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1.
J Consult Clin Psychol ; 89(8): 707-716, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34472897

RESUMO

Objective: Change talk has been proposed as a mechanism of change in motivational interviewing (MI) by mediating the link between MI technical skills and behavioral outcomes. We tested the influence of therapists' relational skills on this mediation model. Method: Secondary analysis of a randomized controlled trial of individual brief MI for heavy drinking among 20-year-old-Swiss young men, where the MI group (n = 179) significantly reduced drinking compared to an assessment-only control. We coded MI sessions and derived: therapists' MI technical skills, clients' change talk (CT) and sustain talk (ST), and global relational ratings (empathy and MI spirit). We tested moderated mediation models with technical skills as the independent variable, CT and ST as parallel mediators, predicting drinking at 3-month follow-up (controlling for baseline drinking), and relational skills as moderators of the path from technical skills to client mediators. Results: Conditional indirect effects were significant for overall MI technical skills, open questions, and simple reflections (i.e., more of these behaviors related to more ST, which was related to more drinking) when relational skills were low. In contrast, there was a significant conditional indirect effect for complex reflections when relational skills were high (i.e., more complex reflections related to less ST). Conclusions: This study provides partial support for the MI technical and relational process models. Interestingly, support was found regarding the negative side of client ambivalence (ST) in this highly precontemplative sample. Accordingly, MI therapists should work cautiously with ST when clients are at early stages of motivational readiness. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Consumo de Bebidas Alcoólicas/terapia , Alcoolismo/psicologia , Alcoolismo/terapia , Análise de Mediação , Entrevista Motivacional , Consumo de Bebidas Alcoólicas/prevenção & controle , Alcoolismo/prevenção & controle , Empatia , Humanos , Masculino , Motivação , Suíça , Adulto Jovem
2.
Am J Prev Med ; 61(4): 606-617, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34544560

RESUMO

INTRODUCTION: Suboptimal and differential participant engagement in randomized trials-including retention at primary outcome assessments and attendance at intervention sessions-undermines rigor, internal validity, and trial conclusions. METHODS: First, this study describes Methods-Motivational Interviewing approach and strategies for implementation. This approach engages potential participants before randomization through interactive, prerequisite orientation sessions that illustrate the scientific rationale behind trial methods in accessible language and use motivational interviewing to diffuse ambivalence about participation. Then, this study examines the potential improvements in retention (proportion of participants assessed at follow-up visits) and attendance (e.g., mean percentage of intervention sessions attended, percentage of participants who attended 0 sessions) in 3 randomized weight-management trials that quickly added prerequisite orientations to their protocols following early signs of suboptimal or differential participant engagement (Supporting Health by Integrating Nutrition and Exercise [2009-2013, n=194]; Get Social [2016-2020, n=217]; GestationaL Weight Gain and Optimal Wellness [2014-2018, n=389]). Using a pre-post analytical design, adjusted estimates from regression models controlling for condition and assessment timepoint (analyses from 2020) are reported. RESULTS: After adding prerequisite orientations, all 3 trials attained higher participant engagement. Retention at assessments was 11.4% and 17.3% higher (Get Social and Supporting Health by Integrating Nutrition and Exercise, respectively). Mean percentage of attendance at intervention sessions was 8.8% higher (GestationaL Weight Gain and Optimal Wellness), and 10.1% fewer participants attended 0 intervention sessions (Get Social). Descriptively, all the remaining retention and attendance outcomes were consistently higher but were nonsignificant. Across the trials, adding prerequisite orientations did not impact the proportion of eligible participants enrolled or the baseline demographics. CONCLUSIONS: The Methods-Motivational Interviewing approach shows promise for increasing the rigor of randomized trials and is readily adaptable to in-person, webinar, and conference call formats. TRIAL REGISTRATION: All 3 trials are registered at www.clinicaltrials.gov (Supporting Health by Integrating Nutrition and Exercise: NCT00960414; Get Social: NCT02646618; and GestationaL Weight Gain and Optimal Wellness: NCT02130232).


Assuntos
Entrevista Motivacional , Exercício Físico , Humanos , Avaliação de Resultados em Cuidados de Saúde
3.
Health Psychol ; 40(7): 439-449, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34435795

RESUMO

OBJECTIVE: The field of implementation science emphasizes efficient and effective fidelity measurement for research outcomes and feedback to support quality improvement. This paper reports on such a measure for motivational interviewing (MI), developed with rigorous methodology and with diverse samples. METHOD: Using item response theory (IRT) methods and Rasch modeling, we analyzed coded (a) recordings (n = 99) of intervention sessions in a clinical trial of African American adolescents with obesity; (b) standard patient interactions (n = 370) in an implementation science study with youth living with HIV; and (c) standard patient interactions (n = 172) in a diverse community sample. RESULTS: These methods yielded a reliable and valid 12-item scale on several indicators using Rausch modeling including single construct dimensionality, strong item-session maps, good rating scale functionality, and item fit after revisions. However, absolute agreement was modest. The 12 items yielded thresholds for 4 categories: beginner, novice, intermediate and advanced. CONCLUSIONS: The 12-item Motivational Interviewing Coach Rating Scale is the first efficient and effective fidelity measure appropriate with diverse ethnic groups, with interventions that are MI only or interventions that integrate MI with other interventions, and with adolescents and families as well as adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Equidade em Saúde , Ciência da Implementação , Entrevista Motivacional , Adolescente , Afro-Americanos/psicologia , Terapia Comportamental , Criança , Feminino , Infecções por HIV/psicologia , Infecções por HIV/terapia , Humanos , Masculino , Obesidade/psicologia , Obesidade/terapia
4.
BMC Cardiovasc Disord ; 21(1): 367, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34334142

RESUMO

BACKGROUND: In the treatment of coronary heart disease, secondary prevention goals are still often unmet and poor adherence to prescribed drugs has been suggested as one of the reasons. We aimed to investigate whether pharmaceutical care by a pharmacist at the cardiology clinic trained in motivational interviewing improves clinical outcomes and patient adherence. METHODS: This was a prospective, randomized, controlled, outcomes-blinded trial designed to compare pharmaceutical care follow-up with standard care. After standard follow-up at the cardiology clinic, patients in the intervention group were seen by a clinical pharmacist two to five times as required over seven months. Pharmacists were trained to use motivational interviewing in the consultations and they tailored their support to each patient's clinical needs and beliefs about medicines. The primary study end-point was the proportion of patients who reached the treatment goal for low-density lipoprotein cholesterol by 12 months after discharge. The key secondary outcome was patient adherence to lipid-lowering therapy at 15 months after discharge, and other secondary outcomes were the effects on patient adherence to other preventive drugs, systolic blood pressure, disease-specific quality of life, and healthcare use. RESULTS: 316 patients were included. The proportion of patients who reached the target for low-density lipoprotein cholesterol were 37.0% in the intervention group and 44.2% in the control group (P = .263). More intervention than control patients were adherent to cholesterol-lowering drugs (88 vs 77%; P = .033) and aspirin (97 vs 91%; P = .036) but not to beta-blocking agents or renin-angiotensin-aldosterone system inhibitors. CONCLUSIONS: Our intervention had no positive effects on risk factors for CHD, but it increased patient adherence. Further investigation of the intervention process is needed to explore the difference in results between patient adherence and medication effects. Longer follow-up of healthcare use and mortality will determine if the increased adherence per se eventually will have a meaningful effect on patient health. TRIAL REGISTRATION: ClinicalTrials.gov NCT02102503, 03/04/2014 retrospectively registered.


Assuntos
Doença das Coronárias/prevenção & controle , Dislipidemias/tratamento farmacológico , Hipolipemiantes/uso terapêutico , Adesão à Medicação , Conduta do Tratamento Medicamentoso , Entrevista Motivacional , Farmacêuticos , Idoso , Anti-Hipertensivos/uso terapêutico , Biomarcadores/sangue , Pressão Sanguínea/efeitos dos fármacos , LDL-Colesterol/sangue , Doença das Coronárias/diagnóstico , Doença das Coronárias/etiologia , Dislipidemias/complicações , Dislipidemias/diagnóstico , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Fatores de Risco de Doenças Cardíacas , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Hipolipemiantes/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Prevenção Secundária , Suécia , Fatores de Tempo , Resultado do Tratamento
5.
J Fam Pract ; 70(6S): S35-S40, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34432622

RESUMO

LEARNING OBJECTIVES: At the end of the activity, participants will be able to: • Recognize obesity as a chronic, relapsing, serious disease warranting long-term management and early intervention to minimize disease burden and decrease associated morbidity and mortality. • Destigmatize obesity to initiate and enhance patient engagement. • Apply guideline-recommended care for screening, diagnosis, and individualized treatment of adults and others with obesity. • Incorporate practical practice management strategies.


Assuntos
Gerenciamento Clínico , Obesidade/terapia , Fármacos Antiobesidade/uso terapêutico , Atitude do Pessoal de Saúde , Comunicação , Objetivos , Humanos , Entrevista Motivacional , Relações Médico-Paciente , Meio Social , Programas de Redução de Peso
6.
Curr Opin Psychiatry ; 34(5): 508-513, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34282103

RESUMO

PURPOSE OF REVIEW: Despite a significant body of literature related to the treatment of gambling disorder, there are still an insufficient number of evaluation studies regarding their effectiveness or firm conclusions on specific treatment elements that contribute to it. The aim of this article was to provide a review of scientific results regarding the treatment of gambling disorder, to present the most commonly applied modalities of treatment and to explore the elements of the most successful therapeutic interventions. RECENT FINDINGS: A substantial body of literature has shown that the most successful therapeutic protocols are psychological interventions, especially based on cognitive-behavioral therapy/methods and/or motivational interviewing. Other interventions with promising results include different self-help interventions and mindfulness. Interventions such as couples therapy and support groups, may have positive effects in terms of increasing therapeutic adherence and retention, while pharmacotherapy is especially useful in patients with comorbidities. SUMMARY: Gambling disorder is a complex mental health problem caused by a wide spectrum of different biological, psychological, and social risk factors. Treatment options for gambling disorder need to be wide, flexible, accessible, and economically justified, providing early inclusion, retention, and sustainability of long-term effects of the treatment, that is, abstinence and higher quality of psychosocial functioning.


Assuntos
Terapia Cognitivo-Comportamental , Jogo de Azar/terapia , Atenção Plena , Entrevista Motivacional , Medicina Baseada em Evidências , Jogo de Azar/psicologia , Humanos , Grupos de Autoajuda
7.
Artigo em Inglês | MEDLINE | ID: mdl-34324798

RESUMO

Background: Many midlife adults (aged 45-64 years) struggle to become physically active in the context of diminished psychological well-being and multiple concurrent stressors, despite the clear association of low physical activity with the development of chronic medical conditions.Objectives: To assess the feasibility (rates of session completion) and acceptability (participant 0-10 ratings of weekly session ease and utility) of a novel 12-week, phone-delivered, midlife-adapted positive psychology-motivational interviewing (PP-MI) intervention to promote physical activity. Secondary aims were pre-post changes in accelerometer-measured physical activity and self-reported psychological and functional measures.Methods: A single-arm proof-of-concept trial of the PP-MI intervention was conducted among 11 inactive midlife adults enrolled from the primary care practices of an urban academic medical center. Descriptive statistics were used to assess feasibility and acceptability outcomes, and mixed effects models were used to examine pre-post changes in psychological, functional, and physical activity outcomes from baseline to 12 weeks.Results: The intervention exceeded a priori thresholds for feasibility and acceptability, with 80.3% session completion across all participants and mean session ratings of 8.3/10 (SD = 2.1). Participants also had medium effect size magnitude improvements in physical activity and psychological outcomes.Conclusions: This remotely delivered, midlife-specific PP-MI intervention was feasible and well-accepted among inactive midlife adults, supporting next-step testing of this program in a randomized trial.Trial Registration: ClinicalTrials.gov identifier: NCT04745182.


Assuntos
Exercício Físico , Entrevista Motivacional , Adulto , Terapia Comportamental , Humanos , Psicologia Positiva , Telefone
8.
BMJ Open ; 11(7): e046896, 2021 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-34330857

RESUMO

OBJECTIVES: The aim of this study was to describe challenges in self-management activities among people with multimorbidity during a 4-week post-discharge period. DESIGN: This is a longitudinal qualitative study using data from a randomised controlled trial (RCT) of motivational interviewing (MI) sessions. SETTING: The RCT was conducted at six wards in two hospitals-one university hospital and one general hospital in Stockholm, Sweden, during 2016-2018. PARTICIPANTS: Sixteen participants from the intervention group, diagnosed with heart failure or chronic obstructive pulmonary disease and at least one other chronic condition, were purposively selected for this study. INTERVENTIONS: Each participant had four or five post-discharge MI sessions with a trained social worker during a period of approximately 4 weeks. The sessions were recorded digitally and analysed using content analysis. Altogether, 70 recorded sessions were analysed. RESULTS: Self-management after hospital discharge was a dynamic process with several shifting features that evolved gradually over time. Patients with multimorbidity experienced two major challenges with self-management in the first 4 weeks following hospital discharge: 'Managing a system-centred care' and 'Handling the burden of living with multiple illnesses at home post-discharge'. CONCLUSIONS: Self-management for patients with multimorbidity in the first post-discharge period does not equate to a fixed set of tasks, but varies over the post-discharge period. Self-management challenges include not only the burden of the disease itself, but also that of navigating and understanding the healthcare system. Hence, self-management support post-discharge involves both aiding patients with care coordination and meeting their gradually shifting disease-related needs. TRIAL REGISTRATION NUMBER: NCT02823795.


Assuntos
Entrevista Motivacional , Autogestão , Hospitais , Humanos , Multimorbidade , Alta do Paciente , Qualidade de Vida , Suécia
9.
BMC Health Serv Res ; 21(1): 685, 2021 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-34247604

RESUMO

BACKGROUND: In sub-Saharan Africa, there is increasing mortality and morbidity of adolescents due to poor linkage, retention in HIV care and adherence to antiretroviral therapy (ART). This is a result of limited adolescent-centred service delivery interventions. This cost-effectiveness and feasibility study were piggybacked on a cluster-randomized trial that assessed the impact of an adolescent-centred service delivery intervention. The service delivery intervention examined the impact of an incentive scheme consisting of conditional economic incentives and motivational interviewing on the health outcomes of adolescents living with HIV in Nigeria. METHOD: A cost-effectiveness analysis from the healthcare provider's perspective was performed to assess the cost per additional patient achieving undetected viral load through the proposed intervention. The cost-effectiveness of the incentive scheme over routine care was estimated using the incremental cost-effectiveness ratio (ICER), expressed as cost/patient who achieved an undetectable viral load. We performed a univariate sensitivity analysis to examine the effect of key parameters on the ICER. An in-depth interview was conducted on the healthcare personnel in the intervention arm to explore the feasibility of implementing the service delivery intervention in HIV treatment hospitals in Nigeria. RESULT: The ICER of the Incentive Scheme intervention compared to routine care was US$1419 per additional patient with undetectable viral load. Going by the cost-effectiveness threshold of US$1137 per quality-adjusted life-years suggested by Woods et al., 2016, the intervention was not cost-effective. The sensitivity test showed that the intervention will be cost-effective if the frequency of CD4 count and viral load tests are reduced from quarterly to triannually. Healthcare professionals reported that patients' acceptance of the intervention was very high. CONCLUSION: The conditional economic incentives and motivational interviewing was not cost-effective, but can become cost-effective if the frequency of HIV quality of life indicator tests are performed 1-3 times per annum. Patients' acceptance of the intervention was very high. However, healthcare professionals believed that sustaining the intervention may be difficult unless factors such as government commitment and healthcare provider diligence are duly addressed. TRIAL REGISTRATION: This trial is registered in the WHO International Clinical Trials Registry through the WHO International Registry Network ( PACTR201806003040425 ).


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Entrevista Motivacional , Adolescente , Fármacos Anti-HIV/uso terapêutico , Análise Custo-Benefício , Estudos de Viabilidade , Infecções por HIV/tratamento farmacológico , Humanos , Motivação , Nigéria , Avaliação de Resultados em Cuidados de Saúde , Qualidade de Vida
10.
Nutrients ; 13(6)2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34208363

RESUMO

The role of post-therapeutic support after weight loss in obesity treatment is not fully understood. Therefore, weight maintenance after a successful weight loss intervention is not very common, especially in obese individuals. This randomized controlled study was conducted to explore the efficacy of following dietary and psychological support in a group of 36 obese individuals. Participants (22 women, 14 men aged 35.58 ± 9.85 years, BMI 35.04 ± 3.80 kg/m2) who completed a 12-month weight loss phase (balanced energy-restricted diet) were randomly allocated to receive 18-month support (SG) or no additional care (CG). The support phase included some elements of Ten Top Tips (TTT), cognitive behavioral therapy (CBT), motivational interviewing (MI) in combination with nutritional education and assessment of the level of physical activity. The primary outcome was the maintenance of anthropometric parameters at an 18-month follow-up. The secondary outcomes included evaluation of biochemical parameters and single nucleotide polymorphisms (SNPs) in genes connected with obesity. A comparison of SG vs. CG after a 30-month period of the study revealed significant differences in weight changes (-3.83 ± 6.09 vs. 2.48 ± 6.24 kg), Body Mass Index (-1.27 ± 2.02 vs. 0.72 ± 2.12 kg/m2), visceral adipose tissue (-0.58 ± 0.63 vs. 0.45 ± 0.74 L), and waist circumference (-4.83 ± 4.05 vs. 1.83 ± 5.97 cm). Analysis of SNPs (rs9939609 FTO, rs987237 TFAP2B, and rs894160 PLIN1) provided further insight into the potential modulating effect of certain genotypes on weight loss and maintenance and extended the knowledge of the potential benefits of personalized medicine. Post-therapeutical support in current clinical practice may increase the chances of long-term weight loss maintenance in obesity treatment even in patients with a genetic predisposition to excessive weight.


Assuntos
Manutenção do Peso Corporal , Aconselhamento , Nutricionistas , Obesidade/terapia , Perda de Peso , Programas de Redução de Peso , Adulto , Dioxigenase FTO Dependente de alfa-Cetoglutarato/genética , Composição Corporal , Terapia Cognitivo-Comportamental , Exercício Físico , Feminino , Humanos , Masculino , Entrevista Motivacional , Perilipina-1/genética , Polimorfismo de Nucleotídeo Único , Fator de Transcrição AP-2/genética
11.
J Med Internet Res ; 23(6): e27853, 2021 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-34152280

RESUMO

BACKGROUND: Facebook can be a suitable platform for public health interventions. Facebook users can express their reaction to the given social media content in many ways using interaction buttons. The analysis of these interactions can be advantageous in increasing reach and engagement of public health interventions. OBJECTIVE: This research aimed at understanding how Facebook users' interactions correlate with organic reach and engagement regarding the same smoking cessation support contents. METHODS: The study population consisted of Facebook users who were reached by a public smoking cessation support page without advertising. We included 1025 nonpaid Facebook posts (N=1025) which used smoking cessation strategies based on a motivational interviewing counseling style. The following data were collected from the "Post Details": the number of people who saw the given nonpaid content (organic reach) which consisted of fan and nonfan reach according to previous "page like" activity; each rate of "engagement indicators" (such as the symbols of "like," "love," "haha," "wow," "sad," "angry"; or other interactions: "shares," "comments," "clicks"); and the rate of negative Facebook interactions (eg, "post hides" or "unlike of page"). Overall, these data were analyzed with the Spearman correlation method. RESULTS: Surprisingly, we found a significant negative correlation between organic reach and the "like" reaction (rs=-0.418; P<.001). The strongest significant positive correlations of organic reach were observed with the "haha" reaction (rs=0.396; P<.001), comments (rs=0.368; P<.001), and the "love" reaction (rs=0.264; P<.001). Furthermore, nonfan reach correlated positively with "shares" (rs=0.388; P<.001) and clicks (rs=0.135; P<.001), while fan reach correlated positively with the "haha" reaction (rs=0.457; P<.001), comments (rs=0.393; P<.001), and the "love" reaction (rs=0.310; P<.001). Contrary to expectations, the "like" reaction was sharply separated by significant negative correlations from "wow" (rs=-0.077; P=.013), "sad" (rs=-0.120; P<.001), "angry" reactions (rs=-0.136; P<.001), and comments (rs=-0.130; P<.001). Additionally, a high rate of negative Facebook interactions was significantly associated with "wow" (rs=0.076; P=.016) and "sad" reactions (rs=0.091; P=.003). CONCLUSIONS: This study has shown that it is possible to hypothesize a disadvantage of the "like" reaction and advantages of other interactions (eg, the "haha" reaction or "comments") in content algorithmic ranking on Facebook. In addition, the correlational analysis revealed a need of a further categorization to fan-specific interactions (eg, "haha" or "love" reactions) and nonfan-specific interactions (eg, "shares" and "clicks"). Regarding the direction of the correlations, these findings suggest that some interactions (eg, negative Facebook interactions, "wow," "sad," and "angry" reactions) may decrease the engagement, while other interactions ("like," "love," "haha" reactions, "shares," and "clicks") may increase the engagement during Facebook-based smoking cessation interventions. This hypothesis-generating research offers an important insight into the relationship between organic reach, engagement, and Facebook users' interactions for public health professionals who design Facebook-based interventions.


Assuntos
Entrevista Motivacional , Abandono do Hábito de Fumar , Mídias Sociais , Terapia Comportamental , Aconselhamento , Humanos
12.
Scand J Psychol ; 62(5): 709-716, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34159598

RESUMO

To explore how quality aspects and clients' verbal behaviors in Motivational Interviewing sessions correspond with counsellors' support of basic psychological needs described in Self-determination Theory, we conducted a mixed method study with quantitative analyses of transformed qualitative data from counselling sessions. Coding manuals identified if the counselling was consistent with Motivational Interviewing and the support of basic psychological needs. The study supported a conceptual relationship between motivational interviewing (MI) and self-determination theory (SDT), except for autonomy support which was conceptualized differently in the two approaches. Relational support in SDT and MI were closely linked to each other and were also strongly related to other MI-congruent and promotive counselors' verbal behavior. Client amotivation in SDT and change talk in MI were negatively correlated, and clients' autonomous motivation in SDT was related to change talk in MI. Counselors emphasized relational support, using decisional balance comprehensively, but offered competence support less often. The counseling was, however, sensitive to the clients' motivational regulation of behavior change.


Assuntos
Entrevista Motivacional , Aconselhamento , Atenção à Saúde , Comportamentos Relacionados com a Saúde , Humanos , Motivação , Autonomia Pessoal
13.
Obes Rev ; 22(10): e13308, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34170612

RESUMO

Currently, the effects of motivational interviewing (MI) on children's anthropometric changes remain unclear. This systematic review and meta-analysis examined the effects of MI on children's anthropometric changes (body mass index [BMI], waist circumference [WC], and body fat percentage [BF%]). We also assessed potential moderators of MI on children's BMI changes. This systematic review searched five databases (CINAHL, Cochrane, PsycINFO, PubMed, and Web of Sciences) from 2005 to 2020 to evaluate the effects of MI interventions that had a comparison group on children's anthropometric change as outcomes (BMI, WC, or BF%). Thirty-three articles met the inclusion criteria. We performed random-effects models and exploratory moderation analyses with mixed-effects models. The pooled effect size of MI was -0.18 (p = 0.002) on BMI, -0.65 (p < 0.001) on WC, and -0.44 (p = 0.005) on children's BF%. The relationship between MI and BMI changes was significantly moderated by the types of intervener (Q = 9.71, p = 0.021) and the existence of supplemental intervention activities (Q = 9.21, p = 0.002). Other potential moderators included children's age, weight status, intervention setting, and targeted behaviors (eating and/or physical activity). Our findings support the effectiveness of MI interventions on improving children's anthropometric outcomes (i.e., BMI, WC, and BF%).


Assuntos
Entrevista Motivacional , Antropometria , Índice de Massa Corporal , Criança , Exercício Físico , Humanos , Circunferência da Cintura
14.
J Subst Abuse Treat ; 129: 108345, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34080540

RESUMO

PURPOSE: We examine in-session self-exploration among Latinx heavy drinkers who received a motivational interview (MI) to reduce heavy drinking. The goals of this study are to report the validity and reliability of an adaptation of the Global Client Rating for Self-Exploration from the Motivational Interviewing Skill Code (MISC SE). METHOD: The study measured the MISC SE as three subscales (Emotional, Cognitive, New Learning/Developing Discrepancy SE) to assess underlying processes that might allow for higher predictive validity in relation to behavioral change (drinking) outcomes. The study created a dichotomous variable, Personally Relevant Vulnerable Making (PR-VM), to distinguish the disclosure of particularly sensitive material related to drinking behavior. The study used the measure of Everyday Discrimination as a criterion variable for the PR-VM measure. The study collected observationally rated data for n = 158 participants. RESULTS: Subscales showed moderate correlations with the MISC SE (r = 0.421 to 0.574, p < .001). The MISC SE was not associated with number of drinking days or percent heavy drinking days at 3-month follow-up. Cognitive and New Learning/Developing Discrepancy SE were associated with fewer drinking days (r = -0.247 to -0.266, p < .005), and Cognitive SE was associated with percent heavy drinking days (r = -0.169, p < .05), Subscale interrater reliability was comparable to the MISC SE (ICC = 0.72 to 0.86). The study observed higher mean scores on the Everyday Discrimination scale when session PR-VM was present than when not present (t (df = 118) = -3.02, p < .005). CONCLUSIONS: The subscale adaptation of the SE measure may provide a sensitive approach to understanding how self-exploration relates to behavior change in the context of MI.


Assuntos
Entrevista Motivacional , Humanos , Psicometria , Reprodutibilidade dos Testes
15.
Int J Clin Pract ; 75(11): e14457, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34105858

RESUMO

BACKGROUND: Cardiovascular disease (CVD) is prevalent worldwide, and for many patients, non-adherence to medication remains a problem. Motivational interviewing is a behavioural, communication strategy used as an intervention aimed to improve health outcomes. AIMS: This systematic review sought to investigate the effect of motivational interviewing delivered as part of pharmacy care on medication adherence, and the effect this has on clinical outcomes. These included systolic and diastolic blood pressure, haemoglobin A1C, lipid profiles and cardiovascular risk scores. METHOD: A systematic review was conducted in six databases: PubMed Central UK, Cochrane Library, CINAHL (EBSCO), PsycINFO, EMBASE and MEDLINE from the inception of motivational interviewing in 1983 to November 2020. Randomised controlled trials (RCTs) that assessed motivational interviewing as part of pharmacy care interventions were selected. The Cochrane risk of bias tool was used to assess the risk of bias for each included study. This review was registered with PROSPERO (registration number CRD42020222954). RESULTS: A total of eight RCTs met the inclusion criteria. Five out of eight studies demonstrated medication adherence significantly improved following motivational interviewing interventions. One study showed a significant improvement for systolic blood pressure change by 7.2 mmHg (95% CI 1.6-12.8 mmHg); this reduction was observed in patients whose baseline blood pressure was above their target blood pressure. No statistically significant effect was seen across other clinical outcomes. CONCLUSION: Motivational interviewing could be an effective behavioural strategy to enhance medication adherence in patients with CVD. Although the evidence is promising thus far, further research is required to explore the impact of motivational interviewing on clinical outcomes as well as the feasibility of implementing motivational interviewing interventions within existing pharmacy care services.


Assuntos
Doenças Cardiovasculares , Entrevista Motivacional , Farmácia , Pressão Sanguínea , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/prevenção & controle , Humanos , Adesão à Medicação
16.
BMJ Open ; 11(6): e047970, 2021 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-34108169

RESUMO

INTRODUCTION: Community-dwelling people recovering from hip fracture have the physical capacity to walk in their community but lack the confidence to do so. The primary aim of this trial is to determine whether motivational interviewing increases time spent walking at 12 months in community-dwelling people after hip fracture compared with an attention placebo control group. Secondary aims are to evaluate cost effectiveness, patient and health service outcomes and to complete a process evaluation. METHODS AND ANALYSIS: An assessor-blinded parallel group randomised controlled design with embedded health economic evaluation and process evaluation will compare the effects of n=270 participants randomly allocated to an experimental group (motivational interviewing) or a control group (dietary advice). For inclusion, participants are aged ≥65 years, living at home independently within 6 months of discharge from hospital after hip fracture and able to walk independently and communicate with conversational English. Key exclusion criteria are severe depression or anxiety, impaired intellectual functioning and being medically unstable to walk. Participants allocated to the experimental group will receive 10 (8 weekly and 2 booster) telephone-based sessions of motivational interviewing to increase walking over 16 weeks. Participants allocated to the control group will receive an equivalent dose of telephone-based dietary advice. The primary outcome is daily time spent walking over 7 days assessed at weeks 0, 9, 26 and 52. Secondary outcomes include measures of psychological-related function, mobility-related function, community participation, health-related quality of life and falls. Health service utilisation and associated costs will be assessed. Process evaluation will assess the fidelity of the motivational interviewing intervention and explore contextual factors through semistructured interviews. ETHICS AND DISSEMINATION: Ethical approval obtained from Eastern Health (E19-002), Peninsula Health (50261/EH-2019), Alfred Health (617/20) and La Trobe University (E19/002/50261). The findings will be disseminated in peer-reviewed journals, conference presentations and public seminars. TRIAL REGISTRATION NUMBER: ACTRN12619000936123.


Assuntos
Fraturas do Quadril , Entrevista Motivacional , Acidentes por Quedas , Idoso , Humanos , Vida Independente , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Afr J Reprod Health ; 25(1): 138-160, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34077120

RESUMO

This study aimed at understanding how, when, and under what circumstances interventions succeed (or fail) to improve male involvement in maternal and child healthcare in Uganda. A realist synthesis approach was used to unpack the complexity of these health interventions to explain their theories and applications in specific circumstances. Our review of 19 studies revealed that men were specifically approached as clients, partners or agents for behavioural change. Broadly, mechanisms of education, training, restriction, environmental restructuring, modeling, enablement, persuasion, incentivization and coercion were used to involve men in maternal and child healthcare. Education, training, modeling, enablement and environmental restructuring mechanisms were more effective in 'cultivating' a sustained will of men to get involved as couples. However, unintended outcomes were inevitable in circumstances where mechanisms did not match specific contexts. Using coercion, restriction or incentivization is more likely to result in short-term and negative outcomes because of context heterogeneities.


Assuntos
Saúde da Criança , Pai/psicologia , Saúde Materna , Apoio Social , Adulto , Criança , Família , Feminino , Humanos , Masculino , Modelos Teóricos , Entrevista Motivacional , Uganda
18.
BMC Public Health ; 21(1): 1048, 2021 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078342

RESUMO

BACKGROUND: The importance of physical activity on health is clear, but changing behaviour is difficult. Successful interventions aiming to improve physical activity and reduce sedentary behaviour is therefore of importance. The aim of this study was to evaluate effects on motivation, self-efficacy and barriers to change behaviour from two different behavioural intervention focusing either on reducing sedentary behaviour or on increasing physical activity as compared to a waiting list control group. METHODS: The study was designed as a cluster randomized control trial (RCT) within two private companies. Self-efficacy, motivation and perceived barriers were together with demographic variables assessed before and after a 6-month intervention. Participant cluster teams were randomly allocated to either the physical activity intervention (iPA), the sedentary behaviour intervention (iSED), or control group. The intervention was multi componential and included motivational counselling based on Cognitive behaviour therapy and Motivational interviewing, group activities and management involvement. Group differences were determined using Bayesian multilevel modelling (parameter estimate; credible interval (CI)), analysing complete cases and those who adhered to the protocol by adhering to at least 3 out of 5 intervention sessions. RESULTS: After the intervention, the complete cases analysis showed that the iPA group had significantly higher autonomous motivation (0.33, CI: 0.05-0.61) and controlled motivation (0.27, CI: 0.04-0.51) for physical activity compared with the control group. The iSED group scored less autonomous and controlled motivation compared to the iPA group (0.38, CI: - 0.69- -0.087 respectively - 0.32, CI: - 0.57-0.07) but no significant differences compared with the control group. Among individuals that adhered to the protocol, the results showed higher scores on Exercise (3.03, CI: 0.28-6.02) and Sedentary self-efficacy (3.59, CI: 0.35-7.15) for individuals in the iPA group and on Sedentary self-efficacy (4.77, CI: 0.59-9.44) for the iSED group compared to the control group. CONCLUSION: These findings indicate that the interventions were successful in increasing self-efficacy in each intervention group and autonomous motivation for exercise in the iPA group, in particular when actively participating in the motivational counselling sessions.


Assuntos
Entrevista Motivacional , Comportamento Sedentário , Exercício Físico , Humanos , Motivação , Autoeficácia
19.
J Addict Nurs ; 32(2): 95-106, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34060760

RESUMO

PURPOSE/BACKGROUND/SIGNIFICANCE: The purpose of this feasibility study was to make system level change using motivational interviewing (MI), tailored discharge education, and electronic medical record (EMR) flow sheet intervention in patients with alcohol use disorder (AUD). Alcohol is known to be one of the most commonly misused addictive substances. METHODS: It is a feasibility study with a descriptive exploratory design of an intervention with MI, tailored discharge education, and EMR flow sheet documentation. Participants were patients with AUD chosen over 3 months from two medical surgical floors. Instruments used were the readiness and confidence rulers (reliability/validity = .84 and .77, respectively). Analysis included descriptive statistics, estimation of effect size, and hypothesis generation. RESULTS: Of 14 participants, EMR flow sheet documentation was completed and the mean post readiness and confidence scores were 8.86 (1.167) and 8.07 (1.639), respectively. CONCLUSION: The pre/post confidence scores were statistically significant (p = .095) using the .10 significance level, indicating the intervention was effective in raising the confidence level for behavior change. High scores indicated patients were in contemplation and intending to change. Seven scores increased postintervention suggesting a future hypothesis that MI, tailored education, and EMR flow sheet documentation intervention is feasible for patients with AUD contemplating change in the near future.


Assuntos
Alcoolismo , Entrevista Motivacional , Estudos de Viabilidade , Hospitais , Humanos , Reprodutibilidade dos Testes
20.
J Addict Nurs ; 32(2): 141-151, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34060766

RESUMO

ABSTRACT: Prescription opioid use disorder in the United States has increased to epidemic proportions and poses a challenging problem to health care providers. Motivational interviewing (MI) is a patient-centered counseling style that can effectively reduce substance abuse, but MI training has not been well incorporated into advanced practice nursing curricula. Standardized patient (SP) simulation is an educational tool that is growing in popularity because of its success in improving nursing skills. Medical students and residents who underwent a formalized MI training with an SP simulation showed positive results. This study aimed to determine whether an MI training with an SP simulation improved NP students' knowledge, confidence, and skills in MI. A one-group pretest-posttest repeated measures design was used. Quantitative data were analyzed using descriptive statistics and repeated measures analysis of variance, and qualitative data were analyzed using content analysis. Results indicated that the MI training showed a significant impact on students' confidence in MI and promising impacts on students' MI knowledge and skills. Students valued the training, favoring the SP component, and plan to use MI in future practice. An MI training can be effectively incorporated into an advanced practice nursing program and would better prepare students to address prescription opioid use disorder and effectively encourage behavior change among their patients.


Assuntos
Prática Avançada de Enfermagem , Entrevista Motivacional , Transtornos Relacionados ao Uso de Opioides , Estudantes de Medicina , Competência Clínica , Humanos , Prescrições
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