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

BackgroundPhysical activity (PA) counselling research has mainly focused on identifying which behavior change techniques (BCTs) are delivered by a counsellor. Less is known about how BCTs are received by clients. State Space Grids (SSG) 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. This study demonstrates how to use SSG to characterize counsellor-client interactions during a PA behavioural support intervention for adults with disabilities. Methods This secondary data analysis study used 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 hours) were double-coded for BCT delivery and receipt statements using a reliable coding method (&amp;gt;84% agreement) and analyzed using SSG methods. Results The SSG analyses revealed 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 study showed how dynamic system methods can be 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 insights into frequencies, durations and sequences of BCT delivery and receipt can help advance our understanding of PA behavioural support for adults with and without disabilities. 

Counsellor-client interactions in a physical activity behavioural intervention for adults with disabilities: A State Space Grid analysis study

Physical Activity (PA) levels for individuals with spinal cord injury (SCI) peak during rehabilitation and sharply decline post-discharge. The ProACTIVE SCI intervention has previously demonstrated very large-sized effects on PA; however, it has not been adapted for use at this critically understudied timepoint. The objective is to evaluate the reach, effectiveness, adoption, implementation, and maintenance of the ProACTIVE SCI intervention delivered by physiotherapists and SCI peer coaches during the transition from rehabilitation to community.A single-group, within-subjects, repeated measures design was employed. The implementation intervention consisted of PA counseling training, champion support, prompts and cues, and follow-up training/community of practice sessions. Physiotherapists conducted counseling sessions in hospital, then referred patients to SCI peer coaches to continue counseling for 1-year post-discharge in the community. The RE-AIM Framework was used to guide intervention evaluation.Reach: 82.3% of patients at the rehabilitation hospital were reached by the intervention. Effectiveness: Interventionists (physiotherapists and SCI peer coaches) perceived that PA counseling was beneficial for patients. Adoption: 100% of eligible interventionists attended at least one training session. Implementation: Interventionists demonstrated high fidelity to the intervention. Intervention strategy highlights included a feasible physiotherapist to SCI peer coach referral process, flexibility in timepoint for intervening, and time efficiency. Maintenance: Ongoing training, PA counseling tracking forms, and the ability to refer to SCI peer coaches at discharge are core components needed to sustain this intervention.The ProACTIVE SCI intervention was successfully adapted for use by physiotherapists and SCI peer coaches during the transition from rehabilitation to community. Findings are important for informing intervention sustainability and scale-up.

Assessing the reach, effectiveness, adoption, implementation, and maintenance of the ProACTIVE SCI physical activity counseling intervention among physiotherapists and SCI peer coaches during the transition from rehabilitation to community

This study aims to assess the effectiveness of M-Gym media in enhancing the learning experience of rhythmic gymnastics for students and lecturers in Indonesia. The development of M-Gym media integrates interactive digital tools and structured instructional content to support the pedagogical process in rhythmic gymnastics education. The research employed a mixed-method approach, combining quantitative assessments and qualitative feedback to evaluate the impact of M-Gym on learning outcomes. Quantitative data were collected through pretest and posttest evaluations to measure the improvement in students' performance and understanding of rhythmic gymnastics. Qualitative data were obtained from interviews and focus group discussions with students and lecturers, providing insights into their experiences and perceptions of using M-Gym in the learning process. The results showed a significance of (p=0.000 &lt;0.05), hence there was a significant improvement in students' rhythmic gymnastics skills and knowledge, evidenced by higher posttest scores compared to pretest scores. In addition, feedback from lecturers and students highlighted the usability, accessibility, and motivational aspects of M-Gym, which contributed to a more engaging and effective learning environment. In conclusion, the M-Gym media development has proven to be an effective tool in enhancing the learning and teaching of rhythmic gymnastics, offering valuable support to both students and lecturers. This study recommends the wider adoption of M-Gym media in rhythmic gymnastics education across Indonesia to further improve educational outcomes and foster a more interactive learning experience. Keywords: Media development, M-Gym, Rhythmic gymnastics 

Effectiveness of m-gym media development in learning rhythmic gymnastics for students and lecturers in Indonesia

Factors influencing exercise and sport participation among adults living with spinal cord injuries in Japan

Health, fitness and lifestyle professionals can play important roles in promoting physical activity in groups at risk of developing an inactive lifestyle, such as people with spinal cord injury (SCI). Tailored counselling is a promising tool to promote and improve physical activity levels. To support professionals to effectively have a conversation about physical activity with clients with SCI, evidence-based training and resources are needed. This project aimed to (1) co-develop an e-learning course on best practices for SCI physical activity counselling and, (2) examine the effectiveness and usability of this course.Guided by the technology-enhanced learning (TEL) evaluation framework, we used a systematic, multistep approach to co-develop and evaluate an e-learning course. The development process was informed by input and feedback from a diverse group of end-users and experts (n > 160) via online surveys and (think-aloud) interviews. A randomized controlled trial was used to compare learning outcomes (post-knowledge and self-efficacy) between participants who completed the course (intervention group) and the wait-listed control group. Usability, learning experiences, and satisfaction were assessed among all participants.Forty-one participants (21 intervention-group; 20 control-group) with various backgrounds (e.g., lifestyle counsellors, physiotherapists, occupational therapists, recreation therapists, fitness trainers) enrolled in the randomized controlled trial. After completing the course, participants in the intervention group showed significantly improved knowledge on the best practices for SCI physical activity counselling and higher self-efficacy for using these best practices in conversations with clients with SCI compared to the control group (p <.001). Participants reported above average usability scores, positive learning experiences, and high levels of satisfaction when completing the course.We used a systematic, multi-step, theory-informed approach to co-develop and evaluate an evidence-based e-learning course on SCI physical activity counselling to support professionals to promote physical activity in their daily practices. The overall positive findings demonstrate that the e-learning course is feasible and ready for further implementation in various health and community settings. Implementation of the e-learning course can help professionals improve the physical activity support they provide to their clients, and subsequently increase physical activity participation in people with SCI. 

The co-development and evaluation of an e-learning course on spinal cord injury physical activity counselling: a randomized controlled trial

OBJECTIVES
This project used a systematic and integrated knowledge translation (IKT) approach to co-create theory- and evidence-based best practices for physical activity counseling for adults with spinal cord injury (SCI).


METHODS
Guided by the IKT Guiding Principles, we meaningfully engaged research users throughout this project. A systematic approach was used. An international, multidisciplinary expert panel (n = 15), including SCI researchers, counselors, and people with SCI, was established. Panel members participated in two online meetings to discuss the best practices by drawing upon new knowledge regarding counselor-client interactions, current evidence, and members' own experiences. We used concepts from key literature on SCI-specific physical activity counseling and health behavior change theories. An external group of experts completed an online survey to test the clarity, usability and appropriateness of the best practices.


RESULTS
The best practices document includes an introduction, the best practices, things to keep in mind, and a glossary. Best practices focused on how to deliver a conversation and what to discuss during a conversation. Examples include: build rapport, use a client-centred approach following the spirit of motivational interviewing, understand your client's physical activity barriers, and share the SCI physical activity guidelines. External experts (n = 25) rated the best practices on average as clear, useful, and appropriate.


CONCLUSION
We present the first systematically co-developed theory- and evidence-based best practices for SCI physical activity counseling. The implementation of the best practices will be supported by developing training modules. These new best practices can contribute to optimizing SCI physical activity counseling services across settings.

Theory- and evidence-based best practices for physical activity counseling for adults with spinal cord injury.

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

The co-development and evaluation of an e-learning course on spinal cord injury physical activity counselling: a randomized controlled trial

Theory- and evidence-based best practices for physical activity counseling for adults with spinal cord injury.