Wearable Technology as a Method of Promoting Physical Activity

According to the World Health Organisation, in the last decade more than a quarter of adults globally are understood to participate in less than the minimum recommended 150 minutes of moderate physical activity (PA) weekly, resulting in physical inactivity accounting for approximately 3.2 million deaths annually (Mendis, 2014; WHO, 2009).

Furthermore, sedentary behaviour remains a public health issue resulting in illnesses or noncommunicable diseases, effectively reinforced in Coughlin & Stewart (2016) study highlighting that obesity remains a global epidemic, with figures reporting 33% of adults and 17% of adolescents within the USA are overweight.

Subsequently, wearable devices are innovative mechanisms which promote positive motivational behaviours towards individuals who consider increasing their PA levels (Mendis, 2014). According to O’Brien et al. (2016) consumer purchase rates of wearable devices, Fitbit and Garmin, were predicted to target younger generations, who currently maintain healthy PA lifestyles, as they were becoming more affordable and introduced as a social feature.

Popular wearable devices evaluate various health and fitness-related components including sleep, step count, heartrate data and calories. Lyons et al. (2014) highlight the importance of introducing self-monitoring behaviour features and supplying visual feedback straight from your mobile allowing easier and appropriate data storing. These behavioural change features desire the need for long-term consumption, where individuals can track their health by setting their own goals or maintaining self-monitoring objectives or track their fitness-related levels for performance purposes.

Subsequently, Mercer et al. (2016) highlights the concern that wearable devices are being targeted towards mobile phone users, stating activity-centred applications offer photographic commands, self-enhancing challenges, encourage self-monitoring, and emphasise current behaviours. These features are reinforced by Conroy et al. (2014) who examined reports of 167 most common mobile applications regarding their authenticity of behavioural change techniques. Conroy et al. (2014) concluded the most conventional techniques for developing behaviour change were goal setting, reinforcing standard behaviour, providing feedback on particular performances and incorporating social supportive classes.

Simultaneously, Lyons et al. (2014) concluded wearable devices offered encouraging self-monitored behaviour strategies, supportive goal setting features and delivered productive advice regarding behaviour change. Further reports highlight data connecting the practicality and capability of devices along with content involved in mobile applications offering guidance on techniques that can be manipulated within behavioural practices more appropriately considering the client’s desires (Lyons et al. 2014). 

Evenson, Goto and Furberg (2015) reported that results from 2012 USA analysis reveal 69% of adults following one health-related aspect with the assistance of a tracking technique. From this, 46% admitted that preserving their health-related data improved their attitude towards maintaining positive wellbeing and encouraged them to consciously remain intrinsically motivated.

Coughlin and Stewart (2016) suggest further research to study the productivity of encouraging PA levels through wearable devices, meanwhile scrutinizes the lack of randomised control trials needed to better discover the opportunities delivered through wearable devices for promoting PA across all generations.

Alternatively, Mercer et al. (2016) concluded wearable devices are advanced projects with promising accomplishments encouraging positive behaviour change across various populations. These devices are easily manipulated into the needs of wider populations and incorporated as part of wellbeing interventions throughout medical environments. Mercer et al. (2016) scrutinised the directed attraction of wearable devices towards younger individuals and proposes encouraging techniques for older users overcoming barriers by effectively solving problems, increasing their self-efficacy performance and provide practices to initiate or improve PA in line with the commitment of additional devices.

A critical review of a recent peer reviewed journal article which has used motivational interviewing as part of the behavioural change intervention

Motivational Interviewing (MI) is described as a collaborative guidance policy primarily client-based to initiate and inspire their motivational experiences and thoughts regarding optimistic behaviour change (Bank, 2019). Sim, Wain and Khong (2009) clarify that MI concentrates on the client’s emotional and physical encounters concerning PA, although the responsibility of the interviewer is knowingly directing the client away from uncertainty and encourage them towards increasing their intrinsic motivation.

As stated by World Health Organisation (WHO, 2009), physical inactivity is the fourth leading reason for death globally, therefore suggests tackling these harsh realities by intentionally recommending professional advice regarding behavioural change counselling to mentally and physically support individuals towards increased PA. Gagnon et al. (2018) reported from a systematic review PA counselling procedures were almost non-existent, which is understood as one of the main concerns’ health professionals face currently without the appropriate training to provide accurate treatment designed for PA. A better understanding of the necessities and mechanisms required for PA counselling would develop insight into the direction the intervention progresses and how it can be implemented (Gagnon et al. 2018).

Within their research, Gagnon et al. (2018) examine the quality and validity of PA counselling assessing the influence an interviewer may have on the motivation among patients in a primary nursing setting. PA counselling is an interview-based intervention which encompasses MI and behavioural change techniques. MI focussed interventions are majorly complicated and consist of four groupings that contain introducing constructive client-clinician relationships, learning a simple resolution in the direction of positive change, solving uncertainty, emphasising motivation to change and integrating this with the client’s pledge to change (Gagnon et al. 2018).

Regarding the theory by Gagnon et al. (2018), several research investigations support the evidence that MI interventions are effective. A meta-analysis involving 72 random control trials concluded that 80% of findings endorsed the effectiveness and quality of MI techniques more successful assisting in various health-related concerns, including weight or mental health matters (Armstrong et al., 2011). Samdal et al. (2017) reported findings from a meta-analysis revealed MI interventions were largely related to an augmented level of maintenance regarding healthy eating behaviours or PA periods over a course of one year among overweight adults.

Gagnon et al., (2018) concluded a single study of 22 MI counselling sessions distributed by university students, who were training to develop into enrolled health professionals, all of which endured sufficient education. The procedure consisted of PA counselling sessions defining relationships with the client, solving uncertainty, highlighting intrinsic motivation, and determining PA strategies conditional to the client’s wish to change.

Moreover, Gagnon et al., (2018) concluded from their research that positive behavioural change adequately correlates to self-monitoring behavioural change techniques and MI techniques, more so between goal setting, action development and problem-solving techniques leading the research analysis.

Thus, it was reported goal setting, action development and problem-solving processes were highlighted as productive behaviour change techniques for encouraging clients to initiate or maintain participating in PA. This information is reinforced through the study of Rhodes and Plaeffli (2010), which states self-monitoring behavioural change techniques initiate a more significant reaction regarding positive behaviour change and maintenance of intrinsic motivation regarding PA.

A theory & literature based critique of a motivational interviewing session – focussing on explaining the techniques used by the interviewer

Motivational interviewing (MI) is an innovative counselling approach that is introduced for enhancing or initiating behaviour change by assisting clients in resolving uncertainty and aims to encourage individuals in implementing changes to their behaviour or maintaining specific behaviours (Bundy, 2004). MI has become extensively researched over the years and considered as the most effective client-centred approach to encourage positive changes regarding individual behaviour (Miller & Rollnick, 1991). MI consists of strategies which must be adhered from the interviewers’ point of concept, by displaying sympathetic traits and never coming across as provocative, while describing convincing statements as opposed to intimidating the client (Miller & Rollnick, 1991). A text-book released by Miller and Rollnick (1991) and a separate journal by Latchford (2010) provide insight into key strategies that define the practice of MI from health professionals within a clinical establishment.

The broad process into these strategies involves demonstrating empathy towards your client through reflective listening (Martin & Hodgson, 2006). Offering empathy is the key principle for starting a conversation, which is transmitted through two stages, surface and deeper. Surface conversations mask the truth about how your client is genuinely feeling and may believe presenting vague answers implies the interviewer would lead the conversation although the subject matter regards their behaviour (Wagner, 2013).

Deeper conversations happen when people feel comfortable and start to become truthful about how they really feel, which will mostly happen in people we trust (Rosengren, 2017). Evolving discrepancy, as characterised by Miller and Rollnick (1991) is motivating the client to accept and initiate the significance of changing their behaviour and establishing balances between current behaviour and expected goals.

Preventing disputes is a key component as arguments generate the likelihood of your client following inconsistency, allowing conversations to flow without immediate conflict will enable the interviewer to adjust to the opposition from the client. Establishing client self-efficacy as defined by Lachford (2010) is the final necessary element within MI, concentrating on the client’s strengths as opposed to dwelling on their vulnerability can enhance their motivation essential for change.

These strategies are essential for delivering successful, directive client-centred interviews, subsequently Latchford (2010) and Miller and Rollnick (1991) equally agree clinical professionals who indicate these strategies as their preferred style of interviewing, have specified that detailed techniques introduced from these strategies are convenient and valuable in rehabilitation. Latchford (2010) defines five techniques used within MI principles, while Miller and Rollnick (1991) define six techniques, with the insertion of decisional balance.

The five techniques approved by both authors were asking open-ended questions allowing the professional to collate as much material desired instead of only ‘yes’ or ‘no’ answers; providing emotional support encouraging the client to highlight their positive assets than faults (Shinitzky & Kub, 2001); debriefing each aspect of the session independently allowing possible underpinning of key themes; determining self-supported observations allowing the client to express their view concerning apprehensions (McCormick et al., 2018); and cognitive listening to establish that professionals have followed the client’s control and recognises their value.

Miller and Rollnick (1991) also included decisional balance as the sixth key technique than can be manipulated, which is used to evaluate the pleasurable and unpleasant attributes regarding current behaviour.

To conclude, Latchford (2010) states with any clinical environment, the main goal when implementing MI interventions is to engage in positive conversation, without introducing constructive welcoming conversation, the client will be extremely dispassionate in sharing information.

References

• Bank, S. (2019). Motivational interviewing. Rehabilitation, 7, 8th.
• Bundy, C. (2004). Changing behaviour: using motivational interviewing techniques. Journal of the Royal Society of Medicine, 97(Suppl 44), 43.
• Conroy, D. E., Yang, C.-H., & Maher, J. P. (2014). Behaviour Change Techniques in Top-Ranked Mobile Apps for Physical Activity. American Journal of Preventive Medicine, 46(6), 649–652.
• Coughlin, S. S., & Stewart, J. (2016). Use of consumer wearable devices to promote physical activity: a review of health intervention studies. Journal of Environment and Health Sciences, 2(6).
• Evenson, K. R., Goto, M. M., & Furberg, R. D. (2015). Systematic review of the validity and reliability of consumer-wearable activity trackers. International Journal of Behavioural Nutrition and Physical Activity, 12(1), 159.
• Gagnon, J.-C., Fortier, M., McFadden, T., & Plante, Y. (2018). Investigating the behaviour change techniques and motivational interviewing techniques in physical activity counselling sessions. Psychology of Sport and Exercise, 36, 90–99.
• Latchford, G. (2010). A brief guide to motivational interviewing. Clinical Psychology Training Programme, Leeds Institute of Health Sciences, University of Leeds.
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• Mendis, S., World Health Organization. Geneva, Switzerland; (2014). Global status report on noncommunicable diseases 2014.
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• Miller, W. R. & Rollnick, S. (1991). Motivational Interviewing: Preparing People to Change Addictive Behaviour. New York: Guilford.
• O’Brien, T., Troutman-Jordan, M., Hathaway, D., Armstrong, S., & Moore, M. (2015). Acceptability of wristband activity trackers among community dwelling older adults. Geriatric Nursing, 36(2, Supplement), S21–S25.
• Rhodes, R. E., & Pfaeffli, L. A. (2010). Mediators of physical activity behaviour change among adult non-clinical populations: a review update. International Journal of Behavioural Nutrition and Physical Activity, 7(1), 37. https://doi.org/10.1186/1479-5868-7-37
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• Wagner, C. C. (2013). Motivational interviewing and client-centred therapy. In Interdisciplinary applications of the person-centred approach (pp. 43–47). Springer.