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Pellemans M, Salmi S, Mérelle S, Janssen W, van der Mei R. Automated Behavioral Coding to Enhance the Effectiveness of Motivational Interviewing in a Chat-Based Suicide Prevention Helpline: Secondary Analysis of a Clinical Trial. J Med Internet Res 2024; 26:e53562. [PMID: 39088244 PMCID: PMC11327631 DOI: 10.2196/53562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 03/01/2024] [Accepted: 06/02/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND With the rise of computer science and artificial intelligence, analyzing large data sets promises enormous potential in gaining insights for developing and improving evidence-based health interventions. One such intervention is the counseling strategy motivational interviewing (MI), which has been found effective in improving a wide range of health-related behaviors. Despite the simplicity of its principles, MI can be a challenging skill to learn and requires expertise to apply effectively. OBJECTIVE This study aims to investigate the performance of artificial intelligence models in classifying MI behavior and explore the feasibility of using these models in online helplines for mental health as an automated support tool for counselors in clinical practice. METHODS We used a coded data set of 253 MI counseling chat sessions from the 113 Suicide Prevention helpline. With 23,982 messages coded with the MI Sequential Code for Observing Process Exchanges codebook, we trained and evaluated 4 machine learning models and 1 deep learning model to classify client- and counselor MI behavior based on language use. RESULTS The deep learning model BERTje outperformed all machine learning models, accurately predicting counselor behavior (accuracy=0.72, area under the curve [AUC]=0.95, Cohen κ=0.69). It differentiated MI congruent and incongruent counselor behavior (AUC=0.92, κ=0.65) and evocative and nonevocative language (AUC=0.92, κ=0.66). For client behavior, the model achieved an accuracy of 0.70 (AUC=0.89, κ=0.55). The model's interpretable predictions discerned client change talk and sustain talk, counselor affirmations, and reflection types, facilitating valuable counselor feedback. CONCLUSIONS The results of this study demonstrate that artificial intelligence techniques can accurately classify MI behavior, indicating their potential as a valuable tool for enhancing MI proficiency in online helplines for mental health. Provided that the data set size is sufficiently large with enough training samples for each behavioral code, these methods can be trained and applied to other domains and languages, offering a scalable and cost-effective way to evaluate MI adherence, accelerate behavioral coding, and provide therapists with personalized, quick, and objective feedback.
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Affiliation(s)
- Mathijs Pellemans
- Department of Mathematics, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- 113 Suicide Prevention, Amsterdam, Netherlands
| | - Salim Salmi
- 113 Suicide Prevention, Amsterdam, Netherlands
- Centrum Wiskunde & Informatica, Amsterdam, Netherlands
| | - Saskia Mérelle
- 113 Suicide Prevention, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam UMC, Amsterdam, Netherlands
| | - Wilco Janssen
- 113 Suicide Prevention, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam UMC, Amsterdam, Netherlands
| | - Rob van der Mei
- Department of Mathematics, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Centrum Wiskunde & Informatica, Amsterdam, Netherlands
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Coetzer-Liversage A, Stein LAR, Shuster CL, Bassett SS, Martin R, Clair Michaud M. Monitoring Motivational Interviewing Strategies: Creating Provider and Client Reports to Encourage Implementation. Subst Use Misuse 2024; 59:1519-1526. [PMID: 38816908 PMCID: PMC11240879 DOI: 10.1080/10826084.2024.2360101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND Motivational interviewing (MI) is an evidence-based practice that has been successfully applied to at-risk youth. Well-validated measures that track MI integrity may not be used in practice settings due to the time to complete them, recording requirements and training involved. A simpler, less resource-intensive instrument may encourage programs and providers to attend more to the quality of MI use during implementation. PURPOSE To validate a method involving two measures, Youth and Provider Logs, to assist in monitoring MI use. METHODS Clients and providers reported on provider behaviors consistent and inconsistent with MI during the session. Factor analyses were conducted to examine whether measures showed clear scales assessing MI use and analyses were conducted to assess validity of these measures. RESULTS Both Youth and Provider Logs showed a clear and consistent 3-factor structure assessing MI-consistent behavior, MI-inconsistent behavior, and alcohol-related topics. Significant correlations were found between Youth Logs and youth reports of rapport with providers, and satisfaction with services. Provider MI-inconsistent scores were significantly inversely predictive of observer fidelity scores over time. CONCLUSION This study offers provider and client measures for tracking use of MI in sessions, which are a simpler, less resource-intensive method for monitoring MI, and may encourage fidelity during implementation.
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Affiliation(s)
| | - L A R Stein
- Department of Psychology, University of Rhode Island, Rhode Island, USA
- Behavioral Sciences Department, Brown University, Providence, RI 02912
- Developmental Disabilities, and Hospitals, Cranston, RI, USA
- Rhode Island Training School, Rhode Island Training School, Cranston, RI, USA
| | - Coral L Shuster
- Department of Psychology, University of Rhode Island, Rhode Island, USA
| | - Shayna S Bassett
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Rosemarie Martin
- Behavioral Sciences Department, Brown University, Providence, RI 02912
- Center for Alcohol/Addiction Studies, Brown University, Providence, RI 02903
| | - Mary Clair Michaud
- Rhode Island Training School, Rhode Island Training School, Cranston, RI, USA
- Rhode Island Department of Children, Youth, and Families, Rhode Island Department of Children, Youth, and Families
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Agung FH, Sekartini R, Sudarsono NC, Hendarto A, Werdhani RA, Pudjiati SR, Hanum L, Naufal A, Sawyer SM. Development and validation of the adolescent behavioural change Counselling Assessment Tool in Indonesia. BMC Health Serv Res 2024; 24:257. [PMID: 38419005 PMCID: PMC10900824 DOI: 10.1186/s12913-024-10582-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 01/09/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Primary care provides an important context to engage adolescents and their families in healthy lifestyles with the goal of reducing future behaviour-related health problems. Developing a valid tool to assess health professionals' skills in behavioural change counselling is integral to improving the quality of clinical care provided to adolescents in Indonesia. METHODS This work was nested within a project to develop a training program to enhance the behaviour-change counselling of adolescents and their parents by Indonesian primary care professionals. Initial item development was based on the content of the training module and the domain structure of the Behavioral Change Counselling Index (BECCI), a commonly used tool to assess counselling quality in healthcare settings. Expert panels were used to test content validity, while face validity was assessed by a group of trained psychologists. Inter-rater agreement was calculated prior to tests of construct validity and reliability, which involved psychologists rating 125 audio-taped counselling sessions between the health professional and adolescent patients, together with a parent. RESULTS An initial 13-item tool was developed using a 1-5 Likert scale. Validity and reliability testing resulted in the decision to use a 14-item tool with a 0-3 Likert scale. The scale was found to have a Cronbach's α coefficient of 0.839 (internal consistency), and there was strong inter-rater agreement (0.931). CONCLUSION The assessment tool known as the Adolescent Behavioural Change Counselling Assessment Tool, is a valid and reliable instrument to measure Indonesian health professionals' behavioural-change counselling skills with adolescent patients. The tool provides an evaluation framework for future interventions that aim to improve health professionals' skills in addressing adolescent behaviour-related health problems.
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Affiliation(s)
- Fransisca Handy Agung
- Faculty of Medicine, Universitas Pelita Harapan, Jl. Jend. Sudirman No.20, Bencongan, Kelapa Dua, 15810, Tangerang, Banten, Indonesia.
| | - Rini Sekartini
- Department of Child Health, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl. Salemba Raya No.6 Jakarta Pusat, 10430, Jakarta, Indonesia
| | - Nani Cahyani Sudarsono
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No.6 Jakarta Pusat, 10430, Jakarta, Indonesia
| | - Aryono Hendarto
- Department of Child Health, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl. Salemba Raya No.6 Jakarta Pusat, 10430, Jakarta, Indonesia
| | - Retno Asti Werdhani
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No.6 Jakarta Pusat, 10430, Jakarta, Indonesia
| | - Sri Retno Pudjiati
- Faculty of Psychology, Universitas Indonesia, Kampus UI, Depok, West Java, Indonesia
| | - Lathifah Hanum
- Faculty of Psychology, Universitas Indonesia, Kampus UI, Depok, West Java, Indonesia
| | - Affan Naufal
- Balaraja Distric Hospital, Jl. Rumah Sakit No 88, Balaraja, Tangerang, Banten, Indonesia
| | - Susan M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital and Murdoch Children's Research Institute, Department of Paediatrics, The University of Melbourne, 50 Flemington Rd, 3052, Parkville, VIC, Australia
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Schwenker R, Dietrich CE, Hirpa S, Nothacker M, Smedslund G, Frese T, Unverzagt S. Motivational interviewing for substance use reduction. Cochrane Database Syst Rev 2023; 12:CD008063. [PMID: 38084817 PMCID: PMC10714668 DOI: 10.1002/14651858.cd008063.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Substance use is a global issue, with around 30 to 35 million individuals estimated to have a substance-use disorder. Motivational interviewing (MI) is a client-centred method that aims to strengthen a person's motivation and commitment to a specific goal by exploring their reasons for change and resolving ambivalence, in an atmosphere of acceptance and compassion. This review updates the 2011 version by Smedslund and colleagues. OBJECTIVES To assess the effectiveness of motivational interviewing for substance use on the extent of substance use, readiness to change, and retention in treatment. SEARCH METHODS We searched 18 electronic databases, six websites, four mailing lists, and the reference lists of included studies and reviews. The last search dates were in February 2021 and November 2022. SELECTION CRITERIA We included randomised controlled trials with individuals using drugs, alcohol, or both. Interventions were MI or motivational enhancement therapy (MET), delivered individually and face to face. Eligible control interventions were no intervention, treatment as usual, assessment and feedback, or other active intervention. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane, and assessed the certainty of evidence with GRADE. We conducted meta-analyses for the three outcomes (extent of substance use, readiness to change, retention in treatment) at four time points (post-intervention, short-, medium-, and long-term follow-up). MAIN RESULTS We included 93 studies with 22,776 participants. MI was delivered in one to nine sessions. Session durations varied, from as little as 10 minutes to as long as 148 minutes per session, across included studies. Study settings included inpatient and outpatient clinics, universities, army recruitment centres, veterans' health centres, and prisons. We judged 69 studies to be at high risk of bias in at least one domain and 24 studies to be at low or unclear risk. Comparing MI to no intervention revealed a small to moderate effect of MI in substance use post-intervention (standardised mean difference (SMD) 0.48, 95% confidence interval (CI) 0.07 to 0.89; I2 = 75%; 6 studies, 471 participants; low-certainty evidence). The effect was weaker at short-term follow-up (SMD 0.20, 95% CI 0.12 to 0.28; 19 studies, 3351 participants; very low-certainty evidence). This comparison revealed a difference in favour of MI at medium-term follow-up (SMD 0.12, 95% CI 0.05 to 0.20; 16 studies, 3137 participants; low-certainty evidence) and no difference at long-term follow-up (SMD 0.12, 95% CI -0.00 to 0.25; 9 studies, 1525 participants; very low-certainty evidence). There was no difference in readiness to change (SMD 0.05, 95% CI -0.11 to 0.22; 5 studies, 1495 participants; very low-certainty evidence). Retention in treatment was slightly higher with MI (SMD 0.26, 95% CI -0.00 to 0.52; 2 studies, 427 participants; very low-certainty evidence). Comparing MI to treatment as usual revealed a very small negative effect in substance use post-intervention (SMD -0.14, 95% CI -0.27 to -0.02; 5 studies, 976 participants; very low-certainty evidence). There was no difference at short-term follow-up (SMD 0.07, 95% CI -0.03 to 0.17; 14 studies, 3066 participants), a very small benefit of MI at medium-term follow-up (SMD 0.12, 95% CI 0.02 to 0.22; 9 studies, 1624 participants), and no difference at long-term follow-up (SMD 0.06, 95% CI -0.05 to 0.17; 8 studies, 1449 participants), all with low-certainty evidence. There was no difference in readiness to change (SMD 0.06, 95% CI -0.27 to 0.39; 2 studies, 150 participants) and retention in treatment (SMD -0.09, 95% CI -0.34 to 0.16; 5 studies, 1295 participants), both with very low-certainty evidence. Comparing MI to assessment and feedback revealed no difference in substance use at short-term follow-up (SMD 0.09, 95% CI -0.05 to 0.23; 7 studies, 854 participants; low-certainty evidence). A small benefit for MI was shown at medium-term (SMD 0.24, 95% CI 0.08 to 0.40; 6 studies, 688 participants) and long-term follow-up (SMD 0.24, 95% CI 0.07 to 0.41; 3 studies, 448 participants), both with moderate-certainty evidence. None of the studies in this comparison measured substance use at the post-intervention time point, readiness to change, and retention in treatment. Comparing MI to another active intervention revealed no difference in substance use at any follow-up time point, all with low-certainty evidence: post-intervention (SMD 0.07, 95% CI -0.15 to 0.29; 3 studies, 338 participants); short-term (SMD 0.05, 95% CI -0.03 to 0.13; 18 studies, 2795 participants); medium-term (SMD 0.08, 95% CI -0.01 to 0.17; 15 studies, 2352 participants); and long-term follow-up (SMD 0.03, 95% CI -0.07 to 0.13; 10 studies, 1908 participants). There was no difference in readiness to change (SMD 0.15, 95% CI -0.00 to 0.30; 5 studies, 988 participants; low-certainty evidence) and retention in treatment (SMD -0.04, 95% CI -0.23 to 0.14; 12 studies, 1945 participants; moderate-certainty evidence). We downgraded the certainty of evidence due to inconsistency, study limitations, publication bias, and imprecision. AUTHORS' CONCLUSIONS Motivational interviewing may reduce substance use compared with no intervention up to a short follow-up period. MI probably reduces substance use slightly compared with assessment and feedback over medium- and long-term periods. MI may make little to no difference to substance use compared to treatment as usual and another active intervention. It is unclear if MI has an effect on readiness to change and retention in treatment. The studies included in this review were heterogeneous in many respects, including the characteristics of participants, substance(s) used, and interventions. Given the widespread use of MI and the many studies examining MI, it is very important that counsellors adhere to and report quality conditions so that only studies in which the intervention implemented was actually MI are included in evidence syntheses and systematic reviews. Overall, we have moderate to no confidence in the evidence, which forces us to be careful about our conclusions. Consequently, future studies are likely to change the findings and conclusions of this review.
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Affiliation(s)
- Rosemarie Schwenker
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Carla Emilia Dietrich
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Selamawit Hirpa
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Monika Nothacker
- Institute for Medical Knowledge Management, Association of the Scientific Medical Societies in Germany, Berlin, c/o Philipps University Marburg, Berlin & Marburg, Germany
| | | | - Thomas Frese
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Susanne Unverzagt
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
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Tafrate RC, Mitchell D, Cox SM, Hogan T. Measuring a motivational interviewing practice orientation in criminal justice practitioners: initial validation of the response style screening questionnaire. Front Psychol 2023; 14:1308086. [PMID: 38144982 PMCID: PMC10746862 DOI: 10.3389/fpsyg.2023.1308086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/21/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction The use of collaborative communication techniques by criminal justice practitioners has been identified as a component of core correctional practices (CCPs). Criminal justice agencies and programs are investing in motivational interviewing (MI) training for their staff with varying intensity, follow-up coaching, and expectations for integration into practice. The present article describes the development and initial validation of the Response Style Screening Questionnaire (RSSQ), a practitioner completed tool assessing an MI-consistent practice orientation. Over three studies, we examined the factor structure, reliability, and correlations between the scale and self-reported and behavioral validity indicators. Method Study 1 examined the factor structure of the RSSQ with a sample of 825 criminal justice practitioners. In Study 2, data from 350 probation officers completing the RSSQ alongside measures of work-orientation and attitudes was used to conduct a confirmatory factor analysis and an initial assessment of its construct validity. In Study 3, correlations between the RSSQ and audio recorded office visits of 33 probation officers coded for MI and relationship building skills examined the scale's criterion validity. Results In Study 1, an exploratory factor analysis with an oblique rotation yielded 18 items on four factors. In Study 2, four and five factor models were tested, with the 4-factor model of Study 1 yielding the best fit. Two of the 4 factor-derived subscales reflect styles inconsistent with MI: (1) Confrontational style, and (2) Sustain Talk style; while the remaining two reflect styles consistent with MI: (3) Eliciting style, and (4) Change Talk style. Confrontational style scores were correlated with a work-orientation reflecting probation as a law enforcement endeavor, while Eliciting and Change Talk scores were correlated with a behavior change and resource broker work-orientations. In Study 3, Confrontational and Sustain Talk style scores were negatively correlated with a variety of MI skills and CCPs displayed on audio recordings, while Change Talk style scores were positively correlated with use of such skills. Discussion Overall, the findings suggest the RSSQ is a potentially useful new practitioner self-report tool for assessing an MI practice orientation.
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Affiliation(s)
- Raymond Chip Tafrate
- Department of Criminology and Criminal Justice, Central Connecticut State University, New Britain, CT, United States
| | - Damon Mitchell
- Department of Criminology and Criminal Justice, Central Connecticut State University, New Britain, CT, United States
| | - Stephen M. Cox
- Department of Criminology and Criminal Justice, Central Connecticut State University, New Britain, CT, United States
| | - Tom Hogan
- Institute for the Study of Crime and Justice, Central Connecticut State University, New Britain, CT, United States
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Beck AK, Baker AL, Britton B, Lum A, Pohlman S, Forbes E, Moore L, Barnoth D, Perkes SJ, Oldmeadow C, Carter G. Adapted motivational interviewing for brief healthcare consultations: A systematic review and meta-analysis of treatment fidelity in real-world evaluations of behaviour change counselling. Br J Health Psychol 2023; 28:972-999. [PMID: 37144242 PMCID: PMC10947272 DOI: 10.1111/bjhp.12664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/23/2023] [Accepted: 04/03/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Behaviour change counselling (BCC) is an adaptation of motivational interviewing (MI) designed to maximize the effectiveness of time-limited health behaviour change consultations. To improve intervention quality and understanding of treatment effects, it is recommended that evaluations of health behaviour change interventions incorporate existing fidelity frameworks (e.g. The National Institutes of Health [NIH] Behaviour Change Consortium) and ensure that treatment fidelity is assessed and reported. PURPOSE This systematic review was designed to examine (a) adherence to NIH fidelity recommendations, (b) provider fidelity to BCC and (c) impact of these variables on the real-world effectiveness of BCC for adult health behaviours and outcomes. METHODS AND RESULTS Searches of 10 electronic databases yielded 110 eligible publications describing 58 unique studies examining BCC delivered within real-world healthcare settings by existing providers. Mean study adherence to NIH fidelity recommendations was 63.31% (Range 26.83%-96.23%). Pooled effect size (Hedges g) for short-term and long-term outcomes was .19 (95% CI [.11, .27]) and .09 (95% CI [.04, .13]), respectively. In separate, random-effects meta-regressions, neither short-term nor long-term effect sizes were significantly modified by adherence to NIH fidelity recommendations. For the subgroup of short-term alcohol studies (n = 10), a significant inverse relationship was detected (Coefficient = -.0114, 95% CI [-.0187, -.0041], p = .0021). Inadequate and inconsistent reporting within the included studies precluded planned meta-regression between provider fidelity and BCC effect size. CONCLUSIONS Further evidence is needed to clarify whether adherence to fidelity recommendations modifies intervention effects. Efforts to promote transparent consideration, evaluation and reporting of fidelity are urgently needed. Research and clinical implications are discussed.
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Affiliation(s)
- Alison K. Beck
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
| | - Amanda L. Baker
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
| | - Ben Britton
- Hunter New England HealthNew LambtonNew South WalesAustralia
| | - Alistair Lum
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
| | - Sonja Pohlman
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
| | - Erin Forbes
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
| | - Lyndell Moore
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
| | - Ditte Barnoth
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
| | - Sarah J. Perkes
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
| | - Chris Oldmeadow
- Clinical Research Design and Statistical ServiceHunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
| | - Gregory Carter
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
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Almansour M, AlQurmalah SI, Abdul Razack HI. Motivational interviewing-an evidence-based, collaborative, goal-oriented communication approach in lifestyle medicine: A comprehensive review of the literature. J Taibah Univ Med Sci 2023; 18:1170-1178. [PMID: 37206188 PMCID: PMC10189272 DOI: 10.1016/j.jtumed.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/07/2023] [Accepted: 03/24/2023] [Indexed: 05/21/2023] Open
Abstract
The global threat of noncommunicable diseases (NCDs) is alarmingly increasing. The health and economic burden of improper lifestyle choices is immense. Reducing modifiable risk factors has been demonstrated to significantly prevent chronic diseases. At this crucial time, lifestyle medicine (LM) has been recognized as an evidence-based medical domain applicable to NCDs. Among the tools used in LM, motivational interviewing (MI) is a patient-centered, collaborative counseling approach. In this evidence-based review article, we discuss recent literature on the application of MI in the six LM pillars defined by the British Society of LM (BSLM): healthy eating, mental wellbeing, healthy relationships, physical activity, minimizing harmful substances, and sleep. MI helps strengthen patients' motivation to ameliorate behaviorally influenced health problems, improve treatment adherence, and optimize medical interventions. Technically correct, theoretically congruent, and psychometrically sound MI interventions yield satisfactory outcomes and help improve patient quality of life. Lifestyle change is often a gradual process involving multiple efforts and setbacks. MI is based on the idea that change is a process rather than an event. Extensive literature evidence supports the benefits of MI treatment, and interest in research on MI application is increasing across all BSLM pillars. MI helps people alter their thoughts and feelings about making changes by recognizing obstacles to change. Even interventions of short duration have been reported to yield better outcomes. Healthcare professionals must understand the relevance and importance of MI in clinical practice.
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Affiliation(s)
- Mohammed Almansour
- Department of Medical Education, College of Medicine, King Saud University, Riyadh, KSA
| | | | - Habeeb Ibrahim Abdul Razack
- Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, KSA
- Corresponding address. Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, KSA
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Cohen ZD, Barnes-Horowitz NM, Forbes CN, Craske MG. Measuring the active elements of cognitive-behavioral therapies. Behav Res Ther 2023; 167:104364. [PMID: 37429044 DOI: 10.1016/j.brat.2023.104364] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 06/09/2023] [Accepted: 07/02/2023] [Indexed: 07/12/2023]
Abstract
Understanding how and for whom cognitive-behavioral therapies work is central to the development and improvement of mental health interventions. Suboptimal quantification of the active elements of cognitive-behavioral therapies has hampered progress in elucidating mechanisms of change. To advance process research on cognitive-behavioral therapies, we describe a theoretical measurement framework that focuses on the delivery, receipt, and application of the active elements of these interventions. We then provide recommendations for measuring the active elements of cognitive-behavioral therapies aligned with this framework. Finally, to support measurement harmonization and improve study comparability, we propose the development of a publicly available repository of assessment tools: the Active Elements of Cognitive-Behavioral Therapies Measurement Kit.
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Affiliation(s)
- Zachary D Cohen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States.
| | | | - Courtney N Forbes
- Department of Psychology, University of California, Los Angeles, United States
| | - Michelle G Craske
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States; Department of Psychology, University of California, Los Angeles, United States
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Erschens R, Fahse B, Festl-Wietek T, Herrmann-Werner A, Keifenheim KE, Zipfel S, Fallgatter AJ, Velten-Schurian K. Training medical students in motivational interviewing using a blended learning approach: a proof-of-concept study. Front Psychol 2023; 14:1204810. [PMID: 37546454 PMCID: PMC10400288 DOI: 10.3389/fpsyg.2023.1204810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Background Difficulties in implementing behavior change in patients with chronic diseases are common in clinical practice. Motivational interviewing (MI) helps clinicians to support patients in overcoming ambivalence while maintaining self-determination. The inclusion of MI in German medical training curricula is still rare. Furthermore, the effects of systematic teaching of MI, especially via blended learning, have hardly been investigated. Methods Medical students participated in three curricular events related to MI, consisting of instructional videos and theoretical and practical components in a blended learning format. The aim of the study was to investigate the effect of teaching MI in students' medical education. A controlled, non-randomized study was conducted with an intervention group and a control group. Both groups completed questionnaires on their experience and knowledge related to MI, completed a knowledge test and rated their satisfaction with the course. MI was taught in the 6th semester of medical coursework as part of a psychosomatic course, in the 8th semester during a psychiatry course and in the 9th semester during a weekly psychiatry clerkship. Results Data from the intervention group (n = 35) and control group (n = 14) were analyzed, with 65.7% of students participating in all three parts of the curriculum. Overall interest in learning MI was high, with M = 2.92 (SD = 1.00). The results indicate a greater increase in knowledge over time in the intervention group. The majority (62.86%) stated that the curriculum was relevant to their future career. Free-form text responses indicated a high level of satisfaction with practical relevance. Conclusion This study demonstrates the usefulness of an MI curriculum for medical students. The integration of MI into medical curricula is a promising curricular addition to improve doctor-patient communication. Future research should address patient perceptions of MI competencies and the persistence of acquired competencies.
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Affiliation(s)
- Rebecca Erschens
- University Medical Hospital Tuebingen, Internal Medicine, Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Germany
| | - Bettina Fahse
- University Medical Hospital Tuebingen, Internal Medicine, Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Germany
- Tübingen Institute for Medical Education (TIME), Faculty of Medicine, Tübingen, Germany
| | - Teresa Festl-Wietek
- Tübingen Institute for Medical Education (TIME), Faculty of Medicine, Tübingen, Germany
| | - Anne Herrmann-Werner
- University Medical Hospital Tuebingen, Internal Medicine, Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Germany
- Tübingen Institute for Medical Education (TIME), Faculty of Medicine, Tübingen, Germany
| | - Katharina E. Keifenheim
- University Medical Hospital Tuebingen, Internal Medicine, Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Germany
| | - Stephan Zipfel
- University Medical Hospital Tuebingen, Internal Medicine, Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Germany
- German Center for Mental Health (DZPG), Tuebingen, Germany
| | - Andreas J. Fallgatter
- German Center for Mental Health (DZPG), Tuebingen, Germany
- Tübingen Center for Mental Health, Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Kerstin Velten-Schurian
- Tübingen Center for Mental Health, Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
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10
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Naar S, Chapman JE, Aarons GA. Efficient and effective measurement of provider competence in community-based substance use treatment settings: Performance of the Motivational Interviewing Coach Rating Scale (MI-CRS). JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 150:209027. [PMID: 36996970 PMCID: PMC11065477 DOI: 10.1016/j.josat.2023.209027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 03/02/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE Efficient and effective fidelity measurement is necessary to improve rigor and reduce burden of motivational interviewing (MI) implementation studies for both fidelity outcomes and quality improvement strategies. This article reports on such a measure developed with rigorous methodology and tested in community-based substance abuse treatment settings. METHODS This scale development study analyzed data from a National Institute on Drug Abuse study testing the Leadership and Organizational Change for Implementation (LOCI) strategy. Utilizing item response theory (IRT) methods and Rasch modeling, we analyzed coded recordings (N = 1089) of intervention sessions of 238 providers from 60 substance use treatment clinics across nine agencies in an implementation trial focusing on MI. RESULTS These methods yielded a reliable and valid 12-item scale representing single construct dimensionality, strong item-session maps, good rating scale functionality, and item fit. Separation reliability and absolute agreement for adjacent categories was high. No items were significantly misfitting, though one was borderline. The LOCI community providers were less likely to be scored in the advanced competence range and items were more difficult compared to the original development sample. CONCLUSIONS The 12-item Motivational Interviewing Coach Rating Scale (MI-CRS) showed excellent performance in a large sample of community-based substance use treatment providers using real recordings. The MI-CRS is the first efficient and effective fidelity measure appropriate for diverse ethnic groups, with interventions that are MI only or interventions that integrate MI with other treatments, and with adolescents and adults. Follow-up coaching by trained supervisors may be needed for community-based providers to achieve the highest level of MI competence.
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Affiliation(s)
- Sylvie Naar
- Florida State University, United States of America.
| | | | - Gregory A Aarons
- University of California, San Diego, United States of America; UC San Diego ACTRI Dissemination and Implementation Science Center, United States of America
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11
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Rey Velasco E, Pedersen HS, Skinner T. Analysis of Patient Cues in Asynchronous Health Interactions: Pilot Study Combining Empathy Appraisal and Systemic Functional Linguistics. JMIR Form Res 2022; 6:e40058. [PMID: 36538352 PMCID: PMC9812272 DOI: 10.2196/40058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Lifestyle-related diseases are among the leading causes of death and disability. Their rapid increase worldwide has called for low-cost, scalable solutions to promote health behavior changes. Digital health coaching has proved to be effective in delivering affordable, scalable programs to support lifestyle change. This approach increasingly relies on asynchronous text-based interventions to motivate and support behavior change. Although we know that empathy is a core element for a successful coach-user relationship and positive patient outcomes, we lack research on how this is realized in text-based interactions. Systemic functional linguistics (SFL) is a linguistic theory that may support the identification of empathy opportunities (EOs) in text-based interactions, as well as the reasoning behind patients' linguistic choices in their formulation. OBJECTIVE This study aims to determine whether empathy and SFL approaches correspond and complement each other satisfactorily to study text-based communication in a health coaching context. We sought to explore whether combining empathic assessment with SFL categories can provide a means to understand client-coach interactions in asynchronous text-based coaching interactions. METHODS We retrieved 148 text messages sent by 29 women who participated in a randomized trial of telecoaching for the prevention of gestational diabetes mellitus (GDM) and postnatal weight loss. We conducted a pilot study to identify users' explicit and implicit EOs and further investigated these statements using the SFL approach, focusing on the analysis of transitivity and thematic analysis. RESULTS We identified 164 EOs present in 42.37% (3478/8209) of the word count in the corpus. These were mainly negative (n=90, 54.88%) and implicit (n=55, 60.00%). We distinguished opening, content and closing messages structures. Most of the wording was found in the content (n=7077, 86.21%) with a declarative structure (n=7084, 86.30%). Processes represented 22.4% (n=1839) of the corpus, with half being material (n=876, 10.67%) and mostly related to food and diet (n=196, 54.92%), physical activity (n=96, 26.89%), and lifestyle goals (n=40, 11.20%). CONCLUSIONS Our findings show that empathy and SFL approaches are compatible. The results from our transitivity analysis reveal novel insights into the meanings of the users' EOs, such as their seek for help or praise, often missed by health care professionals (HCPs), and on the coach-user relationship. The absence of explicit EOs and direct questions could be attributed to low trust on or information about the coach's abilities. In the future, we will conduct further research to explore additional linguistic features and code coach messages. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620001240932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380020.
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Affiliation(s)
- Elena Rey Velasco
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Liva Healthcare, Copenhagen, Denmark
| | | | - Timothy Skinner
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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12
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Schwartz AJ, Richman AR, Scott M, Liu H, White W, Doherty C. Increasing Access to Care for the Underserved: Voices of Riders, Drivers, & Staff of a Rural Transportation Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13539. [PMID: 36294124 PMCID: PMC9603744 DOI: 10.3390/ijerph192013539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
The qualitative data presented in this paper was part of a larger concurrent mixed methods study evaluating the effectiveness of a transportation program (Project TRIP) for low-income residents in rural eastern North Carolina. Twenty stakeholders involved in TRIP were interviewed, including riders (n = 12) of which 83% were over 50 years old, program staff including the program coordinator and 5 case managers (n = 6), and transportation providers (n = 2). Due to the COVID-19 pandemic, interviews were completed by phone with each participant. Themes from the qualitative data included the: (1) Emotional, health, & financial impacts of TRIP, (2) Changes that should be implemented into TRIP when replicating the program, and (3) Unique aspects of how TRIP operates that could inform other rural transportation programs. Thematic analysis was used to analyze the transcript data. The findings are couched in the context of how TRIP potentially defrays the impacts of cumulative disadvantage that residents experience over the life course by increasing access to healthcare.
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Affiliation(s)
- Abby J. Schwartz
- School of Social Work, East Carolina University, Greenville, NC 27858, USA
| | - Alice R. Richman
- Department of Health Education and Promotion, East Carolina University, Greenville, NC 27858, USA
| | - Mallary Scott
- Department of Health Education and Promotion, East Carolina University, Greenville, NC 27858, USA
| | - Haiyong Liu
- Department of Finance and Economics, Texas State University, San Marcos, TX 78666, USA
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13
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McAfee NW, Schumacher JA, Madson MB, Villarosa-Hurlocker MC, Williams DC. The Status of SBIRT Training in Health Professions Education: A Cross-Discipline Review and Evaluation of SBIRT Curricula and Educational Research. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1236-1246. [PMID: 35320126 DOI: 10.1097/acm.0000000000004674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE To assess the quality of curricular research on the Screening Brief Intervention and Referral to Treatment (SBIRT) approach and determine the presence of useful training modalities, particularly motivational interviewing (MI) training, across health care training curricula. METHOD The authors conducted a systematic review of published, peer-reviewed studies in PubMed, ERIC, CINAHL, Ovid HealthSTAR, and PsycINFO databases through March 2021 for English-language studies describing SBIRT, a curriculum for health care trainees, and curricular intervention outcomes. After the records were independently assessed, data were extracted and 20% of the studies were double-coded for interrater reliability. RESULTS Of 1,856 studies, 95 were included in the review; 22 had overlapping samples and were consolidated into 10 nested studies, leaving 83 total. Interrater reliability ranged from moderate (κ = .74, P < .001) to strong (κ = .91, P < .001) agreement. SBIRT training was delivered to trainees across many professions, including nursing (n = 34, 41%), medical residency (n = 28, 34%), and social work (n = 24, 29%). Nearly every study described SBIRT training methods (n = 80, 96%), and most reported training in MI (n = 54, 65%). On average, studies reported 4.06 (SD = 1.64) different SBIRT training methods and 3.31 (SD = 1.59) MI training methods. Their mean design score was 1.92 (SD = 0.84) and mean measurement score was 1.89 (SD = 1.05). A minority of studies measured SBIRT/MI skill (n = 23, 28%), and 4 studies (5%) set a priori benchmarks for their curricula. CONCLUSIONS SBIRT training has been delivered to a wide range of health care trainees and often includes MI. Rigor scores for the studies were generally low due to limited research designs and infrequent use of objective skill measurement. Future work should include predefined training benchmarks and validated skills measurement.
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Affiliation(s)
- Nicholas W McAfee
- N.W. McAfee is assistant professor, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi; ORCID: 0000-0002-7992-9124
| | - Julie A Schumacher
- J.A. Schumacher is professor, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi
| | - Michael B Madson
- M.B. Madson is professor, School of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi; ORCID: 0000-0002-2025-8856
| | - Margo C Villarosa-Hurlocker
- M.C. Villarosa-Hurlocker is assistant professor, Department of Psychology, University of New Mexico, Albuquerque, New Mexico; ORCID: 0000-0002-9744-8551
| | - Daniel C Williams
- D.C. Williams is associate professor, Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
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14
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Janssen W, van Raak J, van der Lucht Y, van Ballegooijen W, Mérelle S. Can Outcomes of a Chat-Based Suicide Prevention Helpline Be Improved by Training Counselors in Motivational Interviewing? A Non-randomized Controlled Trial. Front Digit Health 2022; 4:871841. [PMID: 35801118 PMCID: PMC9253377 DOI: 10.3389/fdgth.2022.871841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To examine whether the outcomes of a chat-based suicide-prevention helpline could be improved by training counselors in motivational interviewing (MI). Methods In a pre- and post-test design, visitors of a chat-based suicide prevention helpline received either the Five-Phase Model (treatment as usual [TAU]) or MI. They completed a pre- and post-chat questionnaire on several suicide-related risk factors. Linear mixed modeling was used to estimate the effect of the condition. Furthermore, the treatment proficiency of newly trained counselors was assessed using MI-Scope. Results A total of 756 visitors and 55 counselors were included in this study. The visitors showed an improvement in suicidal ideation and psychological risk factors after a chat conversation. However, there were no significant differences between the MI and TAU conditions (β = 0.03, 95% CI [−0.23–0.30], p = 0.80). The treatment integrity indices showed that the counselors mostly used MI-consistent techniques but were unable to strategically employ these techniques to evoke enough change talk. Conclusions MI and TAU led to comparable outcomes in a chat-based suicide prevention helpline. The effectiveness of MI might improve by intensifying or improving the training of counselors, keeping the process of engaging more concise or offering visitors multiple sessions of MI.
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Affiliation(s)
- Wilco Janssen
- 113 Suicide Prevention, Amsterdam, Netherlands
- *Correspondence: Wilco Janssen
| | | | | | - Wouter van Ballegooijen
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam UMC, Amsterdam, Netherlands
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15
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Reinauer C, Platzbecker AL, Viermann R, Domhardt M, Baumeister H, Foertsch K, Linderskamp H, Krassuski L, Staab D, Minden K, Kilian R, Holl RW, Warschburger P, Meißner T. Efficacy of Motivational Interviewing to Improve Utilization of Mental Health Services Among Youths With Chronic Medical Conditions: A Cluster Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2127622. [PMID: 34596672 PMCID: PMC8486984 DOI: 10.1001/jamanetworkopen.2021.27622] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Despite the high prevalence of anxiety and depression in youths with chronic medical conditions (CMCs), physicians encounter substantial barriers in motivating these patients to access mental health care services. OBJECTIVE To determine the efficacy of motivational interviewing (MI) training for pediatricians in increasing youths' use of mental health care. DESIGN, SETTING, AND PARTICIPANTS The COACH-MI (Chronic Conditions in Adolescents: Implementation and Evaluation of Patient-Centered Collaborative Healthcare-Motivational Interviewing) study was a single-center cluster randomized clinical trial at the University Children's Hospital specialized outpatient clinics in Düsseldorf, Germany. Treating pediatricians were cluster randomized to a 2-day MI workshop or treatment as usual (TAU). Patient recruitment and MI conversations occurred between April 2018 and May 2020 with 6-month follow-up and 1-year rescreening. Participants were youths aged 12 to 20 years with CMCs and comorbid symptoms of anxiety and depression; they were advised by their MI-trained or untrained physicians to access psychological counseling services. Statistical analysis was performed from October 2020 to April 2021. INTERVENTIONS MI physicians were trained through a 2-day, certified MI training course; they recommended use of mental health care services during routine clinical appointments. MAIN OUTCOMES AND MEASURES The primary outcome of uptake of mental health care services within the 6-month follow-up was analyzed using a logistic mixed model, adjusted for the data's cluster structure. Uptake of mental health services was defined as making at least 1 appointment by the 6-month follow-up. RESULTS Among 164 youths with CMCs and conspicuous anxiety or depression screening, 97 (59%) were female, 94 (57%) had MI, and 70 (43%) had TAU; the mean (SD) age was 15.2 (1.9) years. Compared with patients receiving TAU, the difference in mental health care use at 6 months among patients whose physicians had undergone MI training was not statistically significant (odds ratio [OR], 1.96; 95% CI, 0.98-3.92; P = .06). The effect was moderated by the subjective burden of disease (F2,158 = 3.42; P = .04). Counseling with an MI-trained physician also led to lower anxiety symptom scores at 1-year rescreening (F1,130 = 4.11; P = .045). MI training was associated with longer conversations between patients and physicians (30.3 [16.7] minutes vs 16.8 [12.5] minutes; P < .001), and conversation length significantly influenced uptake rates across conditions (OR, 1.03; 95% CI, 1.01-1.06; P = .005). CONCLUSIONS AND RELEVANCE In this study, use of MI in specialized pediatric consultations did not increase the use of mental health care services among youths with CMCs but did lead to longer patient-physician conversations and lower anxiety scores at 1 year. Additional research is required to determine whether varying scope and duration of MI training for physicians could encourage youths with CMCs to seek counseling and thus improve integrated care models. TRIAL REGISTRATION German Trials Registry: DRKS00014043.
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Affiliation(s)
- Christina Reinauer
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Anna Lena Platzbecker
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Rabea Viermann
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Katharina Foertsch
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Hannah Linderskamp
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Lisa Krassuski
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Doris Staab
- Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité of Humboldt University, Berlin, Germany
| | - Kirsten Minden
- German Rheumatism Research Centre Berlin, and Charité, University Medicine, Berlin, Germany
| | - Reinhold Kilian
- Department of Psychiatry and Psychotherapy II, University of Ulm and BKH Günzburg, Günzburg, Germany
| | - Reinhard W. Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Petra Warschburger
- Department of Psychology, Counseling Psychology, University of Potsdam, Potsdam, Germany
| | - Thomas Meißner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
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16
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Robinson ME. Motivational Interviewing and the Use of Psychological Services Among Youth With Chronic Medical Conditions. JAMA Netw Open 2021; 4:e2129077. [PMID: 34596674 DOI: 10.1001/jamanetworkopen.2021.29077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Marie-Eve Robinson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Division of Endocrinology, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
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