A brief motivational intervention to improve dietary adherence in adolescents
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Motivational interviewing offers health care professionals a potentially effective strategy for increasing a patient's readiness to change health behaviors. Recently, elements of motivational interviewing and the stages of change model have been simplified and adapted for use with patients in brief clinical encounters. This paper describes in detail a brief motivational intervention model to improve and renew dietary adherence with adolescents in the Dietary Intervention Study in Children (DISC). DISC is a randomized, multi-center clinical trial assessing the efficacy and safety of lowering dietary fat to decrease low-density lipoprotein cholesterol in high-risk children. In the first 3 years of follow-up covering ages 8–13, intervention participants (n = 334) were exposed to a family-based group intervention approach to change dietary choices. To address adherence and retention obstacles as participants moved into adolescence (age 13–17), an individual-level motivational intervention was implemented. The DISC motivational intervention integrates several intervention models: stages of change, motivational interviewing, brief negotiation and behavioral self-management. A preliminary test of the intervention model suggests that it was acceptable to the participants, popular with interventionists and appeared to be an age-appropriate shift from a family-based intervention model.Keywords:
Motivational Interviewing
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Motivational Interviewing
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Psychological Distress
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This article reviews studies and current practices of brief motivational intervention in the emergency department and identifies factors related to the effectiveness of brief intervention. Studies of brief intervention in the emergency department have had mixed results with most studies finding improvements in intervention and control groups. Most report brief intervention reducing alcohol's negative consequences without reducing consumption. Clinical practice is incorporating brief intervention as part of emergency treatment, and further research is needed to determine the factors responsible for the improvements noted in most studies.
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Motivational interviewing is a counseling technique that works, in part, by helping people talk about changing their behavior. We describe two conversational agent-based interventions to increase motivation and confidence to promote physical activity and fruit and vegetable consumption that incorporate principles from motivational interviewing. We also explore the efficacy of constraining input, so users are only allowed to express change talk in their conversation with the agent. In a within-subjects experiment we demonstrate that both interventions are effective at increasing motivation, confidence, and self-efficacy for behavior change during a single counseling session. We also demonstrate that coercing user change talk leads to significantly greater increases in confidence compared to equivalent counseling agents that allow users to express statements about not changing their behavior.
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To enhance the skills of primary care residents in addressing substance misuse, residency screening, brief intervention, and referral to treatment (SBIRT) programs increasingly offer motivational interviewing (MI) training, but seldom include feedback and coaching. This innovative 2-round "Virginia Reel" approach, supplementing 3 hours of basic MI instruction, was designed to teach and coach residents to use MI while providing ongoing medical care. SBIRT/MI-competent facilitators served as both trainers and actors at 8 carefully sequenced Objective Structured Clinical Examination (OSCE) stations, providing instruction, role-play practice, and feedback on 17 microskills in 2 successive clinical "visits"/rounds addressing alcohol misuse and diabetes management. Evaluation included OSCE checklists, overall competency assessments, and responses to open-ended questions. Three residents showed improvement between rounds. Resident evaluations were strongly positive, identifying practice of MI skills and receipt of coaching and feedback from MI experts as particularly valuable. Further study is needed to confirm effectiveness of the approach and explore the impact of fewer OSCE stations of longer duration.
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Health promotion and disease prevention have always been essential to public health nursing. With the changing health care system and an increased emphasis on cost‐containment, the role of the nurse is expanding even more into this arena. A challenge for public health nurses, then, is to motivate and facilitate health behavior change in working with individuals, families, and communities and designing programs based on theory. Leading causes of death continue to relate to health behaviors that require change. The purpose of this article is to integrate theory with practice by describing the Transtheoretical Model of Change as well as the principles of motivational interviewing that can be used in motivating behavioral change. A case scenario is presented to illustrate the use of the models with effective interviewing skills that can be used to enhance health. Implications for practice with an emphasis on providing an individually tailored matched intervention is stressed.
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Our trauma division implemented a screening, brief intervention, and referral to treatment (SBIRT) program in 2009 and has maintained more than 92% screening rate for all inpatient admissions since inception. Brief interventions are proven to be more likely to effect and reinforce change if a follow-up contact is made with patients. This led to discussion regarding whether identified patients were more likely to follow up with our SBIRT wellness specialist using motivational interviewing or with our partners, exercise physiology, who use traditional interviewing techniques. We retrospectively reviewed more than 3,000 inpatient admissions in which screening for at-risk alcohol use were positive. Fifty-one percent of identified patients were referred for wellness specialist consultation with a follow-up rate of 52% compared with a follow-up rate of only 21% in the exercise physiology group. Motivational interviewing is more effective in encouraging at-risk alcohol users to participate in follow-up care.
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