Applying state space grids methods to characterize counsellor-client interactions in a physical activity behavioural intervention for adults with disabilities.

BACKGROUND: Physical activity (PA) counselling research has mainly focused on identifying which behaviour change techniques (BCTs) are delivered by a counsellor. Less is known about how BCTs are received by clients. State Space Grids (SSGs) is a dynamic system method that can be used to study counsellor-client interactions by examining frequencies, durations and sequences of BCT delivery and receipt. In this methods paper, we show how SSG methods can be pragmatically used to characterize counsellor-client interactions during a PA behavioural support intervention for adults with disabilities. METHODS: Methods were demonstrated through a secondary analysis of data from adults with spinal cord injury (age: 45.79 ± 13.63; females: n = 5; males: n = 9) who received PA counselling. Transcripts of 30 audio-recorded counselling sessions (total duration: ∼8.3 h) were double-coded for BCT delivery and receipt statements using a reliable coding method (>84% agreement) and analyzed in two different ways using SSGs methods. RESULTS: Applying the SSG analyses to our data demonstrated that frequencies, durations, and sequences of BCT delivery and receipt varied largely within and between dyads. Across all sessions, the counsellor and client spent on average 32-34% of their time on talking about BCTs related to goals and planning, ∼29% of their time talking about other BCTs (e.g., self-belief, support strategies), and the remaining 27-29% of their time talking about other topics (not BCT-specific). CONCLUSION: This paper showed how dynamic system methods can be pragmatically used to characterize counsellor-client interactions and illustrate the variability of how BCTs are delivered by a counsellor and received by clients in a PA behavioural support intervention. We demonstrated that SSGs methods can facilitate the examination of frequencies, durations and sequences of BCT delivery and receipt can help advance our understanding of PA behavioural support for adults with and without disabilities.

A dynamic analysis of physical activity barriers experienced by adults with spinal cord injury.

OBJECTIVES: To track and evaluate changes in the number and types of physical activity barriers experienced by adults with spinal cord injury (SCI) in response to a physical activity counselling intervention, using a newly-developed tracking and coding method. DESIGN: A secondary analysis of data from a randomized controlled trial of a physical activity behavioural intervention (#NCT03111030). SETTING: General community. PARTICIPANTS: Adults with chronic SCI (n = 14). INTERVENTION: An introductory behavioural coaching session followed by eight, weekly follow-up sessions were delivered in-person or by phone/video call. The interventionist utilized behaviour-change techniques tailored to individual participants' readiness for change, barriers, and preferences. Participants set goals for achieving the SCI exercise guidelines. Coaching sessions were audio-recorded and transcribed verbatim. MAIN OUTCOME MEASURE(S): Changes over time in the number of barriers reported within each level of a social-ecological model of influences on physical activity (intrapersonal, interpersonal, institutional, community, policy). RESULTS: A total of 152 physical activity barriers were identified across 122 coaching sessions. Within each level of influence, the number of identified barriers decreased significantly over the intervention period. Intrapersonal barriers (e.g., lack of motivation, low self-efficacy) were most frequently reported and showed the greatest reductions over time. CONCLUSIONS: Using a new coding method to track changes in physical activity barriers, this pilot project showed a significant decrease in barriers over the course of a counselling intervention. Understanding physical activity barrier dynamics can improve the design of physical activity-enhancing interventions. Dynamic barrier-tracking methods could also be used to improve intervention implementation and evaluation.

Measuring behavior change technique delivery and receipt in physical activity behavioral interventions.

PURPOSE/OBJECTIVE: Research on physical activity behavioral support has mainly focused on measuring the absence or presence of behavior change techniques (BCTs) delivered by a counselor. We present a method to measure BCT delivery and receipt in physical activity behavioral support interventions. RESEARCH METHOD/DESIGN: The method was developed and tested using transcripts from behavior change counseling sessions delivered as part of a theory- and evidence-based physical activity intervention for adults with disabilities. Using existing methods, a new method was developed to code counselor and clients' verbal statements (BCTs and other statements). Two coders independently coded 30 transcripts of audio-recorded counseling sessions. Interrater reliability was assessed using percentage agreement and Prevalence Adjusted Bias Adjusted Kappa (PABAK). RESULTS: Forty-eight codes were developed for counselor statements (35 BCT delivery and 13 other statements) and 46 codes for client statements (34 BCT receipt and 12 other statements). The average interrater reliability was considered nearly perfect for the counselor statements (84% agreement; PABAK = .98) and client statements (86% agreement; PABAK = .98). The BCT delivered and received were most frequently related to Goals and Planning (counselor:36%, client:35%), Support Strategies (counselor:21%, client:17%) and Self Belief (counselor:13%, client:24%). CONCLUSIONS/IMPLICATIONS: This study presents a reliable coding method to measure BCT delivery and receipt in physical activity behavioral support interventions. The method can be used to enhance intervention fidelity assessment and study interactions between counselors and clients with and without disabilities. Measuring and evaluating BCT delivery and receipt can provide new insights into what types of behavioral support work best under which circumstances. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Improving Diabetes Care in the British Columbia Southern Interior: Developing Community‒University Initiatives to Address Service Gaps.

OBJECTIVES: Diabetes rates in the British Columbia (BC) interior are rising more rapidly compared with the rest of Canada, whereas diabetes service provision is limited within this region. The purposes of this article were: 1) to identify characteristics of diabetes service delivery; and 2) to co-develop community‒university diabetes research projects to address service barriers and gaps in the BC southern interior across urban, rural and Indigenous populations. METHODS: A 3-step approach was used. In step 1, a web search was conducted to identify diabetes-related services. In step 2, 10 community members working or volunteering in diabetes organizations participated in semistructured telephone interviews pertaining to diabetes service access, priorities, barriers, benefits and gaps. In step 3, a meeting of researchers and community members (n=25) was held to foster collaboration and co-develop research projects. RESULTS: Seventy-eight urban, rural and Indigenous diabetes-related services were identified in the BC southern interior. Provision of care to those with new type 1 diabetes and gestational diabetes diagnoses was identified in the interviews as a key priority; the needs of these groups contribute to a deficiency of resources to deliver prediabetes programs. The meeting produced plans for 2 collaborative projects: (1) the development of a diabetes patient journey map, and (2) development of a diabetes service hub with navigators for patients. CONCLUSIONS: Together, community members and researchers have identified service gaps and formulated research projects to improve diabetes management for urban, rural and Indigenous peoples living in the BC southern interior.