Abstract
BackgroundClinical research investigating effective intervention strategies for adolescents to improve health behaviors has shifted to the application of motivational interviewing (MI). Evidence indicates that MI is an effective intervention for improving health behaviors as related to diet, exercise, and diabetes among adolescents. However, there is a lack of understanding about the mechanisms through which MI works and the contextual factors impacting MI effectiveness. The purpose of this review was to understand how, for whom, and under what circumstances MI works for adolescent health behavior change, which will inform future implementation of this intervention. To provide this in-depth understanding, a realist-informed systematic review was conducted in order to synthesize the evidence on the use of MI for health behaviors. Self-determination theory (SDT) was chosen as the candidate theory for testing in the present review.MethodsDatabases including PsycINFO, Healthstar, Cochrane, and PubMed were searched for articles published until March 2017. The search strategy included studies that examined or reviewed the effectiveness or efficacy of MI to change health behaviors among adolescent populations. The search identified 185 abstracts, of which 28 were included in the review. The literature was synthesized qualitatively (immersion/crystallization) and tested SDT as the candidate theory.ResultsBased on SDT, three mechanisms were found within reviewed studies, including competence, relatedness, and autonomy. The following contexts were found to impact mechanisms: school setting, clinician MI proficiency, parental involvement, and peer involvement.ConclusionsThis realist-informed systematic review provides advances in understanding the mechanisms involved in MI for adolescent health behavior change. Additionally, it provides important practical information as to which contexts create the conditions for these mechanisms to occur, leading to health behavior change. The results can inform future MI interventions for adolescent health behavior change. Future research should continue to test this realist theory and also examine mechanism variables not extensively documented in order to improve our understanding of MI in this population.
Highlights
Clinical research investigating effective intervention strategies for adolescents to improve health behaviors has shifted to the application of motivational interviewing (MI)
Black and colleagues [61] reported that there were no changes in daily activity counts for the group of adolescents, those who were overweight or obese at the start reported increases in daily activity counts, compared to those who were in the normal range for weight
It should be noted that future syntheses might choose to focus on different contexts and mechanisms within MI or to use a comparison theory in order to build additional CMO configurations. This original review is the first to provide critical information on the processes and contextual variables that impact the efficacy of MI for adolescent health behaviors
Summary
Clinical research investigating effective intervention strategies for adolescents to improve health behaviors has shifted to the application of motivational interviewing (MI). Two recent reviews have indicated that MI is effective for the treatment of adolescent health behaviors [17, 18], but a gap remains as to how, why, and in what contexts MI works for adolescents, since the processes of change are somewhat unclear [19] This understanding will provide invaluable information on future implementation of MI in this population. To provide this in-depth understanding, a realist-informed systematic review was conducted to synthesize the evidence on the use of MI for health behaviors, nutrition, eating habits, sedentary behaviors, and exercise in adolescents
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