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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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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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Fredriksen-Goldsen K, Teri L, Kim HJ, La Fazia D, McKenzie G, Petros R, Jung HH, Jones BR, Brown C, Emlet CA. Design and development of the first randomized controlled trial of an intervention (IDEA) for sexual and gender minority older adults living with dementia and care partners. Contemp Clin Trials 2023; 128:107143. [PMID: 36893987 PMCID: PMC10639124 DOI: 10.1016/j.cct.2023.107143] [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: 10/31/2022] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Heightened risks of cognitive impairment, disability, and barriers to care among sexual and gender minority (SGM) older adults are well documented. To date, culturally responsive evidence-based dementia interventions for this population do not exist. OBJECTIVE This study describes the design of the first randomized controlled trial (RCT) testing a culturally responsive cognitive behavioral and empowerment intervention, Innovations in Dementia Empowerment and Action (IDEA), developed to address the unique needs of SGM older adults living with dementia and care partners. METHODS IDEA is a culturally enhanced version of Reducing Disability in Alzheimer's Disease (RDAD), an efficacious, non-pharmaceutical intervention for people with dementia and care partners. We utilized a staggered multiple baseline design with the goal to enroll 150 dyads randomized into two arms of 75 dyads each, enhanced IDEA and standard RDAD. RESULTS IDEA was adapted using findings from the longitudinal National Health, Aging, and Sexuality/Gender study, which identified modifiable factors for SGM older adults, including SGM-specific discrimination and stigma, health behaviors, and support networks. The adapted intervention employed the original RDAD strategies and enhanced them with culturally responsive empowerment practices designed to cultivate engagement, efficacy, and support mobilization. Outcomes include adherence to physical activity, reduction in perceived stress and stigma, and increased physical functioning, efficacy, social support, engagement, and resource use. CONCLUSION IDEA addresses contemporary issues for underserved populations living with dementia and their care partners. Our findings will have important implications for marginalized communities by integrating and evaluating the importance of cultural responsiveness in dementia and caregiving interventions.
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Affiliation(s)
| | - Linda Teri
- University of Washington, School of Nursing, Box 357260, Seattle, WA 98195, USA.
| | - Hyun-Jun Kim
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - David La Fazia
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - Glenise McKenzie
- Oregon Health & Sciences University, School of Nursing, 3076, 3455 SW US Veterans Hospital Rd, Portland, OR 97239, USA.
| | - Ryan Petros
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - Hailey H Jung
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - Brittany R Jones
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - Char Brown
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - Charles A Emlet
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
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Motivational Interviewing and Self-care Practices in Adult Patients With Heart Failure: A Systematic Review and Narrative Synthesis. J Cardiovasc Nurs 2021; 35:107-115. [PMID: 31851149 DOI: 10.1097/jcn.0000000000000627] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Heart failure contributes to frequent hospitalizations, large healthcare costs, and high mortality. Heart failure management includes patient adherence to strict self-care practices (ie, symptom recognition, limiting sodium and fluids, monitoring weight, maintaining an active lifestyle, and medication adherence as well as monitoring other medical conditions). These practices can be difficult to enact and maintain. Motivational interviewing, although not studied extensively in patients with heart failure, may enhance patients' abilities to enact and maintain self-care practices. OBJECTIVE The aim of this study was to examine the effectiveness of motivational interviewing on self-care practices in the adult population with heart failure. METHODS We conducted a narrative systematic review of peer-reviewed research literature focused on motivational interviewing in adult patients with heart failure. The following databases were searched from database inception to March 2019: MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, ERIC, Educational Resource Complete, and Scopus. Of 1158 citations retrieved, 7 studies met the inclusion criteria. RESULTS Outcomes were focused on self-care adherence (ie, maintenance, management, confidence), physical activity/exercise, and knowledge of self-care. Motivational interviewing has been effectively used either alone or in combination with other therapies and has been used in-home, over the telephone, and in hospital/clinic settings, although face-to-face interventions seem to be more effective. A number of limitations were noted in the included studies. CONCLUSION Motivational interviewing is a potentially effective adjunct to enhance self-care practices in patients with heart failure. Further high-quality research is needed to support changes in clinical practice.
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Tian L, Oviatt S. A Taxonomy of Social Errors in Human-Robot Interaction. ACM TRANSACTIONS ON HUMAN-ROBOT INTERACTION 2021. [DOI: 10.1145/3439720] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Robotic applications have entered various aspects of our lives, such as health care and educational services. In such Human-robot Interaction (HRI), trust and mutual adaption are established and maintained through a positive social relationship between a user and a robot. This social relationship relies on the perceived competence of a robot on the social-emotional dimension. However, because of technical limitations and user heterogeneity, current HRI is far from error-free, especially when a system leaves controlled lab environments and is applied to in-the-wild conditions. Errors in HRI may either degrade a user’s perception of a robot’s capability in achieving a task (defined as
performance errors
in this work) or degrade a user’s perception of a robot’s socio-affective competence (defined as
social errors
in this work). The impact of these errors and effective strategies to handle such an impact remains an open question. We focus on social errors in HRI in this work. In particular, we identify the major attributes of perceived socio-affective competence by reviewing human social interaction studies and HRI error studies. This motivates us to propose a taxonomy of social errors in HRI. We then discuss the impact of social errors situated in three representative HRI scenarios. This article provides foundations for a systematic analysis of the social-emotional dimension of HRI. The proposed taxonomy of social errors encourages the development of user-centered HRI systems, designed to offer positive and adaptive interaction experiences and improved interaction outcomes.
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Affiliation(s)
- Leimin Tian
- Faculty of Engineering, Monash University, Australia
| | - Sharon Oviatt
- Faculty of Engineering, Monash University, Australia
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Kuriakose L, Kuczynska P, Timpel P, Yakub F, Bayley A, Papachristou Nadal I. Effectiveness of behaviour change techniques on lifestyle interventions of patients with a high risk of developing cardiovascular disease. Using a qualitative approach. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:998-1009. [PMID: 31965675 DOI: 10.1111/hsc.12933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/29/2019] [Accepted: 12/06/2019] [Indexed: 06/10/2023]
Abstract
This study aimed to identify key active ingredients on the maintenance of behaviour change for lifestyle interventions of patients with a high risk of developing cardiovascular disease (CVD) who participated in a MOtiVational intErviewing InTervention (MOVE IT) randomised control trial (RCT). A process evaluation was carried out using focus groups. Twenty-six participants of the MOVE IT RCT were purposively recruited and split into six focus groups. Four groups had attended six or more sessions of the intensive phase (completers) and two groups had withdrawn before the end of the intensive phase or had not attended any sessions (non-completers). Focus groups were audio recorded, transcribed verbatim and analysed inductively using thematic analysis. Three overall themes were generated from the six focus groups: (a) long-term benefits from diet and physical activity education, (b) group versus individual structure and adherence and (c) impact on health beliefs and risk of CVD. A fourth theme was generated from the two groups of non-completers only: (d) need for professional rapport building and feedback. We found that the key active ingredients for effective behavioural change in lifestyle interventions are having well-developed rapport between facilitators and patients; and providing alternative forms of feedback to encourage maintenance of behaviour change. Furthermore, such programmes also need to have established and strong relationships with associated health professionals (i.e. the General Practitioner) to increase participation and maintenance of engagement.
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Affiliation(s)
- Lisa Kuriakose
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paulina Kuczynska
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Division of Health Services and Management, School of Health Sciences, University of London, London, UK
| | - Patrick Timpel
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Farah Yakub
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adam Bayley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iliatha Papachristou Nadal
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Ismail K, Stahl D, Bayley A, Twist K, Stewart K, Ridge K, Britneff E, Ashworth M, de Zoysa N, Rundle J, Cook D, Whincup P, Treasure J, McCrone P, Greenough A, Winkley K. Enhanced motivational interviewing for reducing weight and increasing physical activity in adults with high cardiovascular risk: the MOVE IT three-arm RCT. Health Technol Assess 2019; 23:1-144. [PMID: 31858966 PMCID: PMC6943381 DOI: 10.3310/hta23690] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Motivational interviewing (MI) enhanced with behaviour change techniques (BCTs) and deployed by health trainers targeting multiple risk factors for cardiovascular disease (CVD) may be more effective than interventions targeting a single risk factor. OBJECTIVES The clinical effectiveness and cost-effectiveness of an enhanced lifestyle motivational interviewing intervention for patients at high risk of CVD in group settings versus individual settings and usual care (UC) in reducing weight and increasing physical activity (PA) were tested. DESIGN This was a three-arm, single-blind, parallel randomised controlled trial. SETTING A total of 135 general practices across all 12 South London Clinical Commissioning Groups were recruited. PARTICIPANTS A total of 1742 participants aged 40-74 years with a ≥ 20.0% risk of a CVD event in the following 10 years were randomised. INTERVENTIONS The intervention was designed to integrate MI and cognitive-behavioural therapy (CBT), delivered by trained healthy lifestyle facilitators in 10 sessions over 1 year, in group or individual format. The control group received UC. RANDOMISATION Simple randomisation was used with computer-generated randomisation blocks. In each block, 10 participants were randomised to the group, individual or UC arm in a 4 : 3 : 3 ratio. Researchers were blind to the allocation. MAIN OUTCOME MEASURES The primary outcomes are change in weight (kg) from baseline and change in PA (average number of steps per day over 1 week) from baseline at the 24-month follow-up, with an interim follow-up at 12 months. An economic evaluation estimates the relative cost-effectiveness of each intervention. Secondary outcomes include changes in low-density lipoprotein cholesterol and CVD risk score. RESULTS The mean age of participants was 69.75 years (standard deviation 4.11 years), 85.5% were male and 89.4% were white. At the 24-month follow-up, the group and individual intervention arms were not more effective than UC in increasing PA [mean 70.05 steps, 95% confidence interval (CI) -288 to 147.9 steps, and mean 7.24 steps, 95% CI -224.01 to 238.5 steps, respectively] or in reducing weight (mean -0.03 kg, 95% CI -0.49 to 0.44 kg, and mean -0.42 kg, 95% CI -0.93 to 0.09 kg, respectively). At the 12-month follow-up, the group and individual intervention arms were not more effective than UC in increasing PA (mean 131.1 steps, 95% CI -85.28 to 347.48 steps, and mean 210.22 steps, 95% CI -19.46 to 439.91 steps, respectively), but there were reductions in weight for the group and individual intervention arms compared with UC (mean -0.52 kg, 95% CI -0.90 to -0.13 kg, and mean -0.55 kg, 95% CI -0.95 to -0.14 kg, respectively). The group intervention arm was not more effective than the individual intervention arm in improving outcomes at either follow-up point. The group and individual interventions were not cost-effective. CONCLUSIONS Enhanced MI, in group or individual formats, targeted at members of the general population with high CVD risk is not effective in reducing weight or increasing PA compared with UC. Future work should focus on ensuring objective evidence of high competency in BCTs, identifying those with modifiable factors for CVD risk and improving engagement of patients and primary care. TRIAL REGISTRATION Current Controlled Trials ISRCTN84864870. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 69. See the NIHR Journals Library website for further project information. This research was part-funded by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London.
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Affiliation(s)
- Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adam Bayley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katherine Twist
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kurtis Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katie Ridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emma Britneff
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Nicole de Zoysa
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jennifer Rundle
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Derek Cook
- Population Health Research Institute, St George's, University of London, London, UK
| | - Peter Whincup
- Population Health Research Institute, St George's, University of London, London, UK
| | - Janet Treasure
- Department of Health Services and Population Research, Institute of Psychiatry, King's College London, London, UK
| | - Paul McCrone
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anne Greenough
- Division of Asthma, Allergy and Lung Biology, King's College London, Guy's Hospital, London, UK
| | - Kirsty Winkley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Mason MJ, Brown A, Moore M. The accuracy of young adult cannabis users' perceptions of friends' cannabis and alcohol use. Addict Behav 2019; 95:28-34. [PMID: 30831338 DOI: 10.1016/j.addbeh.2019.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/17/2019] [Accepted: 02/21/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Understanding the complex influence of peers on young adult substance use is an important component of intervention research and is challenging methodologically. The false consensus theory suggests that individuals falsely attribute their own substance use behaviors onto others, producing biased data. METHODS We tested this theory with 39 young adults who had a cannabis use disorder and a mean age of 20. Participants (egos) recruited three of their close friends (alters). Egos reported their past 30-day cannabis and alcohol use and their perceptions of alters' use. Alters also reported their actual past 30-day cannabis and alcohol use. RESULTS Results demonstrated that egos were very accurate in their perceptions of the frequency of alters' cannabis (ρ = 0.82, p < 0.001) and alcohol (ρ = 0.74, p < 0.001) use. Linear regression models predicted alters' actual cannabis and alcohol use based on egos' perceptions of alters' use, controlling for egos' own substance use. Egos' perceptions of alters' cannabis use strongly predicted alters' actual use (β = 0.80, p < 0.001, adj-R2 = 0.67), and egos' perceptions of alters' alcohol use also predicted alters' actual use (β = 0.66, p < 0.001, adj-R2 = 0.62). Egos' own substance use did not predict alters' use in either model. CONCLUSIONS Results provide evidence that the false consensus theory may be limited when applied to young adults with cannabis use disorder within a close-friend research framework. The results support the hypothesis that young adults are very accurate in their perceptions of the frequency of close friends' substance use and that these perceptions are independent of egos' own use. These findings support the continued use of ego-centric reported close peer substance use for understanding peer effects.
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Affiliation(s)
- Michael J Mason
- University of Tennessee, Center for Behavioral Health Research, 213 Henson Hall, Knoxville, TN 37996-3332, USA.
| | - Aaron Brown
- University of Tennessee, Center for Behavioral Health Research, 213 Henson Hall, Knoxville, TN 37996-3332, USA.
| | - Matthew Moore
- University of Tennessee, Center for Behavioral Health Research, 213 Henson Hall, Knoxville, TN 37996-3332, USA.
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Beck AK, Forbes E, Baker AL, Britton B, Oldmeadow C, Carter G. Adapted motivational interviewing for brief healthcare consultations: protocol for a systematic review and meta-analysis of treatment fidelity in real-world evaluations of behaviour change counselling. BMJ Open 2019; 9:e028417. [PMID: 31366650 PMCID: PMC6678060 DOI: 10.1136/bmjopen-2018-028417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 04/09/2019] [Accepted: 07/01/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Treatment fidelity is an important and often neglected component of complex behaviour change research. It is central to understanding treatment effects, especially for evaluations conducted outside of highly controlled research settings. Ensuring that promising interventions can be delivered adequately (ie, with fidelity) by real-world clinicians within real-world settings is an essential step in developing interventions that are both effective and 'implementable'. Whether this is the case for behaviour change counselling, a complex intervention developed specifically for maximising the effectiveness of real-world consultations about health behaviour change, remains unclear. To improve our understanding of treatment effects, best practice guidelines recommend the use of strategies to enhance, monitor and evaluate what clinicians deliver during patient consultations. There has yet to be a systematic evaluation of whether and how these recommendations have been employed within evaluations of behaviour change counselling, nor the impact on patient health behaviour and/or outcome. We seek to address this gap. METHODS AND ANALYSIS Methods are informed by published guidelines. Ten electronic databases (Medline, PubMed, EMBASE, PsycINFO, CINAHL Complete, ScienceDirect, Taylor and Francis; Wiley, ProQuest and Open Grey) will be searched for published and unpublished articles that evaluate behaviour change counselling within real-world clinical settings (randomised and non-randomised). Eligible papers will be rated against the National Institute of Health fidelity framework. A synthesis, evaluation and critical overview of fidelity practices will be reported and linear regression used to explore change across time. Random-effect meta-regression is planned to explore whether fidelity (outcomes reported and methods used) is associated with the impact of behaviour change counselling. Standardised effect sizes will be calculated using Hedges' g (continuous outcomes) and ORs (binary/dichotomous outcomes). ETHICS AND DISSEMINATION No ethical issues are foreseen. Findings will be disseminated via journal publication and conference presentation(s). PROSPERO REGISTRATION NUMBER CRD42019131169.
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Affiliation(s)
- Alison K Beck
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Erin Forbes
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Ben Britton
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia
| | | | - Gregory Carter
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia
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Gillam DG, Yusuf H. Brief Motivational Interviewing in Dental Practice. Dent J (Basel) 2019; 7:dj7020051. [PMID: 31052431 PMCID: PMC6631588 DOI: 10.3390/dj7020051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/27/2019] [Accepted: 04/17/2019] [Indexed: 12/18/2022] Open
Abstract
Motivational Interviewing has been demonstrated to be effective for a wide range of health behaviors. It is an effective behavior change method, which can be utilized in the dental practice setting. It can be used as a brief intervention to increase motivation to improve patients’ oral hygiene behaviors as well as providing a framework for delivering diet, smoking cessation, oral health changes, and alcohol advice. It involves four processes: engaging, focusing, evoking, and planning, guiding, which supports the patient towards a positive behavior change. Motivational Interviewing is a collaborative, patient-centered approach evoking the patient’s own motivation to change, thereby enhancing the relationship between the clinician and patient and improving patient outcomes. This review will provide an overview on the topic for dental professionals as well as helpful suggestions for supporting a positive behavior change in their dental practices.
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Affiliation(s)
- David G Gillam
- Oral Bioengineering, Institute of Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary University, London E1 2AD, UK.
| | - Huda Yusuf
- Dental Public Health and Primary Care, Institute of Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary University, London E1 2AD, UK.
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Mutschler C, Naccarato E, Rouse J, Davey C, McShane K. Realist-informed review of motivational interviewing for adolescent health behaviors. Syst Rev 2018; 7:109. [PMID: 30053903 PMCID: PMC6064084 DOI: 10.1186/s13643-018-0767-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 07/03/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Clinical research investigating effective intervention strategies for adolescents to improve health behaviors has shifted to the application of motivational interviewing (MI). Evidence indicates that MI is an effective intervention for improving health behaviors as related to diet, exercise, and diabetes among adolescents. However, there is a lack of understanding about the mechanisms through which MI works and the contextual factors impacting MI effectiveness. The purpose of this review was to understand how, for whom, and under what circumstances MI works for adolescent health behavior change, which will inform future implementation of this intervention. To provide this in-depth understanding, a realist-informed systematic review was conducted in order to synthesize the evidence on the use of MI for health behaviors. Self-determination theory (SDT) was chosen as the candidate theory for testing in the present review. METHODS Databases including PsycINFO, Healthstar, Cochrane, and PubMed were searched for articles published until March 2017. The search strategy included studies that examined or reviewed the effectiveness or efficacy of MI to change health behaviors among adolescent populations. The search identified 185 abstracts, of which 28 were included in the review. The literature was synthesized qualitatively (immersion/crystallization) and tested SDT as the candidate theory. RESULTS Based on SDT, three mechanisms were found within reviewed studies, including competence, relatedness, and autonomy. The following contexts were found to impact mechanisms: school setting, clinician MI proficiency, parental involvement, and peer involvement. CONCLUSIONS This realist-informed systematic review provides advances in understanding the mechanisms involved in MI for adolescent health behavior change. Additionally, it provides important practical information as to which contexts create the conditions for these mechanisms to occur, leading to health behavior change. The results can inform future MI interventions for adolescent health behavior change. Future research should continue to test this realist theory and also examine mechanism variables not extensively documented in order to improve our understanding of MI in this population.
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12
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Caldwell AL, Tingen MS, Nguyen JT, Andrews JO, Heath J, Waller JL, Treiber FA. Parental Smoking Cessation: Impacting Children's Tobacco Smoke Exposure in the Home. Pediatrics 2018; 141:S96-S106. [PMID: 29292310 PMCID: PMC5745674 DOI: 10.1542/peds.2017-1026m] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES There is no safe or risk-free level of tobacco use or tobacco smoke exposure. In this randomized controlled trial, we tested a tobacco control intervention in families and specifically evaluated a tailored cessation intervention for the parents and/or caregivers (Ps/Cs) who were smokers while their children were simultaneously enrolled in tobacco prevention. METHODS Ps/Cs and children were recruited from 14 elementary schools across rural and urban settings. Approximately one-fourth (24.3%; n = 110) of the total Ps/Cs enrolled in the randomized controlled trial (n = 453) were smokers, predominantly women (80.9%), with a mean age of 37.7 years. (SD 12.2); 62.7% were African American, 44% had less than a high school education, and 58% earned <$20 000 annually. P/C smokers were offered a tailored cessation intervention in years 1 and 2. Self-report smoking status and saliva cotinine were obtained at baseline, the end of treatment (EOT) and/or year 2, and in the year 4 follow-up. RESULTS Ps/Cs in the intervention group showed a larger increase in self-reported smoking abstinence over time (EOT: 6.5% [SE = 5.7%]; year 4: 40.6% [SE = 5.7%]) than the control group (EOT: 0.0% [SE = 6.5%]; year 4: 13.2% [SE = 6.4%]; F = 4.82; P = .0306). For cotinine, the intervention group showed a decrease from baseline (239.9 [SE = 1.3]) to EOT 99.3 [SE = 1.4]) and then maintenance through year 4 (109.6 [SE = 1.4]), whereas the control group showed increases from baseline (221.1 [SE = 1.4]) to EOT (239.0 [SE = 1.4]) to year 4 (325.8 [SE = 14]; F = 5.72; P = .0039). CONCLUSIONS This study provides evidence that tailored cessation offered to Ps/Cs in their children's schools during their children's enrollment in tobacco prevention may contribute to more robust success in P/C cessation and a reduction of tobacco smoke exposure in children.
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Affiliation(s)
| | - Martha S. Tingen
- Departments of Pediatrics and,Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Joshua T. Nguyen
- Departments of Pediatrics and,Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia
| | | | - Janie Heath
- College of Nursing, University of Kentucky, Lexington, Kentucky; and
| | | | - Frank A. Treiber
- Colleges of Medicine and Nursing, Medical University of South Carolina, Charleston, South Carolina
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Randall CL, McNeil DW. Motivational Interviewing as an Adjunct to Cognitive Behavior Therapy for Anxiety Disorders: A Critical Review of the Literature. COGNITIVE AND BEHAVIORAL PRACTICE 2017; 24:296-311. [PMID: 28871216 PMCID: PMC5580948 DOI: 10.1016/j.cbpra.2016.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Cognitive behavior therapy (CBT) is efficaciously and effectively used in the treatment of anxiety disorders; however, as CBT for anxiety routinely utilizes exposure components, clients often experience ambivalence about treatment and their clinicians often must deal with resistance. Motivational Interviewing (MI) is a therapeutic strategy that addresses ambivalence about change in clinical interventions. MI has been applied as an adjunct for treatments such as CBT in order to increase motivation for and commitment to the intervention, especially when components of the treatment may be challenging (e.g., exposure, cognitive restructuring). Though researchers have commented specifically on the use of MI as a supplement to CBT for anxiety disorders, no comprehensive review has systematically assessed the strengths and limitations of extant literature on the topic, nor across anxiety disorders. Findings are summarized from 6 case studies and uncontrolled trials and 11 randomized controlled trials published through March 2016. An integrated critique of this literature also is offered. Limitations and the preliminary nature of the work in this area notwithstanding, it appears that it is feasible to supplement or integrate CBT with MI and that doing so has the potential to improve treatment initiation and engagement, as well as clinical outcomes. A number of directions for future research are addressed, such as determining which MI approaches to implement, with whom, when, and in what contexts.
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Client Characteristics and Therapist Style: A Combined Analysis of Impact on Retention and Effectiveness in Outpatient Substance Abuse Treatment. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.2478/v10199-011-0028-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AIMS To explore the effects of client and therapist characteristics along with percentage of days abstinent before admission on retention and effectiveness of outpatient substance abuse treatment. DESIGN The study was implemented with naturalistic principles and prospective design. The clients (N = 327) and the therapists (N = 33) were recruited from Finnish outpatient treatment units (N = 7). Results The client's low readiness to change, the therapist's low directiveness and low empathy predicted short duration of treatment. Client's past substance use frequency was likewise a significant predictor of retention in treatment; clients with low percentage of days abstinent at baseline dropped out much more easily. The client's high anger and low percentage of days abstinent at baseline was found to predict low percentage of days abstinent at follow-up. Greater satisfaction with support from therapist was predicted by client's high readiness to change and lower substance use frequency at baseline. Conclusions Retention in treatment was predicted by both client's and therapist's characteristics, while effectiveness in outpatient substance abuse treatment was more dependent on client's characteristics and earlier substance use.
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Simmons CA, Howell KH, Duke MR, Beck JG. Enhancing the Impact of Family Justice Centers via Motivational Interviewing: An Integrated Review. TRAUMA, VIOLENCE & ABUSE 2016; 17:532-541. [PMID: 25966969 DOI: 10.1177/1524838015585312] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The Family Justice Center (FJC) model is an approach to assisting survivors of intimate partner violence (IPV) that focuses on integration of services under one roof and co-location of staff members from a range of multidisciplinary agencies. Even though the FJC model is touted as a best practice strategy to help IPV survivors, empirical support for the effectiveness of this approach is scarce. The current article consolidates this small yet promising body of empirically based literature in a clinically focused review. Findings point to the importance of integrating additional resources into the FJC model to engage IPV survivors who have ambivalent feelings about whether to accept help, leave the abusive relationship, and/or participate in criminal justice processes to hold the offender accountable. One such resource, motivational interviewing (MI), holds promise in aiding IPV survivors with these decisions, but empirical investigation into how MI can be incorporated into the FJC model has yet to be published. This article, therefore, also integrates the body of literature supporting the FJC model with the body of literature supporting MI with IPV survivors. Implications for practice, policy, and research are incorporated throughout this review.
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Brennan L. Does motivational interviewing improve retention or outcome in cognitive behaviour therapy for overweight and obese adolescents? Obes Res Clin Pract 2015; 10:481-6. [PMID: 26598449 DOI: 10.1016/j.orcp.2015.08.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 08/31/2015] [Indexed: 11/25/2022]
Abstract
This study aimed to determine whether motivational interviewing improved retention and/or outcome in cognitive behaviour therapy for overweight and obese adolescents (M=14.4, SD=2.0; 52% female). The first 23 participants were allocated to a standard semi-structure assessment interview, the remaining 19 to a motivational interview, prior to commencing the intervention. The groups did not differ at baseline or on anthropometric (weight, BMI, BMI-z-score, waist circumference, waist-hip or waist-height ratio), body composition (percent body fat, fat mass, lean mass) or attrition measures post-treatment or post-maintenance (p>.01). MI did not improve retention or outcome of cognitive behaviour therapy for adolescent overweight and obesity.
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Affiliation(s)
- Leah Brennan
- School of Psychology, Australian Catholic University, Australia.
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von Kodolitsch Y, Bernhardt AM, Kölbel T, Detter C, Reichenspurner H, Debus ES. Maximizing therapeutic success: The key concepts of individualized medical strategy (IMS). COGENT MEDICINE 2015. [DOI: 10.1080/2331205x.2015.1109742] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Yskert von Kodolitsch
- Centre of Cardiology and Cardiovascular Surgery, German Aortic Center Hamburg, University Heart Center, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany
| | - Alexander M. Bernhardt
- Centre of Cardiology and Cardiovascular Surgery, German Aortic Center Hamburg, University Heart Center, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany
| | - Tilo Kölbel
- Centre of Cardiology and Cardiovascular Surgery, German Aortic Center Hamburg, University Heart Center, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany
| | - Christian Detter
- Centre of Cardiology and Cardiovascular Surgery, German Aortic Center Hamburg, University Heart Center, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany
| | - Hermann Reichenspurner
- Centre of Cardiology and Cardiovascular Surgery, German Aortic Center Hamburg, University Heart Center, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany
| | - Eike Sebastian Debus
- Centre of Cardiology and Cardiovascular Surgery, German Aortic Center Hamburg, University Heart Center, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany
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18
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Bóveda-Fontán J, Barragán-Brun N, Campiñez-Navarro M, Pérula-de Torres LÁ, Bosch-Fontcuberta JM, Martín-Álvarez R, Arbonies-Ortiz JC, Novo-Rodríguez JM, Criado-Larumbe M, Fernández-García JA, Martín-Rioboó E. Effectiveness of motivational interviewing in patients with dyslipidemia: a randomized cluster trial. BMC FAMILY PRACTICE 2015; 16:151. [PMID: 26498221 PMCID: PMC4620004 DOI: 10.1186/s12875-015-0370-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 10/13/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND It is known that making people change their habits is challenging. It is crucial to identify the most effective approach that general practitioners (GPs) should use to help their patients change unhealthy habits. The objective this study was to assess the efficacy of a multifactorial intervention based on Motivational Interviewing performed by general practitioners to enhance lipid levels in patients with dyslipidemia, as compared to standard care. METHODS A multicenter, controlled, randomized, cluster, two-parallel arm trial with a 12-month follow-up conducted in 25 community health centers of the Spanish. 38 GPs and 227 primary care patients with uncontrolled dyslipidemia were included in the trial. GPs performed an intervention based either on Motivational Interviewing (MI) or standard practice. Lipid levels were measured, and the control degree was analyzed based on the criteria of clinical guidelines. RESULTS 107 were assigned to the Experimental Group (EG) and 120 to the Control Group (CG). An overall improvement was achieved in total cholesterol levels (Mean Difference -MD- = -19.60; 95 % CI: -15.33 at -23.87 mg/dl; p < 0.001), LDL-cholesterol levels (MD = -13.78; 95 % CI: -9.77 at -17.79 mg/dl; p < 0.001) and triglycerides (MD = -19.14; CI 95 %: -11.29 at -26.99 mg/dl; p < 0.001). No differences were found between the two groups. However, when we assessed the degree of lipid control by combining cholesterol <200 mg/dl and LDL-cholesterol < 130 mg/dl parameters, it was observed that a higher percentage of patients achieved target figures in the EG versus CG (13.1 % vs. 5.0 %; adjusted OR = 5.77, 95 % CI: 1.67-19.91). CONCLUSION A Motivational Interviewing-based approach conducted by Primary Care physicians aimed at patients with dyslipidemia, achieved a significant reduction in all lipid parameters, cardiovascular risk, weight reduction and the adherence to the Mediterranean diet, similar to that obtained with the usual intervention and superior in the proportion of patients achieving combined lipid control goals and the level of physical exercise. TRIAL REGISTRATION the trial is registered in ClinicalTrials.gov ( NCT01282190 ; January 21, 2011).
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Affiliation(s)
| | | | | | - Luís Ángel Pérula-de Torres
- Unidad Docente de Medicina Familiar y Comunitaria de Córdoba. Distrito Sanitario Córdoba y Guadalquivir. C/Isla de Lanzarote, Córdoba, Spain.
- Maimónides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofia University Hospital/University of Córdoba, Córdoba, Spain.
| | | | | | | | | | - Margarita Criado-Larumbe
- Health Center Villarrubia (UGC Occidente), Teaching Unit of Family and Community Medicine Cordoba. Sanitary District Cordoba and Guadalquivir. Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofía University Hospital/University of Córdoba, Córdoba, Spain.
| | - Jose Angel Fernández-García
- Health Center Villarrubia (UGC Occidente), Teaching Unit of Family and Community Medicine Cordoba. Sanitary District Cordoba and Guadalquivir. Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofía University Hospital/University of Córdoba, Córdoba, Spain.
| | - Enrique Martín-Rioboó
- UGC Fuensanta. Teaching Unit of Family and Community Medicine Cordoba. Maimónides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofía University Hospital/University of Cordoba, Córdoba, Spain.
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Wain RM, Kutner BA, Smith JL, Carpenter KM, Hu MC, Amrhein PC, Nunes EV. Self-Report After Randomly Assigned Supervision Does not Predict Ability to Practice Motivational Interviewing. J Subst Abuse Treat 2015; 57:96-101. [PMID: 25963775 PMCID: PMC4560973 DOI: 10.1016/j.jsat.2015.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 04/03/2015] [Accepted: 04/08/2015] [Indexed: 11/16/2022]
Abstract
The objective of this study was to investigate the relation between self-report and objective assessment of motivational interviewing (MI) skills following training and supervision. After an MI workshop, 96 clinicians from 26 community programs (age 21-68, 65% female, 40.8% Black, 29.6% Caucasian, 24.5% Hispanic, 2.0% Asian, 3.1% other) were randomized to supervision (tele-conferencing or tape-based), or workshop only. At four time points, trainees completed a self-report of MI skill, using items from the MI understanding questionnaire (MIU), and were objectively assessed by raters using the Motivational Interviewing Treatment Integrity (MITI) system. Correlations were calculated between MIU and MITI scores. A generalized linear mixed model was tested on MIU scores, with MITI scores, supervision condition and time as independent variables. MIU scores increased from pre-workshop (mean = 4.74, SD = 1.79) to post-workshop (mean = 6.31, SD = 1.03) (t = 8.69, p < .0001). With supervision, scores continued to increase, from post-workshop to week 8 (mean = 7.07, SD = 0.91, t = 5.60, p < .0001) and from week 8 to week 20 (mean = 7.28, SD = 0.94, t = 2.43, p = .02). However, MIU scores did not significantly correlate with MITI scores, with or without supervision. Self-reported ability increased with supervision, but self-report was not an indicator of objectively measured skill. This suggests that training does not increase correspondence between self-report and objective assessment, so community treatment programs should not rely on clinician self-report to assess the need for ongoing training and supervision and it may be necessary to train clinicians to accurately assess their own skill.
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Affiliation(s)
- R Morgan Wain
- Division of Substance Abuse, New York State Psychiatric Institute, 1051 Riverside Drive, Room 3732, Box 120, New York, NY, 10032, USA.
| | - Bryan A Kutner
- Division of Substance Abuse, New York State Psychiatric Institute, 1051 Riverside Drive, Room 3732, Box 120, New York, NY, 10032, USA.
| | - Jennifer L Smith
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, Room 3732, Box 120, New York, NY, 10032, USA.
| | - Kenneth M Carpenter
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, 1051 Riverside Drive, Room 3732, Box 120, New York, NY, 10032, USA.
| | - Mei-Chen Hu
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 20, New York, NY, 10032, USA.
| | - Paul C Amrhein
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, 1051 Riverside Drive #120, New York, NY, 10032, USA.
| | - Edward V Nunes
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 51, New York, NY, 10032, USA.
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Moral RR, Torres LAPD, Ortega LP, Larumbe MC, Villalobos AR, García JAF, Rejano JMP. Effectiveness of motivational interviewing to improve therapeutic adherence in patients over 65 years old with chronic diseases: A cluster randomized clinical trial in primary care. PATIENT EDUCATION AND COUNSELING 2015; 98:977-983. [PMID: 25858633 DOI: 10.1016/j.pec.2015.03.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 01/29/2015] [Accepted: 03/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of motivational interviewing (MI) in improving medication adherence in older patients being treated by polypharmacy. METHODS Cluster randomized clinical trial in 16 primary care centers with 27 health care providers and 154 patients. Thirty-two health care providers were assigned to an experimental (EG) or control group (CG). INTERVENTIONS MI training program and review of patient treatments. Providers in the EG carried out MI, whereas those in the CG used an "advice approach". Three follow-up visits were completed, at 15 days and at 3 and 6 months. Medication adherence in both groups was compared (p<0.05). RESULTS Patients recruited: 70/84 (EG/CG). Mean age: 76 years; female: 68.8%. The proportion of subjects changing to adherence was 7.6% higher in the EG (p<0.001). Therapeutic adherence was higher for patients in the EG (OR=2.84), women (OR=0.24) and those with high educational levels (OR=3.93). CONCLUSION A face-to-face motivational approach in primary care helps elderly patients with chronic diseases who are being treated by polypharmacy to achieve an improved level of treatment adherence than traditional strategies of providing information and advice. PRACTICE IMPLICATIONS MI is a patient-centered approach that can be used to improve medication adherence in primary care. TRIAL REGISTRATION This trial is registered at ClinicalTrials.gov (NCT01291966).
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Affiliation(s)
- Roger Ruiz Moral
- Faculty of Medicine, Francisco de Vitoria University, Madrid, Spain.
| | - Luis Angel Pérula de Torres
- Teaching Unit of Family and Community Medicine of Córdoba (Córdoba-Guadalquivir Health District), Maimonides Institute for Biomedical Research Córdoba (IMIBIC)/University of Cordoba, Reina Sofia University Hospital, Cordoba, Spain.
| | - Laura Pulido Ortega
- Teaching Unit of Family and Community Medicine of Córdoba (Córdoba-Guadalquivir Health District), Maimonides Institute for Biomedical Research Córdoba (IMIBIC)/University of Cordoba, Reina Sofia University Hospital, Cordoba, Spain.
| | - Margarita Criado Larumbe
- Teaching Unit of Family and Community Medicine of Córdoba (Córdoba-Guadalquivir Health District), Maimonides Institute for Biomedical Research Córdoba (IMIBIC)/University of Cordoba, Reina Sofia University Hospital, Cordoba, Spain.
| | - Ana Roldán Villalobos
- Teaching Unit of Family and Community Medicine of Córdoba (Córdoba-Guadalquivir Health District), Maimonides Institute for Biomedical Research Córdoba (IMIBIC)/University of Cordoba, Reina Sofia University Hospital, Cordoba, Spain.
| | - Jose Angel Fernández García
- Villarrubia Health Center, UGC Occidente (Córdoba-Guadalquivir Health District), Maimonides Institute for Biomedical Research Córdoba (IMIBIC)/University of Córdoba/Reina Sofia University Hospital, Córdoba, Spain.
| | - Juan Manuel Parras Rejano
- Villanueva del Rey Health Center, UGC-Pueblonuevo Penyarroya (Northern Córdoba Health District), Maimonides Institute for Biomedical Research Córdoba (IMIBIC)/University of Córdoba/Reina Sofia University Hospital, Córdoba, Spain.
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Mirkarimi K, Mostafavi F, Eshghinia S, Vakili MA, Ozouni-Davaji RB, Aryaie M. Effect of Motivational Interviewing on a Weight Loss Program Based on the Protection Motivation Theory. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e23492. [PMID: 26380106 PMCID: PMC4568028 DOI: 10.5812/ircmj.23492v2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 09/29/2014] [Accepted: 10/20/2014] [Indexed: 01/26/2023]
Abstract
Background: The prevalence of overweight and obesity is on the increase the world over, which imposes an ever-increasing burden on societies and health care systems. Objectives: This study sought to investigate the effect of motivational interviewing (MI) on a weight-loss program based on the protection motivation theory (PMT). Patients and Methods: This randomized clinical trial study, comprising pretest-posttest with a control group, was conducted on 150 overweight and obese women attending a private nutrition clinic for the first time. Samples were randomly selected using the clinic’s records and then allocated to three groups (50 women in each group) receiving: 1) a standard weight-control program; 2) motivational interviewing; and 3) MI plus intention intervention. Data were collected using a researcher-made questionnaire through in-person interviews and were analyzed using SPSS (version 11) and statistical tests, including the Kruskal-Wallis test, one-way analysis of variance, paired t-test, and linear regression model. Results: In the two intervention groups, the PMT construct scores, namely susceptibility (P = 0.001), severity (P = 0.001), rewards (P =0.004), self-efficacy (P = 0.001), response efficacy (P = 0.001), and costs (P = 0.014), were significantly increased compared to those in the control group. The anthropometric status was statistically significant in the MI group (P = 0.001) and the MI plus intention-intervention group (P = 0.001) at 2 months’ follow-up, while in the control group, weight was meaningfully different after the intervention (P = 0.027). Weight was different between the groups after the intervention, with the Tukey test demonstrating that the differences were statistically significant between the control group and the MI group. Conclusions: Our results demonstrated that MI, combined with the implementation of intention intervention, increased weight loss and PMT construct scores in our study population.
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Affiliation(s)
- Kamal Mirkarimi
- Department of Health Education and Promotion, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Firoozeh Mostafavi
- Department of Health Education and Promotion, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, IR Iran
- Corresponding Author: Firoozeh Mostafavi, Department of Health Education and Promotion, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, IR Iran. Tel: +98-9132118364, Fax: +98-1732421657, E-mail:
| | - Samira Eshghinia
- Metabolic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran
| | - Mohammad Ali Vakili
- Department of Health and Medical Sciences, Golestan University of Medical Sciences, Gorgan, IR Iran
| | - Rahman Berdi Ozouni-Davaji
- Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran
| | - Mohammad Aryaie
- Deputyship of Research, Golestan University of Medical Sciences, Gorgan, IR Iran
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Tanner-Smith EE, Steinka-Fry KT, Hennessy EA, Lipsey MW, Winters KC. Can brief alcohol interventions for youth also address concurrent illicit drug use? results from a meta-analysis. J Youth Adolesc 2015; 44:1011-23. [PMID: 25600491 PMCID: PMC4393344 DOI: 10.1007/s10964-015-0252-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 01/08/2015] [Indexed: 10/24/2022]
Abstract
Brief interventions aimed at reducing alcohol use among youth may interrupt a possible developmental progression to more serious substance use if they can also affect the use of other illicit drugs. This meta-analysis examined the findings of recent research on the effects of brief alcohol interventions for adolescents and young adults on both alcohol and illicit drug use. Eligible studies were those using randomized or controlled quasi-experimental designs to examine the effects of brief alcohol interventions on illicit drug use outcomes among youth. A comprehensive literature search identified 30 eligible study samples that, on average, included participants age 17, with 57 % male participants and 56 % White youth. Three-level random-effects meta-analyses were used to estimate mean effect sizes and explore variability in effects. Overall, brief interventions targeting both alcohol and other drugs were effective in reducing both of these substances. However, the brief interventions that targeted only alcohol had no significant secondary effects on untargeted illicit drug use. The evidence from current research, therefore, shows modest beneficial effects on outcomes that are targeted by brief interventions for youth, but does not show that those effects generalize to untargeted illicit drug use outcomes.
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Affiliation(s)
- Emily E Tanner-Smith
- Department of Human and Organizational Development, Peabody Research Institute, Vanderbilt University, Box 0181 GPC, Nashville, TN, 37203-5721, USA,
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Ayres R, Ingram J, Rees A, Neale J, Beattie A, Telfer M. Enhancing motivation within a rapid opioid substitution treatment feasibility RCT: a nested qualitative study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2014; 9:44. [PMID: 25407020 PMCID: PMC4240819 DOI: 10.1186/1747-597x-9-44] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 10/25/2014] [Indexed: 11/16/2022]
Abstract
Background Opioid substitution treatment (OST) has multiple benefits for heroin injectors and is an evidence-based major component of international treatment. The current qualitative study sought to explore participants’ attitudes to and reasons for participating in a feasibility randomised trial in primary care offering ‘same day’ OST (methadone) for injecting heroin users compared to usual care. Methods Twenty injecting heroin users (8 intervention and 12 controls; 16 males and 4 females) were interviewed; purposive sampling was used to select a maximum variation sample from those who agreed; and analysis used thematic methods. Results Motivation to join the trial included the need to secure treatment set against some ambivalence due to previous negative experiences of trying to obtain OST. Positive effects of securing methadone via the trial, included self-reported improvements in health and self-care; reduction in crime, stress and drug use. Completing the baseline questionnaires at recruitment appeared to enhance motivation for treatment for all participants. For some control participants, this motivation seemed to increase a sense of self-efficacy and cognitive dissonance generated was resolved by seeking treatment from their GP. Self-determination theory suggests that behaviour change may have been initiated during the recruitment appointment, resulting in an increased determination to seek treatment amongst control participants. Conclusions Taking part in the ‘script in a day’ trial enabled participants in the intervention arm to gain same-day access to methadone and reduce their drug use. For those in the control arm, completing the baseline questionnaires at recruitment appeared to create cognitive dissonance between their current health state and own aspirations, so increasing motivation for treatment. Over 50% obtained and were still in receipt of OST (methadone or buprenorphine) at the 3 month follow-up. We suggest that a regular ‘health evaluation’ for injecting heroin users not in treatment, paired with low-barrier access to treatment, may be a way of exploring this and encouraging more into obtaining OST more quickly and at the best time for them. This intervention should be delivered without pressure for change. Clinical trial registration This trial is registered with International Standard Randomised Controlled Trial Number Register: SCript In a Day for injecting drug users: feasibility trial: ISRCTN16846554.
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Affiliation(s)
| | - Jenny Ingram
- School of Social and Community Medicine, University of Bristol, Oakfield House, Bristol BS8 2BN, UK.
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Carr ES, Smith Y. The poetics of therapeutic practice: motivational interviewing and the powers of pause. Cult Med Psychiatry 2014; 38:83-114. [PMID: 24293053 DOI: 10.1007/s11013-013-9352-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Motivational interviewing (MI) is an increasingly prominent behavioral therapy that draws from and claims to synthesize two American therapeutic traditions long thought to be antithetical-"client-centered" and "directive" approaches. This paper proposes that MI achieves its hallmark "client-centered directiveness" through the aesthetic management of the therapeutic encounter, and more particularly, through MI practitioners' marked use of silence. Drawing on data collected during the ethnographic study of MI trainings and the formal analysis of video-recorded MI sessions that are commonly used as models in such trainings, we identify three patterns of pause that regularly fall at specific grammatical junctures within seasoned MI practitioners' turns-at-talk. We demonstrate how these pauses allow MI practitioners to subtly direct the conversation while simultaneously displaying unequivocal signs of client-centeredness. In other words, we show how and explain why the poetics of pause matter to MI. In presenting this case, we more generally highlight practice poetics-that is, the aesthetic management of the style and delivery of a professional message with a particular practical aim in mind-suggesting that this is a central if under-appreciated aspect of therapeutic practices.
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Affiliation(s)
- E Summerson Carr
- School of Social Service Administration, University of Chicago, 969 E. Sixtieth Street, Chicago, IL, 60637, USA,
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25
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Weinstock J, Capizzi J, Weber SM, Pescatello LS, Petry NM. Exercise as an intervention for sedentary hazardous drinking college students: A pilot study. Ment Health Phys Act 2014; 7:55-62. [PMID: 24949085 PMCID: PMC4058428 DOI: 10.1016/j.mhpa.2014.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Young adults 18-24 years have the highest rates of problems associated with alcohol use among all age groups, and substance use is inversely related to engagement in substance-free activities. This pilot study investigated the promotion of one specific substance-free activity, exercise, on alcohol use in college students. Thirty-one sedentary college students who engaged in hazardous drinking (Alcohol Use Disorders Identification Test scores ≥ 8) were randomized to one of two conditions: (a) one 50-minute session of motivational enhancement therapy (MET) focused on increasing exercise, or (b) one 50-minute session of MET focused on increasing exercise plus 8 weeks of contingency management (CM) for adhering to specific exercise activities. All participants completed evaluations at baseline and post-treatment (2-months later) assessing exercise participation and alcohol use. Results of the pilot study suggest the interventions were well received by participants, the MET+CM condition showed an increased self-reported frequency of exercise in comparison to the MET alone condition, but other indices of exercise, physical fitness, and alcohol use did not differ between the interventions over time. These results suggest that a larger scale trial could better assess efficacy of this well received combined intervention. Investigation in other clinically relevant populations is also warranted.
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Affiliation(s)
- Jeremiah Weinstock
- Department of Psychology, Saint Louis University, St. Louis, MO 63103
- Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, CT 06030-3944
| | - Jeffrey Capizzi
- Department of Kinesiology, Neag School of Education, University of Connecticut, Storrs, CT 06269-1110
| | - Stefanie M. Weber
- Department of Psychology, Saint Louis University, St. Louis, MO 63103
| | - Linda S. Pescatello
- Department of Kinesiology, Neag School of Education, University of Connecticut, Storrs, CT 06269-1110
| | - Nancy M. Petry
- Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, CT 06030-3944
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Bray KK, Catley D, Voelker MA, Liston R, Williams KB. Motivational Interviewing in Dental Hygiene Education: Curriculum Modification and Evaluation. J Dent Educ 2013. [DOI: 10.1002/j.0022-0337.2013.77.12.tb05645.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Kimberly Krust Bray
- Division of Dental Hygiene; University of Missouri-Kansas City School of Dentistry
| | - Delwyn Catley
- Department of Psychology; University of Missouri-Kansas City
| | - Marsha A. Voelker
- Division of Dental Hygiene; University of Missouri-Kansas City School of Dentistry
| | | | - Karen B. Williams
- Department of Biomedical and Health Informatics; University of Missouri-Kansas City School of Medicine
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Motivational interviewing and decisional balance: contrasting responses to client ambivalence. Behav Cogn Psychother 2013; 43:129-41. [PMID: 24229732 DOI: 10.1017/s1352465813000878] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A recommendation in original descriptions of motivational interviewing (MI) was to "explore ambivalence". Contrasting procedures for doing so have been clarified through the evolution of MI. AIMS This article describes two conceptually distinct methods for responding to ambivalence: decisional balance (DB) and MI's evocation of change talk, and reviews empirical evidence to recommend when each procedure is appropriate (and inappropriate) in clinical practice. METHOD The authors summarize findings of clinical outcome research to examine how these two interventions impact the resolution of client ambivalence. RESULTS With ambivalent people, a DB intervention tends to decrease commitment to change, whereas evocation (a key element of MI) promotes change. When a person has already made the decision to change, evocation is unnecessary and may deter change, whereas DB may further strengthen commitment. CONCLUSIONS DB is an appropriate procedure when the clinician wishes to maintain neutrality and not favor the resolution of ambivalence in any particular direction. Evocation is appropriate when the clinician intends to help clients resolve ambivalence in the direction of change.
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28
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Bóveda Fontán J, Pérula de Torres LÁ, Campiñez Navarro M, Bosch Fontcuberta JM, Barragán Brun N, Prados Castillejo JA. [Current evidence on the motivational interview in the approach to health care problems in primary care]. Aten Primaria 2013; 45:486-95. [PMID: 24042074 PMCID: PMC6985504 DOI: 10.1016/j.aprim.2013.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 01/08/2013] [Accepted: 01/18/2013] [Indexed: 11/30/2022] Open
Abstract
La entrevista motivacional ha sido ampliamente desarrollada como método clínico para promover en los pacientes cambios de conducta, ayudando a resolver su ambivalencia para obtener sus propias motivaciones. En el presente artículo ofrecemos una revisión de los principales metaanálisis y revisiones, tanto sistemáticas como narrativas, sobre la eficacia de la entrevista motivacional, centrándonos en el ámbito de la atención primaria de salud.
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Jaffray M, Matheson C, Bond CM, Lee AJ, McLernon DJ, Johnstone A, Skea L, Davidson B. Does training in motivational interviewing for community pharmacists improve outcomes for methadone patients? A cluster randomised controlled trial. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2013; 22:4-12. [DOI: 10.1111/ijpp.12049] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 05/25/2013] [Indexed: 11/27/2022]
Abstract
Abstract
Objectives
Feasibility of pharmacist delivered motivational interviewing (MI) to methadone patients has been demonstrated, but its efficacy is untested. This study aimed to determine whether pharmacists trained in MI techniques can improve methadone outcomes.
Methods
A cluster randomised controlled trial by pharmacy, with community pharmacies across Scotland providing supervised methadone to >10 daily patients, aged >18 years, started on methadone <24 months. Pharmacies were randomised to intervention or control. Intervention pharmacists received MI training and a resource pack. Control pharmacists continued with normal practice. Primary outcome was illicit heroin use. Secondary outcomes were treatment retention, substance use, injecting behaviour, psychological/physical health, treatment satisfaction and patient feedback. Data were collected via structured interviews at baseline and 6 months.
Key findings
Seventy-six pharmacies recruited 542 patients (295 intervention, 247 control), mean age 32 years; 64% male; 91% unemployed; mean treatment length 9 months. No significant difference in outcomes between groups for illicit heroin use (32.4% cf. 31.4%), although within-groups use reduced (P < 0.001); treatment retention was higher in the intervention group but not significantly (88% cf. 81%; P = 0.34); no significant difference between groups in treatment satisfaction, although this improved significantly in intervention (P < 0.05). More intervention than control patients said pharmacists had ‘spoken more,’ which approached statistical significance (P = 0.06), and more intervention patients found this useful (P < 0.05).
Conclusions
Limited intervention delivery may have reduced study power. The intervention did not significantly reduce heroin use, but there are indications of positive benefits from increased communication and treatment satisfaction.
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Affiliation(s)
- Mariesha Jaffray
- Division of Applied Medicine (Psychiatry), University of Aberdeen, Aberdeen, UK
| | - Catriona Matheson
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Christine M Bond
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Amanda J Lee
- Medical Statistics Team, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - David J McLernon
- Medical Statistics Team, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Lucy Skea
- Substance Misuse, NHS Grampian, Aberdeen, UK
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Clarke PB, Giordano AL. The Motivational Supervisor: Motivational Interviewing as a Clinical Supervision Approach. CLINICAL SUPERVISOR 2013. [DOI: 10.1080/07325223.2013.851633] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Knowles L, Anokhina A, Serpell L. Motivational interventions in the eating disorders: what is the evidence? Int J Eat Disord 2013; 46:97-107. [PMID: 23001832 DOI: 10.1002/eat.22053] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Eating disorder treatments are plagued by poor engagement and high drop-out. People who disengage from eating disorder treatment appear poorly motivated to change, and may benefit from adaptations of Motivational Interviewing (AMIs). OBJECTIVE To investigate whether the use of interventions specifically designed to enhance motivation in the eating disorders is supported empirically. METHOD Literature was reviewed for relevant studies. RESULTS Eight studies have investigated the efficacy of AMIs. AMIs improve motivation to change bingeing and reduce actual bingeing behavior. There was little support for AMIs for compensatory or restrictive behaviors. There was mixed evidence that AMIs may improve motivation, but little to suggest they are more effective than other approaches. DISCUSSION The widespread interest in using motivational approaches in the eating disorders is not strongly supported by the literature. The current evidence base does not support the widespread dissemination of motivation-enhancing interventions in the eating disorders.
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Affiliation(s)
- Lucy Knowles
- Research Department of Clinical, Educational and Health Psychology, University College London, United Kingdom.
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Narayanan S, Georgiou PG. Behavioral Signal Processing: Deriving Human Behavioral Informatics From Speech and Language: Computational techniques are presented to analyze and model expressed and perceived human behavior-variedly characterized as typical, atypical, distressed, and disordered-from speech and language cues and their applications in health, commerce, education, and beyond. PROCEEDINGS OF THE IEEE. INSTITUTE OF ELECTRICAL AND ELECTRONICS ENGINEERS 2013; 101:1203-1233. [PMID: 24039277 PMCID: PMC3769794 DOI: 10.1109/jproc.2012.2236291] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The expression and experience of human behavior are complex and multimodal and characterized by individual and contextual heterogeneity and variability. Speech and spoken language communication cues offer an important means for measuring and modeling human behavior. Observational research and practice across a variety of domains from commerce to healthcare rely on speech- and language-based informatics for crucial assessment and diagnostic information and for planning and tracking response to an intervention. In this paper, we describe some of the opportunities as well as emerging methodologies and applications of human behavioral signal processing (BSP) technology and algorithms for quantitatively understanding and modeling typical, atypical, and distressed human behavior with a specific focus on speech- and language-based communicative, affective, and social behavior. We describe the three important BSP components of acquiring behavioral data in an ecologically valid manner across laboratory to real-world settings, extracting and analyzing behavioral cues from measured data, and developing models offering predictive and decision-making support. We highlight both the foundational speech and language processing building blocks as well as the novel processing and modeling opportunities. Using examples drawn from specific real-world applications ranging from literacy assessment and autism diagnostics to psychotherapy for addiction and marital well being, we illustrate behavioral informatics applications of these signal processing techniques that contribute to quantifying higher level, often subjectively described, human behavior in a domain-sensitive fashion.
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Affiliation(s)
- Shrikanth Narayanan
- The authors are with the Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, CA 90089 USA
| | - Panayiotis G. Georgiou
- The authors are with the Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, CA 90089 USA
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Krupski A, Joesch JM, Dunn C, Donovan D, Bumgardner K, Lord SP, Ries R, Roy-Byrne P. Testing the effects of brief intervention in primary care for problem drug use in a randomized controlled trial: rationale, design, and methods. Addict Sci Clin Pract 2012; 7:27. [PMID: 23237456 PMCID: PMC3598998 DOI: 10.1186/1940-0640-7-27] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 12/06/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A substantial body of research has established the effectiveness of brief interventions for problem alcohol use. Following these studies, national dissemination projects of screening, brief intervention (BI), and referral to treatment (SBIRT) for alcohol and drugs have been implemented on a widespread scale in multiple states despite little existing evidence for the impact of BI on drug use for non-treatment seekers. This article describes the design of a study testing the impact of SBIRT on individuals with drug problems, its contributions to the existing literature, and its potential to inform drug policy. METHODS/DESIGN The study is a randomized controlled trial of an SBIRT intervention carried out in a primary care setting within a safety net system of care. Approximately 1,000 individuals presenting for scheduled medical care at one of seven designated primary care clinics who endorse problematic drug use when screened are randomized in a 1:1 ratio to BI versus enhanced care as usual (ECAU). Individuals in both groups are reassessed at 3, 6, 9, and 12 months after baseline. Self-reported drug use and other psychosocial measures collected at each data point are supplemented by urine analysis and public health-related data from administrative databases. DISCUSSION This study will contribute to the existing literature by providing evidence for the impact of BI on problem drug use based on a broad range of measures including self-reported drug use, urine analysis, admission to drug abuse treatment, and changes in utilization and costs of health care services, arrests, and death with the intent of informing policy and program planning for problem drug use at the local, state, and national levels. TRIAL REGISTRATION ClinicalTrials.gov NCT00877331.
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Affiliation(s)
- Antoinette Krupski
- Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WA, USA.
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Stewart JS. A critical appraisal of motivational interviewing within the field of alcohol misuse. J Psychiatr Ment Health Nurs 2012; 19:933-8. [PMID: 22384803 DOI: 10.1111/j.1365-2850.2012.01880.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A critical appraisal of the evidence that supports efficacy of the brief intervention, motivational interviewing (MI), within the field of alcohol misuse, was made. In order to undertake this appraisal the author will focus on a review of the concept of MI prior to considering the efficacy for MI within the specific field of alcohol misuse.
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Affiliation(s)
- J S Stewart
- NHS Ayrshire and Arran, Forensic Rehabilitation Unit, Ailsa Hospital, Ayr, UK.
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Moving Ahead: A New Centre of Research Excellence in Brain Recovery, Focusing on Psychosocial Reintegration Following Traumatic Brain Injury. BRAIN IMPAIR 2012. [DOI: 10.1017/brimp.2012.21] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Severe traumatic brain injury (TBI) is the most common cause of brain injury in the Western world and leads to physical, cognitive and emotional deficits that reduce independence. Changes to psychosocial function are the most disruptive, resulting in vocational difficulties, family stress and deteriorating relationships, and are a major target for remediation. But rehabilitation is expensive and its evidence base is limited. Thus, new collaborative initiatives are needed. This article details the development of ‘Moving Ahead’, a model for a Centre of Research Excellence (CRE) for Traumatic Brain Injury Rehabilitation. This CRE offers several major innovations. First, it provides an integrated, multi-faceted approach to addressing psychosocial difficulties embracing different clinical standpoints (e.g., psychological, speech pathology, occupational therapy) and levels of investigation (e.g., basic science to community function) across the lifespan. It is based upon a close relationship with clinicians to ensure transfer of research to practice and, conversely, to ensure that research is clinically meaningful. It provides an integrated platform with which to support and train new researchers in the field via scholarships, postdoctoral fellowships, websites, meetings, mentoring and across-site training, and thus build workforce capacity for individuals with TBI and their families. It has input from the international community to contextualise research more broadly and ensure scientific rigour. Finally, it provides collaboration across sites to facilitate research and data collection.
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Hsieh MY, Ponsford J, Wong D, Schönberger M, McKay A, Haines K. Development of a motivational interviewing programme as a prelude to CBT for anxiety following traumatic brain injury. Neuropsychol Rehabil 2012; 22:563-84. [DOI: 10.1080/09602011.2012.676284] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Cupertino AP, Berg C, Gajewski B, Hui SKA, Richter K, Catley D, Ellerbeck EF. Change in self-efficacy, autonomous and controlled motivation predicting smoking. J Health Psychol 2011; 17:640-52. [PMID: 22076554 DOI: 10.1177/1359105311422457] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although motivational interviewing (MI) has been shown to be effective in changing health behaviors, its effects on smoking cessation have been mixed. The purpose of the present study is to assess factors of motivation and self-efficacy as they mediate the relationship between MI and smoking cessation. This is a secondary analysis of an MI based smoking cessation randomized trial. MI counseling was associated with change in smoking behaviors during a 12 months intervention but was not related to autonomous motivation, controlled motivation, or self-efficacy at baseline and 6 months, the hypothesized mediators. This study confirmed the pathway to quit smoking through increase in self-efficacy.
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Saarnio P. Therapist's preference on motivational interviewing and its relationship to interpersonal functioning and personality traits. COUNSELLING PSYCHOLOGY QUARTERLY 2011. [DOI: 10.1080/09515070.2011.618258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Thompson DR, Chair SY, Chan SW, Astin F, Davidson PM, Ski CF. Motivational interviewing: a useful approach to improving cardiovascular health? J Clin Nurs 2011; 20:1236-44. [PMID: 21492271 DOI: 10.1111/j.1365-2702.2010.03558.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To review and synthesise, systematically, the research findings regarding motivational interviewing and to inform education, research and practice in relation to cardiovascular health. BACKGROUND Motivational interviewing is designed to engage ambivalent or resistant clients in the process of health behaviour change, and it has been widely used in different clinical conditions such as substance abuse, dietary adherence and smoking cessation. Motivational interviewing has also been proposed as a method for improving modifiable coronary heart disease risk factors of patients. DESIGN Systematic review. METHOD Eligible studies published in 1999-2009 were identified from the following databases: CINAHL, Medline, PsycINFO, Cochrane Library, EBSCO, Web of Science, Embase and British Nursing Index. A manual search was conducted of bibliographies of the identified studies and relevant journals. Two researchers independently reviewed the studies. RESULTS Four meta-analyses, one systematic review and three literature reviews of motivational interviewing and five primary studies of motivational interviewing pertaining to cardiovascular health were identified. Despite a dearth of primary studies in cardiovascular health settings, there appears to be strong evidence that motivational interviewing is an effective approach focusing on eliciting the person's intrinsic motivation for change of behaviour. CONCLUSION Motivational interviewing is an effective approach to changing behaviour. It offers promise in improving cardiovascular health status. RELEVANCE TO CLINICAL PRACTICE This review indicates that motivational interviewing is a useful method to help nurses improve health behaviour in people with coronary risk factors.
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Affiliation(s)
- David R Thompson
- Cardiovascular Research Centre, Australian Catholic University, Melbourne, Victoria, Australia.
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Osborn CJ. Bilingual Therapeutics: Integrating the Complementary Perspectives and Practices of Motivational Interviewing and Dialectical Behavior Therapy. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2011. [DOI: 10.1007/s10879-010-9162-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Smedslund G, Berg RC, Hammerstrøm KT, Steiro A, Leiknes KA, Dahl HM, Karlsen K. Motivational interviewing for substance abuse. Cochrane Database Syst Rev 2011; 2011:CD008063. [PMID: 21563163 PMCID: PMC8939890 DOI: 10.1002/14651858.cd008063.pub2] [Citation(s) in RCA: 157] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There are 76.3 million people with alcohol use disorders worldwide and 15.3 million with drug use disorders. Motivational interviewing (MI) is a client-centred, semi-directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. The intervention is used widely, and therefore it is important to find out whether it helps, harms or is ineffective. OBJECTIVES To assess the effectiveness of motivational interviewing for substance abuse on drug use, retention in treatment, readiness to change, and number of repeat convictions. SEARCH STRATEGY We searched 18 electronic databases, 5 web sites, 4 mailing lists, and reference lists from included studies and reviews. Search dates were November 30, 2010 for Cochrane Library, Medline, Embase and PsychINFO. SELECTION CRITERIA Randomized controlled trials with persons dependent or abusing substance. Interventions were MI or motivational enhancement therapy. The outcomes were extent of substance abuse, retention in treatment, motivation for change, repeat conviction. DATA COLLECTION AND ANALYSIS Three authors independently assessed studies for inclusion, and two authors extracted data. Results were categorized into (1) MI versus no-treatment control, (2) MI versus treatment as usual, (3) MI versus assessment and feedback, and (4) MI versus other active treatment. Within each category, we computed meta-analyses separately for post-intervention, short, medium and long follow-ups. MAIN RESULTS We included 59 studies with a total of 13,342 participants. Compared to no treatment control MI showed a significant effect on substance use which was strongest at post-intervention SMD 0.79, (95% CI 0.48 to 1.09) and weaker at short SMD 0.17 (95% CI 0.09 to 0.26], and medium follow-up SMD 0.15 (95% CI 0.04 to 0.25]). For long follow-up, the effect was not significant SMD 0.06 (95% CI-0.16 to 0.28). There were no significant differences between MI and treatment as usual for either follow-up post-intervention, short and medium follow up. MI did better than assessment and feedback for medium follow-up SMD 0.38 (95% CI 0.10 to 0.66). For short follow-up, there was no significant effect . For other active intervention there were no significant effects for either follow-up.There was not enough data to conclude about effects of MI on the secondary outcomes. AUTHORS' CONCLUSIONS MI can reduce the extent of substance abuse compared to no intervention. The evidence is mostly of low quality, so further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
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Affiliation(s)
- Geir Smedslund
- Norwegian Knowledge Centre for the Health ServicesPostboks 7004St. Olavs plassOsloN‐0130Norway
| | - Rigmor C Berg
- Norwegian Knowledge Centre for the Health ServicesPostboks 7004St. Olavs plassOsloN‐0130Norway
| | - Karianne T Hammerstrøm
- Norwegian Knowledge Centre for the Health ServicesPostboks 7004St. Olavs plassOsloN‐0130Norway
| | - Asbjørn Steiro
- Norwegian Knowledge Centre for the Health ServicesPostboks 7004St. Olavs plassOsloN‐0130Norway
| | - Kari A Leiknes
- Norwegian Knowledge Centre for the Health ServicesPostboks 7004St. Olavs plassOsloN‐0130Norway
| | - Helene M Dahl
- Institute of Clinical MedicineDepartment of Clinical PsychiatryUniversity of Tromsø, Asgard,TromsøNorway9291
| | - Kjetil Karlsen
- Institute of Clinical MedicineDepartment of Clinical PsychiatryUniversity of Tromsø, Asgard,TromsøNorway9291
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Moyers TB, Houck J. Combining Motivational Interviewing With Cognitive-Behavioral Treatments for Substance Abuse: Lessons From the COMBINE Research Project. COGNITIVE AND BEHAVIORAL PRACTICE 2011. [DOI: 10.1016/j.cbpra.2009.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Folta SC, Nelson ME. Reducing cardiovascular disease risk in sedentary, overweight women: strategies for the cardiovascular specialist. Curr Opin Cardiol 2010; 25:497-501. [PMID: 20616709 DOI: 10.1097/hco.0b013e32833cd569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To describe the issue of cardiovascular disease in women, and to discuss evidence-based strategies for promoting lifestyle changes to reduce risk in sedentary, overweight women. RECENT FINDINGS Given a recent focus on long-term risk of cardiovascular disease, particularly for women, lifestyle change is especially important. Within practices, motivational interviewing holds promise as an effective counseling approach. Cardiologists may also refer women to evidence-based community programs designed to change diet and physical activity behaviors. SUMMARY Increasing fitness, improving food intake, and weight control are key elements in prevention. Ideally, motivational interviewing and community-based programs will work synergistically, with health messages and change efforts mutually supported in both settings.
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Affiliation(s)
- Sara C Folta
- John Hancock Research Center on Physical Activity, Nutrition, and Obesity Prevention, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.
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Weinstock J. A review of exercise as intervention for sedentary hazardous drinking college students: rationale and issues. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2010; 58:539-544. [PMID: 20452930 PMCID: PMC2886733 DOI: 10.1080/07448481003686034] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
College students have high rates of alcohol problems despite a number of intervention initiatives designed to reduce alcohol use. Substance use, including heavy drinking, often occurs at the expense of other, substance-free, activities. This review examines the promotion of one specific substance-free activity-exercise-as an intervention for hazardous drinking. Exercise has numerous physical and mental health benefits, and data suggest that students who engage in exercise regularly are less likely to drink heavily. However, the adherence to exercise necessary to achieve these benefits and possibly reduce drinking is poor, and improved exercise adherence interventions are needed. A novel combination of motivational enhancement therapy and contingency management is discussed as a means to address the critical issue of exercise adherence.
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Affiliation(s)
- Jeremiah Weinstock
- Calhoun Cardiology Center-Behavioral Health within the Department of Medicine, University of Connecticut Health Center, Farmington, Connecticut 06030-3944, USA.
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Population-based smoking cessation in women post partum: adherence to motivational interviewing in relation to client characteristics and behavioural outcomes. Midwifery 2010; 26:202-10. [DOI: 10.1016/j.midw.2008.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Revised: 03/17/2008] [Accepted: 04/11/2008] [Indexed: 11/11/2022]
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Field C, Caetano R. The role of ethnic matching between patient and provider on the effectiveness of brief alcohol interventions with Hispanics. Alcohol Clin Exp Res 2009; 34:262-71. [PMID: 19951297 DOI: 10.1111/j.1530-0277.2009.01089.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evaluating the effectiveness of treatments such as brief alcohol interventions among Hispanics is essential to effectively addressing their treatment needs. Clinicians of the same ethnicity as the client may be more likely to understand the culture-specific values, norms, and attitudes and, therefore, the intervention may be more effective. Thus, in cases in which Hispanic patients were provided intervention by a Hispanic clinician improved drinking outcomes were expected. METHODS Patients were recruited from an urban Level I Trauma following screening for an alcohol-related injury or alcohol problems. Five hundred thirty-seven Hispanics were randomly assigned to brief intervention or treatment as usual. Hierarchical linear modeling was used to determine the effects of ethnic match on drinking outcomes including volume per week, maximum amount, and frequency of 5 or more drinks per occasion. Analyses controlled for level of acculturation and immigration status. RESULTS For Hispanics who received brief motivational intervention, an ethnic match between patient and provider resulted in a significant reduction in drinking outcomes at 12-month follow-up. In addition, there was a tendency for ethnic match to be most beneficial to foreign-born Hispanics and less acculturated Hispanics. CONCLUSION As hypothesized, an ethnic match between patient and provider significantly enhanced the effectiveness of brief intervention among Hispanics. Ethnic concordance between patient and provider may have impacted the effectiveness of the intervention through several mechanisms including cultural scripts, ethnic-specific perceptions pertaining to substance abuse, and ethnic-specific preferred channels of communication.
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Affiliation(s)
- Craig Field
- Center for Social Work Research, School of Social Work, University of Texas at Austin, Health Behavior Research and Training Institute, Austin, Texas 78703, USA.
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Smedslund G, Berg RC, Hammerstrøm KT, Steiro A, Leiknes KA, Dahl HM, Karlsen K. Motivational interviewing for substance abuse. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2009. [DOI: 10.1002/14651858.cd008063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Gjermo PE, Grytten J. Cost-effectiveness of various treatment modalities for adult chronic periodontitis. Periodontol 2000 2009; 51:269-75. [DOI: 10.1111/j.1600-0757.2009.00313.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Almomani F, Williams K, Catley D, Brown C. Effects of an oral health promotion program in people with mental illness. J Dent Res 2009; 88:648-52. [PMID: 19605879 DOI: 10.1177/0022034509338156] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
More knowledge is needed regarding what works to prevent oral health problems and reduce disparities in oral health. Motivational interviewing (MI) has demonstrated utility for improving health behavior, including among those with severe mental illness. This study tests whether MI enhances the efficacy of an oral health education intervention in individuals with severe mental illness. Sixty individuals were randomly assigned to MI plus oral health education or oral health education alone. Plaque scores, oral health knowledge, and self-regulation were assessed at baseline and at 4 and 8 weeks. Repeated-measures ANOVA showed improvement (p < 0.05) in plaque, autonomous regulation, and oral health knowledge across time for both groups; however, individuals receiving MI improved significantly more when compared with those receiving oral health education alone. Results suggest that MI is effective for enhancing short-term oral health behavior change for people with severe mental illness and may be useful for the general population.
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Affiliation(s)
- F Almomani
- Jordan University of Science & Technology, Faculty of Applied Medical Sciences, PO Box 3030, Irbid 22110, Jordan.
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