| Objectives:To intervene the obese children for weight and take stage-matched interventional measures for children at different stages (stage of physical exercise and cognition of the harm of obesity) based on Transtheoretical Model of Change(TTM) and Motivational Interviewing (MI), and then evaluate the effect of intervention; to explore a usefuk simple intervention model which is easy for obese children to stick to and to promote the relevance of the intervention.Method:This is an experimental study. After the pilot study aiming to perfect the interventional programs>, assessment tools and questionnaires,128qualified obese children were selected from2primary schools of Changsha by random sampling. According to their location of schools, the samples were divided into two groups:65in intervention group and63in control group. The 《Health education and self-assessment brochure for obese children》 were delivered to obese children and their supporters in experimental group after baseline; And Motivational interviewing (MI) was carried out for the obese children in the stage of Pre-contemplation and contemplation to enhance their motivation to weight control, yet the control group was not given these. The two groups were respectively receipted the same assessment at four time phrase:baseline (T0)、 one month after intervention(T1)、 three months after intervention(T3)、follow-up (six months after baseline, T6) The three following reports were completed and given to the subjects at5-8days after baseline, one month after intervention, and two months after intervention, respectively. The Follow-up reports were written according to the assessment questionnaire completed by the obese which summarized the current status of weight loss、 problems existing corresponding measures and so on. In the study, there were some key factors needed to evaluate. The physical exercise situation(average times of indoor/outdoor exercise、the times of keeping30mins、3d、7d or more)、 state of the communication with supporters(frequency and satisfaction)、 weight management process(Stage、Self-efficacy Decisional-balance and process of change)、 Diet(vegetables、 fruits、 meat)、BMI (Body Mass Index) were evaluated for all participants pre and post intervention. Long-term effects of the intervention on physical exercise situation、 state of the communication with supporters、 weight control process、 Diet、 BMI were further evaluated in the following6months as the follow-up process.Results:1. The baseline results showed that the majority of children(65.6%) were in Pre-contemplation/Contemplation/Preparation stage; But fewer children were in Action/Maintenance stage, and a weaker awareness of weight control by exercising.2. Analysis of post-intervention data(1) Physical exercise situationsRepeated measures analysis of variance showed that main intervention、time effects and interactions between time and intervention on times of keeping exercise30mins、3d、7d or more were all significant(P<0.05). And the interaction diagram indicated that the increase degree of times of keeping exercise30mins、3d、7d or more were higher in intervention group than that of control group in the3-month intervention.Compared the physical exercise situations between the intervention and control group at T0、T1、T3and T6, there were no significant differences(P>0.05) in times of keeping exercise30mins、3d、7d or more at T0,all indicators above between the two groups were statistically significant (P<0.05) at T1、T3and T6.(2) Diet situationsVegetables、 fruits、 meat at T0、T1、 T3and T6were analyzed by Chi-Square Test and the trend of change showed that the times of vegetables and fruits in-take increased and the the times of meat decreased in intervention group as time evolved.(3) Communication with the supportersCompared the frequency and satisfaction of communication with the supporters between the intervention and control group at T0、T1、T3and T6, the results indicated that the differences between the frequency and satisfaction of communication with the supporters didn’t reached significant (P>0.05) at To, and the differences between the intervention and control group at T1、T3and T6were significant(P<0.05).(4) Exercise to lose control processRepeated measures analysis of variance showed that main intervention、time effects and interactions between time and intervention on the Process of Change、Self-Efficacy、 Decisional-Balance reached significant(P<0.05). And the interaction diagram showed that the increase degree of Cognitive Processes、 Behavioral Processes、 Self-Efficacy、 Pros and Cons were higher in intervention group than that of control group in the3-month intervention and follow-up as time evolved.Compared the exercise to weight control process between the intervention and control group at T0、 T1、 T3and T6, there were no significant differences (P>0.05) in the Stages、 Cognitive Processes、 Behavioral Processes、 Self-Efficacy、 Pros and Cons at To, and all indicators above between the two groups were statistically significant (P<0.05) at T1、 T3and T6.(5) BMI situationCompared the BMI between the intervention and control group at To、 T1、 T3and T6and the trend chart of change showed there was no obvious difference between the two groups.(6) The forecasting model of whether to go for exercise after follow-upModelled the generalized estimating equations(GEE), the results indicated that gendern age、 Pros were not significantly different(P>0.05) in whether to participate in exercise; There existed positive correlation between whether to go to exercise and the Correlation coefficient was0.383(P<0.05), Cognitive Processes、Behavioral Processes、 Self-Efficac、Cons、goals about weight loss and times of keeping exercise7d or more were all statistically significant(P<0.05). After been controlled the indicators above, then the differences between the two groups whether to participate in exercise were significant after follow-up(P<0.05). Conclusion:1. The intervention based on TTM increased the times of30min、3d、7d or more; the intervention improved the communication situations between obese children and supporters, especially the frequency and satisfaction of communication.2. TTM advanced the stages of change; improved the Processes of weight control to change in a beneficial direction.3. The effect of TTM on BMI will be needed further studies. |
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