Motivational Interviewing Sessions Research Articles

Variations in perceptions of parenting role related to children\u2019s physical activity and sedentary behaviours \u2013 a qualitative study in a Northern European context

BackgroundThe aim of the study was to increase understanding of the variation in parental perceptions of their roles and responsibilities in relation to children’s physical activity and sedentary behaviours.MethodsThis qualitative study was based on data from the Healthy School Start intervention study II, in the form of recorded motivational interviewing (MI) sessions with mothers and fathers participating in the intervention. Forty-one MI sessions where parents discussed physical activity and/or sedentary behaviour were selected for analysis. Data analysis was performed using a phenomenographic approach.ResultsThree categories describing a structural relationship of parents’ different views on their own role in relation to their child’s habits were identified: 1) The parent decides – Child physical activity according to my beliefs and views as a parent and where I, as a parent, decide, 2) Parent-child interaction – child physical activity is formed in interaction between me as a parent and my child or 3) The child/someone else decides – The child or someone other than me as a parent decides or has the responsibility for my child’s physical activity. All three categories included four subcategories of specific activities: organised activity, activity in everyday life, being active together and screen time, describing practical approaches used in each of the three categories.ConclusionsThis study found variation in mothers’ and fathers’ perceptions of their roles and responsibilities for their child’s physical activity and sedentary behaviours related to specific types of activities. The results indicate areas where parents need support in how to guide their children and how parental responsibility can have a positive influence on children’s physical activity and sedentary habits.

Motivational interviewing technical and relational skills, change talk, and alcohol outcomes-A moderated mediation analysis.

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).

A motivational interviewing intervention improves the burden of physical symptoms in patients with heart failure: A secondary outcome analysis of a randomized clinical trial

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Center of Excellence for Nursing Scholarship, Rome, Italy Background. Patients with heart failure (HF) experience a variety of physical symptoms. Symptoms are perceived by patients as burdensome and, as such, negatively affect quality of life. Besides, physical symptoms are among the first reasons for seeking emergency care and hospitalization. Findings from the MOTIVATE-HF trial show that motivational interviewing (MI) leads to better self-care. However, whether MI also reduces the burden of physical symptoms is not yet known. Purpose. To evaluate the effectiveness of MI on the burden of physical symptoms in patients with HF. Methods. Secondary outcome analysis of the MOTIVATE-HF trial. The study was a three-arm, multicenter randomized controlled trial with a 12-month follow-up. Patients with HF and their informal caregivers were enrolled and randomly divided into three arms: MI performed only with patients (Arm 1); MI performed both with patients and caregivers (Arm 2); usual care (Arm 3). Patients with a diagnosis of HF in NYHA functional class II-IV were recruited in three Italian centers. Participants underwent one face-to-face MI session, followed by three phone calls within two months from enrollment. Physical symptoms were measured with the Heart Failure Somatic Perception Scale (HFSPS) with the dimensions of dyspnea, chest discomfort, early and subtle, and edema. Higher scores at the HFSPS and its dimensions indicate worse physical symptom. Data were collected at baseline, and 3 (T1), 6 (T2), 9 (T3) and 12 (T4) months after enrollment. T-test was used to compare differences in HFSPS scores in Arms 1 and 2 versus Arm 3 at each follow-up. Changes over time were analyzed with mixed linear longitudinal models. Results. A sample of 510 patients (median 74 years, 58% male) and their caregivers (median 55 years, 75.5% female) were randomized to Arm 1 (n = 155), Arm 2 (n = 177) and Arm 3 (n = 178). Chest discomfort improved in Arms 1 and 2 versus Arm 3 at T4 (mean difference(Δ): -8.13, P = .014). Dyspnea also improved in Arms 1 and 2 than Arm 3 both at T3 and T4 (Δ: -7, P = .027 and Δ: -6.78, P = .038, respectively). HFSPS total score improved in Arms 1 and 2 versus Arm 3 at T3 (Δ: -4.55, P = .048). Over the year of observation, the mixed linear longitudinal models showed a significant improvement in Chest discomfort and total HFSPS score in Arm 2 versus Arm 3 (β = -2.61, P = .002 and, β = -1.35, P = .02). Conclusions. The results of this secondary analysis indicate that MI may be effective in decreasing the burden of physical symptoms in HF patients, especially if also caregivers are involved in the intervention. Since symptom burden is among the first reasons for seeking emergency care and hospitalization in HF, MI might be a viable option to improve symptom burden via self-care.

Does motivational interviewing reduce health services use and mortality in heart failure patients? A secondary analysis of the MOTIVATE-HF trial

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Center of Excellence for Nursing Scholarship, Rome, Italy Background. Health services use and mortality are high among patients with heart failure (HF). The MOTIVATE-HF was a randomized controlled trial in which we demonstrated that Motivational Interviewing (MI) can effectively improve HF patient self-care (primary outcome). However, it is still unclear if MI can reduce health services use and mortality. Purpose. To test the efficacy of MI in reducing health services use (emergency services and hospitalizations), and all-cause mortality in HF patients. Methods. The MOTIVATE-HF was a multicenter parallel trial (1:1:1) with randomization of patient and informal caregiver dyads across three arms: Arm 1, MI administered to patients; Arm 2, MI administered to patients and caregivers; Arm 3, standard of care. Participants were enrolled from three Italian HF specialty centers. Patients were included only if they had HF in NYHA functional class II-IV and excluded if they had a recent coronary event, lived in a residential setting, or had severe cognitive impairment. Informal caregivers were nominated by the patients as the person mainly responsible for their care. The intervention consisted of one face-to-face MI session followed by 3 telephone contacts within 2 months from enrollment. Follow-up and reassessment occurred after 3-, 6-, 9- and 12-months post-randomization. A longitudinal generalized mixed model and a Cox proportional-hazard model were fitted to compare rates of health care services use and mortality among the three study arms during follow-ups. Results. The sample of 510 HF patients (median age 74 years; IQR 65-82; 58% male) was distributed as follows: Arm 1, n = 155; Arm 2, n = 177; and Arm 3, n = 178. Within the 12 months" period, 25 patients (16.1%) in Arm 1, 30 patients (17%) in Arm 2, and 20 patients (11.2%) in Arm 3 used health services at least once (p = 0.25) without significant differences at any follow up. Regarding all-cause mortality, at 3 months, 3 patients (1.9%) in Arm 1, 1 patient (0.6%) in Arm 2, and 9 patients (5.1%) in Arm 3 had died (p = 0.02). At 6 months, 5 patients (3.2%) in Arm 1, 1 patient (1.7%) in Arm 2 and 12 patients (6.7%) in Arm 3 had died (p = 0.05). No significant group differences were observed at 9 or 12 months. Mortality was lower in Arm 2 compared to Arm 3 in the first 3 months (HR = 0.112, 95% CI: 0.014–0.882, p = 0.038), whereas no difference was detected in the following months (p = 0.699). Mortality was also lower in Arm 1 compared to Arm 3 in the first 3 months, but this reduction did not reach statistical significance (HR = 0.383, 95% CI:0.104–1.414, p = 0.155). Conclusions. This analysis indicates that MI was not effective in reducing health services use in our sample, but it was effective in reducing all-cause mortality, at least in the short-term period. MI could be an inexpensive intervention to reduce HF mortality but further studies are needed to see if more frequent MI interventions could produce greater sustained reduction in health services use and mortality.

Motivational interviewing for caries prevention in adolescents: a randomized controlled trial.

The objective of this study is to investigate the effectiveness of motivational interviewing (MI) in changing health behaviors (snack and toothbrushing) and preventing dental caries among adolescents. Five hundred andtwelve adolescents with unfavorable caries-related behaviors ("snacking three times or more a day" and/or "toothbrushing less often than twice a day") were randomly assigned to three groups. Group I received prevailing health education (oral health talks and pamphlets). Participants in group II joined a one-on-one face-to-face MI session. In group III, a patient communication tool (Cariogram) was incorporated to facilitate the MI process. At baseline and 24months post-intervention, a self-administered questionnaire gathered information of participants' sociodemographic characteristics and oral health self-efficacy and behaviors. Their oral hygiene and tooth status were assessed by a blinded examiner. After 24months, 460 (89.8%) participants were followed up. Compared with group I, (i) restriction of frequent snacking was more likely in group II [OR (95% CI): 3.91 (1.48-10.33)] and group III [OR (95% CI): 6.33 (2.46-16.27)], whereas group III tended to adopt the behavior of toothbrushing twice a day [OR (95% CI): 4.80 (1.79-12.85)]; (ii) no significant between-group difference in plaque score reduction was found (p > 0.05); and (iii) groups II and III developed fewer cavitated teeth (△DICDASII 3-6MFT) [β (95% CI): - 0.19 (- 0.37, - 0.01) and - 0.20 (- 0.38, - 0.02), respectively], whereas increment of total carious lesions (△DICDASII 1-6MFT) was lower in group III [β (95% CI): - 0.63 (- 1.24, - 0.02)]. MI outperformed prevailing health education in improving oral health behaviors and preventing dental caries among adolescents. Incorporating MI into dental care for caries-prone adolescents contributes to optimal health outcomes. HKUCTR-1852 ( http://www.hkuctr.com/ ) (Hong Kong, 2013).

Self-management challenges following hospital discharge for patients with multimorbidity: a longitudinal qualitative study of a motivational interviewing intervention

ObjectivesThe aim of this study was to describe challenges in self-management activities among people with multimorbidity during a 4-week post-discharge period.DesignThis is a longitudinal qualitative study using data from a...

Active Ingredients and Mechanisms of Change in Motivational Interviewing for Smoking Cessation in Patients With Coronary Artery Disease: A Mixed Methods Study.

Background: For patients with coronary artery disease (CAD), smoking is an important risk factor for the recurrence of a cardiovascular event. Motivational interviewing (MI) may increase the motivation of the smokers to stop smoking. Data on MI for smoking cessation in patients with CAD are limited, and the active ingredients and working mechanisms of MI in smoking cessation are largely unknown. Therefore, this study was designed to explore active ingredients and working mechanisms of MI for smoking cessation in smokers with CAD, shortly after a cardiovascular event.Methods: We conducted a qualitative multiple case study of 24 patients with CAD who participated in a randomized trial on lifestyle change. One hundred and nine audio-recorded MI sessions were coded with a combination of the sequential code for observing process exchanges (SCOPE) and the motivational interviewing skill code (MISC). The analysis of the cases consisted of three phases: single case analysis, cross-case analysis, and cross-case synthesis. In a quantitative sequential analysis, we calculated the transition probabilities between the use of MI techniques by the coaches and the subsequent patient statements concerning smoking cessation.Results: In 12 cases, we observed ingredients that appeared to activate the mechanisms of change. Active ingredients were compositions of behaviors of the coaches (e.g., supporting self-efficacy and supporting autonomy) and patient reactions (e.g., in-depth self-exploration and change talk), interacting over large parts of an MI session. The composition of active ingredients differed among cases, as the patient process and the MI-coaching strategy differed. Particularly, change talk and self-efficacy appeared to stimulate the mechanisms of change “arguing oneself into change” and “increasing self-efficacy/confidence.”Conclusion: Harnessing active ingredients that target the mechanisms of change “increasing self-efficacy” and “arguing oneself into change” is a good MI strategy for smoking cessation, because it addresses the ambivalence of a patient toward his/her ability to quit, while, after the actual cessation, maintaining the feeling of urgency to persist in not smoking in the patient.

How is motivational interviewing (un)related to self-determination theory: An empirical study from different healthcare settings.

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.

Ameliorating Prediabetes With Healthy Lifestyles: A Stage-Tailored Motivational Interviewing Pilot

This study assessed the feasibility, acceptability, and preliminary efficacy of a nurse-led, 3-session, stage-tailored motivational interviewing (MI) program in modifying the lifestyles of 23 primarily African American (52%) females who were overweight/obese and had prediabetes. All participants attended all 3 MI sessions. More than 90% were satisfied with the program. The participants (baseline mean age = 45, BMI = 39.2, and A1C = 5.98) demonstrated significant decreases in waist circumferences and systolic/diastolic blood pressures, and improvements in exercise self-efficacy, readiness for behavioral changes, eating patterns, and moderate-intensity physical activity (PA). This pilot was well-accepted and efficacious in promoting healthy lifestyle among overweight/obese female adults with prediabetes.

Periodontal health education session can improve oral hygiene in patients with gingivitis: A masked randomized controlled clinical study.

The aim of this clinical trial was to evaluate the effect of a periodontal health education session (PHES), which included education on the pathogenesis and consequences of periodontal diseases on oral hygiene motivation in patients with gingivitis. A randomized controlled clinical trial was conducted on 50 (26 females and 24 males) patients with gingivitis who underwent periodontal treatment. Subjects were randomly allocated into the PHES group (experimental group) and standard oral hygiene education group (control group). The Rustogi Modified Navy Plaque Index (RMNPI) and Papillary Bleeding Index (PBI) were used to evaluate oral hygiene at baseline and were repeated after 1, 3, and 6 months. Knowledge about periodontal disease was measured and the participants' motivation was determined using the Oral Hygiene Motivation Scale. Although baseline knowledge levels and motivation scores were not different between the groups, following the educational motivational interviewing (MI) session, levels were higher in the experimental compared with the control group. The subjects' RMNPI and PBI scores at the 1-, 3-, and 6- month re-examinations were statistically higher in the control group than the experimental group. Furthermore, the level of knowledge and intrinsic and total motivation scores were moderately positively correlated with a reduction in clinical indices at 6 months compared with baseline. The results of this study indicated that increased knowledge and awareness about periodontal diseases and its consequences, including systemic effects, via educational MI session increased intrinsic motivation and improved oral hygiene of patients with gingivitis, especially regarding interproximal surfaces.

Keeping adults physically active after Falls Management Exercise (FaME) programmes end: development of a physical activity maintenance intervention

BackgroundFalls prevention exercise programmes help to improve muscle strength, balance and physical function, and reduce falling rates in older adults. Improvements in muscle strength, balance and physical function are reversed if older adults do not continue to be physically active after falls prevention exercise programmes end. This paper describes the design process of an intervention that aimed to maintain physical activity in older adults exiting falls prevention exercise programmes.MethodsThe development of the Keeping Adults Physically Active (KAPA) intervention and its implementation plan was guided by Bartholomew’s Intervention Mapping approach. The intervention mapping approach involved (1) performing a needs assessment and developing intervention objectives using previous literature; (2) identifying theory-based intervention strategies from a systematic review and the National Institute of Clinical Excellence guidelines; and (3) designing the KAPA intervention and its implementation plan with the guidance from an expert steering group.ResultsThe KAPA intervention comprised of six group sessions of motivational interviewing, delivered monthly by trained and mentor-supported falls prevention practitioners. Intervention sessions lasted up to 90 min and were delivered in community settings over a 6-month duration. Participant manuals, illustrated exercise books, physical activity diaries and pedometers supported the KAPA intervention.ConclusionsThe intervention development process, consisting of Bartholomew’s Intervention Mapping approach and the input from an expert steering group, was successful in creating the evidence-based KAPA intervention ready to be evaluated in a feasibility trial.

Development of Motivational Interviewing Treatment Integrity (MITI) Fidelity Codes Assessing Motivational Interviewing with Couples.

This study evaluated preliminary reliability and validity evidence for novel scores that extend the motivational interviewing treatment integrity (MITI) coding system to assess elements unique to motivational interviewing (MI) with couples. We recruited 20 cismale couples where at least one partner was aged 18-29; reported substance use; and was HIV-negative. Couples were randomized to a three-session MI or attention-matched education control. Four coders rated audio-recordings of initial sessions in both conditions. Novel global scores had high nearly-exact percent agreement (Decreasing Dyadic Ambivalence = 100%; Facilitating Dyadic Functioning = 94%). Consistency for novel behavior counts was good (ICCdyadic reflections = .72) and above minimum thresholds (nearly-exact agreement for Relationship Affirmations = 78%). MI sessions generated novel and established MITI codes that were significantly better than education sessions, providing preliminary evidence of validity. Findings provided initial support for the use of these novel scores in future research evaluating MI-based substance use and HIV risk reduction studies with couples.

Motivational Interviewing Enhances Group Cognitive Behavioral Therapy for Anxiety Disorders.

This pilot study tested whether the addition of motivational interviewing (MI) prior to group cognitive behavioral therapy (CBT) for anxiety may improve the effectiveness of the treatment. Prior to group CBT, 40 individuals with a principal diagnosis of an anxiety disorder (40% panic disorder, 25% generalized anxiety disorder, 22.5% social phobia, and 12.5% others) were randomly assigned to receive either three individual sessions of MI or were assigned to a control group that did not receive MI. The pretreatment MI group, compared to the control group, experienced significantly greater reduction in anxiety symptoms post-CBT. These results suggest that brief MI pretreatment enhances the efficacy of CBT on anxiety. A combination of MI and CBT may be particularly promising for the treatment of anxiety, with MI directed at increasing motivation and commitment to change, and CBT directed at helping the client achieve the desired changes.

ILC-OPI: impulsive lifestyle counselling versus cognitive behavioral therapy to improve retention of patients with opioid use disorders and externalizing behavior: study protocol for a multicenter, randomized, controlled, superiority trial

BackgroundSubstance use disorders show a high comorbidity with externalizing behavior difficulties, creating treatment challenges, including difficulties with compliance, a high risk of conflict, and a high rate of offending post-treatment. Compared with people with other substance use disorders those with opioid use disorders have the highest risk of criminal activity, but studies on the evidence base for psychosocial treatment in opioid agonist treatment (OAT) are scarce. The Impulsive Lifestyle Counselling (ILC) program may be associated with better retention and outcomes among difficult-to-treat patients with this comorbidity.MethodsThe study is a multicenter, randomized, controlled, superiority clinical trial. Participants will be a total of 137 hard-to-treat individuals enrolled in opioid agonist treatment (OAT). Participants will be randomized to either a standard treatment (14 sessions of individual manual-based cognitive behavioral therapy and motivational interviewing (MOVE-I)) or six sessions of ILC followed by nine sessions of MOVE-I. All participants will receive personalized text reminders prior to each session and vouchers for attendance, as well as medication as needed. The primary outcome is retention in treatment. Secondary measures include severity of drug use and days of criminal offending for profit three and nine months post-randomization. A secondary aim is, through a case-control study, to investigate whether participants in the trial differ from patients receiving treatment as usual in municipalities where ILC and MOVE-I have not been implemented in OAT. This will be done by comparing number of offences leading to conviction 12 months post-randomization recorded in the national criminal justice register and number of emergency room contacts 12 months post-randomization recorded in the national hospital register.DiscussionThis is the first randomized, controlled clinical trial in OAT to test the effectiveness of ILC against a standardized comparison with structural elements to increase the likelihood of exposure to the elements of treatment. Results obtained from this study may have important clinical, social, and economic implications for publicly funded treatment of opioid use disorder.Trial registrationISRCTN, ISRCTN19554367, registered on 04/09/2020.

Barriers and Facilitators for Implementing Motivational Interviewing as a Return to Work Intervention in a Norwegian Social Insurance Setting: A Mixed Methods Process Evaluation

Purpose The aim of this study was to evaluate potential barriers and facilitators for implementing motivational interviewing (MI) as a return to work (RTW) intervention in a Norwegian social insurance setting. Methods A mixed-methods process evaluation was conducted alongside a randomized controlled trial involving MI sessions delivered by social insurance caseworkers. The study was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework using focus groups with the caseworkers. MI fidelity was evaluated through audio-recordings of MI sessions and questionnaires to sick-listed participants. Results Lack of co-worker and managerial support, time and place for practicing to further develop MI skills, and a high workload made the MI intervention challenging for the caseworkers. The MI method was experienced as useful, but difficult to master. MI fidelity results showed technical global scores over the threshold for “beginning proficiency” whereas the relational global score was under the threshold. The sick-listed workers reported being satisfied with the MI sessions. Conclusions Despite caseworker motivation for learning and using MI in early follow-up sessions, MI was hard to master and use in practice. Several barriers and facilitators were identified; these should be addressed before implementing MI in a social insurance setting.Trial registration ClinicalTrials.gov: NCT03212118 (registered July 11, 2017).

Effect of the School-Based Asthma Care for Teens (SB-ACT) program on asthma morbidity: a 3-arm randomized controlled trial

Urban adolescents with asthma often have inadequate preventive care. We tested the effectiveness of the School-Based Asthma Care for Teens (SB-ACT) program on asthma morbidity and preventive medication adherence. Methods: Subjects/Setting- 12-16yr olds with persistent asthma in Rochester, NY schools. Design- 3-group randomized trial (2014-2019). SB-ACT Intervention- Two core components: 1) Directly observed therapy (DOT) of preventive asthma medications, provided in school for at least 6-8 weeks for the teen to learn proper technique and experience the benefits of daily preventive therapy; 2) 4-6 weeks later, 3 sessions of motivational interviewing (MI) to discuss potential benefits from DOT and enhance motivation to take medication independently. We included 2 comparison groups: 1) DOT-only for 6-8wks, and 2) asthma education (AE) attention control. Masked follow-up assessments were conducted at 3, 5, and 7mos. Outcomes- Mean number of symptom-free days (SFDs)/2 weeks and medication adherence. Analyses- Modified intention-to-treat repeated measures analysis. Results: We enrolled 430 teens (56% Black, 32% Hispanic, 85% Medicaid). There were no group differences at baseline. We found no difference in SFDs at any follow-up timepoint. More teens in the SB-ACT and DOT-only groups reported having a preventive asthma medication at each follow-up (p<.001), and almost daily adherence at 3 and 5-months (p<.001, p=.003) compared to AE. By 7 months there were no significant differences between groups in adherence (p=.49). Conclusion: SB-ACT improved preventive medication availability and short-term adherence but did not impact asthma symptoms. Further work is needed to create developmentally appropriate and effective interventions for this group.

Analysis of Behavior Classification in Motivational Interviewing.

Analysis of client and therapist behavior in counseling sessions can provide helpful insights for assessing the quality of the session and consequently, the client's behavioral outcome. In this paper, we study the automatic classification of standardized behavior codes (i.e. annotations) used for assessment of psychotherapy sessions in Motivational Interviewing (MI). We develop models and examine the classification of client behaviors throughout MI sessions, comparing the performance by models trained on large pretrained embeddings (RoBERTa) versus interpretable and expert-selected features (LIWC). Our best performing model using the pretrained RoBERTa embeddings beats the baseline model, achieving an F1 score of 0.66 in the subject-independent 3-class classification. Through statistical analysis on the classification results, we identify prominent LIWC features that may not have been captured by the model using pretrained embeddings. Although classification using LIWC features underperforms RoBERTa, our findings motivate the future direction of incorporating auxiliary tasks in the classification of MI codes.

An efficacy trial of adaptive interventions for alcohol use disorder

BackgroundAdaptive interventions, sometimes referred to as “stepped care”, are those interventions in which the type or dosage of treatment offered to patients is tailored to baseline clinical presentation and then adjusted over time in response to patient progress or lack thereof. Currently, no adaptive brief interventions exist specifically for alcohol use disorder (AUD). MethodThis study used a sequential multiple assignment randomized trial design with 160 individuals with AUD recruited both locally and nationally who had a goal to reduce or abstain from drinking. Participants received brief advice (BA) and then the study reassessed them three weeks later; the study randomized those who did not respond to BA, defined as reducing their drinking to low-risk guidelines, to two session of motivational interviewing (MI) or more BA. The study then reassessed participants at week 8. The study re-randomized nonresponders to receive either MI alone or MI plus behavioral self-control therapy (BSCT), also referred to as coping skills therapy, and evaluated participants at week 13. ResultsOverall, participants receiving any BSCT made the greatest reductions in drinking. Participants who received MI at week 4 and BSCT at week 8 outperformed all other groups. ConclusionFindings reveal that prolonged treatment, more sessions, and/or a specific combination of MI and BSCT provided optimal outcomes. Future research should determine whether such an algorithm holds across heterogenous groups of individuals with AUD.

Fidelity of motivational interviewing with families in high-caries-risk children.

Motivational interviewing (MI) is a promising behavioural intervention for prevention of dental caries in children. Few studies have reported on fidelity of MI delivered in dental settings. The aim of this paper is to explore the fidelity of implementing MI in a clinical dental practice setting, as part of an intervention study investigating caries-preventive effects of MI delivered to high-caries-risk children and their primary caregivers. Three oral health therapy clinicians trained in MI (counsellors) provided MI to high-caries-risk children and their primary caregivers. All MI sessions (n=34) were audio-recorded and analysed using the MI Treatment Integrity code 4.2.1. Qualitative analysis of counsellor self-reflections identified barriers to MI delivery. All counsellors were found to adhere to the MI process and demonstrated fair to good MI proficiency for global scores, with a mean (95% CI) of 3.3 (3.1-3.4) recorded for technical scores and 3.6 (3.5-3.8) for relational scores. The mean (95% CI) per cent complex reflections was 23% (19.4-27.1) and the mean reflection:question ratio was 0.7 (0.6-0.9). No significant differences were observed between counsellors for MI proficiency. Cultural barriers, environmental distractions, participant dental anxiety and counsellor tendency towards prescriptive advice-giving were identified by counsellors as hindrances to effective MI. Motivational interviewing is a skill which requires multifaceted training, practice and mentoring to meet accepted proficiency thresholds. Monitoring of MI using a validated tool is essential to ensure delivery as intended and accurately attribute outcomes to the intervention. Dental organizations intending to implement MI for caries prevention should be aware of the demands on time and resources required to deliver proficient MI and monitor fidelity.

Effectiveness of a psychological intervention delivered by general nurses for alcohol use disorders in people living with HIV in Zimbabwe: a cluster randomized controlled trial.

IntroductionThere have been very few randomized clinical trials of interventions for alcohol use disorders (AUD) in people living with HIV (PLWH) in African countries. This is despite the fact that alcohol use is one of the modifiable risk factors for poor virological control in PLWH on antiretroviral therapy.MethodsSixteen clinic clusters in Zimbabwe were selected through stratified randomization and randomized 1: 1 to Intervention and Control arms. Inclusion criteria for individual participants were being adult, living with HIV and a probable alcohol use disorder as defined by a score of 6 (women) or 7 (men) on the Alcohol Use Disorders Identification Test (AUDIT). In the Intervention clusters, participants received 8 to 10 sessions of Motivational Interviewing blended with brief Cognitive Behavioural Therapy (MI‐CBT). In the control clusters, participants received four Enhanced Usual Care (EUC) sessions based on the alcohol treatment module from the World Health Organisation mhGAP intervention guide. General Nurses from the clinics were trained to deliver both treatments. The primary outcome was a change in AUDIT score at six‐month post‐randomization. Viral load, functioning and quality of life were secondary outcomes. A random‐effects analysis‐of‐covariance model was used to account for the cluster design.ResultsTwo hundred and thirty‐four participants (n = 108 intervention and n = 126 control) were enrolled across 16 clinics. Participants were recruited from November 2016 to November 2017 and followed through to May 2018. Their mean age was 43.3 years (SD = 9.1) and 78.6% (n = 184) were male. At six months, the mean AUDIT score fell by −6.15 (95% CI −6.32; −6.00) in the MI‐CBT arm, compared to a fall of − 3.09 95 % CI − 3.21; −2.93) in the EUC arm (mean difference −3.09 (95% CI −4.53 to −1.23) (p = 0.05). Viral load reduced and quality of life and functioning improved in both arms but the difference between arms was non‐significant.ConclusionsInterventions for hazardous drinking and AUD comprising brief, multiple alcohol treatment sessions delivered by nurses in public HIV facilities in low‐income African countries can reduce problematic drinking among PLWH. Such interventions should be integrated into the primary care management of AUD and HIV and delivered by non‐specialist providers. Research is needed on cost‐effectiveness and implementation of such interventions, and on validation of cut‐points for alcohol use scales in low resource settings, in partnership with those with lived experience of HIV and AUD.