Efficacy of brief motivational interviewing delivered to parents via information communication technology in promoting regular physical activity among Hong Kong Chinese paediatric cancer survivors

Abstract

Paediatric cancer survivors experience a wide array of physical and psychosocial late effects throughout their lives, all of which jeopardise their quality of life (QoL). Physical activity (PA) exerts protective and beneficial effects that mitigate cancer- and treatment-related late effects for paediatric cancer survivors. Nonetheless, paediatric cancer survivors tend to be physically inactive and therefore do not reap the health benefits associated with PA. Motivational interviewing (MI) has demonstrated its promising effect on enhancing adaptive behaviour changes, including PA. Yet, empirical evidence is lacking for its efficacy in promoting PA adoption and maintenance among paediatric cancer survivors. The aims of this thesis were as follows: (1) to evaluate and summarise the current evidence relating to the effectiveness of interventions in promoting PA among paediatric cancer survivors; (2) to explore parental perspectives regarding the importance of PA for survivors; and (3) to examine the effectiveness of a brief MI delivered via instant messaging (IM) applications on PA levels, cancer-related fatigue and QoL in Hong Kong Chinese paediatric cancer survivors. A systematic review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement guidelines. Subsequently, an exploratory qualitative study involving interviews with a purposive sample of 28 parents of survivors were performed to explore parental perceptions of the importance of PA for their children. A pilot randomised controlled trial (RCT) was then conducted, followed by the main RCT. A total of 161 Chinese paediatric cancer survivors aged 9 to 16 years and their parents were recruited in two paediatric outpatient clinics in Hong Kong. These 161 parent-child dyads were randomly assigned to either an experimental group (n = 81; brief MI delivered via IM applications) or a control group (n = 80; usual care). The primary outcome was the survivors’ PA levels at 12 months after intervention started. The secondary outcomes included the cancer-related fatigue levels, left- and right- hand grip strengths, peak expiratory flow rates, and QoL of the children at 6 and 12 months after intervention started. Final data analysis followed the intention-to-treat principle. The systematic review revealed that digital health interventions (e.g., information communication technology) seem to be a feasible approach to promote increased levels of PA in paediatric cancer survivors. The qualitative study indicated that the parents were generally unaware of the significance of PA for their children. The RCT showed that compared with the control group, the experimental group exhibited a significantly greater improvement in PA levels (p < 0.001), cancer-related fatigue (p < 0.001), left- (p < 0.001), and right-hand grip strength (p < 0.001), and QoL (p < 0.001) over 12-month follow-up. This study provides empirical evidence that brief MI delivered to parents via ICT is effective and feasible in promoting the adoption and maintenance of regular PA, reducing cancer-related fatigue, and improving muscle strength and QoL among paediatric cancer survivors. Further studies should be performed to ascertain the sustainability of brief MI. Findings from this thesis have significant implications for paediatric cancer survivorship care provided in current clinical practice.