Motivational Counseling Session Research Articles

Sustained Long-Term Efficacy of Motivational Counseling and Text Message Reminders on Daily Sitting Time in Patients With Rheumatoid Arthritis: Long-Term Follow-up of a Randomized, Parallel-Group Trial.

To evaluate the 18-month postintervention efficacy following a 4-month individually tailored behavioral intervention on daily sitting time in patients with rheumatoid arthritis (RA). In an observer-blinded randomized trial, 150 RA patients were included. During 4 months, the intervention group (n = 75) received 3 motivational counseling sessions and tailored text messages aimed at increasing light-intensity physical activity through reduction of sedentary behavior. The control group (n = 75) maintained their usual lifestyle. The primary outcome was change from baseline to 18 months postintervention in objectively measured daily sitting time (using ActivPAL). Secondary outcomes included changes in clinical patient-reported outcomes and cardiometabolic biomarkers. A mixed-effect repeated measures analysis of covariance model in the intent-to-treat population was applied. At 22 months follow-up from baseline, 12 participants were lost to follow-up. Compared to baseline, sitting time in the intervention group decreased 1.10 hours/day, whereas it increased by 1.32 hours/day in the control group, a between-group difference of -2.43 hours/day (95% confidence interval [95% CI] -2.99, -1.86; P < 0.0001) favoring the intervention group. For most secondary outcomes, between-group differences favored the intervention: visual analog scale (VAS) pain -15.51 mm (95% CI -23.42, -7.60), VAS fatigue -12.30 mm (95% CI -20.71, -3.88), physical function -0.39 Health Assessment Questionnaire units (95% CI -0.53, -0.26), total cholesterol -0.86 mmoles/liter (95% CI -1.03, -0.68), triglycerides -0.26 mmoles/liter (95% CI -0.43, -0.09), and average glucose -1.15 mmoles/liter (95% CI -1.39, -0.91). The 4-month postintervention results showed that patients in the intervention reduced their daily sitting time and improved patient-reported outcomes and total cholesterol levels compared to the control group. Eighteen months after intervention, patients in the intervention group were still significantly less sedentary than controls. Findings suggest that a behavioral approach is beneficial for promoting long-term physical activity and health in patients with RA.

Pregnancy, exercise and nutrition research study with smart phone app support (Pears): Study protocol of a randomized controlled trial

ObjectiveMaternal adiposity confers an increased risk of GDM in pregnancy. A low glycemic index (GI) dietary intervention has been found to improve glucose homeostasis and reduce gestational weight gain. Mobile Health (mHealth) Technology-assisted interventions are becoming commonplace as an aid to treating many chronic diseases. The aim of this study is to assess the impact of a ‘healthy lifestyle package’ with mHealth smart phone technology as support compared with usual care on the incidence of GDM in an overweight and obese pregnant population. MethodsWe propose a randomized controlled trial of an mHealth assisted healthy lifestyle intervention package versus standard obstetric care in pregnant women with a BMI ≥25kg/m2–39.9kg/m2. Patients are randomized to control or intervention group in a 1:1 ratio. The intervention arm healthy lifestyle package includes a motivational counseling session to encourage behavior change, involving targeted, low GI nutritional advice and daily physical activity prescription delivered before 18weeks gestation, as well as a smart phone app to provide ongoing healthy lifestyle advice and support throughout pregnancy. The primary outcome is the incidence of GDM at 29weeks' gestation and power analysis indicates that 253 women are required in each group to detect a difference. ConclusionThis will be the first clinical trial to evaluate the effectiveness of a smart phone technology-assisted targeted healthy lifestyle intervention, which is grounded in behavior change theories and techniques, to support antenatal management of an overweight and obese pregnant population in preventing GDM.

“Weekend” as a symbolic sign in motivational counseling sessions in the probation service with substance abusers

This study explores the meanings that substance-abusing clients attach to weekend during motivational counseling sessions in Finnish Probation Service. By applying Peirce's semiotic theory of signs, this article studies “weekend” as a symbolic sign, and analyzes: (a) What kind of meanings the clients attach to it? (b) What does weekend mean to the clients' motivation to change? The analyses are based on videotaped and transcribed data consisting of 98 motivational counseling sessions. The results of the study display that the general meaning of weekend is constructed as an obstacle to change. Weekend stands for an excuse to drink, a need to drink, a desire to drink and incapability to change in the clients' talk. The results show that by applying the semiotic approach new and significant meaning constellations can be found in the client's change relevant talk during motivational counseling.

Exercise on prescription: a randomized study on the effect of counseling vs counseling and supervised exercise

The aim of this study was to compare short- (0-4 months) and long-term (0-10 months) effects of high-intensive Exercise on Prescription (EoP) intervention (counseling and supervised exercise) implemented in primary healthcare in a number of Danish counties with a low-intensive intervention (counseling) using maximal oxygen uptake (VO(2max)) as the primary outcome. The study was conducted as a randomized trial in 2005-2006 with a high and a low-intensive group. All the patients referred to the EoP scheme by their GP in the counties of Vejle and Ribe, Denmark, were eligible for the trial. The high-intensive EoP group received 4 months of group-based supervised training and attended five motivational counseling sessions. The low-intensive group only attended four motivational counseling sessions. Three hundred and twenty-seven patients entered the EoP scheme, and 52 (16%) volunteered for the randomized trial. No short- or long-term differences were found between the high and the low-intensive groups for VO(2max) (short-term 95% CI -1.1; 4.4 mL O(2)/(kg min), long-term 95% CI -1.6 to 2.1). The present study did not demonstrate any significant clinical outcome for the high-intensive EoP intervention as opposed to the low-intensive intervention.

CAN A HEALTH EDUCATOR IMPROVE PHYSICAL ACTIVITY WITH MOTIVATIONAL COUNSELING IN A CLINICAL SETTING?

Healthcare providers are challenged to motivate patients to become physically active during brief clinical consultations. In a randomized-control trial, we previously demonstrated that Motivational Counseling (MC) added to traditional cardiac rehabilitation significantly enhances physical activity and exercise. PURPOSE This investigation was conducted to determine the feasibility of applying research to practice by adding MC to daily practice within an established clinical setting. METHODS Brief MC sessions (wks 1, 2 & 7) conducted by a health educator were added to a 12-wk early outpatient cardiac rehabilitation program of exercise, education and medical support. One hundred and one patients (71% males) were assessed at baseline and 12 wks. Physical activity was quantified with the Lo-PAR; an interview-administered recall of the previous week's sleep and activity at work, in the home and during recreation. RESULTS Patients ranged in age from 33–91 (Mean=63, SD=13) years and had experienced a recent cardiac event (angina, myocardial infarction, angioplasty or bypass surgery). A dependent sample t-test indicated a significant mean difference between baseline and 12-wk physical activity scores (p < 0.05). The mean physical activity score changed from 228 (SD=21) to 267 (SD=37) MET-hrs/wk. The proportion of patients classified as very inactive (< 225 MET-hrs/wk) changed from 43% at baseline to 11% at 12 wks. Inactive-somewhat active patients (225–250 MET-hrs/wk) changed from 44% to 27%. Active patients (251–300 MET-hrs/wk) changed from 13% to 50%. None of the patients were very active (> 300 MET-hrs/wk) at baseline compared to 12% at 12 wks. The mean difference between scores for exercise alone was also significant from baseline to 12-wks (p < 0.05). The mean exercise scores changed from 3 (SD = 4) MET-hrs/wk to 18 (SD = 12) MET-hrs/wk. CONCLUSIONS It was concluded that it is feasible for a non-mental health specialist to successfully integrate MC into a clinical setting and significantly improve physical activity in the early phase of recovery from heart disease.

Reducing the Risk of Alcohol-Exposed Pregnancies: A Study of a Motivational Intervention in Community Settings

To test the feasibility and impact of a motivational intervention in reducing drinking and/or increasing effective contraception in women who are at risk for an alcohol-exposed pregnancy. A multisite single-arm pilot study was conducted in 6 community settings in 3 large cities. A total of 2384 women were screened for eligibility; 230 were eligible on the basis of their alcohol use and lack of contraception. Of the eligible women, 190 consented and were enrolled, and 143 (75.3%) completed the 6-month follow-up. The intervention consisted of 4 manual-guided motivational counseling sessions delivered by mental health clinicians and 1 contraceptive counseling session delivered by a family planning clinician. Outcome measures include intervention completion rates, alcohol use (frequency, quantity, and bingeing), contraceptive use and effectiveness, and risk for alcohol-exposed pregnancy. Among women who completed the 6-month follow-up, 68.5% were no longer at risk of having an alcohol-exposed pregnancy; 12.6% of women who completed the program reduced drinking only; 23.1% used effective contraception only; and 32.9% reported both. Results were consistent across the 6 diverse high-risk settings. This study provides evidence that providing 4 sessions of motivational interviewing plus a contraception counseling session is feasible and strongly suggests that this intervention can decrease the risk of alcohol-exposed pregnancy in women in high-risk settings. Additional investigation in a randomized controlled trial is warranted.

EatSmart: Efficacy of a multifaceted preventive nutrition intervention in clinical practice

Background. We evaluated a multifaceted preventive nutrition intervention to improve dietary habits among adult primary care patients. Methods. We randomized six group practices in a managed care organization. Participants completed baseline and 3-month follow-up surveys. The intervention comprised (1) mailed personalized dietary recommendations and educational booklets focusing on fruits and vegetables, red meat, and dairy foods, tailored to patients' baseline intake and stage of readiness to change eating behaviors; (2) verbal endorsement by the primary care provider of the benefits of these recommendations; and (3) two motivational counseling sessions with telephone counselors to set dietary goals. Results. Among the 230 subjects in the intervention group and 274 in the control group, mean age was 54 years, 70% were female, and 91% were white and 7% African American. Eighty-nine percent of the participants completed the follow-up survey. We measured change in intake of foods using results from the baseline and follow-up food frequency questionnaires. Using an intention-to-treat analysis and adjusting for age, sex, race, and baseline intake, the change in fruit and vegetable intake in the intervention group was 0.6 (95% confidence interval 0.3, 0.8) servings/day higher than in the control group. There was no intervention effect on red meat and dairy products. Conclusions. Tailored clinical nutrition interventions that combine brief physician endorsement with practice supports may be effective in changing patients' eating behavior.

EatSmart: efficacy of a multifaceted preventive nutrition intervention in clinical practice.

We evaluated a multifaceted preventive nutrition intervention to improve dietary habits among adult primary care patients. We randomized six group practices in a managed care organization. Participants completed baseline and 3-month follow-up surveys. The intervention comprised (1) mailed personalized dietary recommendations and educational booklets focusing on fruits and vegetables, red meat, and dairy foods, tailored to patients' baseline intake and stage of readiness to change eating behaviors; (2) verbal endorsement by the primary care provider of the benefits of these recommendations; and (3) two motivational counseling sessions with telephone counselors to set dietary goals. Among the 230 subjects in the intervention group and 274 in the control group, mean age was 54 years, 70% were female, and 91% were white and 7% African American. Eighty-nine percent of the participants completed the follow-up survey. We measured change in intake of foods using results from the baseline and follow-up food frequency questionnaires. Using an intention-to-treat analysis and adjusting for age, sex, race, and baseline intake, the change in fruit and vegetable intake in the intervention group was 0.6 (95% confidence interval 0.3, 0.8) servings/day higher than in the control group. There was no intervention effect on red meat and dairy products. Tailored clinical nutrition interventions that combine brief physician endorsement with practice supports may be effective in changing patients' eating behavior.