Brief motivational interviewing delivered via information communication technologies to promote regular physical activity in pediatric cancer survivors: A pilot randomized controlled trial
Author: Ankie Tan Cheung (RN, PhD), The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong
Pediatric cancer is an emerging global child health priority as it is a leading cause of death in children and adolescents (Miller et al., 2020). Ongoing advances in early detection and cancer treatment contribute to a significant increase in the overall five-year survival rate of pediatric cancer, currently approaching 85% (Miller et al., 2020). Despite improved survival rate, an estimated two-thirds of pediatric cancer survivors develop at least one chronic health condition, including cardiopulmonary disease, endocrine and musculoskeletal disease, cancer-related fatigue, functional impairment, and psychological distress, all of which jeopardize their quality of life (QoL) throughout the survivorship trajectory (Oeffinger et al., 2006).
Physical activity (PA) has protective and beneficial effects in attenuating the late effects incurred by cancer and/or its treatment (Morales et al., 2021). However, many pediatric cancer survivors do not participate in adequate physical activity to confer the health benefits associated with PA. The problem of physical inactivity is particularly critical in Hong Kong Chinese pediatric cancer survivors, with approximately 92.2% of Chinese survivors (vs 52.1% Western counterparts) do not comply with the World Health Organization recommended PA guideline for children and adolescents (i.e., minimum of 60 min of moderate-to-vigorous PA daily) (Chung et al., 2014; Stolley et al., 2010).
Adopting an innovative and sustainable approach to promote regular PA in pediatric cancer survivors is therefore necessary. Growing evidence suggests the efficacy of using motivational interviewing (MI) with parents to promote health-enhancing behavior in children, such as eating habits and weight management (Norman et al., 2016; Wong & Cheng, 2013). Yet, empirical evidence is lacking for its feasibility in promoting PA among pediatric cancer survivors. Therefore, we conducted a two-group pre-/post-test pilot randomized controlled trial to examine the feasibility and preliminary effect of a brief MI to promote PA, improve cancer-related fatigue, muscular strength, peak expiratory flow rate and QoL in pediatric cancer survivors. A total of 30 pediatric cancer survivors aged between 9 and 16 years and their parents were recruited. These parent-child dyads were randomly allocated to the intervention (n=16; a 3-month brief MI delivered via instant messaging applications) and control groups (n=14; usual care). According to Cohen’s (1992) guidelines, small-to-medium effect sizes were found for the outcome variables. All parents were satisfied with the intervention and supported the use of mobile instant messaging applications (i.e., WhatsApp/WeChat) to deliver the brief MI intervention. Many parents described the approach was feasible and acceptable to motivate them to encourage their children to engage in regular PA. Most parents reported that the intervention enhanced their awareness of the significance of PA for their children and understanding of the specific health benefits thereof. It is worth noting that parents perceived that the intervention provided them personalized support that suited the needs of their families. Further, the parents appreciated the flexibility of the communication with the counselor, the continuous and timely professional advice throughout the intervention period. However, a larger-scale randomized controlled trial is warranted to ascertain the efficacy of such an intervention in promoting PA in pediatric cancer survivors.
Chung, O. K., Li, H. C., Chiu, S. Y., Ho, K. Y., & Lopez, V. (2014). The impact of cancer and its treatment on physical activity levels and behavior in Hong Kong Chinese childhood cancer survivors. Cancer Nursing, 37(3), E43–E51. https://doi.org/10.1097/NCC.0b013e3182980255
Cohen, J. (1992). A power primer. Psychol Bull, 112(1), 155-159.
Morales, J. S., Valenzuela, P. L., Velázquez-Díaz, D., Castillo-García, A., Jiménez-Pavón, D., Lucia, A., & Fiuza-Luces, C. (2021). Exercise and Childhood Cancer-A Historical Review. Cancers, 14(1), 82. https://doi.org/10.3390/cancers14010082
Miller, K. D., Fidler-Benaoudia, M., Keegan, T. H., Hipp, H. S., Jemal, A., & Siegel, R. L. (2020). Cancer statistics for adolescents and young adults, 2020. CA: A Cancer Journal for Clinicians, 70(6), 443–459. https://doi.org/10.3322/caac.21637
Oeffinger, K. C., Mertens, A. C., Sklar, C. A., Kawashima, T., Hudson, M. M., Meadows, A. T., Friedman, D. L., Marina, N., Hobbie, W., Kadan-Lottick, N. S., Schwartz, C. L., Leisenring, W., Robison, L. L., & Childhood Cancer Survivor Study (2006). Chronic health conditions in adult survivors of childhood cancer. The New England Journal of Medicine, 355(15), 1572–1582. https://doi.org/10.1056/NEJMsa060185
Stolley, M. R., Restrepo, J., & Sharp, L. K. (2010). Diet and physical activity in childhood cancer survivors: a review of the literature. Annals of Behavioral Medicine : a publication of the Society of Behavioral Medicine, 39(3), 232–249. https://doi.org/10.1007/s12160-010-9192-6