Motivational Interviewing Approach Research Articles

Schizophrenia and Comorbid Substance Use Disorder: Integrated Psychosocial Treatment in a Community Psychiatric Hospital: Results From an Rct with 12 Months Follow-up

Substance use disorders are highly prevalent among people with schizophrenia. Dually diagnosed patients present with unfavorable course and poor long-term outcomes. Integrated, motivation-based treatment for both disorders in the same setting is considered the treatment of choice. However, integrated treatment programs are not readily available and effect sizes of the programs are modest. To evaluate an integrated psychosocial treatment program for people with schizophrenia and substance use disorders in the setting of a community psychiatric hospital. 100 in-patients with schizophrenia and substance use disorders were randomized to Integrated Treatment (IT) or Treatment as usual (TAU). The IT group was initially treated in a specialized open ward; upon discharge they were offered treatment in a specialized out-patient program of the hospital. The TAU group was initially treated in another non-specialized open ward; upon discharge they were offered treatment in the non-specialized out-patient unit of the hospital. TAU included pharmacotherapy, medical treatment, supportive psychotherapy and further aids by nursing staff and social workers. IT included all elements of TAU plus manualized group therapy with motivational interviewing, psychoeducation and cognitive-behavioral approaches. Assessments were performed at baseline and after 3, 6 and 12 months. The IT group had slightly less drop-outs in the follow-up period (non-significant). The IT group was more satisfied with treatment and they developed a higher motivation to reduce substance use. Both groups succeeded in reducing substance use during follow-up, whereas the IT group did slightly better (non-significant).

Preventing Premature Death of Somatic Causes Among Patients with Schizophrenia

Background Patients with schizophrenia have increased somatic morbidity and increased mortality. Knowledge of how to integrate the prevention and care of somatic illness into the treatment of psychiatric patients is required. The aims of the study were to investigate whether a three year interventional programme to improve the physical health is effective. Method An 'Active awareness” and motivational interviewing approach to increase knowledge and understanding of physical health problems in patients with schizophrenia. The intervention is health promotion activities characterized by attention turned away from disease and focus on health. Patients have an intense monitoring of physical health parameters and individual guidance in healthy food and how to live a physical active life. The intervention is part of a program together with the intervention title: 'Preventing premature death of somatic causes among patients with mental illness and co morbid substance use disorders”, both conducted in The Central Region in Jutland in Denmark. Preliminary results after one year 164 patients are participating. There are wide problems with obesity and very low level of physical activity among patients. The included patients are in a high risk of cardio vascular diseases and diabetes type 2. The patients have great interest in the program and it is unproblematic getting patients to participate with measurements, questionnaires and the attached supervision. Conclusions The intervention seems relevant and manageable in an outpatient’s setting. The preliminary results are promising in the ongoing process of improving physical health and we will implement the programme in daily practice.

Prevention of Premature Death of Somatic Causes in Patients with Mental Illness and Comorbid Substance Use Disorder

Introduction Physical comorbidities are common in patients with mental illness and substance use disorder. Both regular use of alcohol and cannabis have been associated with adverse health effects. However, their physical comorbidities can also be explained by other unhealthy lifestyle choices, i.e. lack of physical activity, poor nutrition and smoking. Aim The aim of this study is to analyse baseline and follow up data after one and a half year of a 3-year interventional programme of improvement of physical health in patients with mental illness and comorbid substance use disorder. Methods All patients with mental illness and substance use disorder referred to Department M at Aarhus University Hospital Risskov, Denmark from 1 July 2013 and onwards are included in the programme. The study takes an active awareness and motivational interviewing approach to increase knowledge and understanding of physical health problems. The intervention includes health promotion activities, and physical health parameters are monitored. Further guidance on healthy food intake, smoking cessation and a physically active life is provided. Results 50 patients are expected to be participating in the programme after one and a half year. Preliminary results after one-year show that 89,7 % smoke cigarettes, their level of physical activity is low, which is seen in the extent of their sedentary behaviour. Further there are problems with insufficient food intake among patients. Conclusions This study indicates, that patients with mental illness and comorbid substance use disorder need guidance on a healthier lifestyle. They show an interest in this interventional programme.

Computerized intervention to increase motivation for diabetes self-management in adolescents with type 1 diabetes

Purpose: The purpose of this study was to assess the feasibility of a three-session computer intervention to improve diabetes management among African-American youth with type 1 diabetes. Methods: The 3 Ms (Medication, Meter, and Meals) intervention was based on the Information-Motivation-Behavioral Skills model of health behavior change and Motivational Interviewing approaches. Feasibility was assessed based on rates of intervention participation and intervention satisfaction using a mixed-methods approach. Participants included 23 youths aged 10–13. Results: Mean satisfaction rates from questionnaires were high across ratings for both general satisfaction and helpfulness of the intervention for improving diabetes care. Intervention participation rates were also high, with 87% completing all three sessions. Thematic analyses suggests that adolescents found the intervention helpful for changing their diabetes management behaviors, their thoughts about the importance of diabetes care, reminding them to complete care, feeling empowered about diabetes management feeling supported by family. Conclusion: Adolescents found The 3 Ms computer-delivered intervention to be helpful in improving diabetes care and completed a high percentage of sessions. The delivery of motivation-building interventions that do not require a highly trained human interventionist during routine diabetes clinic visits has the potential to improve adolescent health at reduced costs-savings.

Differences between men and women in dietary intakes and metabolic profile in response to a 12-week nutritional intervention promoting the Mediterranean diet.

Few studies have compared men and women in response to nutritional interventions but none has assessed differences between men and women in the response to a nutritional intervention programme based on the self-determination theory (SDT) and using the Mediterranean diet (MedDiet) as a model of healthy eating, in a context of CVD prevention and within a non-Mediterranean population. The present study aimed to document differences between men and women in changes in dietary, anthropometric and metabolic variables, in response to a nutritional intervention programme promoting the adoption of the MedDiet and based on the SDT. A total of sixty-four men and fifty-nine premenopausal women presenting risk factors for CVD were recruited through different media advertisements in the Québec City Metropolitan area (Canada). The 12-week nutritional programme used a motivational interviewing approach and included individual and group sessions. A validated FFQ was administered to evaluate dietary intakes from which a Mediterranean score (Medscore) was derived. Both men and women significantly increased their Medscore in response to the intervention (P<0·0001). Men showed a significantly greater decrease in red and processed meat (-0·4 (95 % CI -0·7, -0·1) portions per d) and a greater increase in fruit (0·9 (95 % CI 0·2, 1·6) portions per d) intakes than women. Significant decreases were observed for BMI and waist circumference in both men and women (P≤0·04). Significant greater decreases were found for total cholesterol (total-C):HDL-cholesterol (HDL-C) (-0·2; 95 % CI -0·4, -0·03) and TAG:HDL-C (-0·2; 95 % CI -0·4, -0·04) ratios in men than in women. When adjusting for the baseline value of the response variable, differences between men and women became non-significant for red and processed meat and fruit intakes whereas significant differences between men and women (i.e. larger increases in men than women) were observed for legumes, nuts and seeds (0·6 (95 % CI 0·2, 1·0) portions per d) and whole-grain products (0·5 (95 % CI 0·01, 1·0) portions per d) intakes. For metabolic variables, differences between men and women became non-significant for total-C:HDL-C and TAG:HDL-C ratios when adjusted for the baseline value of the response variable. The present results suggest that the nutritional intervention promoting the adoption of the Mediterranean diet and based on the SDT led to greater improvements in dietary intakes in men than in women, which appear to have contributed to beneficial anthropometric and metabolic changes, more particularly in men. However, the more deteriorated metabolic profile found in men at baseline seems to contribute to a large extent to the more beneficial changes in CVD risk factors observed in men as compared with women.

A randomized controlled trial of the effects of a brief intervention to increase chlamydia and gonorrhea testing uptake among young adult female emergency department patients.

The objective of this study was to test the effect of a brief educational and counseling intervention on increasing the uptake of free testing for Chlamydia trachomatis (chlamydia) and Neisseria gonorrhea (gonorrhea) among young female emergency department (ED) patients. Women are particularly vulnerable to more serious consequences of these infections due to asymptomatic presentation. Increased testing is important to detect, treat, and halt the spread of these infections among asymptomatic women. This was a randomized controlled trial. Research assistants (RAs) approached female patients in two EDs. Eligible patients were between 18 and 35 years of age, who reported having sex with males, but were not attending the ED for either treatment of sexually transmitted infection (STI) or testing for possible STI exposure. Participants responded to survey questions about their lifetime and past 3-month substance use, number of recent sexual partners, condom use, and perception of risks for chlamydia and gonorrhea infections. Following the survey, the RAs randomized participants into study control or treatment arms. Each treatment arm participant received a brief educational/counseling intervention from the RA. The brief intervention focused on the woman's personal risks for chlamydia and gonorrhea and condoms attitudes and usage. As the primary outcome of this study, participants were offered free urine tests for chlamydia and gonorrhea infection postintervention or post-survey completion, depending on group assignment. A total of 171 women completed the baseline assessment and were offered chlamydia and gonorrhea testing. The mean (±SD) age was 26 (±4.76) years, 18% were Hispanic, and 12% were Spanish-speaking only. The brief intervention that was offered to increase these women's awareness of their STI risk did not result in increased acceptance of testing; 48% in the brief intervention group accepted testing (95% confidence interval [CI] = 32% to 64%) versus 36% in the control group (95% CI = 19% to 53%). In a multivariable logistic regression, only self-identifying as being Hispanic was associated with greater willingness to be tested. Of the asymptomatic women tested (n = 71), five tested positive for chlamydia. This represents a positivity rate of 7%. There were no positive test results for gonorrhea. Women who reported high-risk factors for STI, such as younger age (≤25 years), having sex in the past 90 days without using condoms, identified substance use, or previous STI, were not more likely to accept the offer of chlamydia and gonorrhea testing. The brief intervention used in this study did not increase the uptake of testing for chlamydia and gonorrhea infections in this sample, in comparison to receiving no intervention. Although Hispanic women were more likely to accept chlamydia and gonorrhea testing, it is concerning that those women who report STI risk factors were not more likely to accept the offer of chlamydia and gonorrhea testing. Future research should focus on the refinement of an intervention protocol to focus on prior STI and lack of condom use to increase the uptake of testing among this high-risk group.

Interventions combining motivational interviewing and cognitive behaviour to promote medication adherence: a literature review.

This article presents an integrative review of the evidence for combined motivational interviewing and cognitive behavioural interventions that promote medication adherence. We undertook this review to establish a scientific foundation for development of interventions to promote medication adherence and to guide clinical practice. The World Health Organization has designated medication adherence as a global problem. Motivational interviewing and cognitive behaviour interventions have been found to individually promote medication adherence. However, there is a gap in the literature on the effect of combined motivational interviewing and cognitive behavioural approaches to promote medication adherence. Integrative review. COCHRANE, PubMed and CINAHL were searched to access relevant studies between 2004-2014. Inclusion criteria were interventions combining motivational interviewing and cognitive behavioural therapy with medication adherence as the outcome. Articles were assessed for measures of adherence and methodological rigour. Analysis was performed using an integrative review process. Six articles met the inclusion criteria. A randomised controlled trial reported pretreatment missed doses of 5·58 and post-treatment of 0·92 and trended towards significance. Four cohort studies had effect sizes of 0·19-0·35 (p < 0·05). A case study had a pretreatment adherence rate of 25% and post-treatment 77% (p < 0·01). Although there were a limited number of studies on combined motivational interviewing and cognitive behavioural interventions, five out of six were effective at improving medication adherence. Future studies with large rigorous randomised trials are needed. This review provides clinicians with the state of the science in relation to combined motivational interviewing and cognitive behavioural therapy interventions that promote medication adherence. A summary of intervention components and talking points are provided to aid nurses in informing decision-making and translating evidence into practice.

Gender differences in the long-term effects of a nutritional intervention program promoting the Mediterranean diet: changes in dietary intakes, eating behaviors, anthropometric and metabolic variables.

BackgroundLong-term adherence to principles of the Mediterranean diet (MedDiet) following a nutritional intervention promoting the Mediterranean food pattern in Canadian men and women is not known. Moreover, gender differences in dietary and metabolic profile in such an intervention context has never been addressed. Objective was to determine gender differences in long-term effects of a 12-week nutritional intervention program promoting the adoption of the MedDiet and based on the Self-Determination Theory (SDT) on dietary intakes, eating behaviors, anthropometric and metabolic variables, in men and women presenting cardiovascular risk factors.MethodsSixty-four men and 59 premenopausal women were recruited. The 12-week nutritional program used a motivational interviewing approach and included individual and group sessions. A food frequency questionnaire was administered to evaluate dietary intakes from which a Mediterranean score (Medscore) was derived and the Three-Factor Eating Questionnaire allowed assessment of eating behaviors. Measurements were performed at baseline and after the 12-week nutritional intervention, and then at 3 and 6-month post intervention.ResultsNo gender difference was observed in changes in the Medscore during the nutritional intervention and follow-up. However, the Medscore returned towards baseline values during follow-up in men and women (P <0.0001). Men reported larger decreases in red and processed meat and larger increases in whole fruit intakes than women (P = 0.03 and P = 0.04, respectively). Men showed a greater decrease in habitual susceptibility to disinhibition than women (P = 0.03). A gender by time interaction was found for waist circumference, i.e. men had lower waist circumference at the end of the intervention as well as at follow-up than at baseline while women’s waist circumference decreased in response to the intervention only (P = 0.05). As for metabolic variables, changes observed in total-cholesterol (C) to HDL-C ratio, triglyceride levels and triglycerides to HDL-C ratio were more pronounced in men than in women after the intervention as well as at follow-up (P ≤0.03).ConclusionsOur results indicate that the 12-week nutritional intervention based on the SDT leads to more pronounced beneficial changes in long-term dietary intakes in men than in women and to greater improvements in metabolic profile in men.Trial registrationCurrent Controlled Trials NCT01852721.

Enhancing parental motivation to monitor african american adolescents' diabetes care: development and Beta test of a brief computer-delivered intervention.

BackgroundAfrican American youth are at increased risk for poor diabetes management. Parenting behaviors such as parental monitoring are significant predictors of youth diabetes management and metabolic control, but no intervention has targeted parental monitoring of daily diabetes care.ObjectiveThe purpose of the present study was to develop and pilot test a three-session computer-delivered intervention to enhance parental motivation to monitor African American pre-adolescents’ diabetes management.MethodsThe 3 Ms (Medication, Meter, and Meals) intervention was based on the Information-Motivation-Behavioral Skills (IMB) model of health behavior change and Motivational Interviewing approaches. Five caregivers of African American youth aged 10-13 years diagnosed with type 1 diabetes for a minimum of one year (ie, the target population) reviewed the intervention and provided feedback via semi-structured interviews. Interviews were transcribed and analyzed using thematic analysis.ResultsCaregivers’ responses to interview questions suggest that The 3 Ms was helpful (minimum rating was 8 out of 10) and they would recommend the program to another parent of a child with diabetes (minimum rating was 9 out of 10). Three of five reported that The 3 Ms program increased the likelihood that they would talk to their child about diabetes. Thematic analysis suggested two primary themes: caregivers found the intervention to be a useful reminder of the importance of supervising their child’s diabetes care and that it evoked a feeling of shared experience with other parents.ConclusionsThe 3 Ms computer-delivered intervention for increasing parental monitoring of African-American youth with type 1 diabetes was well-received and highly rated by a small sample of representative caregivers.Trial RegistrationClinicalTrials.gov NCT01515930; http://clinicaltrials.gov/ct2/show/NCT01515930 (Archived by WebCite at http://www.webcitation.org/6Rm0vq9pn).

Pilot Feasibility Study of a Brief, Tailored Mobile Health Intervention for Depression among Patients with Chronic Pain

This pilot feasibility study investigated a brief, tailored mobile health intervention to provide brief treatment and motivate further depression treatment seeking among patients with comorbid chronic pain. The computer tablet intervention was delivered in a hospital clinic using a blended motivational interviewing and cognitive behavioral therapy approach. Individuals were at least age 18, and screened positive for depression during a visit for chronic pain. Participants completed assessments before the intervention and at two-week follow-up. The 64 participants were most often over 50 years old, female, and Caucasian. Participant ratings demonstrated an increase in interest to seek depression treatment and willingness to make life changes to mitigate symptoms. A significant reduction in mean depression score and non-significant reductions on both measures of disability were observed. This intervention was feasible and acceptable, demonstrated promise in reducing depression and increasing treatment interest, and should be tested in a trial.

Using brief motivational interviewing to address the complex needs of a challenging patient with heart failure.

Hospitals and healthcare providers are looking for methods to reduce hospitalization rates and improve patient outcomes for patients with heart failure (HF). Using behavioral approaches to increase patients' confidence in their abilities to perform self-care is 1 such approach. Motivational interviewing is an empirically validated modality that has shown promise in improving motivation to change and confidence in the ability to do so. This case represents a number of themes common in the management of care for a HF patient and explores a 4-session brief motivational interviewing approach to address these themes. The manner in which patient frustration is linked to hospitalization is discussed along with possible ways to address problems in self-care behaviors. With the use of this brief motivational interviewing approach, the patient reported an increase in her motivation and ability to change and developed a postdischarge plan for incorporating self-care behaviors in her daily routine. Motivational interviewing may be an effective method of increasing the self-care behaviors of patients with HF.

Motivational interviewing as a framework to guide school-based coaching

In school-based settings, coaching is described as a professional development practice in which a person with specialized knowledge works with a teacher to change current practices to better student outcomes. Coaching has emerged as a strategy to support the successful deployment of evidence-based interventions. Still, little is known about the coaching process itself, and the literature does not yet clearly define the activities and skills that comprise the coaching process. In this article, we explore theoretical support for motivational interviewing (MI) [Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change. New York, NY: Guilford Press] as a behavior change theory to guide coaching practice and research. In addition, we propose activities to conceptualize the coaching process, identify skills that are likely to contribute to successful coaching, highlight specific interventions or models that have used an MI approach to increase implementation fidelity within the context of a coaching relationship, and discuss implications for future research and practice.

Integrating psychological screening into reviews of patients with COPD.

People with chronic obstructive pulmonary disease (COPD) have a high prevalence of anxiety and depression, which can have an impact on their symptoms and the way they manage their condition. Intervention that takes psychological distress into account may lead to better outcomes than simple advice-giving. To explore the feasibility of integrating psychological screening and intervention into nurse-led reviews of patients with COPD. Nurses were given training on a pathway developed for patients with COPD. This included screening for depression and anxiety and assessing their severity; providing self-management education by means of a motivational approach; and offering pulmonary rehabilitation. The nurses' level of confidence increased following training. Patients were accepting of the screening process and felt more able and motivated to manage their condition after the intervention. Eleven of the 35 patients that took part in the study period had evidence of anxiety and/or depression. Out of a total of 16 patients eligible for pulmonary rehabilitation, 12 agreed to referral. Of these, three patients were seen by their GP, one was started on antidepressants, and one was referred to the psychology service. Training practice nurses to screen for depression and anxiety, and to offer self-management education using a motivational interviewing approach, increased the reported capability and motivation of patients with COPD to manage their condition. It may also improve the uptake of pulmonary rehabilitation. Use of this pathway does not place a burden on other care providers or greatly increase prescribing costs.

Motivational interviewing in inflammatory bowel disease patients: A useful tool for outpatient counselling

BackgroundMost inflammatory bowel disease patients miss follow-up visits and are non-adherent to therapy due to the lack of an engaging patient–physician relationship. Motivational interviewing is a patient-centred counselling method used to elicit/strengthen motivation towards change. The aim of this study was to assess the role of motivational interviewing in patients affected by inflammatory bowel disease. MethodsThe study included consecutive patients with inflammatory bowel disease presenting for the first consultation (June 2012–February 2013). All consultations were carried out applying the motivational interviewing approach. After each consultation, patients filled out a questionnaire asking demographic data, and their past and current experience. ResultsOverall, 23 males (51.1%) and 22 females (48.9%), mean age 36.1±15.2 years, were enrolled. Before and after experiencing the motivational interviewing approach (mean visit duration 41.5±8.7min) “overall satisfaction rate”, “physician's communication skills”, and “perceived empathy” were 60% vs 100%, 40% vs 95.6%, and 40% vs 100%, respectively. Satisfaction was lower in patients affected by indeterminate colitis (p=0.004), and of younger age (p=0.02). ConclusionThe motivational interview approach is appreciated by inflammatory bowel disease patients. Despite being time-consuming, the motivational interview appears considerably worthwhile at the first visit and in younger patients. Motivational interviewing can help physicians to deal with their patients, moving from “cure” to “care”.

Improving the counselling skills of lay counsellors in antiretroviral adherence settings: a cluster randomised controlled trial in the Western Cape, South Africa.

Little research has investigated interventions to improve the delivery of counselling in health care settings. We determined the impact of training and supervision delivered as part of the Options: Western Cape project on lay antiretroviral adherence counsellors' practice. Four NGOs employing 39 adherence counsellors in the Western Cape were randomly allocated to receive 53 h of training and supervision in Options for Health, an intervention based on the approach of Motivational Interviewing. Five NGOs employing 52 adherence counsellors were randomly allocated to the standard care control condition. Counselling observations were analysed for 23 intervention and 32 control counsellors. Intervention counsellors' practice was more consistent with a client-centred approach than control counsellors', and significantly more intervention counsellors engaged in problem-solving barriers to adherence (91 vs. 41 %). The Options: Western Cape training and supervision package enabled lay counsellors to deliver counselling for behaviour change in a manner consistent with evidence-based approaches.

Impact of an adherence intervention on the effectiveness of tenofovir gel in the CAPRISA 004 trial.

High adherence is important in microbicide trials, but no adherence interventions to date have demonstrated empiric improvements in microbicide adherence or effectiveness. Approximately midway during the CAPRISA 004 trial, we implemented a novel adherence intervention (Adherence Support Program-ASP), based on an Information-Motivation-Behavioral Skills model and incorporating a Motivational Interviewing approach. We assessed the impact of the ASP on adherence and tenofovir gel effectiveness using a before-and-after comparison. Of the 889 women in the trial, 774 contributed 486.1 women-years of follow-up pre-ASP and 828 contributed 845.7 women-years of follow-up post-ASP. Median adherence rose from 53.6 % pre-ASP to 66.5 % post-ASP. Detectable tenofovir levels increased from 40.6 % pre-ASP to 62.5 % post-ASP in 64 women who had paired tenofovir drug samples. Gel effectiveness improved post-ASP; HIV incidence in the tenofovir gel arm was 24 % lower pre-ASP compared to 47 % lower post-ASP. Following implementation of the ASP, microbicide adherence improved with a concomitant increase in the effectiveness of tenofovir gel.

Motivational interviewing to reduce sexual risk-taking in men who have sex with men: The launch of a pilot service

This article highlights the need for sexual risk reduction interventions and outlines the process of developing a pilot risk reduction service for men who have sex with men based on a motivational interviewing approach.

Lay counselors’ ability to deliver counseling for behavior change.

Options for Health is an evidence-based sexual risk reduction intervention based on motivational interviewing (MI). Thirty-nine antiretroviral adherence lay counselors were trained to deliver Options for Health to help their patients to optimize their antiretroviral treatment adherence. An evaluation of counselors' ability to deliver the intervention after 35 hr of training revealed that counselors struggled with elements of the 8-step Options protocol and failed to achieve proficiency in MI. The current study aimed to determine the impact of refresher training and supervision on counselors' proficiency in the intervention. Audio-recordings of counseling sessions were collected for 22 of 39 counselors after 18 hr of refresher training and supervision had been delivered over a 12-month period. Recordings were transcribed, translated, and analyzed for fidelity to the Options protocol and the MI approach. Analysis was conducted using the Motivational Interviewing Treatment Integrity Tool and an instrument developed by the researchers. Results were compared to findings from an evaluation of counselors' performance immediately following the initial 35-hr training. Counselors improved their delivery of some intervention steps, but not others; their use of micro-counseling skills and therapeutic approach improved to such an extent that they closely approximated the MI approach. This study contributes evidence for the positive impact of ongoing training and supervision on lay health worker practice. Although counselors did not achieve complete proficiency in the Options protocol, refresher training and supervision improved counselors' basic counseling communication skills and therapeutic approach, enabling them to deliver better quality counseling for behavior change.

Steps to Growing Up Healthy: a pediatric primary care based obesity prevention program for young children.

BackgroundLeading medical organizations have called on primary care pediatricians to take a central role in the prevention of childhood obesity. Weight counseling typically has not been incorporated into routine pediatric practice due to time and training constraints. Brief interventions with simple behavior change messages are needed to reach high-risk children, particularly Latino and Black children who are disproportionately affected by obesity and related comorbidities. Steps to Growing Up Healthy (Added Value) is a randomized controlled trial testing the efficacy of brief motivational counseling (BMC) delivered by primary care clinicians and the added value of supplementing BMC with monthly contact by community health workers (CHW) in the prevention/reversal of obesity in Latino and Black children ages 2-4 years old.Methods/DesignMother-child dyads (targeted n = 150) are recruited for this 12-month randomized trial at an inner-city pediatric primary care clinic and randomized to: 1) BMC delivered by clinicians and nurses at well, sick, and WIC visits with the goal of reducing obesogenic behaviors (BMC); 2) BMC plus monthly phone calls by a CHW (BMC + Phone); or 3) BMC plus monthly home visits by a CHW (BMC + Home). During BMC, the medical team facilitates the selection of a specific goal (i.e., reduce sugar sweetened beverage consumption) that is meaningful to the mother and teaches the mother simple behavioral strategies. Monthly contacts with CHWs are designed to identify and overcome barriers to goal progress. Dyads are assessed at baseline and 12 months and the primary outcome is change in the child’s BMI percentile. We hypothesize that BMC + Phone and BMC + Home will produce greater reductions in BMI percentiles than BMC alone and that BMC + Home will produce greater reductions in BMI percentiles than BMC + Phone.DiscussionSteps to Growing Up Healthy will provide important information about whether a brief primary care-based intervention that utilizes a motivational interviewing and goal setting approach can be incorporated into routine care and is sufficient to prevent/reverse obesity in young children. The study will also explore whether monthly contact with a community health worker bridges the gap between the clinic and the community and is an effective strategy for promoting obesity prevention in high-risk families.Trial registrationClinicalTrials.gov NCT01973153

Implementing a One-on-One Peer Support Program for Cancer Survivors Using a Motivational Interviewing Approach: Results and Lessons Learned

Implementing a One-on-One Peer Support Program for Cancer Survivors Using a Motivational Interviewing Approach: Results and Lessons Learned