; 95% CI, -8.03 to -3.35; P < .001; 12 months: β = -9.16; 95% CI, -11.31 to -7.00; P < .001), left handgrip strength (6 months: β = 2.69; 95% CI, 0.96-4.43; P = .002; 12 months: β = 5.52; 95% CI, 3.70-7.33; P < .001), right handgrip strength (6 months: β = 2.75; 95% CI, 1.01-4.50; P = .002; 12 months: β = 5.45; 95% CI, 3.62-7.27; P < .001), peak expiratory flow rate (12 months: β = 28.51; 95% CI, 16.10-40.92; P < .001), and quality of life (6 months: β = 5.01; 95% CI, 1.19-8.82; P = .01); 12 months: β = 14.19; 95% CI, 10.84-17.54; P < .001).

Conclusions and relevance: In this randomized clinical trial, mobile instant messaging-delivered brief motivational interviewing was effective in promoting the adoption and maintenance of regular physical activity and ameliorating cancer- or treatment-related adverse effects in children who survived cancer.

Trial registration: ClinicalTrials.gov Identifier: NCT03859271.

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.. Theoretical Framework of the Brief Motivational Interviewing

Attentive to the motivational intervention (MI) spirit of collaboration, compassion, evocation, and acceptance, and the principles of expressing empathy, highlighting discrepancies, avoiding arguments, rolling with resistance, and supporting self-efficacy, this study explored the potential to enhance parents' intrinsic motivation to encourage their child to engage in physical activity (PA) through an MI attuned to their perspectives and ambivalence. The reasoning, in other words, was that the brief MI sessions would support and enhance parents' autonomy and self-efficacy and convince them to motivate their children to be more physically active. Throughout the 4 fundamental processes of brief MI with the adaptation of the menu of strategies and use of micro skills (eliciting and reinforcing preparatory/implementing change talk), it is anticipated that parents' ambivalence toward the engagement in PA for their child will be resolved by exploring both positive and negative aspects of ambivalence (ie, pros and cons of their child performing PA) and their discrepancy in changing the behavior will be developed (indicated by preparatory and implementing change talks). Brief MI could also enhance parents' perceived competency in PA by providing resources and information regarding PA in children who have survived cancer. This probably enables the parents to act as role models in PA behavior and hence proactively motivate their child to adopt and maintain regular PA. The expectation was that PA would improve the children's cancer-related fatigue levels, muscle strength, lung function, and quality of life.

Figure 2.. Patient Flow Diagram

T1 indicates 1 month after starting the intervention; T2, 3 months after starting the intervention; T3, 6 months after starting the intervention; and T4, 12 months after starting the intervention.