Search

The aim of this study was to assess the fidelity of a motivational interviewing (MI) intervention with caregivers of young children in primary healthcare in Southern Brazil. Seven trained interventionists conducted one MI session with each caregiver at their home. The sessions were audio-recorded and a randomly selected subset (n = 109) was coded by a single reviewer using the Motivational Interviewing Treatment Integrity 3.1.1. criteria (MITI 3.1.1.). This instrument establishes parameters of MI proficiency for beginners and experts measuring the global ratings of five MI principles (evocation, collaboration, autonomy/support, direction and empathy), the global MI spirit score, and the behavior counts of MI basic skills: to inform, to ask, and to listen. The mean global MI spirit rating was 4.0 (95%CI 3.9-4.1). Mean MI principle scores ranged from 3.8 (95%CI 3.7-3.9) to 4.3 (95%CI 4.2-4.4). The overall reflection-to-question ratio was 0.9 (95 CI 0.8-1.0), % open questions was 76.3 (95%CI 73.1-79.6), % complex reflections was 66.1 (95%CI 63.1-69.1), and % MI-adherent information was 94.1 (95%CI 93.5-94.5). Interventionists with higher scores conducted more and longer sessions than those with lower scores (p = 0.012). Those with beginner proficiency had a higher proportion of caregivers changing their oral health knowledge (p = 0.005). In conclusion, a good degree of MI fidelity was found, with higher fidelity among interventionists who conducted more interviews and spent more time talking with caregivers.

BACKGROUND: With the rise of computer science and artificial intelligence, analyzing large data sets promises enormous potential in gaining insights for developing and improving evidence-based health interventions. One such intervention is the counseling strategy motivational interviewing (MI), which has been found effective in improving a wide range of health-related behaviors. Despite the simplicity of its principles, MI can be a challenging skill to learn and requires expertise to apply effectively. OBJECTIVE: This study aims to investigate the performance of artificial intelligence models in classifying MI behavior and explore the feasibility of using these models in online helplines for mental health as an automated support tool for counselors in clinical practice. METHODS: We used a coded data set of 253 MI counseling chat sessions from the 113 Suicide Prevention helpline. With 23,982 messages coded with the MI Sequential Code for Observing Process Exchanges codebook, we trained and evaluated 4 machine learning models and 1 deep learning model to classify client- and counselor MI behavior based on language use. RESULTS: The deep learning model BERTje outperformed all machine learning models, accurately predicting counselor behavior (accuracy=0.72, area under the curve [AUC]=0.95, Cohen κ=0.69). It differentiated MI congruent and incongruent counselor behavior (AUC=0.92, κ=0.65) and evocative and nonevocative language (AUC=0.92, κ=0.66). For client behavior, the model achieved an accuracy of 0.70 (AUC=0.89, κ=0.55). The model's interpretable predictions discerned client change talk and sustain talk, counselor affirmations, and reflection types, facilitating valuable counselor feedback. CONCLUSIONS: The results of this study demonstrate that artificial intelligence techniques can accurately classify MI behavior, indicating their potential as a valuable tool for enhancing MI proficiency in online helplines for mental health. Provided that the data set size is sufficiently large with enough training samples for each behavioral code, these methods can be trained and applied to other domains and languages, offering a scalable and cost-effective way to evaluate MI adherence, accelerate behavioral coding, and provide therapists with personalized, quick, and objective feedback.

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.

PURPOSE: Anxiety, depression, poor sleep quality and lower quality of life (QOL) are associated with worse outcomes in heart failure (HF) patients. Motivational interview (MI) has been effective in different patient populations to promote self-care. However, its effect on anxiety, depression, sleep quality and QOL in HF patients is unknown. The aim of this study was to evaluate the effect of MI on anxiety, depression, sleep quality and QOL over 12 months from the intervention. METHODS: This was a planned, secondary outcome analysis of the MOTIVATE-HF study, a three-arm randomized controlled trial (1:1:1) evaluating the effect of MI in improving self-care in HF patients. In Arm 1, the patient received MI, while in Arm 2, the patient and the caregiver received MI. Arm 3, the control group, received standard treatment. Endpoints were evaluated with the Hospital Anxiety and Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI), the 12-Item Short-Form Health Survey (SF-12) and the Kansas City Cardiomyopathy Questionnaire (KCCQ) every three months for one year. RESULTS: We enrolled and randomized 510 HF patient and caregiver dyads (155 dyads in Arm 1, 177 dyads in Arm 2, and 178 dyads in Arm 3). A total of 238 HF patients and 235 caregivers completed the 12-month trial. No significant changes were seen in anxiety, depression and sleep quality over time among the three study arms, but disease-specific QOL improved in the intervention groups, especially in Arm 2. CONCLUSION: Clinicians may want to include both patients and caregivers when providing MI interventions. Further research is needed to investigate the required intensity of MI to be effective on sleep quality, anxiety and depression (ClinicalTrials.gov Identifier: NCT02894502).

Following a successful proof-of-concept, the next step is a fully randomized pilot study of TMI relative to a control condition in preparation for a stepped-wedge cluster randomized full scale trial. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

IMPORTANCE: Intimate partner violence (IPV) and heavy drinking are co-occurring public health problems, but integrated brief interventions for these conditions have not been tested. OBJECTIVE: To determine whether a brief motivational intervention provided at the time of an emergency department (ED) visit reduces IPV and heavy drinking. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial conducted at 2 US academic urban EDs between January 2011 and December 2014 to assess the effectiveness of a motivational intervention for IPV-involved female ED patients (ages: 18-64 years; N = 600) who exceeded sex-specific safe drinking limits. All received social service referrals; 2:2:1 to brief intervention (n = 242), assessed control (n = 237), or no-contact control (n = 121). INTERVENTIONS: A 20- to 30-minute manual-guided motivational intervention (recorded and monitored for fidelity) delivered by master's-level therapists with a follow-up telephone booster. The assessed control group received the same number of assessments as the brief intervention group; the no-contact control group was assessed only once at 3 months. MAIN OUTCOMES AND MEASURES: Incidents of heavy drinking and experiencing IPV measured over prespecified, 12 weekly assessments using an interactive voice response system. RESULTS: Of 600 participants, 80% were black women with a mean age of 32 years. Retention was 89% for 2 or more interactive voice response system calls. Seventy-eight percent of women completed the 3-month interview, 79% at 6 months, and 71% at 12 months. During the 12-week period following the brief motivational intervention, there were no significant differences between the intervention group and the assessed control group on weekly assessments for experiencing IPV (odds ratio [OR], 1.02; 95% CI, 0.98-1.06) or heavy drinking (OR, 0.99; 95% CI, 0.96-1.03). From baseline to 12 weeks, the number of women with any IPV in the past week decreased from 57% (134 of 237) in the intervention group to 43% (83 of 194) and from 63% (145 of 231) in the assessed control group to 41% (77 of 187) (absolute difference of 8%). From baseline to 12 weeks, the number of women with past week heavy drinking decreased from 51% (120 of 236) in the intervention group to 43% (83 of 194) and from 46% (107 of 231) in the assessed control group to 41% (77 of 187) (absolute difference of 3%). At 12 months, 43% (71 of 165) of the intervention group and 47% (78 of 165) of the assessed control group reported no IPV during the previous 3 months and 19% (29 of 152) of the intervention group and 24% (37 of 153) of the control group had reduced their alcohol consumption to sex-specific National Institute on Alcohol Abuse and Alcoholism safe drinking levels. CONCLUSIONS AND RELEVANCE: For women experiencing IPV and heavy drinking, the use of a brief motivational intervention in the ED compared with assessed and no-contact controls did not significantly reduce the days of heavy drinking or incidents of IPV. These findings do not support a brief motivational intervention in this setting. TRIAL REGISTRATION: clinicaltrials.gov Identifer: NCT01207258.

BACKGROUND: Although the mental and physical benefits of physical activity are well-established, there is a racial/ethnic disparity in activity such that minorities are much less likely to engage in physical activity than are White individuals. Research suggests that a lack of motivation may be an important barrier to physical activity for racial/ethnic minorities. Therefore, interventions that increase participants' motivation may be especially useful in promoting physical activity within these groups. Physical activity interventions that utilized the clinical technique of motivational interviewing (MI) in conjunction with the theoretical background of self-determination theory (SDT) have been effective in increasing White individuals' physical activity. Nevertheless, it remains unclear the extent to which these results apply to minority populations. METHODS/DESIGN: The current study involves conducting a 12-week physical activity intervention based on SDT and MI to promote physical activity in a racially/ethnically-diverse sample. It is hypothesized that this intervention will successfully increase physical activity in participants. Specifically, it is expected that minorities will experience a greater relative increase in physical activity than Whites within the intervention group because minorities are expected to have lower baseline levels of activity. DISCUSSION: Results from this study will give us a greater understanding of the generalizability of SDT interventions designed to improve motivation for physical activity and level of physical activity. TRIAL REGISTRATION: Clinical Trials Gov. Identifier NCT02250950 Registered 24 September 2014.

INTRODUCTION: Systematic assessments of Motivational Interviewing (MI) in smoking behavior have been rare to date. This study aimed to determine whether an integrated approach, involving staff training in MI techniques, was sufficient to affect change in smoking status or intensity in low-income pregnant and postpartum women. METHODS: Overall, 500 consecutive smokers were recruited at first prenatal visit to public antenatal clinics. Following staff training, 500 more were recruited (intervention group). Data were recorded at 28-32 weeks gestation, after birth, at 3-4 and 7-9 months postpartum. The primary outcome measure was self-reported continued abstinence from smoking verified by urinary cotinine analysis. Changes in smoking intensity were also measured. RESULTS: There was no significant difference in the proportion of smokers in the intervention and control groups who reported stopping smoking at 28-32 weeks gestation (8.2% vs. 8.8%; p = .73), 1 week after birth (8.6% vs. 11.4%; p = .14), 3-4 months after birth (5.8% vs. 4.8%; p = .48), or 7-9 months after birth (5.2% vs. 4.0%; p = .36). Although more cases were nonsmoking at the second visit, 14.8% [95% CI = 11.8-18.5] vs. 13.1% controls [95% CI = 10.3-16.6], this was not statistically significant. CONCLUSIONS: MI delivered at a number of time points during pregnancy and up to 9 months postpartum failed to affect quit rates. It may have had a small effect in preventing relapse among spontaneous quitters in late pregnancy though the validity of this remains uncertain.

Motivational Interviewing (MI) is an evidence-based approach that provides probation and parole officers with specific skills to enhance their clients' motivations to change problematic behaviors. This study investigated the outcomes of MI training with probation and parole officers whose state agency required them to complete MI training. Results show that officers' MI skills, self-efficacy, and knowledge increased following training, with some exceptions. Recommendations from implementation science literature are provided for improving MI trainings.