Telephone-based Motivational Interviewing Research Articles

Effectiveness of Motivational Interviewing in Increasing Use of Hearing Protection Devices Among Agricultural Producers.

Agricultural producers are frequently exposed to noise that is hazardous to their hearing and cardiovascular health, and have among the highest rates of noise-induced hearing loss of all occupations. However, despite information-sharing approaches, few producers wear sufficient hearing protection. There is a need to develop effective methods of protecting producers from their noise exposure. We provided a series of 2 to 3 short (30-minute) telephone-based motivational interviewing (MI) sessions to noise-exposed agricultural producers. We assessed intervention effectiveness through changes in measuring hearing protector use pre- and post-intervention using a one-group pre/posttest design. The sample (N = 29) predominantly consisted of crop producers from Michigan. The mean percentage of time hearing protection was used increased from 44.9% to 51.8% after the intervention, approximately a 7% increase (p =.105). Regression analysis suggested the relationship between intervention dose and use of hearing protection was not correlative. There was a marginal increase in the use of hearing protection after the intervention, although setting-specific increases in use were uneven. Intervention dose did not correlate with a change in hearing protection use. Further research is warranted to determine the effectiveness of MI, how it compares to information sharing, and to identify intervention dose parameters that promote efficiency.

Effects of Individualized Aerobic Exercise Training on Physical Activity and Health-Related Physical Fitness among Middle-Aged and Older Adults with Multimorbidity: A Randomized Controlled Trial.

The presence of multimorbidity in middle-aged and older adults, which reduces their physical activity and quality of life, is a global health challenge. Exercise is one of the most important health behaviors that individuals can engage in. Previous studies have revealed that aerobic exercise training is beneficial for healthy middle-aged and older adults and those with various chronic diseases, but few studies have designed individualized aerobic exercise training for individuals with multimorbidity. Although individuals with multimorbidity are considerably less adherent to physical activity interventions, telephone-based motivational interviewing may help in strengthening motivation and promoting behavioral change for increasing physical activity and health-related physical fitness. This study aimed to examine whether a 12-week individualized aerobic exercise training in a rehabilitation center combined with telephone-based motivational interviewing is effective in promoting physical activity and health-related physical fitness among middle-aged and older adults with multimorbidity. A randomized controlled trial was conducted. Forty-three participants (aged > 40) were recruited and randomly assigned to the intervention group, comparison group, or control group. The participants’ physical activity and health-related physical fitness were assessed at baseline and at 12 weeks. The results indicated that after individualized aerobic exercise training combined with telephone-based motivational interviewing, the participants reported increased total physical activity (Fin = 481.3, p = 0.011), vigorous-intensity physical activity (Fin = 298.9, p = 0.007), dominant and nondominant hand grip (kg) (Fin = 1.96, p = 0.019; Fin = 2.19, p = 0.027, respectively), FEV1/FVC (Fin = 0.045, p = 0.043), VO2 max (ml/kg/min) (Fin = 5.30, p = 0.001), VO2 max predicted (%) (Fin = 21.6, p = 0.001), work (watts) (Fin = 22.5, p = 0.001), and anaerobic threshold (L/min) (Fin = 0.165, p = 0.011). Twelve weeks of individualized aerobic exercise training in the rehabilitation center combined with telephone-based motivational interviewing can increase the total physical activity, vigorous physical activity, and cardiorespiratory fitness of middle-aged and older adults with multimorbidity.

Impact of Patient-Clinical Team Secure Messaging on Communication Patterns and Patient Experience: Randomized Encouragement Design Trial.

BackgroundAlthough secure messaging (SM) between patients and clinical team members is a recommended component of continuous care, uptake by patients remains relatively low. We designed a multicomponent Supported Adoption Program (SAP) to increase SM adoption among patients using the Veterans Health Administration (VHA) for primary care.ObjectiveOur goals were to (1) conduct a multisite, randomized, encouragement design trial to test the effectiveness of an SAP designed to increase patient engagement with SM through VHA’s online patient portal (My HealtheVet [MHV]) and (2) evaluate the impact of the SAP and patient-level SM adoption on perceived provider autonomy support and communication. Patient-reported barriers to SM adoption were also assessed.MethodsWe randomized 1195 patients at 3 VHA facilities who had MHV portal accounts but had never used SM. Half were randomized to receive the SAP, and half served as controls receiving usual care. The SAP consisted of encouragement to adopt SM via mailed educational materials, proactive SM sent to patients, and telephone-based motivational interviews. We examined differences in SM adoption rates between SAP recipients and controls at 9 months and 21 months. Follow-up telephone surveys were conducted to assess perceived provider autonomy support and self-report of telephone communication with clinical teams.ResultsPatients randomized to the SAP had significantly higher rates of SM adoption than the control group (101/595, 17.0% vs 40/600, 6.7%; P<.001). Most adopters in the SAP sent their first message without a motivational interview (71/101, 70.3%). The 10-percentage point difference in adoption persisted a full year after the encouragement ended (23.7%, 142/600 in the SAP group vs 13.5%, 80/595 in the control group, P<.001). We obtained follow-up survey data from 49.54% (592/1195) of the participants. SAP participants reported higher perceived provider autonomy support (5.7 vs 5.4, P=.007) and less telephone use to communicate with their provider (68.8% vs 76.0%, P=.05), compared to patients in the control group. Patient-reported barriers to SM adoption included self-efficacy (eg, not comfortable using a computer, 24%), no perceived need for SM (22%), and difficulties with portal password or login (17%).ConclusionsThe multicomponent SAP was successful in increasing use of SM 10 percentage points above standard care; new SM adopters reported improved perceptions of provider autonomy support and less use of the telephone to communicate with their providers. Still, despite the encouragement and technical assistance provided through the SAP, adoption rates were lower than anticipated, reaching only 24% at 21 months (10% above controls). Common barriers to adoption such as limited perceived need for SM may be more challenging to address and require different interventions than barriers related to patient self-efficacy or technical difficulties.Trial RegistrationClinicalTrials.gov NCT02665468; https://clinicaltrials.gov/ct2/show/NCT02665468

Telephone-based motivational interviewing enhanced with individualised personality-specific coping skills training for young people with alcohol-related injuries and illnesses accessing emergency or rest/recovery services: a randomized controlled trial (QuikFix).

Recent meta-analyses of motivational interviewing (MI) for reducing risky alcohol use in young people have reported modest effects. Few studies have targeted individual patient factors to increase MI effectiveness. This study determined if MI enhanced with individualised personality-specific coping skills training (QuikFix) was more efficacious than standard MI or an assessment feedback/information (AF/I) control among young people with alcohol-related injuries or illnesses. Single-centre, single-blind, three-group superiority randomized controlled trial with 1-, 3-, 6- and 12-months follow-ups. Telephone intervention, Brisbane, Australia. A total of 398 young people (16-25years; M age=20.30years, SD=2.12; 54% female) with alcohol-related injuries and/or illnesses were recruited from an emergency department (ED) or rest/recovery service (RRS). The primary outcome was total standard (10 g ethanol) drinks in the past month (Timeline Follow back [TLFB]) at 12months (primary time point). Secondary outcomes were total drinking days and standard drinks per drinking day (TLFB) in the past month and the frequency of alcohol-related problems in the past 3months (Rutgers Alcohol Problem Index). Young people were randomized to two sessions of QuikFix enhanced with individualised personality-specific coping skills training (n=132), two sessions of MI (n=136) or one session of AF/I (n=130), all delivered by telehealth. QuikFix resulted in greater reductions (all P<0.0017) in the primary outcome of total standard drinks (M=19.50, CI 99.75%=[11.31, 27.68]) than both MI (M=32.61, CI 99.75%=[24.82, 40.40]; Cohen's D=0.40) and AF/I (M=34.12, CI 99.75%=[26.59, 41.65]; D=0.45) at 12months (retention n=324/398, 81%). QuikFix had greater reductions on drinking days (M=3.16, CI 99.75%=[2.37, 3.96]) than both MI (M=4.53, CI 99.75%=[3.57, 5.48];D=0.38) and AF/I (M=4.69, CI 99.75%=[3.73, 5.65];D=0.42) and fewer drinks per drinking day (M=5.02, CI 99.75%=[3.71, 6.33]) than AF/I (M=7.15, CI 99.75%=[5.93, 8.38;D=0.47) at 12months. Young people with alcohol-related injuries and/or illnesses who attended ED and rest/recovery services and received an individualised personality-specific coping skills training intervention (QuikFix) had greater reductions in the amount of alcohol consumed at 12months compared with those who received motivational interviewing or an assessment feedback/information intervention.

A Pilot Randomized Controlled Trial to Assess the Impact of Motivational Interviewing on Initiating Behavioral Therapy for Migraine.

Relaxation, biofeedback, and cognitive behavioral therapy are evidence-based behavioral therapies for migraine. Despite such efficacy, research shows that only about half of patients initiate behavioral therapy recommended by their headache specialists. Motivational interviewing (MI) is a widely used method to help patients explore and overcome ambivalence to enact positive life changes. We tested the hypothesis that telephone-based MI would improve initiation, scheduling, and attending behavioral therapy for migraine. Single-blind randomized controlled trial comparing telephone-based MI to treatment as usual (TAU). Participants were recruited during their appointments with headache specialists at two sites of a New York City medical center. ages from 16 to 80, migraine diagnosis by United Council of Neurologic Subspecialty fellowship trained and/orcertified headache specialist, and referral for behavioral therapy for prevention in the appointment of recruitment. having done behavioral therapy for migraine in the past year. Participants in the MI group received up to 5 MI calls. TAU participants were called after 3months for general follow-up data. The prespecified primary outcome was scheduling a behavioral therapy appointment, and secondary outcomes were initiating and attending a behavioral therapy appointment. 76 patients were enrolled and randomized (MI=36, TAU=40). At baseline, the mean number of headache days was 12.0±9.0. Self-reported anxiety was present for 36/52 (69.2%) and depression for 30/52 (57.7%). Follow-up assessments were completed for 77.6% (59/76, MI=32, TAU=27). The mean number of MI calls per participant was 2.69±1.56 [0 to 5]. There was a greater likelihood of those in the MI group to initiating an appointment (22/32, 68.8% vs 11/27, 40.7%, P=.0309). There were no differences in appointment scheduling or attendance. Reasons stated for not initiating behavioral therapy were lack of time, lack of insurance/funding, prioritizing other treatments, and travel plans. Brief telephone-based MI may improve rates of initiation of behavioral therapy for migraine, but other barriers appear to lessen the impact on scheduling and attending behavioral therapy appointments.

Telephone-based Motivational Interviewing for Smoking Cessation in Crohn's Disease Patients

Telephone-based Motivational Interviewing for Smoking Cessation in Crohn's Disease Patients

QuikFix: A Randomized Controlled Trial of Telephone-Based Motivational Interviewing Enhanced with Individualised Personality-Targeted Coping Skills Training for Young People with Alcohol-Related Injuries and Illnesses Accessing Emergency Services

Background: Alcohol related visits to emergency departments (EDs) among young people present a unique opportunity for alcohol treatment. Brief interventions using motivational interviewing (MI) targeting alcohol consumption have been widely studied for young people in EDs, but effect sizes are modest. Yet, most existing studies have not adapted MI to the needs of young people or targeted individual patient factors to increase effectiveness, and the public health impact of MI. This study compared the efficacy of telephone-delivered Assessment Feedback/Information (AF/I), standard MI, and QuikFix MI enhanced with individualised personality-risk targeted coping skills training for reducing alcohol consumption and related problems in young people presenting to an ED or rest/recovery service with alcohol-related injuries or illnesses. Methods: This single-blind superiority trial randomized 398 young people (16-25 years), to one-session of AF/I, or two sessions of AF/I plus MI or QuikFix. Participants were assessed at baseline, 1, 3, 6 and 12 months on the primary outcomes of alcohol consumption and alcohol-related problems. Findings: Reductions in consumption and alcohol-related problems were seen across the sample at all post-baseline assessments. At 1 month, QuikFix had significantly greater reductions in total standard (10 gm ethanol) drinks than MI (β = -15.09, 95% CI = [-24.09, -6.09]). At 12 months, QuikFix had greater reductions in total standard drinks and drinking days than both MI (β=-14.51, 95% CI = [-23.77, -5.26] and β = -0.34, 95% CI = [-0.52, -0.16]) and AF/I (β = -21.87, 95% CI = [-30.95, -12.79] and β = - 0.44, 95% CI = [-0.62, -0.27]) and had fewer standard drinks per drinking day compared with AF/I (β = -1.83, 95% CI = [-3.22, -0.45]) but not MI (β = -1.09, 95% CI = [-2.50, 0.32]). No differential effects on alcohol-related problems were found, but all groups improved. Interpretation: QuikFix had stronger effects on the alcohol consumption of young ED or rest/recovery service attendees than AF/I or MI over 12 months. Trial Registration: registered ANZCTR ACTRN 12613000108718. Funding Statement: This project was funded by an Australian National Health and Medical Research Council (NHMRC) Project Grant (APP1044046). Leanne Hides and Susan Cotton are supported by NHMRC Senior Research Fellowships. Gary Chan is supported by a University of Queensland Research Fellowship. During the study Jason Connor was supported by a NHMRC Career Development Fellowship (APP1031909). Declaration of Interests: The authors declare they have no conflicts of interest. Ethics Approval Statement: Ethical approvals were obtained from the relevant university and hospital human research ethics committees. SPIRIT and CONSORT Guidelines were followed.

Telephone-based motivational interviewing versus usual care in primary care to increase physical activity: a randomized pilot study

BackgroundDiabetes and prediabetes are chronic conditions that affect over 40% of the US adult population combined. Regular physical activity can benefit people with diabetes through improved glucose control and can reduce the conversion of prediabetes to diabetes. Studies are needed in settings where people with these conditions can be identified and provided the skills and support to increase physical activity. The primary care setting meets this need, but there are insufficient high-quality trials to recommend this approach be broadly implemented.MethodsWe conducted a randomized, 24-week pilot study in Southern California to assess the feasibility of using information technology systems available in primary care for identifying potential participants, test methods for obtaining physical activity clearance, conducting mail-based assessments, and delivering telephone-based motivational interviewing to increase physical activity. Eligibility criteria included age between 18 and 74 years, diabetes or prediabetes, and physically inactive based on a clinical assessment tool. At baseline and follow-up, physical activity was assessed by a 7-day accelerometry, cardiometabolic risk factors were collected from electronic medical records, and psychosocial factors were assessed from validated questionnaires administered through a mail survey. Participants were block randomized into intervention or usual care. Staff collecting outcome data were blinded to group assignment. Analysis of covariance was used to assess the difference at follow-up between the intervention and usual care, adjusting for baseline.ResultsA total of 67 participants were randomized. Follow-up mail assessments were completed by 53 participants. Of 224 potential intervention calls, 194 were completed (87%). Psychosocial measures significantly improved in four of the five factors for physical activity motivation relative to participants in the usual care arm. The more internally focused factors for exercise self-regulation and outcome expectancies scores were significantly greater for participants in intervention compared with usual care. Moderate to vigorous physical activity improved in intervention participants relative to usual care, but the difference was not statistically significant. No adverse events were noted.ConclusionsThe objectives of this pilot study were met. If a fully powered trial is successful, primary care settings with “behind-the-scenes” information technology support may be appropriate to increase physical activity among patients with prediabetes and diabetes.Trial registrationExercise Promotion in Primary Care (EPPC), NCT03429088, registered on February 5, 2018.

Impact of motivational interviewing on engagement in a parent-exclusive paediatric obesity intervention: randomized controlled trial of NOURISH+MI.

Attrition and treatment adherence are notorious challenges in paediatric obesity interventions. To evaluate if brief, pretreatment motivational interviewing (MI) can improve retention (at baseline, post-assessment and follow-up assessment) and adherence (i.e. attendance) in a parent-exclusive paediatric obesity intervention. MI was implemented with parents as an adjunct to a larger randomized controlled trial of Nourishing Our Understanding of Role-modeling to Improve Support and Health (NOURISH+ ), a parent intervention for children with overweight ages 5-11years. Parents (N=112) were randomized to receive two MI sessions (one telephone and one in person) or reminder calls. Parents (91% women; 52% African American) who completed one telephone MI session were more likely to attend baseline (74%) compared with parents who received reminder calls only (53%, p<.001). After a second MI session, there were no group differences in treatment initiation (p>.05). Treatment attendance, post or 4-month follow-up assessment completion did not differ between conditions (p>.05). One MI session implemented prior to treatment can improve baseline attendance; a second MI session did not enhance these effects. A single-session telephone-based MI pretreatment might be a cost and time-effective strategy to enhance recruitment efforts. Further strategies to address retention and treatment attendance are needed.

Investigation of Motivational Interviewing and Prevention Consults to Achieve Cardiovascular Targets (IMPACT) trial

BackgroundPatients undergoing cardiovascular (CV) procedures often have suboptimal CV risk factor control and may benefit from strategies targeting healthy lifestyle behaviors and education. Implementation of prevention strategies may be particularly effective at this point of heightened motivation. MethodsA prospective, randomized, pilot study was conducted in 400 patients undergoing a nonurgent CV procedure (cardiac catheterization ± revascularization) to evaluate the impact of different prevention strategies. Patients were randomized in a 1:1:1 fashion to usual care (UC; group A, n = 134), in-hospital CV prevention consult (PC; group B, n = 130), or PC plus behavioral intervention program (telephone-based motivational interviewing and optional tailored text messages) (group C, n = 133). The primary end point was the Δ change in non–high-density lipoprotein cholesterol (non–HDL-C) from baseline to 6 month. ResultsThe mean age was 64.6 ± 10.8 years, 23.7% were female, and 31.5% were nonwhite. After 6 months, the absolute difference in non–HDL-C for all participants was −19.8 mg/dL (95% CI −24.1 to −15.6, P < .001). There were no between-group differences in the primary end point for the combined PC groups (B and C) versus UC, with a Δ adjusted between group difference of −5.5 mg/dL (95% CI −13.1 to 2.1, P = .16). Patients in the PC groups were more likely to be on high-intensity statins at 6 months (52.9% vs 38.1%, P = .01). After excluding participants with baseline non–HDL-C <100 mg/dL (initial exclusion criterion), Δ non–HDL-C and Δ low-density lipoprotein cholesterol were improved in the PC groups compared to UC (non–HDL-C −8.13 mg/dL [−16.00 to −0.27], P = .04; low-density lipoprotein cholesterol −7.87mg/dL [−15.10 to −0.64], P = .03). ConclusionsAlthough non–HDL-C reduction at 6 months following a nonurgent CV procedure was not significant in the overall cohort, an increased uptake in high-potency statins may translate into improved long-term health outcomes and cost reductions.

Baseline predictors of DMT reinitiation among patients with multiple sclerosis following an MI-CBT intervention.

Patients with multiple sclerosis (MS) are often nonadherent to their disease modifying therapy (DMT). While recent studies demonstrate enhanced DMT adherence following intervention grounded in motivational interviewing (MI), little is known about how to address DMT reinitiation among MS patients who have prematurely discontinued DMT against medical advice and do not intend to reinitiate. We examined baseline predictors of DMT reinitiation among patients with MS who discontinued medications against medical advice following a telephone-based MI and Cognitive Behavioral Therapy (MI-CBT) intervention. Following MI-CBT intervention, 66 patients reported whether or not they opted to reinitiate DMT. Rate of disease progression (β=0.295) and perceived personal control (β=-0.131) emerged as unique significant predictors of DMT reinitiation following intervention. Clinical characteristics and health-related beliefs may be used to prospectively identify patients most likely to reinitiate DMT following MI-CBT intervention, furthering the goal of preserving brain health and preventing neurologic decline in MS via appropriate DMT utilization. Further study is warranted to delineate potential mediators and moderators of DMT reinitiation outcomes.

Can We Identify Minority Patients at Risk of Nonadherence to Antiplatelet Medication at the Time of Coronary Stent Placement?

Lack of medication adherence is associated with significant morbidity and mortality, particularly among minorities. We aim to identify predictors of nonadherence to antiplatelet medications at the time of percutaneous coronary intervention (PCI) with stent among African American and Hispanic patients. We used data collected for a randomized clinical trial that recruited 452 minority patients from a large US health insurance organization in 2010 post-PCI to compare telephone-based motivational interviewing by trained nurses with an educational video. The primary outcome was 12-month adherence to antiplatelet medications measured by the claims-based medication possession ratio (MPR). Adequate adherence was defined as an MPR of 0.80 or higher. More than half of the sample (age, 69.52 ± 8.8 years) was male (57%) and Hispanic (57%). Most (78%) had a median income below $30 000 and 22% completed high school or higher. Univariate analyses revealed that symptoms of depression (<.01) and not having a spouse (P = .03) were associated with inadequate adherence. In multivariate analysis, baseline self-reported adherence (1.4; 95% confidence interval [CI], 1.05-1.89), depressive symptoms (0.49; 95% CI, 0.7-0.90), comorbidity (0.89; 95% CI, 0.80-0.98), and telephone-based motivational interviewing by trained nurses (3.5; 95% CI, 1.9-2.70) were associated with adherence. Having multiple comorbidities, depression, suboptimal adherence to medications, and low English proficiency at the time of PCI increase the risk of poor 12-month adherence to antiplatelets among minorities. Identifying these risk factors can guide PCI therapy and the use of evidence-based strategies to improve long-term adherence.

Effects of nurse-led home-based exercise & cognitive behavioral therapy on reducing cancer-related fatigue in patients with ovarian cancer during and after chemotherapy: A randomized controlled trial

BackgroundHigh levels of fatigue have been documented in ovarian cancer patients. However, increased levels of fatigue are positively associated with a high risk of sleep disturbance and depression. ObjectiveTo investigate the feasibility of a nurse-led home-based exercise and cognitive behavioral therapy (E&CBT) for ovarian cancer adults with cancer-related fatigue on outcomes of fatigue, plus other secondary outcomes (sleep disturbance and depression), either during or after completion of primary cancer treatment. DesignRandomized, single-blind control trial. SettingsGynaecologic oncology department of the First Hospital of Jilin University in China. Participants72 eligible women who recently had surgery and completed their first cycle of adjuvant chemotherapy were randomly assigned to two groups. InterventionThe experimental group received exercise and cognitive behavioral therapy. Five nurses with nursing master degree were trained to deliver this intervention. Patients received online interventions each week in the patient's place of residence or in the nurse-led clinic, as requested. Home visits, coupled with telephone-based motivational interviews twice a week were available with the permission of the participants. comparison group participants received services as usual. MeasurementsThe primary outcome was measured by the Chinese version of the Piper Fatigue Scale that has 4 subscales (Behavior, Affect, Sensory, and Cognition). Secondary outcomes were measured using the Self-Rating Depression Scale and the Pittsburgh Sleep Quality Index questionnaire. Repeated-measure ANOVA was used to examine the effectiveness of this intervention in reducing fatigue, depression, and improving sleep quality. ResultsFor baseline comparisons, no significant differences were found between the two groups. After the interventions, total fatigue scores were significantly reduced from T1 to T2, to T3 in the experimental group (4.37, 4.24, 3.90), respectively. The comparison group showed almost no change in total fatigue score over time. In the repeated measures ANOVA, the differences of behavioral fatigue score (F=11.647, p=0.001) and cognitive fatigue score (F=5.741, p=0.019) were statistically significant for the group by time interaction. After the interventions, the experimental group participants demonstrated significantly lower symptoms of depression compared with the comparison group (T2: p=0.001 and T3: p<0.001). Sleep duration, sleep dysfunction, daytime dysfunction as well as total sleep quality significantly improved. ConclusionNurse-delivered home-based E&CBT have measurable benefits in helping women with ovarian cancer to decrease cancer-related fatigue, depressive symptoms, and improving their quality of sleep.

Effects of telephone-based motivational interviewing in lifestyle modification program on reducing metabolic risks in middle-aged and older women with metabolic syndrome: A randomized controlled trial

BackgroundLifestyle modification is often difficult for middle-aged and older women living in the community who are at high risk of physical inactivity and metabolic syndrome. ObjectivesTo examine the effects of telephone-based motivational interviewing in a 12-week lifestyle modification program on physical activity, MetS, metabolic risks (fasting plasma glucose, blood pressure, triglyceride, high-density lipoprotein, and central obesity), and the number of metabolic risks in community-living middle-aged and older women diagnosed with metabolic syndrome. Research design and methodA randomized controlled trial was conducted. Recruited were 328 middle-aged and older women from a community health center in Taiwan. Eligible women medically diagnosed with metabolic syndrome (n=115) were randomly assigned to one of three groups: The experimental group received an individualized telephone delivered lifestyle modification program that included motivational interviewing delivered by an experienced nurse. The brief group received a single brief lifestyle modification counseling session with a brochure. The usual care group received standard care. Physical activity was assessed with the International Physical Activity Questionnaire and metabolic risks were determined by serum markers and anthropometric measures at pre- and post-intervention. One hundred women completed the study and an intention-to-treat analysis was performed. Generalized estimating equations were used to examine the intervention effects. ResultsWomen in the experimental group increased physical activity from 1609 to 1892 MET-min/week (β=846, p=.01), reduced the percentage of diagnosed with metabolic syndrome to 81.6% (β=−0.17, p=.003), and decreased the number of metabolic risks from 4.0 to 3.6 (β=−0.50, p<.001), compared to the usual care group (4.4–4.6). There was not a reduction in the percentage of diagnosed with metabolic syndrome in the brief group, but they had fewer metabolic risks after 12 weeks (mean=4.0 vs. 4.6, β=−0.2, p=.02) compared to the usual care group. ConclusionsMotivational interviewing as a component of an individualized physical activity and lifestyle modification program has positive benefit in reducing metabolic risks in middle-aged and older women.

Rationale and design of the Investigation of Motivational Interviewing and Prevention Consults to Achieve Cardiovascular Targets (IMPACT) trial

Patients undergoing cardiovascular procedures remain at increased risk for myocardial infarction, stroke, and cardiovascular death. Risk factor control in this patient population remains suboptimal and would likely benefit from strategies targeting education, lifestyle, and healthy behaviors. The IMPACT trial is a 400-subject prospective randomized trial designed to compare different cardiovascular prevention strategies in subjects following a cardiovascular intervention. The trial began enrollment in the Spring of 2012 and is randomizing subjects in a 1:1:1 manner to usual care, a one-time cardiovascular prevention consult, or a one-time cardiovascular prevention consult plus behavioral intervention program (telephone-based motivational interviewing and tailored text messages) over a 6-month period. The primary end point is non-high-density lipoprotein cholesterol. Secondary end points include other plasma lipid values, metabolic risk, smoking cessation, physical activity, dietary intake, medication use and adherence, and quality of life. The IMPACT trial provides data on different management strategies for risk factor optimization in subjects following cardiovascular procedures. The results will provide a platform for the continued development of novel multidisciplinary interventions in this high-risk population.

Telephone-based motivational interviewing for medication adherence: a systematic review.

Adherence to prescribed medications continues to be a problem in the treatment of chronic disease. Motivational interviewing (MI) has been shown to be successful for eliciting patients' motivations to change their medication-taking behaviors. Due to the constraints of the US healthcare system, patients do not always have in-person access to providers. Because of this, there is increasing use of non-traditional healthcare delivery methods such as telephonic counseling. A systematic review was conducted among published studies of telephone-based MI interventions aimed at improving the health behavior change target of medication adherence. The goals of this review were to (1) examine and describe evidence and gaps in the literature for telephonically delivered MI interventions for medication adherence and (2) discuss the implications of the findings for research and practice. The MEDLINE, CINAHL, psycINFO, psycARTICLES, Academic Search Premier, Alt HealthWatch, Health Source: Consumer Edition, and Health Source: Nursing/Academic Edition databases were searched for peer-reviewed research publications between 1991 and October 2012. A total of nine articles were retained for review. The quality of the studies and the interventions varied significantly, which precluded making definitive conclusions but findings among a majority of retained studies suggest that telephone-based MI may help improve medication adherence. The included studies provided promising results and justification for continued exploration in the provision of MI via telephone encounters. Future research is needed to address gaps in the current literature but the results suggest that MI may be an efficient option for healthcare professionals seeking an evidence-based method to reach remote or inaccessible patients to help them improve their medication adherence.

Affective mediators of a physical activity intervention for depression in multiple sclerosis.

Previous analyses showed that a telephone-based intervention to increase physical activity in individuals with multiple sclerosis (MS) and depression resulted in significantly improved depressive symptoms compared to a wait-list control group. The aim of this study was to test positive affect and negative affect as mediators of the effect of the physical activity counseling on depressive symptoms. Ninety-two adults with MS, who met diagnostic criteria for either major depression or dysthymia and who reported low levels of physical activity, were randomized 1:1 to a 12-week telephone-based motivational interviewing (MI) intervention to improve physical activity (n = 44) or to a 12-week wait-list control group (n = 48). Self-reported positive and negative affect, physical activity, and depressive symptoms were gathered at baseline and postintervention. Path-analysis was used to test whether positive affect and negative affect mediated the positive effects of the intervention on depressive symptoms. Both positive and negative affect were significant mediators of the effects of the intervention on depressive symptoms; however, only positive affect mediated the association between changes in physical activity and improved depressive symptoms. Findings support physical activity and positive affect as key mediators of the MI treatment effect on improved mood. Decreases in negative affect were also evident in the treatment group, but were not related to improved physical activity. Findings may suggest the use of exercise-based interventions in conjunction with treatments that specifically target negative affective mechanisms for depression.

A randomized trial of telephone-based motivational interviewing for adolescent chronic headache with medication overuse

Nearly 2% of youths suffer from chronic migraine or chronic tension-type headache (CTTH). A contributing factor in approximately 20%-50% of these youths is medication overuse, which involves taking analgesics three or more times per week for three months. The objective of this study was to test motivational interviewing (MI) as an approach to promote adherence to recommendations regarding not only analgesic overuse but also other aspects of treatment plans. A randomized controlled trial was conducted comparing the experimental condition (standard of care clinic-based treatment with supplemental MI phone calls; N = 24) to a control condition (standard of care clinic-based treatment without these supplemental MI phone calls; N = 23). Four months after enrollment, a research assistant who was blinded to study condition telephoned adolescents inquiring about headache frequency, headache severity, and disability. Headache frequency was lower in the experimental condition versus control condition for those with relatively lower initial levels of headache frequency. In contrast, we did not find greater improvement in headache severity and disability for the experimental condition relative to the control condition. Our findings provided some preliminary, albeit limited, support for MI as an approach to improve outcomes for adolescent medication-overuse headache (MOH).

Telephone-Based Motivational Interviewing to Promote Physical Activity and Stage of Change Progression in Older Adults

This study examined the efficacy of motivational interviewing (MI) for increasing physical activity in aging adults. Eighty-six participants aged 55 years and older were randomly assigned to receive either four weekly sessions of telephone-based MI for increasing physical activity, or a healthy activity living guide (information only control). Changes from baseline weekly caloric expenditure from physical activity, self-efficacy for physical activity, and stage of change for physical activity were compared across groups at posttreatment and six months follow-up. Results indicated that MI participants had higher weekly caloric expenditures from physical activity at posttreatment, but not at six months follow-up; higher self-efficacy for physical activity at six months follow-up; and demonstrated greater stage of change progression across assessments. These findings support the use of telephone-based MI for increasing physical activity in older adults in the short-term. Future studies will need to determine if follow-up booster sessions increase long-term efficacy.

Direct and Mediated Effects of Two Theoretically Based Interventions to Increase Consumption of Fruits and Vegetables in the Healthy Body Healthy Spirit Trial

This study tested the effects of two theory-based interventions to increase fruit and vegetable intake. Hypothesized intervention mediators included self-efficacy (SE), social support (SS), autonomous motivation (AM), and controlled motivation (CM). At baseline, 1,021 African American adults were recruited from 16 churches randomized to one comparison and two intervention groups: Group 1 (standard educational materials), Group 2 (culturally targeted materials), and Group 3 (culturally targeted materials and telephone-based motivational interviewing). A well-fitted model based on structural equation modeling-χ(2)(df = 541, N = 353, 325) = 864.28, p < .001, normed fit index = .96, nonnormed fit index = .98, comparative fit index = .98, root mean square error of approximation = .042-demonstrated that AM was both a significant mediator and moderator. In the subgroup with low baseline AM, AM mediated 17% of the effect of the Group 3 intervention on fruit and vegetable intake. Conversely, SS, SE, and CM were not significant mediators. Implications related to theory and intervention development are discussed.