Clients' perceptions of motivational interviewing with couples: A qualitative examination of male couples' statements to counselors in session.

The past two decades have seen expanding interest in the application of Motivational Interviewing (MI) with couples. Thus far, literature detailing the development of MI with couples has focused primarily on elucidating counseling processes and techniques or on evaluating intervention effects. To date no published studies have examined client-perceptions of the counseling process in MI with couples. This study involved qualitative analysis of 55 sessions from 24 couple (48 individuals) who received short (3-session) courses of MI with couples in the context of a randomized controlled trial. All participants identified as cisgender male and were 18 or older. In each couple, at least one partner was aged 18 to 29, HIV negative, and reported drug use in the past 30 days. Analysis revealed that client couples attributed the benefits of MI with couples to the expectancy-related effects s (merely structuring time to talk) and common factors (the presence of the counsellor as a non-judgmental observer). Clients also conveyed appreciation for techniques and activities that enhanced dyadic functioning through communication skill building and the identification of shared values. Finally, clients appreciated the opportunity to discuss drug use and sexual behavior in an integrated way. Findings indicate the utility of counselor-delivered behavioral interventions. They also align with recent formulations of the counselor's role in MI with couples as well as the introduction of facilitating dyadic functioning as a distinct process. Finally, they highlight the potential value of training counselors to address the intersection of drug use, sexual risk, and sexual pleasure in sessions. These dimensions of practice receive inconsistent attention across counseling training program curricula.

Family-Centered Treatment Program for Problematic Gaming and Excessive Screen Use in a Clinical Child and Youth Population (FAME): Protocol for a Feasibility Pilot Mixed Method Study.

BACKGROUND: Screen time among children and adolescents has increased dramatically, raising concerns about its impact on development and mental health. While research highlights both potential benefits and risks, excessive use has been linked to issues like anxiety, depression, and gaming addiction. Despite growing concern, effective interventions are scarce. Recognizing the importance of family dynamics in child development, we propose a family-centered program to address problematic gaming and excessive screen use in a clinical population. By involving both children and parents, we aim to create a more comprehensive approach to prevention and treatment. OBJECTIVE: This study aims to determine the possibility of distributing and evaluating a family-centered group program for problematic gaming and excessive screen use (FAME) in a clinical child and adolescent psychiatry (CAP) population. We will monitor the recruitment rate; track the retention and attendance rates of both parents and children; and assess whether each session's objectives are met, the content is delivered within the allotted time, and the necessary resources (eg, facilitators and materials) are available. Additionally, we will gather qualitative and quantitative feedback from participants through postprogram surveys and individual interviews with both children and parents. METHODS: A total of 10 families with ongoing contact with CAP in Skåne, Sweden, will be recruited and offered participation in a family-centered group program targeting children aged 10-18 years with reported difficulties regarding screen gaming or screen use. The intervention to be tested is a newly developed, family-centered, psychoeducational, cognitive behavioral therapy-based intervention addressing both positive and negative aspects of screen use; setting boundaries; the connection between thoughts, feelings, and behaviors; conflict triggers; and sleep hygiene. The primary goal of the pilot study is to test the feasibility of the program, as well as recruitment and the analysis of participants' experiences with the program. RESULTS: A total of 11 children and their parents were enrolled during first quarter of 2024. A 4-session pilot was delivered in first quarter of 2024, and the first results are expected in the third quarter of 2024. CONCLUSIONS: The overarching goal of this pilot study is to determine the possibility of distributing and evaluating a family-centered group program for problematic gaming and excessive screen use (FAME) in a clinical CAP population. The insights gained from this study will guide our future research, which will focus on conducting a larger-scale evaluation of the intervention's impact on family screen time conflicts and inform future strategies for the implementation of family-centered interventions in child and youth clinics. TRIAL REGISTRATION: ClinicalTrials.gov NCT06098807; https://clinicaltrials.gov/study/NCT06098807. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56387.

The effect of online motivational interviewing on pregnant women's smoking cessation behaviour: A randomized controlled trial.

PURPOSE: This study aims to examine the effect of online individual motivational interviewing based on the transtheoretical model on pregnant women's smoking cessation behaviour. MATERIAL AND METHOD: Sixty-two pregnant women who did not complete the 16th gestational week and who smoked were randomly assigned to intervention (n = 31) and control (n = 31) groups. While the intervention group was administered model-based motivational individual counselling interventions, the control group was administered no interventions. FINDINGS: The results showed that 58.1% of the pregnant women in the intervention group and 22.6% of the pregnant women in the control group ceased smoking. CONCLUSION: Online motivational interviewing based on the transtheoretical model was found to be effective in pregnant women's smoking cessation.

Clinician and patient experiences with shared decision-making to promote daily arm use for individuals with chronic stroke: an exploratory qualitative study.

Purpose: To explore the attitudes and experiences of clinicians and individuals with chronic stroke on the use of shared decision-making (SDM) during upper extremity rehabilitation to improve daily arm use in the home environment. Specifically, we aimed to describe clinician and client perspectives regarding the facilitators and barriers to using SDM within the context of a self-directed upper extremity intervention for individuals living in the community with chronic stroke. Methods: Data were collected within the context of an interventional study examining the feasibility of the Use My Arm-Remote intervention. Focus group interviews were conducted with the clinicians (n = 3) providing the intervention and individual semi-structured interviews with the participants (n = 15) of the study. All interview data were collected after the end of the intervention period. Data were analyzed using thematic analysis. Results: The following themes were identified: (1) Equal partnership; (2) Enhancing clinician confidence; and (3) This is different. Facilitators and barriers were identified within each theme. Key facilitators for clinicians were competence with SDM and patient characteristics; while facilitators for patients were open and trusting relationships with clinicians and personalized experience. Key barriers to SDM for clinicians were lack of expertise in SDM and participant buy in; while patients identified a lack of foundational knowledge of stroke rehabilitation as a potential barrier. Conclusions: Key barriers were analyzed using the consolidated framework for advancing implementation science to interpret results and identify strategies for enhancing the implementation of SDM in a virtual setting. The CFIR-ERIC tool highlighted the need for targeted educational meetings and materials to address the training and educational needs of both clinicians and patients for future iterations of this intervention.

Research protocol for bridging research, accurate information and dialogue (BRAID)-clinical trials: a mixed-methods study of a community-based intervention to improve trust and diversify participation in clinical trials.

Cultural beliefs, personal experiences, and historic abuses within the healthcare system-rooted in structural racism-all contribute to community distrust in science and medicine. This lack of trust, particularly within underserved communities, contributes to decreased participation in clinical trials and a lack of representation in the data. Open dialogue about community concerns and experiences related to research participation and medical care processes can help build trust and change attitudes and behaviors that affect community health. This protocol outlines an approach to increase trust in science and clinical trials among communities in the Bronx, New York that are typically underrepresented in research data. Bridging Research, Accurate Information and Dialogue (BRAID) is a two-phased, evidence-based community engagement model that creates safe spaces for bilateral dialogues between trusted community messengers, and clinicians and scientists. The team will conduct a series of BRAID Conversation Circles on the topic of clinical trials with local trusted community messengers. Participants will be members of the community who are perceived as "trusted messengers" and can represent the community's voice because they have insight into "what matters" locally. Conversation Circles will be audiotaped, transcribed, and analyzed to identify emergent challenges and opportunities surrounding clinical trial participation. These key themes will subsequently inform the codesign and co-creation of tailored messages and outreach efforts that community participants can disseminate downstream to their social networks. Surveys will be administered to all participants before and after each Conversation Circle to understand participants experience and evaluate changes in knowledge and attitudes about clinical trials, including protections for research participants the advantages of having diverse representation. Changes in motivation and readiness to share accurate clinical trial information downstream will also be assessed. Lastly, we will measure participants dissemination of codesigned science messages through their social networks by tracking participant specific resource URLs of materials and videos posted on a BRAID website. This protocol will assess the effectiveness and adoptability of an innovative CBPR model that can be applied to a wide range of public health issues and has the potential to navigate the ever-changing needs of the communities that surround health systems.

Identifying motivational interviewing techniques in Quitline smoking cessation counselling sessions from Queensland, Australia.

Motivational interviewing (MI) is a common approach for smoking cessation counselling, yet little is known about the use of MI techniques in practice. This qualitative content analysis applied a published classification of content and relational MI techniques to a sample of 30 Quitline transcripts (January-March 2019) from Queensland, Australia. Overall, 36 MI techniques (94.7%) were identified at least once within the total sample. On average, 20 techniques (52.6%) were used in an individual conversation with a small difference observed between initial and follow-up calls. Techniques most frequently applied across conversations were largely relational, while techniques addressing client ambivalence/resistance were less frequently/never applied. Variability in techniques between individual initial and follow-up calls highlights the high degree of personalisation when applying MI to smoking cessation. Further investigations exploring associations of individual techniques and cessation outcomes are warranted. The classification may prove useful for assessments of fidelity for training and monitoring activities.

Learning & motivational talk in smoking cessation interventions: An examination of session language in two randomized trials.

OBJECTIVES: Motivational Interviewing (MI), a client-centered approach that seeks to evoke and resolve ambivalence, and health education (HE), which provides health information and advice, may both provide some benefit to unmotivated smokers. In HE, it is possible that client language reflective of new learning, or "learning talk" (LT), and rejection of health advice, or "rejection talk," (RT), may uniquely reflect intent of subsequent behavior change. METHODS: This project utilized MI and HE sessions from two randomized clinical trials (RCTs), one in a low-income, diverse community civilian sample of 255 unmotivated smokers, and the other in a sample of Veterans with mental illness who were unmotivated smokers (n = 55). Mixed methods approaches were utilized to reliably code sessions using the Motivational Interviewing Skill Code 2.5 (MISC 2.5)1 and a refined Learning Talk coding system2. RESULTS: Reliability of LT and RT codes ranged from fair to excellent (ICCs from 0.43-0.93). CONCLUSION: LT appears to be a unique construct and its impact on post-session changes in smoking is warranted. PRACTICE IMPLICATIONS: This system can be used in a study to code existing interventions for smokers using both MI and HE techniques and relate in-session client LT to subsequent smoking behaviors.

Co-designing a motivational interviewing training platform to enhance oncology healthcare professional communication.

Background: Oncology healthcare professionals (HCPs) using motivational interviewing may motivate and support patients with chronic illness to adhere to medications. Research of online motivational interviewing training focusing on medication adherence in cancer is limited. Objective: Co-design, develop, and preliminarily evaluate a motivational interviewing training platform (MITP) for oncology HCPs focused on medication adherence. Methods: We used co-design and design science research methodology to develop and test the MITP in two phases: 1) program co-design and development and 2) interactive platform design and development. Results: HCPs expressed a high demand for a practical and tailored motivational interviewing training. MITP is an online three-hour training comprising education, roleplay videos, and formative assessments. MITP was reported to be acceptable, usable, and useful by users. Innovation: This study used a novel approach combining co-design and design science research methodology, and digital media to develop a flexible and acceptable online motivational interviewing training focused on medication adherence in cancer. Discussion and conclusion: Applied rigorous methodology ensured the MITP was developed to address knowledge gaps and the needs of oncology HCPs for supporting patient adherence, and to be usable and useful. Study findings may inform future research on online motivational interviewing training and its potential impact on medication adherence.

Efficacy of Behavioral Intervention, Text Messaging, and Extended Intervention to Address Alcohol Misuse in Sexual Minority Men with HIV: A Factorial Randomized Clinical Trial.

This clinical trial examined the individual and combined effects of three different approaches to reducing alcohol misuse among a sample of sexual minority men (SMM) with HIV. Specifically, we used a 2 × 2 × 2 randomized factorial design to compare: (a) behavioral intervention based in motivational interviewing (MI) vs. brief intervention (BI), (b) interactive text messaging (ITM) for alcohol use vs. no ITM, and (c) extended intervention (EI) length of nine months vs. a one-month intervention duration. Participants (N = 188) were SMM with HIV and alcohol misuse recruited in Miami, FL, and Boston, MA. Participants were randomized to one of eight intervention combinations and assessed at 6- and 12-month follow-ups. Large reductions of over 50% in drinks per week and heavy drinking days were observed in all conditions at follow-up. Those who received ITM, compared to those who did not, reported significantly lower drinks consumed per week at 6 and 12 months (incidence rate ratios = 0.73 [95% CI = 0.57, 0.90] and 0.72 [95% CI = 0.56, 0.87], respectively), and increased odds of cessation of alcohol misuse at 12 months, odds ratio = 1.46, 95% CI = 1.03, 2.08. Results provided no evidence of better alcohol use outcomes for either MI or EI relative to their comparison conditions, and no specific combination of intervention components demonstrated a notable benefit. This study suggests a two-session BI can effectuate substantial reductions in alcohol use in SMM with HIV and that adding one month of ITM can yield further improvements. Clinical Trials Number: NCT02709759.

Breaking the cycle of reoccurring low back pain with integrated motivational interviewing and cognitive behavioural therapy to facilitate education and exercise advice: a superiority randomised controlled trial study protocol.

BACKGROUND: Non-specific low back pain is a common and costly global issue. Many people with low back pain live for years with ongoing symptom recurrence and disability, making it crucial to find effective prevention strategies. Motivational interviewing (MI) is an evidence-based patient-centred counselling style that helps motivate individuals to change their behaviours. In combination, MI and cognitive-behavioural therapy (MI-CBT) has the potential to yield long term improvements in pain and disability and reduce incidence of recurrence. METHOD: This is a two-arm superiority randomised controlled trial comparing MI-CBT and Education (n = 83) with Education only (n = 83). Participants that have recovered from a recent episode of non-specific low back pain (7th consecutive day with pain ≤ 2 on a 0-10 numeric pain rating scale) will be eligible for inclusion into the study. Both groups will receive five 30-min sessions over a 10-week period as well as the Navigating Pain booklet, homework book and a standardised exercise programme. In the intervention group, MI-CBT techniques will be used to provide individualised support, identify beliefs, and increase engagement with the resources provided. Outcomes measures include pain (current and in the last 7 days) as rated on the numeric pain rating scale. This will be used to determine recurrence (number of participants who report back pain ≥ 3 out of 10 on the numeric pain rating scale). Furthermore, self-reported (1) pain intensity; (2) pain catastrophizing; (3) fear-avoidance beliefs; (4) pain self-efficacy; (5) depression and anxiety; (6) disability will be measured. All outcomes will be measured at baseline, and again at 3-, 6-, and 12-months post allocation. DISCUSSION: The effective delivery of self-management strategies to prevent recurrence of low back pain is an important aspect that requires urgent attention. This study will provide new information on the effectiveness of using an MI-CBT approach to facilitate self-management through education and exercise to improve low back pain outcomes. Evidence emerging from this trial has the potential to inform clinical practice and healthcare management of non-specific low back pain. TRIAL REGISTRATION: Prospectively registered with Australian New Zealand Clinical Trials Registry: ACTRN12623000746639 (10/07/2023).

Generation of Backward-Looking Complex Reflections for a Motivational Interviewing-Based Smoking Cessation Chatbot Using GPT-4: Algorithm Development and Validation.

Background: Motivational interviewing (MI) is a therapeutic technique that has been successful in helping smokers reduce smoking but has limited accessibility due to the high cost and low availability of clinicians. To address this, the MIBot project has sought to develop a chatbot that emulates an MI session with a client with the specific goal of moving an ambivalent smoker toward the direction of quitting. One key element of an MI conversation is reflective listening, where a therapist expresses their understanding of what the client has said by uttering a reflection that encourages the client to continue their thought process. Complex reflections link the client's responses to relevant ideas and facts to enhance this contemplation. Backward-looking complex reflections (BLCRs) link the client's most recent response to a relevant selection of the client's previous statements. Our current chatbot can generate complex reflections-but not BLCRs-using large language models (LLMs) such as GPT-2, which allows the generation of unique, human-like messages customized to client responses. Recent advancements in these models, such as the introduction of GPT-4, provide a novel way to generate complex text by feeding the models instructions and conversational history directly, making this a promising approach to generate BLCRs. Objective: This study aims to develop a method to generate BLCRs for an MI-based smoking cessation chatbot and to measure the method's effectiveness. Methods: LLMs such as GPT-4 can be stimulated to produce specific types of responses to their inputs by "asking" them with an English-based description of the desired output. These descriptions are called prompts, and the goal of writing a description that causes an LLM to generate the required output is termed prompt engineering. We evolved an instruction to prompt GPT-4 to generate a BLCR, given the portions of the transcript of the conversation up to the point where the reflection was needed. The approach was tested on 50 previously collected MIBot transcripts of conversations with smokers and was used to generate a total of 150 reflections. The quality of the reflections was rated on a 4-point scale by 3 independent raters to determine whether they met specific criteria for acceptability. Results: Of the 150 generated reflections, 132 (88%) met the level of acceptability. The remaining 18 (12%) had one or more flaws that made them inappropriate as BLCRs. The 3 raters had pairwise agreement on 80% to 88% of these scores. Conclusions: The method presented to generate BLCRs is good enough to be used as one source of reflections in an MI-style conversation but would need an automatic checker to eliminate the unacceptable ones. This work illustrates the power of the new LLMs to generate therapeutic client-specific responses under the command of a language-based specification.

Neural Conversational Agent for Weight Loss Counseling: Protocol for an Implementation and Feasibility Study.

BACKGROUND: Obesity is a common, serious and costly chronic disease. Current clinical practice guidelines recommend that providers augment the longitudinal care of people living with obesity with consistent support for the development of self-efficacy and motivation to modify their lifestyle behaviors. Lifestyle behavior change aligns with the goals of motivational interviewing (MI), a client-centered yet directive counseling modality. However, training health care providers to be proficient in MI is expensive and time-consuming, resulting in a lack of trained counselors and limiting the widespread adoption of MI in clinical practice. Artificial intelligence (AI) counselors accessible via the internet can help circumvent these barriers. OBJECTIVE: The primary objective is to explore the feasibility of conducting unscripted MI-consistent counseling using Neural Agent for Obesity Motivational Interviewing (NAOMI), a large language model (LLM)-based web app for weight loss counseling. The secondary objectives are to test the acceptability and usability of NAOMI's counseling and examine its ability to shift motivational precursors in a sample of patients with overweight and obesity recruited from primary care clinics. METHODS: NAOMI will be developed based on recent advances in deep learning in four stages. In stages 1 and 2, NAOMI will be implemented using an open-source foundation LLM and (1) few-shot learning based on a prompt with task-specific instructions and (2) domain adaptation strategy based on fine-tuning LLM using a large corpus of general psychotherapy and MI treatment transcripts. In stages 3 and 4, we will refine the best of these 2 approaches. Each NAOMI version will be evaluated using a mixed methods approach in which 10 adults (18-65 years) meeting the criteria for overweight or obesity (25.0≥BMI≤39.9) interact with NAOMI and provide feedback. NAOMI's fidelity to the MI framework will be assessed using the Motivational Interviewing Treatment Integrity scale. Participants' general perceptions of AI conversational agents and NAOMI specifically will be assessed via Pre- and Post-Interaction Questionnaires. Motivational precursors, such as participants' confidence, importance, and readiness for changing lifestyle behaviors (eg, diet and activity), will be measured before and after the interaction, and 1 week later. A qualitative analysis of changes in the measures of perceptions of AI agents and counselors and motivational precursors will be performed. Participants will rate NAOMI's usability and empathic skills post interaction via questionnaire-based assessments along with providing feedback about their experience with NAOMI via a qualitative interview. RESULTS: NAOMI (version 1.0) has been developed. Participant recruitment will commence in September 2024. Data collection activities are expected to conclude in May 2025. CONCLUSIONS: If proven effective, LLM-based counseling agents can become a cost-effective approach for addressing the obesity epidemic at a public health level. They can also have a broad, transformative impact on the delivery of MI and other psychotherapeutic treatment modalities extending their reach and broadening access. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/60361.

Evaluating the feasibility and utility of telephonic motivational interviewing in older adults.

Older adults face unique barriers and challenges related to physical activity (PA) participation. Motivational interviewing (MI) is a commonly used health coaching strategy to support behavior change that holds potential for older adults. Previous research on MI strategies has focused primarily on face-to-face delivery, limiting insights regarding virtual programs. Objectives: The purpose of this study was to determine if MI could be delivered telephonically with high fidelity and high acceptability in older adult participants. The study is designed to inform future trials evaluating its effectiveness in supporting virtual PA programs. Methods: This study evaluated the feasibility and acceptability of telephonic MI among older adults that enrolled in an online version of the Walk with Ease program. Results: Of 39 participants referred, 29 enrolled and 27 provided feedback. Participants were highly accepting and adherent, with 74 % of patients attending at least five of six sessions, and 96 % of participants indicating satisfaction with the MI provided. Coaches improved program enjoyment by helping set effective goals and providing ongoing accountability. Conclusions: Evaluations documented adequate fidelity and high acceptability of telephonic delivery, and motivation results revealed large, significant increases in autonomous regulation (quality of motivation). Innovation: Telephonic MI using non-healthcare professional coaches is feasibly delivered with high fidelity, and is acceptable to older adult participants. The innovative delivery format offers novel opportunities supporting virtual and telehealth interventions to reduce chronic disease risk among older adults.

Vaccine hesitancy educational interventions for medical students: A systematic narrative review in western countries.

Physician recommendations can reduce vaccine hesitancy (VH) and improve uptake yet are often done poorly and can be improved by early-career training. We examined educational interventions for medical students in Western countries to explore what is being taught, identify effective elements, and review the quality of evidence. A mixed methods systematic narrative review, guided by the JBI framework, assessed the study quality using MERSQI and Cote & Turgeon frameworks. Data were extracted to analyze content and framing, with effectiveness graded using value-based judgment. Among the 33 studies with 30 unique interventions, effective studies used multiple methods grounded in educational theory to teach knowledge, skills, and attitudes. Most interventions reinforced a deficit-based approach (assuming VH stems from misinformation) which can be counterproductive. Effective interventions used hands-on, interactive methods emulating real practice, with short- and long-term follow-ups. Evidence-based approaches like motivational interviewing should frame interventions instead of the deficit model.

Motivational Interviewing for the Prevention and Treatment of Pediatric Obesity: A Primer.

Motivational interviewing (MI), which is recommended for prevention and treatment of pediatric obesity, is a patient-centered counseling style used to modify behaviors. When using MI, pediatric providers generally avoid direct attempts to convince or persuade. Instead, they help patients or parents think about and verbalize their reasons for and against change and how their behavior aligns with their values and goals. MI relies on specific techniques, including reflective listening, to strategically balance the need to "comfort the afflicted" and "afflict the comfortable"; to balance the expression of empathy with the need to build discrepancy for change, thereby encouraging "change talk".

Effectiveness of Motivational Interviewing and cross platform messaging application in improving oral health knowledge, attitude and behaviours among pregnant women- A Randomized Controlled Trial.

Background: Body goes through significant hormonal and physiological changes during pregnancy, which could be linked to changes in oral health. Many women are unaware of the negative consequences of poor dental health during and after pregnancy, both for themselves and their children. Therefore, this study aimed to assess the effectiveness of Motivational Interviewing (MI) and cross platform messaging application (WhatsApp messenger) for oral health education on the oral health knowledge, attitude and behaviours among pregnant women attending ante natal care. Methods: A randomized controlled trial was conducted among 84 pregnant women. Simple random sampling was employed to select participants after oral examination. Participants were randomly allocated to two groups (Group 1: Cross-platform messaging application [WhatsApp]; Group 2: MI) using a lottery method. Pregnant women aged 18 years and older, gestational age between 8 and 30 weeks were included. A face-to-face interview and oral examination were conducted to assess baseline knowledge and oral hygiene status. A follow-up examination was conducted after one month of intervention. Inferential statistics, including the chi-square test and independent t-test, were used to compare variables between the two groups. Results: The mean knowledge score at baseline was comparable between Group 1 (WhatsApp) and Group 2 (MI). However, post-intervention, Group 2 showed a significantly higher mean knowledge score compared to Group 1. Post-intervention, Group 2 exhibited a significantly better oral hygiene status compared to Group 1. Significant improvements in oral health behaviours were observed in Group 2 compared to Group 1 (p < 0.001). Conclusions: The findings suggested that while both interventions were effective, MI showed superior results in improving knowledge, oral hygiene status, and oral health behaviours. The personalized and client-centred approach of MI enables participants to explore and resolve ambivalence, promoting a deeper understanding of the importance of oral health during pregnancy. Registration: CTRI ( CTRI/2021/09/036407, 10/09/2021).

Medical Students' Efforts to Address COVID-19 Vaccine Hesitancy Through Motivational Interviewing.

Background The coronavirus disease 2019 (COVID-19) pandemic reaffirmed health disparities in the United States (US) and highlighted the need for public health strategies to combat vaccine hesitancy, especially amongst vulnerable populations. The Green Family Foundation Neighborhood Health Education Learning Program (NeighborhoodHELP) at Florida International University (FIU) serves a predominantly uninsured population, making it a critical area of opportunity for addressing vaccine hesitancy. Motivational interviewing (MI), a technique that supports individuals in making autonomous health decisions, has shown promise in encouraging vaccine acceptance. Medical students at FIU's Herbert Wertheim College of Medicine (HWCOM) are involved in the longitudinal care of the individuals in NeighborhoodHELP and receive training in MI within their clinical skills curriculum, making them optimally positioned to conduct outreach to encourage COVID-19 vaccination. Project goals There were two primary goals of this project: first, to systematically track and improve COVID-19 vaccination rates among individuals in NeighborhoodHELP, and second, to equip future physicians with hands-on experience in MI. Methods The COVID-19 Vaccination Promotion Initiative recruited medical students previously trained in MI to conduct outreach to unvaccinated individuals within NeighborhoodHELP. Students engaged in discussions about the COVID-19 vaccine with NeighborhoodHELP members, assisted in scheduling vaccination appointments, and updated medical records. The student team regularly met with faculty advisors to discuss changes in vaccine and public health data and to discuss challenges and successes with outreach efforts. To incentivize participation and enhance vaccine uptake, $25 gift cards were offered to individuals who agreed to receive the vaccine following the outreach conversations. Results From June 2021 to January 2023, the team made an estimated 720-1516 phone calls to NeighborhoodHELP individuals. The team encountered a challenge of low answering rates, with 35% of individuals being unreachable despite multiple attempts. Among those reached, 20% expressed no interest in receiving the vaccine, while 50% were interested in receiving the vaccine or had already been vaccinated. Vaccination rates among NeighborhoodHELP adults rose from 15.2% to 44.3% during this time. Student experiences with MI were generally positive, with many noting success in engaging hesitant individuals. However, the team also encountered challenges, such as growing vaccine apathy within the community and difficulties in reaching patients via cold calls, which limited the overall impact of their outreach efforts. Conclusions By using MI techniques, medical students engaged with community members in meaningful conversations about the importance and safety of COVID-19 vaccination. However, the initiative fell short of the 50% vaccination target, facing challenges such as reliance on unsolicited phone calls and the complexities of incentivizing vaccinations through this outreach method.  Future initiatives could benefit from exploring alternative outreach methods, such as in-person engagement at community events or through partnerships with local organizations, to overcome the limitations of phone-based outreach. Additionally, investigating the relative efficacy of in-person versus telephone-based communication in promoting vaccination could provide valuable insights.

The Impact of Motivational Interviewing and MOTIVE Tool Use by Pharmacists on Vaccine Acceptance.

Vaccines have played a significant role in reducing infectious disease burden. However, vaccine hesitancy remains a persistent challenge in public health, including for pharmacists who often interact with patients regarding vaccines. Thus, this study assesses the impact of motivational interviewing (MI) training and the MI-based vaccine hesitancy discussion tools (MOTIVE) on pharmacists' management of vaccine hesitancy. Pharmacists in eight Midwestern pharmacy practices who completed MI and MOTIVE training and engaged with vaccine-hesitant patients participated in this study. The pharmacist participants completed post-encounter surveys identifying the vaccine discussed, the tool utilized, and the outcome of the conversation. Descriptive results from 362 encounters indicated that the primary reasons for hesitancy were safety (39%), care coordination (31.5%), and efficacy (30.4%). Post encounter, 35.4% of patients received vaccines, 26% planned to, 25.1% considered it, and 13.5% were uninterested. The findings highlight the importance of patient-centered communication, such as MI, between patients and pharmacists to identify and address reasons for vaccine hesitancy. Pharmacists, equipped with conversation tools such as the MOTIVE tools, may effectively influence vaccine acceptance. Future research should evaluate the utility of MI and the MOTIVE tools in other settings and regions.

Evidence for motivational interviewing in educational settings among medical schools: a scoping review.

BACKGROUND: Motivational interviewing (MI) is a person-centred approach focused on empowering and motivating individuals for behavioural change. Medical students can utilize MI in patient education to engage with patients' chronic health ailments and maladaptive behaviours. A current scoping review was conducted to 1) determine the types of MI (conventional, adapted, brief and group MI) education programs in medical schools, delivery modalities and teaching methods used; 2) classify educational outcomes on the basis of Kirkpatrick's hierarchy; and 3) determine the key elements of MI education via the FRAMES (feedback, responsibility, advice, menu of options, empathy, self-efficacy) model. METHODS: This scoping review was conducted via the framework outlined by Arksey and O'Malley. Two online databases, CINAHL and MEDLINE Complete, were searched to identify MI interventions in medical education. Further articles were selected from bibliography lists and the Google Scholar search engine. RESULTS: From an initial yield of 2019 articles, 19 articles were included. First, there appears to be a bimodal distribution of most articles published between the two time periods of 2004--2008 and 2019--2023. Second, all the studies included in this review did not use conventional MI but instead utilized a variety of MI adaptation techniques. Third, most studies used face-to-face training in MI, whereas only one study used online delivery. Fourth, most studies have used a variety of interactive experiences to teach MI. Next, all studies reported outcomes at Kirkpatrick's Level 2, but only 4 studies reported outcomes at Kirkpatrick's Level 3. According to the FRAMES model, all studies (n=19; 100%) reported the elements of responsibility and advice. The element that was reported the least was self-efficacy (n = 12; 63.1%). CONCLUSION: Our findings suggest that motivational interviewing can be taught effectively in medical schools via adaptations to MI and a variety of teaching approaches. However, there is a need for further research investigating standardized MI training across medical schools, the adequate dose for training in MI and the implementation of reflective practices. Future studies may benefit from exploring and better understanding the relationship between MI and self-efficacy in their MI interventions.

Home-based motivational interviewing for late-life rural hoarding disorder: a pilot study.

OBJECTIVES: The primary purpose of this pilot study was to determine the feasibility and acceptability of a novel brief (six-session) motivational interviewing home-based intervention for hoarding disorder designed for rural older adults. The secondary aims were to examine the engagement of proposed mechanisms of change and the preliminary efficacy of symptom reduction. METHOD: Fifteen rural-dwelling older adults were enrolled in the pilot trial for Project RECLAIM (Reduce Clutter and Increase Meaning). Engagement of proposed mechanisms of change was assessed weekly for reported engagement in sorting/discarding behaviors and from baseline to post-treatment on readiness for change and motivation. Symptom reduction was assessed from baseline to post-treatment on hoarding symptoms and general psychological functioning. RESULTS: Sixty percent of participants completed all six sessions of RECLAIM. Over the course of treatment, participants reported significant decreases in household clutter (d = -0.85) and object attachment (d = -1.01) and increases in positive affect (d = 0.71), readiness for change (d = 0.40) and motivation (d = 0.52), and sorting between sessions (ß = 3.82). CONCLUSION: The significant reductions in hoarding symptoms after only six sessions of treatment suggest that a brief, in-home, intervention may be a viable option for symptom reduction, particularly for rural-dwelling older adults.