Motivational interviewing and cognitive behaviour therapy in the treatment of adolescent overweight and obesity : study design and methodology

Background

Despite the high prevalence and negative physical and psychosocial consequences of overweight and obesity in adolescents, very little research has evaluated treatment in this population. Consequently, clinicians working with overweight and obese adolescents have little empirical research on which to base their practise. Cognitive behavioural therapy has demonstrated efficacy in promoting behaviour change in many treatment resistant disorders. Motivational interviewing has been used to increase motivation for change and improve treatment outcomes. In this paper we describe the rationale and design of a randomised controlled trial testing the efficacy of motivational interviewing and cognitive behaviour therapy in the treatment of overweight and obese adolescents.
Methods

Participants took part in a motivational interview or a standard semi-structured assessment interview and were then randomly allocated to a cognitive behavioural intervention or a wait-list control condition. The cognitive behavioural intervention, the CHOOSE HEALTH Program, consisted of 13 individual treatment sessions (12 face-to-face, 1 phone call) followed by 9 maintenance sessions (7 phone calls, 2 face-to-face). Assessments were conducted prior to participation, after the treatment phase and after the maintenance phase of intervention. Improvement in body composition was the primary outcome; secondary outcomes included improved cardiovascular fitness, eating and physical activity habits, family and psychosocial functioning.
Conclusion

Despite the demonstrated effectiveness of motivational interviewing and cognitive behavioural therapy in the long-term management of many treatment resistant disorders, these approaches have been under-utilised in adolescent overweight and obesity treatment. This study provides baseline data and a thorough review of the study design and treatment approach to allow for the assessment of the efficacy of motivational interviewing and cognitive behavioural therapy in the treatment of adolescent overweight and obesity. Data obtained in this study will also provide much needed information about the behavioural and psychosocial factors associated with adolescent overweight and obesity.

Developing english skills through reflective portfolios in Hong Kong universities

This research concerns the use of portfolios by teachers of English (L2) to assist non-native speakers in Hong Kong universities to complete their studies in English. Portfolios as an English learning tool have yet to win converts from the ranks of language teachers in Hong Kong chiefly because of concerns about reliability and fairness. Two recent initiatives in Hong Kong have, however, prompted a reappraisal of the place of portfolios in English language learning. They include the use of learning portfolios in secondary school and ePortfolios by university students for learning and employment purposes.

As an English (L2) teacher of many years, I initiated my research to investigate the experiences of seven university students in Hong Kong in using reflective portfolios for English learning. Three research questions framed my research: 1) in what ways can reflective portfolios impact on L2 learning strategies? 2) what are the effects of reflective portfolios on progress in L2 acquisition as perceived by students? 3) what are the perceptions of university students towards reflective portfolios as a method of L2 learning?

To gain a holistic understanding of the complex phenomena under scrutiny, a case study methodology and grounded theory were utilised, the former to organise and generate qualitative data, and the latter to analyse data from three sources provided by the seven participating students: semi-structured interviews, portfolio artefacts, and weekly learning diaries.

There were two levels of data analysis. For the first level, analysis focused on coded data from portfolio artefacts, diary entries and interview transcripts as reported by students. The second level involved analysis from the Confucian and sociocultural perspectives. I pursued interpretation and continuous refinement of the data by using techniques drawn from grounded theory. The findings revealed that students generally employed a wide spread of L2 learning strategies in the cognitive, meta-cognitive, and socio-affective domain, reported increased awareness of effective language strategies, and considered portfolios a means of supporting time management and record-keeping, and a site for extended writing practice through reflection.

The findings suggest that students display a cyclical, context-specific shift in learning conception from quantitative to qualitative. Connected to this is students’ apparent ability to formulate strategic responses to externally imposed demands. It is found that such responses are culturally triggered, underpinned by Confucian beliefs. Although the Confucian tradition emphasises respect for established authority, the findings point to students’ creative re-configuration of mental schemata to engender change in role enactment and power relations, with the portfolio as a mediating tool of their experiences.

Based on the findings, I argue that my research has addressed the three research questions and contributed to two crucial aspects of L2 learning. The first pertains to the need for a balanced view of individual effort and social context in second language acquisition, corroborating the significant link between context and learner engagement. Another contribution centres on an enhanced understanding of the relationship between portfolios, reflection and L2, where students’ diaries in English and portfolio artefacts enable them to engage in critical reflection and to identify strategies for L2 improvement.

Can social cognitive theory constructs explain socio-economic variations in adolescent eating behaviours? A mediation analysis

Adolescents of low socio-economic position (SEP) are less likely than those of higher SEP to consume diets in line with current dietary recommendations. The reasons for these SEP variations remain poorly understood. We investigated the mechanisms underlying socio-economic variations in adolescents’ eating behaviours using a theoretically derived explanatory model. Data were obtained from a community-based sample of 2529 adolescents aged 12–15 years, from 37 secondary schools in Victoria, Australia. Adolescents completed a web-based survey assessing their eating behaviours, self-efficacy for healthy eating, perceived importance of nutrition and health, social modelling and support and the availability of foods in the home. Parents provided details of maternal education level, which was used as an indicator of SEP. All social cognitive constructs assessed mediated socio-economic variations in at least one indicator of adolescents’ diet. Cognitive factors were the strongest mediator of socio-economic variations in fruit intakes, while for energy-dense snack foods and fast foods, availability of energy-dense snacks at home tended to be strong mediators. Social cognitive theory provides a useful framework for understanding socio-economic variations in adolescent's diet and might guide public health programmes and policies focusing on improving adolescent nutrition among those experiencing socio-economic disadvantage.

Being 'fat' in today's world : a qualitative study of the lived experiences of people with obesity in Australia

Objective  To develop an in-depth picture of both lived experience of obesity and the impact of socio-cultural factors on people living with obesity.

Design  Qualitative methodology, utilizing in-depth semi-structured interviews with a community sample of obese adults (body mass index ≥30). Community sampling methods were supplemented with purposive sampling techniques to ensure a diverse range of individuals were included.

Results  Seventy-six individuals (aged 16–72) were interviewed. Most had struggled with their weight for most of their lives (n = 45). Almost all had experienced stigma and discrimination in childhood (n = 36), as adolescents (n = 41) or as adults (n = 72). About half stated that they had been humiliated by health professionals because of their weight. Participants felt an individual responsibility to lose weight, and many tried extreme forms of dieting to do so. Participants described an increasing culture of ‘blame’ against people living with obesity perpetuated by media and public health messages. Eighty percent said that they hated or disliked the word obesity and would rather be called fat or overweight.

Discussion and Conclusion  There are four key conclusions: (i) the experiences of obesity are diverse, but there are common themes, (ii) people living with obesity have heard the messages but find it difficult to act upon them, (iii) interventions should be tailored to address both individual and community needs and (iv) we need to rethink how to approach obesity interventions to ensure that avoid recapitulating damaging social stereotypes and exacerbating social inequalities.

Influencing student retention and success : a qualitative assessment of library use by distance education students from low socio-economic backgrounds

Poster presentation

The flower workshop in psychosocial rehabilitation: A pilot study

We report a pilot study with the Flower Workshop, a new modality of psychosocial rehabilitation group activity. Cognitive performance in schizophrenia and other mental conditions can be impaired depending on the tasks to be executed and their respective social context. The vulnerability of these individuals can be reduced by means of cognitive and socio-affective facilitation. We conducted a pilot study to introduce the Flower Workshop in a public Mental Health Service in the city of Ribeirao Preto (Sao Paulo-Brasil) with 12 participants during 18 months (2002-2003). With cognitive and socio-affective facilitation, participants were able to construct vases and make flower arrangements successfully.

A socio-environmental development programme in action in Brazilian Amazonia

This paper deals with the process of scaling up and scaling down grassroots demands through a state-sponsored socio-environmental development programme in Brazilian Amazonia called Proambiente (Pro-environment). The paper attempts to understand the links between the three different levels of the programme actions: the macro (federal government), intermediate (NGOs), and local (community) levels. The central paper s issue is to understand how a state-sponsored socio-environmental development programme interacts with and impacts local communities. The theoretical paper s framework involves the approaches of participatory development and governance. The methodology is based on three levels of qualitative analysis (macro-, intermediary- and local-level). The paper (a) describes the trajectory of the Proambiente and the process of scaling up communities demands; (b) reveals contradictions within the Proambiente implementation; and (c) debates the impacts of the programme actions at local level. The paper reveals that once the state encompasses local people s demands and creates a development programme, the development model absorbs multi-actor interests that change local people s proposals. It also shows that the challenge facing a socio-environmental development programme like the Proambiente is to find a balance between production and conservation aims.

Testo e memoria tra semiotica e scienze cognitive: una situazione sperimentale intorno al ricordo di un film

The research project presented in this dissertation is about text and memory. The title of the work is "Text and memory between Semiotics and Cognitive Science: an experimental setting about remembering a movie". The object of the research is the relationship between texts or "textuality" - using a more general semiotic term - and memory. The goal is to analyze the link between those semiotic artifacts that a culture defines as autonomous meaningful objects - namely texts - and the cognitive performance of memory that allows to remember them. An active dialogue between Semiotics and Cognitive Science is the theoretical paradigm in which this research is set, the major intend is to establish a productive alignment between the "theory of text" developed in Semiotics and the "theory of memory" outlined in Cognitive Science. In particular the research is an attempt to study how human subjects remember and/or misremember a film, as a specific case study; in semiotics, films are “cinematographic texts”. The research is based on the production of a corpus of data gained through the qualitative method of interviewing. After an initial screening of a fulllength feature film each participant of the experiment has been interviewed twice, according to a pre-established set of questions. The first interview immediately after the screening: the subsequent, follow-up interview three months from screening. The purpose of this design is to elicit two types of recall from the participants. In order to conduce a comparative inquiry, three films have been used in the experimental setting. Each film has been watched by thirteen subjects, that have been interviewed twice. The corpus of data is then made by seventy-eight interviews. The present dissertation displays the results of the investigation of these interviews. It is divided into six main parts. Chapter one presents a theoretical framework about the two main issues: memory and text. The issue of the memory is introduced through many recherches drown up in the field of Cognitive Science and Neuroscience. It is developed, at the same time, a possible relationship with a semiotic approach. The theoretical debate about textuality, characterizing the field of Semiotics, is examined in the same chapter. Chapter two deals with methodology, showing the process of definition of the whole method used for production of the corpus of data. The interview is explored in detail: how it is born, what are the expected results, what are the main underlying hypothesis. In Chapter three the investigation of the answers given by the spectators starts. It is examined the phenomenon of the outstanding details of the process of remembering, trying to define them in a semiotic way. Moreover there is an investigation of the most remembered scenes in the movie. Chapter four considers how the spectators deal with the whole narrative. At the same time it is examined what they think about the global meaning of the film. Chapter five is about affects. It tries to define the role of emotions in the process of comprehension and remembering. Chapter six presents a study of how the spectators account for a single scene of the movie. The complete work offers a broad perspective about the semiotic issue of textuality, using both a semiotic competence and a cognitive one. At the same time it presents a new outlook on the issue of memory, opening several direction of research.

Controlled Software Evaluation Methodology: Case Simulation and Cognitive User Analysis

Software for use with patient records is challenging to design and difficult to evaluate because of the tremendous variability of patient circumstances. A method was devised by the authors to overcome a number of difficulties. The method evaluates and compares objectively various software products for use in emergency departments and compares software to conventional methods like dictation and templated chart forms. The technique utilizes oral case simulation and video recording for analysis. The methodology and experiences of executing a study using this case simulation are discussed in this presentation.