Novel motivational interviewing-based intervention improves engagement in physical activity and readiness to change among adolescents with chronic pain.

INTRODUCTION: Engaging adolescents with chronic pain in physical activities is challenging. Motivational interviewing (MI) combined with activity promotion may encourage teens to make behavioural changes. This research aimed to assess the feasibility and acceptability of our MI-based physical activity promotion programme, the M3 training. METHODS: In our exploratory study with 35 adolescent-parent dyads, we evaluated the feasibility by enrolment, drop-out and retention rates. Acceptability of the M3 training was examined by adherence rates and participation experiences through open-ended questions. We also assessed changes in pain self-efficacy and readiness to change after the M3 training intervention. RESULTS: The M3 training was feasible with an adequate enrolment (77.8%) and retention (85.7%) rate. Both teens and parents found the M3 training acceptable and considered exercise and physical activity the most helpful elements of the programme (36% and 37%, respectively). While self-efficacy remained unchanged, we identified a significant increase in the readiness to change for adolescents and parents. CONCLUSION: M3 training improved physical activity engagement while prioritising adolescents' autonomy. Furthermore, it appears to be a clinically relevant approach and could result in a positive shift in readiness to change within a shorter timeframe. PATIENT OR PUBLIC CONTRIBUTION: The preliminary version of the M3 training was reviewed and commented upon by the public (adolescents and adults). Adolescents who participated in this study were designing their own movement programme, considering their lived experiences. Participants' feedback was used to create the online version of the M3 training (which will be published elsewhere).

Acceptability of a pilot motivational interviewing intervention at public health facilities to improve the HIV treatment cascade among people who inject drugs in Indonesia.

BACKGROUND: HIV-positive people who inject drugs (PWID) experience challenges in initiating and adhering to antiretroviral treatment (ART). Counselling using motivational interviewing (MI) techniques may help them formulate individualised strategies, and execute actions to address these challenges collaboratively with their providers. We evaluated the acceptability of MI from a pilot implementation at three public health facilities in Indonesia. METHODS: Adapting the acceptability constructs developed by Sekhon (2017) we assessed the acceptability to HIV-positive PWID clients (n = 12) and providers (n = 10) in four synthesised constructs: motivation (attributes that inspire engagement); cost consideration (sacrifices made to engage in MI); learned understanding (mechanism of action); and outcomes (ability to effect change with engagement). We included all providers and clients who completed ≥ 2 MI encounters. Qualitative analysis with an interpretive paradigm was used to extract and categorise themes by these constructs. RESULTS: In motivation, clients valued the open communication style of MI, while providers appreciated its novelty in offering coherent structure with clear boundaries. In cost consideration, both groups faced a challenge in meeting MI encounters due to access or engagement in other health care areas. In learned understanding, clients understood that MI worked to identify problematic areas of life amenable to change to support long-term ART, with reconciliation in family life being the most targeted change. By contrast, providers preferred targeting tangible health outcomes to such behavioural proxies. In outcomes, clients were confident in their ability to develop behaviours to sustain ART uptakes, whereas providers doubted the outcome of MI on younger PWID or those with severe dependence. CONCLUSIONS: There is broad acceptability of MI in motivating engagement for both actors. Relative to providers, clients were more acceptable in its mechanism and had greater confidence to perform behaviours conducive to ART engagement. Design innovations to improve the acceptability of MI for both actors are needed.

Effect of Motivational Interviewing on Lifestyle Modification among Patients with Hypertension Attending the Family Medicine Clinics of ISTH, Irrua, Nigeria (Milmaph Study) - A Randomised Control Trial Study Protocol.

BACKGROUND: Hypertension is a leading cause of morbidity and mortality globally. Over a quarter of patients with hypertension have uncontrolled hypertension. Lifestyle modification has been shown to improve blood pressure control, thus measures that would help patients with hypertension achieve positive lifestyle modification would improve BP control. The study aims to determine the effect of motivational interviews on lifestyle modification and blood pressure control among patients with hypertension attending the Family Medicine Clinics of Irrua Specialist Teaching Hospital (ISTH), Irrua, Nigeria. METHODS: The proposed study will be a randomised control trial (PACTR202301917477205). About 212 adults between 18 and 65 years with hypertension presenting to the Family Medicine Clinics of ISTH will be randomised into intervention and control groups. The intervention group will be given a motivational interview (MI) on lifestyle modification at the start of the study and monthly for 6 months in addition to standard care for the management of hypertension. The control group will be given standard care for the management of hypertension only without MI and seen monthly for 6 months. Both groups will be assessed at baseline and 6 months. At baseline, a qualitative technique will be used to determine the reason for not adopting lifestyle modification. STUDY OUTCOME: The primary outcome shall be lifestyle modification at 6 months while the secondary outcome shall be blood pressure control at 6 months. CONCLUSION: Findings from the study will provide cost-effective ways of blood pressure control and reduction in the disease burden of hypertension in Nigeria.

CONTEXTE: L'hypertension est l'une des principales causes de morbidité et de mortalité à l'échelle mondiale. Plus d'un quart des patients hypertendus ont une hypertension non contrôlée. La modification du mode de vie a été démontrée pour améliorer le contrôle de la pression artérielle, ainsi les mesures qui aideraient les patients hypertendus à réaliser une modification positive de leur mode de vie amélioreraient le contrôle de la PA. L'étude vise à déterminer l'effet des entretiens motivationnels sur la modification du mode de vie et le contrôle de la pression artérielle chez les patients hypertendus fréquentant les cliniques de médecine familiale de l'hôpital spécialisé d'enseignement d'Irrua (ISTH), Irrua, Nigeria. MÉTHODES: L'étude proposée sera un essai contrôlé randomisé (PACTR202301917477205). Environ 212 adultes âgés de 18 à 65 ans atteints d'hypertension se présentant aux cliniques de médecine familiale de l'ISTH seront randomisés en groupes d'intervention et de contrôle. Le groupe d'intervention recevra un entretien motivationnel (EM) sur la modification du mode de vie au début de l'étude et mensuellement pendant 6 mois en plus des soins standard pour la prise en charge de l'hypertension. Le groupe témoin recevra uniquement les soins standard pour la prise en charge de l'hypertension sans EM et sera vu mensuellement pendant 6 mois. Les deux groupes seront évalués au départ et à 6 mois. Au début, une technique qualitative sera utilisée pour déterminer la raison de la non-adoption de la modification du mode de vie. RÉSULTAT DE L'ÉTUDE: Le critère de jugement principal sera la modification du mode de vie à 6 mois, tandis que le critère de jugement secondaire sera le contrôle de la pression artérielle à 6 mois. CONCLUSION: Les résultats de l'étude fourniront des moyens rentables de contrôle de la pression artérielle et de réduction de la charge de morbidité de l'hypertension au Nigeria. MOTS-CLÉS: hypertension, entretien motivationnel, modification du mode de vie, contrôle de la pression artérielle, médecine familiale.

Professionals' perspectives on interventions to reduce problematic alcohol use in older adults: a realist evaluation of working elements.

OBJECTIVES: This study set out to understand how (which elements), in what context and why (which mechanisms) interventions are successful in reducing (problematic) alcohol use among older adults, from the perspective of professionals providing these interventions. DESIGN: Guided by a realist evaluation approach, an existing initial programme theory (IPT) on working elements in alcohol interventions was evaluated by conducting semistructured interviews with professionals. SETTING AND PARTICIPANTS: These professionals (N=20) provide interventions across several contexts: with or without practitioner involvement; in-person or not and in an individual or group setting. Data were coded and links between contexts, elements, mechanisms and outcomes were sought for to confirm, refute or refine the IPT. RESULTS: From the perspective of professionals, there are several general working elements in interventions for older adults: (1) pointing out risks and consequences of drinking behaviour; (2) paying attention to abstinence; (3) promoting contact with peers; (4) providing personalised content and (5) providing support. We also found context-specific working elements: (1) providing personalised conversations and motivational interviewing with practitioners; (2) ensuring safety, trust and a sense of connection and a location nearby home or a location that people are familiar with in person and (3) sharing experiences and tips in group interventions. Furthermore, the mechanisms awareness and accessible and low threshold participation were important contributors to positive intervention outcomes. CONCLUSION: In addition to the IPT, our findings emphasise the need for social contact and support, personalised content, and strong relationships (both between client and practitioner, and client and peers) in interventions for older adults.

Nourishing Conversations: Using Motivational Interviewing in a Community Teaching Kitchen to Promote Healthy Eating via a Food as Medicine Intervention.

It is well known that dietary choices impact both individual and global health. However, there are numerous challenges at the personal and systemic level to fostering sustainable healthy eating patterns. There is a need for innovative ways to navigate these barriers. Food as Medicine (FM) and Culinary Medicine (CM) are approaches to helping individuals achieve healthier diets that also recognize the potential to alleviate the burden of chronic diseases through healthy eating. Teaching kitchens, which offer an interactive environment for learning nutrition and cooking skills, are valuable educational tools for FM and CM interventions. Motivational interviewing (MI), a type of person-centered counseling, facilitates behavior change and may enhance FM and CM programs involving teaching kitchens. In this commentary, we share our experience with using MI in a community-based CM program at a teaching kitchen. In demonstrating our application of MI principles, we hope to offer an additional strategy for improving dietary quality and delivering nutrition education.

Testing a modified motivational interviewing counseling program.

BACKGROUND: Motivational Interviewing is a well-established person-centered counseling approach toward positive behavioral change. However, several limitations have been reported using motivational interviewing applications. PURPOSE: This study explored the potential of an innovative intervention (namely, modified motivational interviewing) to address the limitations associated with the original form of Motivational Interviewing. METHODS: The research used a phenomenological qualitative design to include three focus groups with a total sample size of 24 university nursing students to examine their experiences with the Modified Motivational Interviewing. The focus groups were transcribed verbatim and then coded to extract the themes. RESULTS: The following ten themes emerged from the data analysis: increasing discrepancy; ambivalence; ready, willing, and able; change as a natural process; the role of the modified motivational interviewing facilitator; spontaneous generalization; peer support facilitates change; help-seeking behavior; practical applications of the modified motivational interviewing; and problems encountered during the implementation of modified motivational interviewing. CONCLUSIONS: The proposed intervention can potentially be a cost-effective replacement for the original format of motivational interviewing intervention. Further research is needed to support the modified motivational interviewing.

Influence of motivational interviewing on postoperative mobilization in the enhanced recovery after surgery (ERAS®) pathway in elective colorectal surgery - a randomized patient-blinded pilot study.

PURPOSE: Early mobilization is an essential component of the Enhanced Recovery after Surgery (ERAS®)-pathway. However, a large percentage of patients fail to achieve the ERAS® recommended goal (360 min out of bed from post-operative day 1/POD1). Motivational Interviewing (MI) is an evidence-based type of patient-centered consultation to promote intrinsic motivation. This study aims to evaluate if MI can improve postoperative mobilization. METHODS: This two-arm, patient-blinded pilot randomized controlled trial included ERAS®-patients undergoing elective bowel resections. Conversations were validated by MI Treatment Integrity. Two validated motion sensors (movisens) and self-assessments were used to measure mobilization (POD1-POD3: Time out of bed, time on feet and step count). RESULTS: 97 patients were screened, 60 finally included and randomized. Cumulatively across POD1-3, the intervention group (IG) was longer out of bed than the control group (CG) (median: 685 vs. 420 min; p=0.022). The IG achieved the ERAS®-goal of 360 min/day more frequently across POD1-3 (27.4% vs. 10.61%; p=0.013). Time on feet was 131.5 min/day (median per POD) in IG vs. 95.8 min/day in the CG (p=0.212), step count was 1347 in IG vs. 754 steps/day in CG (p=0.298). CONCLUSION: MI could be conducted low threshold and was well accepted by patients. MI can improve mobilization in the context of ERAS®. Despite better performance, it should be noted that only 27.4% of the IG reached the ERAS®-compliance goal of 360 min/day. The findings of this pilot study stipulate to further test the promising perioperative effects of MI within a multicenter superiority trial. REGISTRATION: This study was registered prospectively in the German Clinical Trials Register on 25.02.2022. Trial registration number is "DRKS00027863".

Behavioral Therapy for People With Diabetes Who Smoke: A Scoping Review.

BACKGROUND: Tobacco smoking exacerbates diabetes-related complications; its prevalence is notwithstanding substantial. Persons with diabetes face a number of barriers and challenges to quitting such as multiple lifestyle restrictions; tailored interventions are required for smoking cessation. OBJECTIVE: To identify research on behavioral interventions for smoking cessation in diabetes. METHODS: Studies had to be randomized controlled trials, quasiexperimental or systematic reviews. The behavioral interventions included were: the 5As, Cognitive-Behavioral Therapy, Motivational Interviewing, Contingency Management, Health Coaching and Counselling, as compared to standard care. The outcomes were self-reported and/or biochemically verified smoking cessation. CINAHL Complete, MEDLINE Complete, the Cochrane databases of systematic reviews and randomized controlled trials, PsychInfo and PubMed Central were searched until July, 2023. Keywords used included diabetes, smoking cessation and each of the behavioral interventions included. RESULTS: 1615 papers were identified. Three studies on the 5As/brief advice, 4 on Motivational Intervention and 1 on counseling were retained. The results on the 5As and Motivational Interviewing were conflicting. More intensive interventions appear to be more successful in achieving smoking cessation in smokers with diabetes. CONCLUSIONS: Future research should focus on the continued development and evaluation of structured smoking cessation interventions based on the 5As, Motivational interviewing and Cognitive Behavioral Therapy.

Booklet and Motivational Interviewing to Promote Self-efficacy in Parents/Caregivers of Children with Asthma: A Clinical Trial.

Background: Asthma is the most common chronic disease in childhood which accounts for numerous annual hospitalizations due to a lack of management and proper management of the disease. Thus, this study aimed to evaluate the effect of using an educational booklet with or without combination with motivational interviewing (MI) on the self-efficacy of parents/caregivers in the control and management of childhood asthma. Methods: A clinical trial was carried out with 86 parents/caregivers of children with asthma aged between 2 and 12 years who were followed up in primary health care units from March 2019 to December 2020. Participants were randomly assigned to two groups: one of the groups read the booklet and the other read the booklet combined with the MI. The Brazilian version of the Self-Efficacy and Their Child's Level of Asthma Control scale was applied before and 30 days after the intervention for assessment of self-efficacy. Data were analyzed using SPSS version 20.0 and R 3.6.3 software. P values<0.05 were considered significant. Results: There were 46 participants in the booklet group and 40 in the booklet and MI group. Both groups were effective in increasing total self-efficacy scores after the intervention (P<0.001). No statistically significant difference was found between the scores of the two groups (P=0.257). Conclusion: The educational booklet with or without combination with MI can increase the self-efficacy of parents/caregivers of children with asthma. The findings could be considered by healthcare providers for the empowerment of caregivers of children with asthma in the control and management of their children's asthma.Trial Registration Number: U1111-1254-7256.

Efectividad de la entrevista motivacional en la atención fisioterápica de los trastornos musculoesqueléticos de la espalda / Effectiveness of the motivational interview in the physiotherapy care of musculoskeletal disorders of the back: A quasi-experimental study

Objetivo: Evaluar la efectividad de la entrevista motivacional (EM) junto al tratamiento fisioterapéutico habitual en pacientes con trastornos musculoesqueléticos (TME) de la espalda en atención primaria (AP). Métodos: Estudio cuasiexperimental en pacientes que iniciaron su tratamiento en el año 2020 en una unidad de fisioterapia tras diagnóstico médico de TME en la espalda, con seguimiento prospectivo de 2grupos con actuación terapéutica: grupo experimental (GE) y grupo de control (GC). Se empleó la EM solo en el GE. A ambos grupos se les entrevistó telefónicamente a los 3y 6meses de finalizar el tratamiento fisioterápico, preguntando por el cumplimiento de pautas domiciliarias y por la percepción subjetiva del estado de salud (escala de Barthel). Se ajustaron modelos de regresión lineales (coeficiente de regresión, IC del 95%) y logísticos (OR, IC del 95%). Resultados: La población de estudio fue de 154 personas (76,6% mujeres). La salud percibida fue significativamente mejor (p<0,001) en el GE que en el GC, tanto a los 3meses de seguimiento (7,4 versus 5,0, respectivamente) como a los 6(7,1 versus 4,6, respectivamente). Hubo una fuerte asociación entre percepción de salud y cumplimiento (coeficiente de regresión 3,0 [IC del 95%=2,5-3,4]). La asociación entre la EM y el cumplimiento terapéutico se mantuvo tras ajustes multivariados (OR a 6meses=383,6 [IC del 95% = 31,0-4.742,4]). Conclusiones: la incorporación de la EM como complemento de los tratamientos de fisioterapia es una herramienta factible y efectiva para mejorar el cumplimiento de las pautas domiciliarias y la percepción subjetiva de salud. (AU)

Objective: To evaluate the effectiveness of motivational interviewing (MI) combined with the usual physiotherapy treatment in patients with back musculoskeletal disorders (MSD) in primary care (PC). Methods: Quasi-experimental study with 2groups with therapeutic action (control group and experimental group) and prospective follow-up, in a physiotherapy unit in PC, in patients who began their treatment in 2020, with a medical diagnosis of MSD in the back. MI was used only in the face-to-face visits of the experimental group. Both groups were interviewed by telephone about 3and 6months after finishing the physiotherapy treatment. For this purpose, the Barthel scale was used for the subjective perception of the state of health, and the scale of compliance with home guidelines. Linear (regression coefficient, 95% CI) and logistic (OR, 95% CI) regression models were fitted. Results: The study population was 154 people (76.6% women). Perceived health was significantly better (P<.001) in the experimental group than in the control group, both at 3(7.4 versus 5.0, respectively) and at 6months of follow-up (7.1 versus 4.6, respectively). There was a strong association between perceived health and compliance (regression coefficient 3.0 [95% CI=2.5–3.4]). The strong association between MI and treatment adherence was maintained after multivariate adjustments (6-month OR=383.6 [95% CI 31.0–4742.4]). Conclusions: MI is a feasible and effective complement to physiotherapy treatments to improve compliance with home recommendations and subjective perception of health. (AU)

Preliminary evaluation of a novel group-based motivational interviewing intervention with adolescents: a feasibility study.

Drinking is closely intertwined with social life among many adolescents, particularly in Europe. Group-based interventions, such as group-based motivational interviewing (group MI), have shown the capacity to prevent and reduce hazardous drinking and related problems among adolescents, but few examinations have been conducted in a European high school setting. This study examines the preliminary outcomes of a pilot group MI intervention among Danish adolescents. High school students (ages 15-18 years) were randomly allocated to two 1-h group MI sessions delivered in a school setting (N = 65) or an assessment only control condition (N = 67). Data were collected in August and November 2020 using online self-administrated questionnaires regarding the acceptability of the intervention and past month alcohol use. The pilot group MI intervention showed high feasibility and acceptability in this setting and with this age group. Group MI adolescents significantly reduced peak drinks per drinking day compared to assessment only adolescents (-2.7 drinks, p < 0.05). Results are discussed in relation to the metrics being evaluated during COVID-19 lockdown, including increased social restrictions at follow-up compared to baseline. Group MI shows promise for reducing hazardous alcohol use among Danish adolescents. In addition, the findings indicate the importance of building on and extending this work in future larger, better-powered randomized controlled trials.

Efficacy of Nursing Interventions Using Motivational Interviewing Aimed at Weight Loss in Overweight/Obese Breast Cancer Patients Undergoing Endocrine Therapy.

OBJECTIVE: Obesity adversely impacts breast cancer treatment and outcomes. This study assessed the efficacy of nurses' motivational interviews (MI) in promoting weight loss among breast cancer patients. METHODS: Motivational Interviewing was performed at 4, 8, and 12 weeks from baseline in 27 overweight/ obese breast cancer patients receiving adjuvant endocrine therapy. An average weight loss rate of 5% at week 12 was the threshold for determining whether MI intervention was clinically meaningful. Clinical and sociodemographic variables were gathered from medical records and self-administered questionnaires. Body weight, body mass index (BMI), physical activity time, sedentary time, self-efficacy for weight loss, and mood scores were evaluated at baseline, 4, 8, 12, and 24 weeks. RESULTS: Significant reductions in body weight were observed throughout compared with baseline; 51.9% of participants attained the 5% weight loss target, but the average weight loss rate was 3.9% at week 12. BMI notably decreased at 8, 12, and 24 weeks compared with baseline. Physical activity increased significantly at 12 weeks, while sedentary time decreased at 8 and 24 weeks. CONCLUSIONS: Nursing-administered MI did not achieve the goal of 5% weight loss at week 12. However, it increased physical activity and reduced sedentary time, showing potential for promoting healthier habits.

The effect of nurse-led motivational interviewing based on the trans-theoretical model on promoting physical activity in healthy older adults: A randomized controlled trial.

AIM: The aim of this study was to evaluate the effect of motivational interviewing based on the trans-theoretical model promoting physical activity in older adults. METHODS: A randomized controlled trial study was conducted with 117 older adults (intervention group: 58, and control group: 59) between April and November 2019. The data were collected via a questionnaire, trans-theoretical model scales, the Physical Activity Scale for the Elderly, the Katz Activities of Daily Living scale and a pedometer. The 24-week intervention consisted of regular motivational interviewing. The control group received usual care at the family health centre. RESULTS: Following the intervention, the Intervention Group showed significant improvements Exercise Processes of Change Scale, Exercise Self-Efficacy Scale and Perceived Benefits of the Decisional Balance Scale for Exercise. There was a significant difference between the groups in terms of stages of change. In the Intervention Group, 81.5% were in the contemplation stage in the pre-test, while in the post-test, 70.4% had transitioned to the action stage. In contrast, in the control group, 62.5% were in the contemplation stage initially, but in the post-test, only 9.3% had reached the action stage. The mean number of step counts increased significantly in favour of the Intervention Group, as did the Physical Activity Scale for the Elderly total score. CONCLUSION: The trial indicated that after the trans-theoretical model-based motivational interviewing, the stages of change among the older adults improved, as did their exercise behaviours. It is recommended that the trans-theoretical model and motivational interviewing be used by nurses to improve healthy lifestyle stage behaviours in older adults.

Applications of motivational interviewing in adolescent solid organ transplant.

BACKGROUND: Adolescence is a developmental period that is known for the highest risk of difficulties with adoption and maintenance of health behaviors for successful transplant. Motivational interviewing (MI) has been demonstrated to be an effective strategy in the management of modifiable factors impacting adherence in both adult transplant and analogous pediatric chronic illness populations. AIMS: This paper describes MI and its applicability to adolescent transplant, providing examples of its potential use at each stage of the transplant journey. MATERIALS AND METHODS: Literature on the principles and utilization of MI are reviewed, as well as the use of MI in adult transplant and similar pediatric populations. RESULTS: Evidence suggests high applicability of concepts of MI to pediatric transplant. DISCUSSION: Systems-level factors influencing health behavior change are discussed, along with the importance of recognizing and managing provider bias in MI-based interactions. MI does not require a licensed behavioral health provider to use it effectively; rather, it can be used by various multidisciplinary team members throughout the course of clinical care. CONCLUSION: MI shows great promise as a useful intervention through all stages in the transplant journey. Though particularly well-suited to adolescents, its principles are effective across the lifespan, including with caregivers. It represents an interactional style for use by multidisciplinary team members in many patient-and caregiver-facing scenarios. As the goal is to support the patient's autonomy in decision-making, it is important for providers to recognize their own biases. Further resources for training are provided.

Motivational interviewing skills practice enhanced with artificial intelligence: ReadMI.

BACKGROUND: Finding time in the medical curriculum to focus on motivational interviewing (MI) training is a challenge in many medical schools. We developed a software-based training tool, "Real-time Assessment of Dialogue in Motivational Interviewing" (ReadMI), that aims to advance the skill acquisition of medical students as they learn the MI approach. This human-artificial intelligence teaming may help reduce the cognitive load on a training facilitator. METHODS: During their Family Medicine clerkship, 125 third-year medical students were scheduled in pairs to participate in a 90-minute MI training session, with each student doing two role-plays as the physician. Intervention group students received both facilitator feedback and ReadMI metrics after their first role-play, while control group students received only facilitator feedback. RESULTS: While students in both conditions improved their MI approach from the first to the second role-play, those in the intervention condition used significantly more open-ended questions, fewer closed-ended questions, and had a higher ratio of open to closed questions. CONCLUSION: MI skills practice can be gained with a relatively small investment of student time, and artificial intelligence can be utilized both for the measurement of MI skill acquisition and as an instructional aid.

The Williams and McCoy model of motivational spirited cognitive behavioral change communication.

PURPOSE: The Williams and McCoy Motivational Spirited Cognitive Behavioral Change Communication (MIS-CBC) is an innovative model combining the spirit of motivational interviewing (MI) communication, and cognitive behavioral therapy (CBT) as a patient-centered care model to improve continuity of care while enabling patients to progress during therapy. CONCLUSIONS: Incorporating this model into Psychiatric Mental Health Advance Practice Nurse practice allows for provision of best practice with populations experiencing low motivation and subject to dropout. The model aims to improve patient motivation and engagement of CBT to achievement "full dose" CBT with more flexibility to significantly improve patient outcomes, particularly with patient populations subject to interruptions in psychotherapy. PRACTICE IMPLICATIONS: The Williams and McCoy MIS-CBC model has implications in areas of both practice and academia addressing episodic psychotherapy in populations where interruptions and dropout frequently occur.

Entrevista motivacional como estrategia de mejoramiento de la salud bucal de niños y cuidadores. Revisión en sombrilla / Motivational interviewing as a strategy to improve the oral health of children and caregivers. Umbrella review

Objetivo: demostrar la efectividad de la entrevista motivacional (EM) en el mejoramiento de algunos indicadores de salud bucal en niños de 0 a 12 años y sus cuidadores. Material y métodos: estudio de revisión en sombrilla (umbrella review). Se realizó búsqueda en bases de datos electrónicas (PubMed, MEDLINE, SCOPUS, EBSCO) y Google Scholar desde el año 2010 hasta el año 2020, con las siguientes palabras clave: ('motivational interviewing' OR 'motivational interview' OR 'motivational interviewing style' OR 'motivational intervention' OR 'motivational counseling' OR 'brief motivational counseling' OR 'maternal counseling' OR 'behavioral intervention') AND (“caries” OR 'dental caries' OR 'tooth decay' OR 'dental decay' OR 'carious lesions' OR 'DMFT index' OR “ICDAS”) AND ('gingival diseases' OR “gingivitis” OR “CPITN” OR 'gingival bleeding' OR 'dental calculus') AND (“children” OR “families” OR “caregivers”). Se incluyeron artículos originales sobre la efectividad de la entrevista motivacional en salud bucal (EMSB) en niños de hasta 12 años y cuidadores, tipo revisión sistemática de la literatura y metanálisis, desde el año 2010 hasta el 2020. Resultados: 69 artículos (2 revisiones sistemáticas y 4 metanálisis). Los indicadores encontrados fueron: cambios en la presentación de caries de la infancia temprana, higiene bucal, condiciones gingivales y frecuencia de visitas a la consulta odontológica, con resultados alentadores y, en otros, contradictorios. Conclusiones: la evidencia sobre la efectividad de la entrevista motivacional en comparación con la educación convencional muestra cambios positivos en indicadores de salud bucal, como mejoramiento de la higiene dental y de la presentación de la caries en la primera infancia. (AU)

Objective: to demonstrate, the effectiveness of motivational interviewing in improving oral health indicators in children aged 0 to 12 years and their caregivers. Material and method: an umbrella review design. Search in electronic databases (PubMed, MEDLINE, SCOPUS, EBSCO) and Google Scholar since 2010 to 2020, with the following keywords: ('Motivational interviewing' OR 'motivational interview' OR 'motivational interviewing style' OR 'motivational intervention' OR 'motivational counseling' OR 'brief motivational counseling' OR 'maternal counseling' OR 'behavioral intervention') AND (“caries” OR 'dental caries' OR 'tooth decay' OR 'dental decay' OR 'carious lesions' OR 'DMFT index' OR “ICDAS”) AND ('gingival diseases' OR “gingivitis” OR “CPITN” OR 'gingival bleeding' OR 'dental calculus') AND (“children” OR “families” OR “caregivers”), original articles on the effectiveness of motivational interviewing in oral health (EMSB) in children between 0 and 12 years of age and caregivers, type systematic review of the literature and metaanalysis. Results: 69 articles were found (2 systematic reviews and 4 metaanalysis). The indicators found: change in early childhood caries, oral hygiene, gingival conditions and frequency of visits to the dental office with promise results and others contradictories. Conclusion: the evidence on the effectiveness of motivational interviewing compared to conventional education shows positive changes in oral health indicators such as improvement in dental hygiene and the presentation of caries in early childhood, among others. (AU)

Clinical Interviewing: An Essential but Neglected Method of Medicine.

Clinical interviewing is the basic method to understand how a person feels and what are the presenting complaints, obtain medical history, evaluate personal attitudes and behavior related to health and disease, give the patient information about diagnosis, prognosis, and treatment, and establish a bond between patient and physician that is crucial for shared decision making and self-management. However, the value of this basic skill is threatened by time pressures and emphasis on technology. Current health care trends privilege expensive tests and procedures and tag the time devoted to interaction with the patient as lacking cost-effectiveness. Instead, the time spent to inquire about problems and life setting may actually help to avoid further testing, procedures, and referrals. Moreover, the dialogue between patient and physician is an essential instrument to increase patient's motivation to engage in healthy behavior. The aim of this paper was to provide an overview of clinical interviewing and its optimal use in relation to style, flow and hypothesis testing, clinical domains, modifications according to settings and goals, and teaching. This review points to the primacy of interviewing in the clinical process. The quality of interviewing determines the quality of data that are collected and, eventually, of assessment and treatment. Thus, interviewing deserves more attention in educational training and more space in clinical encounters than it is currently receiving.

Psychosocial interventions for stimulant use disorder.

BACKGROUND: Stimulant use disorder is a continuously growing medical and social burden without approved medications available for its treatment. Psychosocial interventions could be a valid approach to help people reduce or cease stimulant consumption. This is an update of a Cochrane review first published in 2016. OBJECTIVES: To assess the efficacy and safety of psychosocial interventions for stimulant use disorder in adults. SEARCH METHODS: We searched the Cochrane Drugs and Alcohol Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, three other databases, and two trials registers in September 2023. All searches included non-English language literature. We handsearched the references of topic-related systematic reviews and the included studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing any psychosocial intervention with no intervention, treatment as usual (TAU), or a different intervention in adults with stimulant use disorder. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. MAIN RESULTS: We included a total of 64 RCTs (8241 participants). Seventy-three percent of studies included participants with cocaine or crack cocaine use disorder; 3.1% included participants with amphetamine use disorder; 10.9% included participants with methamphetamine use disorder; and 12.5% included participants with any stimulant use disorder. In 18 studies, all participants were in methadone maintenance treatment. In our primary comparison of any psychosocial treatment to no intervention, we included studies which compared a psychosocial intervention plus TAU to TAU alone. In this comparison, 12 studies evaluated cognitive behavioural therapy (CBT), 27 contingency management, three motivational interviewing, one study looked at psychodynamic therapy, and one study evaluated CBT plus contingency management. We also compared any psychosocial intervention to TAU. In this comparison, seven studies evaluated CBT, two contingency management, two motivational interviewing, and one evaluated a combination of CBT plus motivational interviewing. Seven studies compared contingency management reinforcement related to abstinence versus contingency management not related to abstinence. Finally, seven studies compared two different psychosocial approaches. We judged 65.6% of the studies to be at low risk of bias for random sequence generation and 19% at low risk for allocation concealment. Blinding of personnel and participants was not possible for the type of intervention, so we judged all the studies to be at high risk of performance bias for subjective outcomes but at low risk for objective outcomes. We judged 22% of the studies to be at low risk of detection bias for subjective outcomes. We judged most of the studies (69%) to be at low risk of attrition bias. When compared to no intervention, we found that psychosocial treatments: reduce the dropout rate (risk ratio (RR) 0.82, 95% confidence interval (CI) 0.74 to 0.91; 30 studies, 4078 participants; high-certainty evidence); make little to no difference to point abstinence at the end of treatment (RR 1.15, 95% CI 0.94 to 1.41; 12 studies, 1293 participants; high-certainty evidence); make little to no difference to point abstinence at the longest follow-up (RR 1.22, 95% CI 0.91 to 1.62; 9 studies, 1187 participants; high-certainty evidence); probably increase continuous abstinence at the end of treatment (RR 1.89, 95% CI 1.20 to 2.97; 12 studies, 1770 participants; moderate-certainty evidence); may make little to no difference in continuous abstinence at the longest follow-up (RR 1.14, 95% CI 0.89 to 1.46; 4 studies, 295 participants; low-certainty evidence); reduce the frequency of drug intake at the end of treatment (standardised mean difference (SMD) -0.35, 95% CI -0.50 to -0.19; 10 studies, 1215 participants; high-certainty evidence); and increase the longest period of abstinence (SMD 0.54, 95% CI 0.41 to 0.68; 17 studies, 2118 participants; high-certainty evidence). When compared to TAU, we found that psychosocial treatments reduce the dropout rate (RR 0.79, 95% CI 0.65 to 0.97; 9 studies, 735 participants; high-certainty evidence) and may make little to no difference in point abstinence at the end of treatment (RR 1.67, 95% CI 0.64 to 4.31; 1 study, 128 participants; low-certainty evidence). We are uncertain whether they make any difference in point abstinence at the longest follow-up (RR 1.31, 95% CI 0.86 to 1.99; 2 studies, 124 participants; very low-certainty evidence). Compared to TAU, psychosocial treatments may make little to no difference in continuous abstinence at the end of treatment (RR 1.18, 95% CI 0.92 to 1.53; 1 study, 128 participants; low-certainty evidence); probably make little to no difference in the frequency of drug intake at the end of treatment (SMD -1.17, 95% CI -2.81 to 0.47, 4 studies, 479 participants, moderate-certainty evidence); and may make little to no difference in the longest period of abstinence (SMD -0.16, 95% CI -0.54 to 0.21; 1 study, 110 participants; low-certainty evidence). None of the studies for this comparison assessed continuous abstinence at the longest follow-up. Only five studies reported harms related to psychosocial interventions; four of them stated that no adverse events occurred. AUTHORS' CONCLUSIONS: This review's findings indicate that psychosocial treatments can help people with stimulant use disorder by reducing dropout rates. This conclusion is based on high-certainty evidence from comparisons of psychosocial interventions with both no treatment and TAU. This is an important finding because many people with stimulant use disorders leave treatment prematurely. Stimulant use disorders are chronic, lifelong, relapsing mental disorders, which require substantial therapeutic efforts to achieve abstinence. For those who are not yet able to achieve complete abstinence, retention in treatment may help to reduce the risks associated with stimulant use. In addition, psychosocial interventions reduce stimulant use compared to no treatment, but they may make little to no difference to stimulant use when compared to TAU. The most studied and promising psychosocial approach is contingency management. Relatively few studies explored the other approaches, so we cannot rule out the possibility that the results were imprecise due to small sample sizes.

Outcome of BMI2+: Motivational Interviewing to Reduce BMI Through Primary Care AAP PROS Practices.

BACKGROUND: Pediatric obesity rates in the United States remain at an all-time high. Pediatric primary care clinicians and registered dietitians can help treat childhood obesity, and motivational interviewing (MI) has shown promising effects in prior trials. METHODS: We randomized 18 pediatric primary care practices to receive the Brief Motivational Interviewing to Reduce BMI or BMI2+ intervention or continue with usual care (UC). Practices were recruited through the American Academy of Pediatrics Pediatric Research in Office Settings network. The intervention comprised 4 components1: in-person and telehealth MI counseling by pediatric clinicians; 4 recommended sessions,2 6 telephone MI counseling sessions from a registered dietitian,3 text message reminders and tailored motivational messages, and4 parent educational materials. The main outcome was the change in the percentage of the 95th percentile of BMI. The study was conducted 2017 through 2021. RESULTS: There was a significant treatment x time interaction (b = 0.017, 95% confidence interval: [0.0066-0.027]) for the main outcome, favoring the UC group, with youth in the intervention arm showing a greater relative increase in their percent of the 95th percentile. CONCLUSIONS: There was no overall benefit of the intervention and, contrary to expectations, youth in the intervention arm gained more weight, based on percent of the distance from the 95th percentile than matched youth from UC practices. The absolute excess weight gain among intervention relative to UC youth was small, approximately 0.5 BMI units and 1 kg over 2 years. We offer several potential explanations for these unexpected findings.