Use Of Motivational Interviewing Research Articles

Review of barriers and interventions to promote treatment engagement for pediatric attention deficit hyperactivity disorder care.

Attention deficit hyperactivity disorder (ADHD) is a common and impairing behavioral health disorder, impacting over 5% of children worldwide. There are multiple evidence-based pharmacological and psychosocial treatments for ADHD, and greater service utilization is associated with improved acute and long-term outcomes. However, long-term outcomes are suboptimal as multimodal treatments are often not accessed and most care ends prematurely. This narrative review discusses barriers to engagement for children and adolescents with ADHD and their families as well as interventions to overcome these barriers. Families face a variety of structural and attitudinal barriers, ranging from cost and access to stigma and low self-efficacy to successfully implement change. There are multiple interventions that may enhance engagement with ADHD care including psychoeducation, integration of behavioral services in general medical settings, telehealth as well as specific adaptations to existing ADHD treatments, such as the use of motivational interviewing or shared decision making. Integration of behavioral health into general medical settings and telehealth have been found in controlled studies to increase access by reducing both structural and attitudinal barriers. Adding motivational interviewing, shared decision making and other engagement interventions to evidence-based ADHD treatments has been found to reduce attitudinal barriers that translates into improved participation and satisfaction while enhancing outcomes. However, little is known about how to promote extended engagement with ADHD services even though a chronic care model for ADHD is recommended.

Review of Evidence-Based Strategies to Treat Alcohol Use Disorder

Alcohol use disorder (AUD) is a serious, prevalent disorder that affects millions of people. There are numerous evidence-based treatments and strategies to treat AUD, but they are under-utilized for a variety of reasons, including provider stigma, lack of knowledge, lack of professional support, shortage of willing providers, and patient barriers. Disulfiram, naltrexone, and acamprosate are approved but underused medications for the treatment of AUD. Nonpharmacological strategies and treatments include the use of motivational interviewing when talking to patients about their alcohol use, peer support or mutual help groups, and individualized therapy. Nurses are in a prime position to educate themselves and patients on evidence-based treatments for AUD and to help patients access those treatments. [Journal of Psychosocial Nursing and Mental Health Services, 59(12), 7-11.].

A scoping review of the use of motivational interviewing in oral healthcare settings

##Statement of the problem Recently, attention has been given to the use of motivational interviewing (MI), a therapeutic approach that helps people to change, in the oral healthcare setting. MI can be used to evoke positive change in oral health practices using a patient-centred approach that supports dental practitioner-patient relationship building. This can include a broad focus on oral hygiene, nutrition and lifestyle behaviours, or can be specific to elements of oral healthcare such as periodontal treatment. However, the research literature on the efficacy of MI in this context is sparse. ##Purpose of the study The purpose of this study is to collate what is currently known on the use of MI in the oral healthcare setting. ##Materials and methods This comprehensive scoping review collated 50 published articles on this topic. Articles were scrutinised and analysed using thematic analysis. ##Results Findings indicate that there is a heterogeneous literature base on the use of MI in the oral healthcare setting of varying quality. However, evidence is building for positive outcomes where MI training has contributed to increased confidence, professionalism and relationship building in oral healthcare practitioners, and improved oral healthcare outcomes in patients across a range of oral health issues and oral healthcare prevention. Conclusion: Further research is recommended into what constitutes optimal MI training delivery to ensure best practice and outcomes for patients and professionals.

Exploring Effectiveness of Online Nutrition-Related Diabetes Education Training for Interdisciplinary Healthcare Students at a Student-Run Free Clinic

ObjectivesThe objective of this project was to explore the effectiveness of online nutrition-related diabetes education training for interdisciplinary healthcare students volunteering at a student-run free clinic (SRFC). Providing online nutrition-related diabetes education training to interdisciplinary healthcare students at a student-run free clinic may increase participants’ familiarity with and confidence in providing nutrition-related diabetes education to patients. MethodsStudent volunteers (n = 16) at a SRFC watched an online training video on nutrition-related diabetes education. Topics covered in the training video included the relationship between diet and type 2 diabetes, and the use of motivational interviewing and SMART goals to counsel patients with type 2 diabetes. Using a pre-test/post-test design with eight Likert-scaled (strongly disagree to strongly agree) items, students rated statements indicating familiarity with and confidence in providing nutrition-related diabetes education to patients. Wilcoxon signed-rank tests were conducted to test for statistically significant shifts in each Likert-scaled item pre- to post-test. Statistical significance was set at P ≤ 0.05. ResultsResults showed an overall positive shift in response ratings from the pre- to post-test for all Likert-scaled items. Seven of the eight sets of results had a statistically significant positive shift in response rating (P values < 0.05). ConclusionsFindings indicate that providing online nutrition-related diabetes education to interdisciplinary students volunteering at a SRFC has potential to increase their familiarity with and confidence in providing nutrition-related diabetes education to their patients with diabetes. Funding SourcesNo funding was received.

An audit to assess physical health monitoring of patients following their admission to the general adult psychiatric inpatient wards in Mersey Care NHS Foundation Trust

AimsThis audit aimed to establish whether patients undergo physical health monitoring within 24 hours of admission to one of the general adult inpatient wards in Mersey Care NHS Foundation Trust, as per Trust policy.BackgroundMean life expectancy in individuals with severe and enduring mental illness (SMI) is 15-20 years shorter than that of the general population. A significant proportion of excess mortality in patients with SMI is due to natural causes, e.g. cardiovascular disease and type II diabetes mellitus. Although SMI patients are at greater risk of developing chronic physical health problems, they often receive worse health care than the general population. Shared care of SMI patients between primary and secondary healthcare professionals causes uncertainty over who is responsible for monitoring the physical health of these patients.MethodA list of all inpatients on the eight general adult wards in the Trust was obtained in September 2020, producing a sample of 135 inpatients.An audit tool was designed, capturing demographic data – gender, age, ethnicity. The patient's psychiatric diagnosis was recorded. The tool captured whether each of the following were measured following admission – body mass index (BMI), blood pressure (B.P), serum cholesterol level, QRISK score and HbA1c level, and, if so, whether this was done within 24 hours of admission. For those patients who were smokers, being offered nicotine replacement therapy was documented.ResultOf the 135 inpatients, 10 didn't have any physical health monitoring completed and were excluded from the sample, making the final sample 125 inpatients. 68 of the inpatients were male, 57 were female. 98 had a diagnosis of an SMI, 27 did not. Most inpatients were of “white British” ethnicity. 91% of the sample had a BMI measured within 24 hours of admission, but only 62% had a B.P done, 59% had a serum cholesterol level done and 58% had an HbA1c level done within 24 hours of admission. 78% of eligible patients had a QRISK score calculated. 97% of inpatients who were smokers were offered nicotine replacement therapy, but only 13% accepted it.ConclusionThe majority of patients admitted to the general adult inpatient wards have an SMI. The audit findings show need for improvement in physical health monitoring following admission. Creation and implementation of a checklist of physical health parameters to be measured within 24 hours of admission could help improve performance. Use of motivational interviewing may help increase uptake of nicotine replacement therapy in smokers.

Use of motivational interviewing in behavioural interventions among adults with obesity: A systematic review and meta-analysis.

This review aimed to identify whether motivational interviewing (MI) (a counselling approach for supporting behaviour change [BC]) helps to reduce bodyweight and BMI in an adult obesity context. This included evaluating effectiveness of MI interventions within this population and reporting the methodology used, including theoretical underpinnings and identification of BC and MI techniques. Eight databases were searched using controlled vocabulary. Eligible studies included adults with obesity (BMI ≥30 kg/m2 ), author-reported interventions using MI aiming to reduce body weight or BMI, and comparator groups not receiving an MI intervention. Data extraction and quality appraisal tools were used to identify study characteristics, intervention content was coded for techniques, and random-effects meta-analysis were conducted to investigate effects. Meta-analysis of 12 studies indicated no overall pooled effect on bodyweight and BMI outcomes between intervention and control groups (SMD=-0.01 [95%CI -0.13 to 0.12, P=.93]). Findings were limited by multiple sources accounting for risk of bias, and poor reporting of intervention fidelity and content. Intervention and control content descriptions indicated similar techniques, with social support, goal setting (behaviour) and self-monitoring of behaviour occurring most frequently across both. Findings do not contribute additional evidence for MI use in this context, however methodological limitations were identified which must be resolved to better identify the intervention effects on obesity-related outcomes.

Cross-cultural adaptation of motivational interviewing for use in rural Nepal

BackgroundMotivational Interviewing (MI) has a robust evidence base in facilitating behavior change for several health conditions. MI focuses on the individual and assumes patient autonomy. Cross-cultural adaptation can face several challenges in settings where individualism and autonomy may not be as prominent. Sociocultural factors such as gender, class, caste hinder individual decision-making. Key informant perspectives are an essential aspect of cross-cultural adaptation of new interventions. Here, we share our experience of translating and adapting MI concepts to the local language and culture in rural Nepal, where families and communities play a central role in influencing a person’s behaviors.MethodsWe developed, translated, field-tested, and adapted a Nepali MI training module with key informants to generate insights on adapting MI for the first time in this cultural setting. Key informants were five Nepali nurses who supervise community health workers. We used structured observation notes to describe challenges and experiences in cross-cultural adaptation. We conducted this study as part of a larger study on using MI to improve adherence to HIV treatment.ResultsParticipants viewed MI as an effective intervention with the potential to assist patients poorly engaged in care. Regarding patient autonomy, they initially shared examples of family members unsuccessfully dictating patient behavior change. These discussions led to consensus that every time the family members restrict patient's autonomy, the patient complies temporarily but then resumes their unhealthy behavior. In addition, participants highlighted that even when a patient is motivated to change (e.g., return for follow-up), their family members may not “allow” it. Discussion led to suggestions that health workers may need to conduct MI separately with patients and family members to understand everyone’s motivations and align those with the patient’s needs.ConclusionsMI carries several cultural assumptions, particularly around individual freedom and autonomy. MI adaptation thus faces challenges in cultures where such assumptions may not hold. However, cross-cultural adaptation with key informant perspectives can lead to creative strategies that recognize both the patient’s autonomy and their role as a member of a complex social fabric to facilitate behavior change.

Contact Tracing for COVID-19: The Use of Motivational Interviewing and the Role of Social Work.

One method in mitigating the impact of COVID-19 is that of contact tracing. It is estimated that in the US, 35,000–100,000 contact tracers will be hired (and trained) to talk to recently-infected individuals, understand who they have exposed to the virus, and encourage those exposed to self-quarantine. The Center for Disease Control recommends the use of motivational interviewing (MI) by contact tracers to encourage compliance with contact tracing/quarantine. Contact tracers need to sensitively communicate with COVID-19-exposed individuals who may also be experiencing other issues caused by the pandemic, such as anxiety, depression, grief, anger, intimate partner violence, health problems, food insecurity, and/or unemployment. Social workers are particularly prepared to address the mental health and other psychosocial problems that may be encountered in the tracing process. This article describes contact tracing, its use in other diseases, the role of MI, psychosocial issues that contact tracers may encounter, and how social work can respond to these needs. A sample dialogue of contact tracing using MI is presented with a discussion of the content and skills used in the process.

Practitioners’ Use of Motivational Interviewing in Sport: A Qualitative Enquiry

This study explored the use of motivational interviewing (MI) in sport contexts by experts in that approach. Specifically, the purpose was to understand which aspects of the MI approach are deemed valuable for working in sport and to begin to understand how these aspects are best applied. Nine practitioners participated in semistructured interviews, and thematic analysis identified themes related to core and subcomponents of MI (e.g., relational spirit, technical microskills, applied tools, and the MI communication styles continuum). Additional themes relate to integrating MI with other interventions, the challenges of working with athletes (e.g., mandated attendance, ambivalence about change), and unique aspects of working in sport contexts (e.g., frequency, duration, and location of contact points). The participants also outlined essential ingredients for an MI training curriculum for practitioners in sport. This counseling approach appears to have valuable relational and technical components to facilitate the building of the therapeutic alliance, enhance athlete readiness for change, and support delivery of action-oriented interventions in applied sport psychology.

Improving centre-based group exercise participation of older adults using the behaviour change wheel

An emphasis on active ageing could help to delay the onset of frailty. In Singapore, Senior Activity Centres provide free and guided group exercise sessions for older adults. However, one...

85. Weight Management in Adolescents and Young Adults: An Educational Intervention for Integrated Clinical Teams at School-Based and Family Planning Clinics

Obesity affects nearly 20% of adolescents in the United States. To enhance equitable access to evidence-based obesity management, an educational intervention targeting Advanced Nurse Practitioners (ANPs) and Social Workers (SWs) was implemented at a nine clinic system that provides primary care and family planning services to > 10,000 low-income adolescents and young adults (AYA) annually. The goal of this intervention was to improve providers’ knowledge, attitudes, and behaviors in the following domains: medical management of obesity, use of motivational interviewing (MI) for behavior modification, avoiding weight-related stigma, and addressing social determinants of health.

Stages of Change Scale to Measure Work Readiness of Transition-Age Youth With Disabilities: A Promising Approach

The experience of transitioning into adulthood is a critical phase in life. The navigation of government benefits adds further complexity that can affect employment outcomes for youth with disabilities. Some individuals hesitate to work out of fear to losing access to monetary, disability, and related health care benefits. However, using available work incentives while pursuing employment and career paths can provide opportunities to work and address poverty without forgoing needed services. The Wisconsin Promoting Readiness of Minors in Supplemental Security Income (PROMISE) research grant aimed to positively change youth readiness to work through the use of Motivational Interviewing, work incentive benefits counseling, financial capability building, shifting expectations, and help in navigating transition resources. To measure the impact on readiness to work, 126 transition-age youth receiving supplemental security income (SSI), 188 of their family members, and 411 Division of Vocational Rehabilitation (DVR) counselors working with the youth and families completed a modified Stages of Change Scale survey. Results indicated that youths’ work readiness and positive feelings about work significantly increased from baseline to follow-up, along with an increase in employment rates. The implications of these findings highlight the utility of incorporating the stages of change theory into the design and implementation of services and supports to increase work readiness for youth with disabilities in transition.

Fidelity of motivational interviewing training for dental hygiene students.

Use of Motivational Interviewing (MI), a patient centered counseling strategy in the health professions, has demonstrated efficacy. Given the varied training associated with the delivery of health interventions, it is essential adherence and competence are equivocally assured. Motivational Interviewing Treatment Integrity (MITI) coding evaluated our recorded standardized patient oral assessment and planning sessions to identify the skills in which MI-trained students (n=26) performed compared to student counterparts (n=24) not trained in the MI curriculum. The full integration of MI in those receiving the MI curriculum resulted in the dental hygiene students with higher ratings for all global ratings, behavioral counts, and summary scores. MI-trained mean scores for evocation, collaboration, autonomy support, empathy, and direction ranged from 4.16(±0.43) to 3.85 (±0.67). All students receiving MI training reached competence in all 5 of the referenced MITI global variables: evocation, collaboration, autonomy support, empathy, and direction. The most substantial improvements for MITI behavioral and summary variables were in Giving Information, MI Adherence, and proportion of Open-Ended Questions. Complex Reflections, and subsequently Ratios of Complex Reflections to Open-Ended Questions were notably below proficiency in the MI group. Knowing which elements were adhered to well and which were lacking helps inform student MI learning outcomes. Results inform the design of MI training curricula to address areas of weakness and maximize performance across all MI fidelity domains.

Motivational interviewing with individuals at risk of sex trafficking

Summary Motivational interviewing is an evidence-based practice designed to collaboratively strengthen a person’s commitment to change. Used in a wide variety of practice settings, motivational interviewing is recommended for use with individuals who are at risk of sex trafficking when discussing sex trading or relationships with potential traffickers. However, little is known about the uses of motivational interviewing with this population in practice. The current study examined whether and how social workers who encounter individuals at risk of sex trafficking use motivational interviewing. We explored perceptions of motivational interviewing use, applicability, and engagement practices by conducting in-depth, semi-structured interviews with 24 hour service providers in a Midwest region. Findings Practitioners discussed a wide variety of perceptions of motivational interviewing, ranging from completely unfamiliar, to inapplicable to their service population, to favoring its use. Those who did implement motivational interviewing described challenges to engagement with this population and provided examples in which they did not validate the clients’ perceived benefits of situations that enhanced their risk, a principal tenant of motivational interviewing. Such actions may have contributed to practitioner-client discord and ultimately reduced clients’ engagement. Applications Providers who encounter sex trafficking in practice should be trained in the use of motivational interviewing and applicability, specifically regarding how to validate the client’s internal arguments for and against sex trading and related behaviors. Future research should continue to understand whether and how motivational interviewing can be adapted for transient populations, and continue testing the efficacy of motivational interviewing with these populations.

Behavioral Sciences in the Promotion of Oral Health

The importance and value of behavioral sciences in dentistry have long been recognized, and their contribution to dental education, research, clinical practice, and oral health policy has been significant over the past half century. Over time behavioral sciences have expanded our understanding of oral health beyond “disease” to a broader biopsychosocial concept of oral health. This in turn has led dentistry away from a focus of “treatment” to oral health “care,” notably in the new millennium. Key oral health behaviors have been identified for more than half a century: the importance of diet, oral hygiene, dental services, and other factors. Various behavioral models and theories have been proposed, particularly since the 1970s, providing useful frameworks with sound psychological basis to help understand the paths of oral health behaviors. These models draw on theories of self-efficacy, motivation, counseling, and “behavior change.” Since the 1980s, there has been a greater understanding that these behaviors often share a common pathway with the etiology of other diseases (common risk factors). Furthermore, the relationship between individual factors and the broader environmental factors has been increasingly emphasized since the 1990s, leading to a united call for action in addressing oral health inequalities. Within the past decade, there are useful examples of models, frameworks, and techniques of behavior change with respect to oral health, involving planning, prompting, encouraging, goal setting, and/or motivating. In particular, there is a growing interest and use of motivational interviewing. Likewise, behavioral therapies, such as cognitive behavioral therapy, are increasingly being employed in dental practice in the management of dental anxiety, pain, and psychosomatic dental and oral problems, with promising results. Recommendations are outlined for future directions for behavioral sciences in the promotion of oral health.

Provider behaviors that predict motivational statements in adolescents and young adults with HIV: a study of clinical communication using the Motivational Interviewing framework

ABSTRACT Medical care providers’ use of Motivational Interviewing (MI) is linked to improved medication adherence, viral load, and associated behaviors in adolescents and young adults living with HIV. Mastering MI is difficult for busy providers; however, tailoring MI training to the specific MI communication strategies most relevant for HIV treatment context may be a strategy to increase proficiency. The present study aimed to identify communication strategies likely to elicit motivational statements among adolescent-young adult patients living with HIV. Language used by MI-exposed providers during 80 HIV medical clinic visits was transcribed and coded to characterize patient-provider communication within the MI framework. Sequential analysis, an approach to establish empirical support for the order of behavioral events, found patients were more likely to express motivational statements after provider questions phrased to elicit motivation, reflections of motivational statements, and statements emphasizing patients’ decision-making autonomy. Patients were more likely to express amotivational statements when providers asked questions phrased to elicit amotivational statements or reflected amotivational language. Training providers to strategically phrase their questions and reflections to elicit change language and to emphasize patients’ autonomy may be critical skills for working with adolescents and young adults living with HIV.

Use of Motivational Interviewing for Promotion of Physical Activity During Pregnancy

Use of Motivational Interviewing for Promotion of Physical Activity During Pregnancy

Making Positive Changes Counseling (MPCC) Program: A Creative Adaptation of Motivational Interviewing for Use with Children in School Settings

ABSTRACTMotivational Interviewing (MI)-based counseling can be creatively adapted for working with elementary school students in disciplinary alternative education program (DAEP) settings. The purpose of this article is to describe the implementation of MI with elementary-aged students in the DAEP. The Making Positive Changes Counseling (MPCC) program is a six-session program, which addresses children’s readiness for change, exploration of values and goals and current behaviors, recognition of personal strengths, perspective taking, recognition for possible changes, and effective decision making. The program is an adaptation of the standardized MI approach utilizing visuals and age-appropriate materials that are easily adaptable to individualized (or even group) guidance format.

Poster PresentationsAssessment practice amongst educational psychologistsEducational psychologists’ use of motivational interviewing: Findings and implications for practicePerfectionism in UK secondary schools: The relationship with anxiety and depression, and how pupil views can inform interventionStepping over the boundary: Educational psychologists work with familiesResilience: Perspectives from a health needs education hub

Poster PresentationsAssessment practice amongst educational psychologistsEducational psychologists’ use of motivational interviewing: Findings and implications for practicePerfectionism in UK secondary schools: The relationship with anxiety and depression, and how pupil views can inform interventionStepping over the boundary: Educational psychologists work with familiesResilience: Perspectives from a health needs education hub

Motivational Interviewing to Promote Employment

This article evaluated the use of motivational interviewing (MI) to increase employment. In Study 1, 910 unemployed participants were randomly assigned to either the control (standard employment program) or the experimental condition. Experimental participants who were not ready to seek employment (assessed by the University of Rhode Island Change Assessment Scale) received MI plus the standard employment program. Study 2 evaluated this approach within the entire Opportunities for Employment population (N = 992). Compared with the control participants, participants in the experimental condition in Study 1 and participants in Study 2 increased motivation for employment, employment program participation, and employment and employment retention.