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BACKGROUND: Alcohol use disorders (AUDs) contribute significantly to the global disease burden in terms of morbidity and mortality. While effective treatment options exist, engagement with care remains a challenge, impacting treatment outcomes and resource allocation, particularly in resource-constrained settings. In this review, we aim to systematically examine and synthesize the evidence on interventions targeting initiation of and adherence to treatment for AUDs. METHODS: A search was conducted on six electronic databases (MEDLINE, PsycINFO, Embase, Global Health, CINAHL and CENTRAL) using search terms under the following concepts: alcohol use disorders, initiation/adherence, treatments, and controlled trial study design. Due to the heterogeneity in intervention content and outcomes among the included studies, a narrative synthesis was conducted. Risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. RESULTS: The search yielded 32 distinct studies testing eleven categories of interventions. 23 out of 32 studies reported effectiveness of interventions in improving at least one initiation or adherence outcome, with 11 studies reporting an improvement in at least one outcome related to drinking, and four studies reporting improvements in at least one measure of well-being or disability. Community Reinforcement Approach and Family Training (CRAFT) emerged as a prominent approach for treatment initiation, contingency management for adherence, and motivational interviewing (MI) for both treatment initiation and adherence. CONCLUSION: Integrating initiation and adherence interventions into AUD treatment services holds immense potential for optimizing client outcomes and fostering overall well-being. However, generalizability of these strategies remains uncertain owing to the lack of studies conducted in low- and middle-income countries. Addressing this gap is crucial for enhancing global access to effective treatments for AUDs.
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Trastornos Relacionados con Alcohol , Humanos , Trastornos Relacionados con Alcohol/terapia , Alcoholismo/terapia , Entrevista Motivacional/métodos , Cooperación del PacienteRESUMEN
Background: Body goes through significant hormonal and physiological changes during pregnancy, which could be linked to changes in oral health. Many women are unaware of the negative consequences of poor dental health during and after pregnancy, both for themselves and their children. Therefore, this study aimed to assess the effectiveness of Motivational Interviewing (MI) and cross platform messaging application (WhatsApp messenger) for oral health education on the oral health knowledge, attitude and behaviours among pregnant women attending ante natal care. Methods: A randomized controlled trial was conducted among 84 pregnant women. Simple random sampling was employed to select participants after oral examination. Participants were randomly allocated to two groups (Group 1: Cross-platform messaging application [WhatsApp]; Group 2: MI) using a lottery method. Pregnant women aged 18 years and older, gestational age between 8 and 30 weeks were included. A face-to-face interview and oral examination were conducted to assess baseline knowledge and oral hygiene status. A follow-up examination was conducted after one month of intervention. Inferential statistics, including the chi-square test and independent t-test, were used to compare variables between the two groups. Results: The mean knowledge score at baseline was comparable between Group 1 (WhatsApp) and Group 2 (MI). However, post-intervention, Group 2 showed a significantly higher mean knowledge score compared to Group 1. Post-intervention, Group 2 exhibited a significantly better oral hygiene status compared to Group 1. Significant improvements in oral health behaviours were observed in Group 2 compared to Group 1 (p < 0.001). Conclusions: The findings suggested that while both interventions were effective, MI showed superior results in improving knowledge, oral hygiene status, and oral health behaviours. The personalized and client-centred approach of MI enables participants to explore and resolve ambivalence, promoting a deeper understanding of the importance of oral health during pregnancy. Registration: CTRI ( CTRI/2021/09/036407, 10/09/2021).
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Conocimientos, Actitudes y Práctica en Salud , Entrevista Motivacional , Salud Bucal , Mujeres Embarazadas , Humanos , Femenino , Embarazo , Entrevista Motivacional/métodos , Adulto , Mujeres Embarazadas/psicología , Adulto Joven , Higiene Bucal/métodos , Higiene Bucal/psicología , AdolescenteRESUMEN
Objective: Intimate partner violence (IPV) perpetrators with alcohol and/or other drug use problems (ADUPs) have been identified as one of the main high-risk and highly resistant groups of perpetrators requiring special attention in intervention programs for IPV perpetrators. This randomized controlled trial (RCT) aimed to evaluate whether an individualized motivational plan adjusted to ADUPs (IMP-ADUPs) was superior to standard motivational strategies (IMP) in reducing ADUPs, and IPV and increasing treatment adherence in IPV perpetrators. Method: Data from a full sample of IPV perpetrators (n = 140) and a subsample of participants with ADUPs (n = 55) were collected at pre- and post-intervention and 12-month follow-up. Final outcomes included alcohol, cocaine, and cannabis use, self-reported IPV, risk of recidivism assessed by facilitators, and official IPV recidivism. Proximal outcomes included treatment adherence (stage of change, intervention dose, active participation, and dropout). Results: Both intent-to-treat (ITT) and per-protocol (PP) analyses were conducted. The IMP-ADUPs condition was superior to the IMP in reducing alcohol use at post-intervention in both the full sample and ADUPs subsample. The full sample of participants in the IMP-ADUPs condition were in a more advanced stage of change post-intervention and showed increased active participation during the intervention process than IMP participants. All participants were in a more advanced stage of change at post-intervention and reduced their alcohol use and their risk of recidivism at post-intervention and 12-month follow-up. Conclusions: These results underscore the need to develop individualized treatment approaches to address participants' risks and needs and promote their motivation to change.
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Violencia de Pareja , Motivación , Trastornos Relacionados con Sustancias , Humanos , Violencia de Pareja/psicología , Violencia de Pareja/prevención & control , Masculino , Femenino , Adulto , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/terapia , Persona de Mediana Edad , Entrevista Motivacional/métodos , Resultado del TratamientoRESUMEN
With its unique position, primary health care (PHC) can provide health promotion and prevention services, including lifestyle behavioural counselling. Unhealthy lifestyle behaviours are very prevalent among patients attending PHC, with many patients unwilling to change or in the precontemplation stage. While patients in the contemplation stage are better managed using the 5As approach of motivational interviewing counselling, those unwilling or not ready for change necessitate a different approach, such as the 5Rs of motivational interviewing (MI) counselling. The 5Rs MI approach holds promise in motivating unwilling individuals to consider embarking on the journey of behavioural change. The 5Rs approach is not a stand-alone checklist of tasks implemented in isolation but is best integrated within a theoretical behavioural change framework. Of the four health-related behavioural change theoretical frameworks that are frequently used, the transtheoretical stages of the change model are the most used. This continued professional development article provides a summary review of the literature on behavioural change theories as they apply to lifestyle health behaviour change and presents the 5Rs approach as a feasible and practical approach to manage patients who are unwilling to change or in the precontemplation stage. This offers a beacon of hope for improved patient outcomes in a PHC system saddled with high prevalence of modifiable unhealthy lifestyle behaviours.
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Conductas Relacionadas con la Salud , Promoción de la Salud , Entrevista Motivacional , Atención Primaria de Salud , Humanos , Promoción de la Salud/métodos , Estilo de Vida , Motivación , Consejo , Modelo Transteórico , Terapia Conductista/métodosRESUMEN
BACKGROUND: Non-specific low back pain is a common and costly global issue. Many people with low back pain live for years with ongoing symptom recurrence and disability, making it crucial to find effective prevention strategies. Motivational interviewing (MI) is an evidence-based patient-centred counselling style that helps motivate individuals to change their behaviours. In combination, MI and cognitive-behavioural therapy (MI-CBT) has the potential to yield long term improvements in pain and disability and reduce incidence of recurrence. METHOD: This is a two-arm superiority randomised controlled trial comparing MI-CBT and Education (n = 83) with Education only (n = 83). Participants that have recovered from a recent episode of non-specific low back pain (7th consecutive day with pain ≤ 2 on a 0-10 numeric pain rating scale) will be eligible for inclusion into the study. Both groups will receive five 30-min sessions over a 10-week period as well as the Navigating Pain booklet, homework book and a standardised exercise programme. In the intervention group, MI-CBT techniques will be used to provide individualised support, identify beliefs, and increase engagement with the resources provided. Outcomes measures include pain (current and in the last 7 days) as rated on the numeric pain rating scale. This will be used to determine recurrence (number of participants who report back pain ≥ 3 out of 10 on the numeric pain rating scale). Furthermore, self-reported (1) pain intensity; (2) pain catastrophizing; (3) fear-avoidance beliefs; (4) pain self-efficacy; (5) depression and anxiety; (6) disability will be measured. All outcomes will be measured at baseline, and again at 3-, 6-, and 12-months post allocation. DISCUSSION: The effective delivery of self-management strategies to prevent recurrence of low back pain is an important aspect that requires urgent attention. This study will provide new information on the effectiveness of using an MI-CBT approach to facilitate self-management through education and exercise to improve low back pain outcomes. Evidence emerging from this trial has the potential to inform clinical practice and healthcare management of non-specific low back pain. TRIAL REGISTRATION: Prospectively registered with Australian New Zealand Clinical Trials Registry: ACTRN12623000746639 (10/07/2023).
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Terapia Cognitivo-Conductual , Dolor de la Región Lumbar , Entrevista Motivacional , Educación del Paciente como Asunto , Humanos , Entrevista Motivacional/métodos , Dolor de la Región Lumbar/terapia , Terapia Cognitivo-Conductual/métodos , Educación del Paciente como Asunto/métodos , Terapia por Ejercicio/métodos , Recurrencia , Adulto , Masculino , Estudios de Equivalencia como AsuntoRESUMEN
BACKGROUND: The World Health Organization's (WHO) Mental Health Gap Action Programme (mhGAP) is a validated intervention that can be provided by non-specialised healthcare workers to individuals with unhealthy alcohol use. However, it typically requires several in-person sessions at a health facility, which may limit its feasibility and effectiveness in remote settings. This trial compares mhGAP-Standard, a 4 to 6 in-person session intervention, to mhGAP-Remote, a 1 in-person session intervention followed by 8 week of short message service (SMS) in Lesotho. We hypothesise that mhGAP-Remote is superior to mhGAP-Standard in reducing alcohol use (as detailed by the primary and secondary outcomes below). METHODS: This is a two-arm randomised open-label multicentre superiority trial. Participants allocated to mhGAP-Standard receive 4 in-person sessions using motivational interviewing, identifying triggers, and alternative behaviours, with the option of two additional booster sessions. Participants in the mhGAP-Remote arm receive 1 in-person session covering the same content, followed by standardised SMSs over 8 weeks that reinforce intervention content. Non-specialist providers deliver the intervention and receive weekly supervision. Adults (Nplanned = 248) attending participating health facilities for any reason and who meet criteria for unhealthy alcohol use based on the Alcohol Use Disorders Identification Test ([AUDIT] score ≥ 6 for women, ≥ 8 for men) are individually randomised to the two arms (1:1 allocation, stratified by participant sex and age (≥ 50 vs < 50 years old). Follow-up assessments occur at 8, 20, and 32 weeks post-randomisation. The primary outcome is change in self-reported alcohol use (continuous AUDIT score), from baseline to 8 weeks follow-up. Change in the AUDIT from baseline to 20 and 32 weeks follow-up is a secondary outcome. Change in the biomarker phosphatidylethanol (secondary), liver enzyme values in serum (exploratory), and HIV viral load (for people with HIV only; exploratory) are also evaluated from baseline throughout the entire follow-up period. A linear regression model will be conducted for the primary analysis, adjusted for the stratification factors. Three a priori sensitivity analyses for the primary outcome are planned based on per protocol treatment attendance, recovery from unhealthy alcohol use, and clinically significant and reliable change. DISCUSSION: This trial will provide insight into feasibility and effectiveness of a shortened and primarily SMS supported version of mhGAP, which is especially relevant for settings where regular clinic attendance is a major barrier. TRIAL REGISTRATION: clinicaltrials.gov NCT05925270 . Approved on June 29th, 2023.
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Entrevista Motivacional , Envío de Mensajes de Texto , Humanos , Lesotho , Masculino , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/prevención & control , Femenino , Ensayos Clínicos Controlados Aleatorios como Asunto , Adulto , Estudios Multicéntricos como Asunto , Resultado del Tratamiento , Alcoholismo/terapia , Persona de Mediana Edad , Factores de TiempoRESUMEN
OBJECTIVE: Motivational Interviewing (MI) is described as a method for improving clinical outcomes by reducing client ambivalence. If this is true, MI's focus on improving clients' motivational language should be most useful for clients with ambivalence about change and less valuable for those who are ready to implement new behaviors or are opposed to change. To address this hypothesis and potentially add precision to MI delivery in clinical settings, we tested whether the relationship between clients' in-session motivational language and posttreatment alcohol use depended on their baseline motivation to change. METHOD: Client speech from 149 sessions from Project MATCH were analyzed. A cluster analysis of the percent change talk during the first decile of the session identified three motivational groups: opposed, ambivalent, and ready. The change in percent change talk (C-PCT) across the session was calculated for each group. Zero-inflated negative binomial analysis was used to test whether the effect of C-PCT on end-of-treatment drinking varied between motivational groups. RESULTS: The count part of the model revealed a significant interaction between C-PCT and membership in the ambivalent group (b = -17.710, 95% CI [-25.775, -9.645], p < .001), only for those who received MI. Favorable C-PCT was associated with less drinking (b = -15.735, p = .004). Only baseline drinking was a significant predictor of abstinence at follow-up (b = .032, 95% CI [0.012, 0.051], p = .001). CONCLUSION: A putative MI mechanism-improved client motivational language-appears most important for clients who express ambivalence in the opening minutes of the session, with minimal value for those who do not. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Alcoholismo , Motivación , Entrevista Motivacional , Humanos , Entrevista Motivacional/métodos , Masculino , Femenino , Adulto , Alcoholismo/terapia , Alcoholismo/psicología , Consumo de Bebidas Alcohólicas/psicología , Consumo de Bebidas Alcohólicas/terapia , Persona de Mediana EdadRESUMEN
Introduction: The COVID pandemic and affiliated infodemic led to widespread health misinformation, generating confusion and distrust. Physicians must identify and address misinformation, with attention to cultural/health literacy, equity, and autonomy. Most medical students receive training in core communication techniques but are rarely taught how to combat misinformation with patients and lack opportunities for practice in diverse settings. Methods: We used mixed methods to evaluate the impact of a role-play-based training curriculum on 44 third- and fourth-year medical students' comfort and confidence applying ask-respond-tell-seek solutions (ARTS) and motivational interviewing (MI) to discuss vaccine hesitancy, using COVID-19 as an example. There were three training iterations: prior to volunteering at a community health fair, during a medicine clinical rotation, and during a pediatrics rotation. Pre- and postsession questionnaires were administered. Likert-scale questions assessed comfort and confidence using ARTS and MI. Narrative responses focused on previous experiences with vaccine hesitancy, challenges faced, and session takeaways. Results: Students' comfort, confidence with ARTS/MI, and self-reported ability to discuss COVID-19 vaccinations improved as measured by pre- and postsession surveys (p < .05). Qualitatively, students reported increased confidence delivering recommendations in plain language and exploring patients' thought processes behind choices. Discussion: Reinforcement of core communications strategies in medical school can positively impact trainees' ability and ease addressing misinformation. We recommend this 45-minute training session to effectively increase medical students' comfort and confidence in discussing COVID-19 vaccines with patients. It can be adapted to any health professions school with an existing communications thread.
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COVID-19 , Comunicación , Curriculum , Desempeño de Papel , SARS-CoV-2 , Estudiantes de Medicina , Humanos , Estudiantes de Medicina/psicología , COVID-19/prevención & control , Pandemias/prevención & control , Encuestas y Cuestionarios , Vacilación a la Vacunación/psicología , Educación de Pregrado en Medicina/métodos , Entrevista Motivacional/métodos , FemeninoRESUMEN
BACKGROUND: For transition-aged youth experiencing homelessness (TAYEH) moving to transitional housing, a motivational network intervention (MNI) may help modify high-risk networks, thereby reducing substance use and strengthening prosocial connections. METHODS: Thirty-six TAYEH received a four-session MNI integrated into usual housing case management or usual case management. Intervention acceptability, feasibility, and motivational interviewing fidelity were evaluated. RESULTS: Nearly all participants would recommend the MNI to others, formed goals, and believed the program improved their lives. Case managers delivered the program with fidelity. However, sample size and number of sessions delivered fell short of targets due to COVID-19 disruptions and other factors and limited our ability to examine preliminary effects on substance use and network outcomes in a fully powered trial. CONCLUSION: Case managers can successfully deliver the MNI, but its use may not be feasible unless adaptations are made to accommodate the instability this population faces when they enter housing.
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Entrevista Motivacional , Trastornos Relacionados con Sustancias , Humanos , Femenino , Masculino , Adolescente , Adulto Joven , Manejo de Caso/organización & administración , Adulto , Personas con Mala Vivienda/psicología , Jóvenes sin Hogar/psicología , COVID-19/prevención & control , COVID-19/epidemiología , Motivación , Vivienda , Estudios de FactibilidadRESUMEN
BACKGROUND: Motivational interviewing (MI) is a person-centred approach focused on empowering and motivating individuals for behavioural change. Medical students can utilize MI in patient education to engage with patients' chronic health ailments and maladaptive behaviours. A current scoping review was conducted to 1) determine the types of MI (conventional, adapted, brief and group MI) education programs in medical schools, delivery modalities and teaching methods used; 2) classify educational outcomes on the basis of Kirkpatrick's hierarchy; and 3) determine the key elements of MI education via the FRAMES (feedback, responsibility, advice, menu of options, empathy, self-efficacy) model. METHODS: This scoping review was conducted via the framework outlined by Arksey and O'Malley. Two online databases, CINAHL and MEDLINE Complete, were searched to identify MI interventions in medical education. Further articles were selected from bibliography lists and the Google Scholar search engine. RESULTS: From an initial yield of 2019 articles, 19 articles were included. First, there appears to be a bimodal distribution of most articles published between the two time periods of 2004--2008 and 2019--2023. Second, all the studies included in this review did not use conventional MI but instead utilized a variety of MI adaptation techniques. Third, most studies used face-to-face training in MI, whereas only one study used online delivery. Fourth, most studies have used a variety of interactive experiences to teach MI. Next, all studies reported outcomes at Kirkpatrick's Level 2, but only 4 studies reported outcomes at Kirkpatrick's Level 3. According to the FRAMES model, all studies (n=19; 100%) reported the elements of responsibility and advice. The element that was reported the least was self-efficacy (n = 12; 63.1%). CONCLUSION: Our findings suggest that motivational interviewing can be taught effectively in medical schools via adaptations to MI and a variety of teaching approaches. However, there is a need for further research investigating standardized MI training across medical schools, the adequate dose for training in MI and the implementation of reflective practices. Future studies may benefit from exploring and better understanding the relationship between MI and self-efficacy in their MI interventions.
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Entrevista Motivacional , Facultades de Medicina , Humanos , Educación Médica/métodos , Curriculum , Estudiantes de Medicina/psicología , Educación de Pregrado en MedicinaRESUMEN
BACKGROUND: Cigarette smoking poses a major public health risk. Chatbots may serve as an accessible and useful tool to promote cessation due to their high accessibility and potential in facilitating long-term personalized interactions. To increase effectiveness and acceptability, there remains a need to identify and evaluate counseling strategies for these chatbots, an aspect that has not been comprehensively addressed in previous research. OBJECTIVE: This study aims to identify effective counseling strategies for such chatbots to support smoking cessation. In addition, we sought to gain insights into smokers' expectations of and experiences with the chatbot. METHODS: This mixed methods study incorporated a web-based experiment and semistructured interviews. Smokers (N=229) interacted with either a motivational interviewing (MI)-style (n=112, 48.9%) or a confrontational counseling-style (n=117, 51.1%) chatbot. Both cessation-related (ie, intention to quit and self-efficacy) and user experience-related outcomes (ie, engagement, therapeutic alliance, perceived empathy, and interaction satisfaction) were assessed. Semistructured interviews were conducted with 16 participants, 8 (50%) from each condition, and data were analyzed using thematic analysis. RESULTS: Results from a multivariate ANOVA showed that participants had a significantly higher overall rating for the MI (vs confrontational counseling) chatbot. Follow-up discriminant analysis revealed that the better perception of the MI chatbot was mostly explained by the user experience-related outcomes, with cessation-related outcomes playing a lesser role. Exploratory analyses indicated that smokers in both conditions reported increased intention to quit and self-efficacy after the chatbot interaction. Interview findings illustrated several constructs (eg, affective attitude and engagement) explaining people's previous expectations and timely and retrospective experience with the chatbot. CONCLUSIONS: The results confirmed that chatbots are a promising tool in motivating smoking cessation and the use of MI can improve user experience. We did not find extra support for MI to motivate cessation and have discussed possible reasons. Smokers expressed both relational and instrumental needs in the quitting process. Implications for future research and practice are discussed.
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Entrevista Motivacional , Cese del Hábito de Fumar , Humanos , Cese del Hábito de Fumar/psicología , Cese del Hábito de Fumar/métodos , Entrevista Motivacional/métodos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Consejo/métodosRESUMEN
OBJECTIVES: Women in the criminal justice system and women who have been subject to domestic abuse are at high risk of cancer but underrepresented in health promotion research. We aimed to co-produce, pilot and evaluate a health promoting programme delivered on group walks. DESIGN: A programme co-produced by women, based on motivational interviewing, created the opportunity for supportive conversations about cancer prevention. METHODS: Programme development in two workshops with women with lived experience using authentic vignettes to prompt help-seeking conversations. A small pilot and a qualitative evaluation was done using framework analysis. RESULTS: The programme appeared acceptable to women and the walk leaders. Women felt included and found it a safe space for sensitive conversations. They appeared empowered and more confident to seek help. Walk leaders expressed confidence in delivering this informal programme, which used prompts rather than delivering didactic training. CONCLUSION: Cancer prevention for high-risk groups can be delivered in a personalised and novel way by creating informal opportunities for supportive conversations about cancer prevention. Careful co-production of the programme of walks with women, using scenarios and quotes that were authentic vignettes, ensured that these came directly from the women's lived experience and enabled women to talk about change. Our findings indicate that this approach was practical, relevant and acceptable to them with some evidence of women feeling empowered to make informed decisions about their health. We recommend that future cancer prevention programmes for underrepresented groups take an asset-based approach by utilising pre-existing community organisations to increase reach and sustainability. PATIENT AND PUBLIC INVOLVEMENT: Women with lived experience co-designed and tested the programme. Provisional findings were fed back to the women and the women's organisation that partnered with this research.
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Promoción de la Salud , Humanos , Femenino , Promoción de la Salud/métodos , Proyectos Piloto , Adulto , Investigación Cualitativa , Neoplasias/prevención & control , Evaluación de Programas y Proyectos de Salud , Persona de Mediana Edad , Entrevista MotivacionalRESUMEN
OBJECTIVE: To determine the effectiveness of preventive interventions in children who have undergone caries-related dental extractions. METHODS: Rapid review across five databases (CENTRAL, Ovid Medline, Embase, Web of Science and Scopus). Quality was assessed using the Risk of Bias 2 tool. RESULTS: Five studies were included, all randomised controlled trials involving pre-and/or post-extractions activity. Three studies involved oral health education (computer game, motivational interviewing, visual aids), one delivered clinical prevention (fissure sealants), and one an enhanced prevention programme combining additional health education and a clinical intervention (fluoride varnish). Retention was mixed (55%-80% in the intervention groups). Of the three studies measuring caries, all reported less caries development in the test group. However, only a study involving a dental nurse-delivered structured conversation, informed by motivational interviewing, showed an improvement in oral health. Two studies reporting on plaque and gingival bleeding had conflicting results. A study reporting on subsequent dental attendance did not demonstrate a clear improvement. CONCLUSION: Few published studies have explored prevention-based interventions in high caries-risk children requiring dental extractions. Whilst evidence of clinical benefit of preventive interventions in this population is limited, the potential use of contemporary behaviour change techniques appears promising. There is an urgent need for more high-quality longer-term trials using contemporary methodologies.
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Caries Dental , Salud Bucal , Extracción Dental , Humanos , Caries Dental/prevención & control , Niño , Educación en Salud Dental/métodos , Selladores de Fosas y Fisuras/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Entrevista Motivacional , Fluoruros Tópicos/uso terapéuticoRESUMEN
BACKGROUND: Gay, bisexual, and other men who have sex with men living with HIV (GBMSM-LWH) in the United States bear a heavy burden of bacterial sexually transmitted infections (STIs). Timely diagnosis and treatment are key to prevention. Only a few studies have combined home specimen self-collection for bacterial STI screening with live audio and video (AV) conferencing. None have focused on GBMSM-LWH or incorporated motivational interviewing (MI), a client-centered, strengths-based counseling approach that seeks to support individuals to create positive behavioral change. OBJECTIVE: Our study seeks to investigate the feasibility and acceptability of an MI-based telehealth intervention that integrates home specimen self-collection from different anatomical sites of possible exposure and MI delivered via live AV conferencing to engage sexually active GBMSM-LWH in bacterial STI screening. METHODS: Participants are being recruited from across the United States via advertising on mobile dating apps and social networking sites and via peer referral. Phase 1 involves piloting the delivery of an innovative telehealth intervention for bacterial STI screening to 75 GBMSM-LWH. Our intervention includes three components: (1) a pretest live AV conferencing session involving an MI-guided discussion to elicit awareness of bacterial STIs; fill any knowledge gaps; bolster the perceived importance of regularly testing for gonorrhea, chlamydia, and syphilis; and build self-efficacy for specimen self-collection; (2) home self-collection and return via mail of a urine sample (for gonorrhea and chlamydia testing), a throat swab (for gonorrhea and chlamydia testing), a rectal swab (for gonorrhea and chlamydia testing), and a finger-stick blood sample (for syphilis testing); and (3) a posttest live AV conferencing session involving an MI-guided discussion to prepare participants for receiving test results and formulate personalized action plans for seeking treatment (if warranted) and repeat testing. Descriptive statistics and progression ratios will be calculated, and potential variations in our intervention's feasibility and acceptability will be numerically summarized and graphically visualized. Phase 2 involves elucidating attitudes, facilitators, and barriers related to engaging in each intervention component via semistructured in-depth interviews with a purposive subsample of 20 participants who complete progressively smaller subsets of the pretest session, specimen return for bacterial STI testing, and the posttest session. Thematic analysis will be used to identify, analyze, and report patterns in the data. Quantitative and qualitative data will be integrated at the design, methods, interpretation, and reporting levels. RESULTS: Study procedures were approved by the Institutional Review Board at the University of Michigan in September 2023. Participant recruitment began in April 2024. CONCLUSIONS: Our study will advance multiple goals of the STI National Strategic Plan for the United States for 2021 to 2025, specifically those pertaining to preventing new STIs; accelerating progress in STI research, technology, and innovation; and reducing STI-related health disparities. TRIAL REGISTRATION: ClinicalTrials.gov NCT06100250; https://www.clinicaltrials.gov/study/NCT06100250. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/64433.
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Estudios de Factibilidad , Entrevista Motivacional , Enfermedades Bacterianas de Transmisión Sexual , Telemedicina , Adulto , Humanos , Masculino , Homosexualidad Masculina/psicología , Tamizaje Masivo/métodos , Tamizaje Masivo/psicología , Entrevista Motivacional/métodos , Aceptación de la Atención de Salud/psicología , Minorías Sexuales y de Género/psicología , Enfermedades Bacterianas de Transmisión Sexual/diagnóstico , Enfermedades Bacterianas de Transmisión Sexual/prevención & control , Estados Unidos/epidemiologíaRESUMEN
INTRODUCTION: To improve treatment access for emerging adults with cannabis use disorder (CUD), we developed a telehealth counseling-plus-mHealth intervention and remotely conducted a single-arm open pilot study to preliminarily evaluate its feasibility in primary care. METHODS: A multidisciplinary team including youth developed the intervention using the structure of the MOMENT intervention: two weekly counselor-delivered Motivational Enhancement Therapy (MET) sessions, then two weeks of smartphone surveys (4 prompted/day) querying socioemotional contexts and cannabis use, with pre-programmed messages on report of personal triggers for use (Ecological Momentary Intervention; EMI). The team adapted the MET for virtual delivery; created material to enhance self-reflection, plan behavior change, and anticipate withdrawal; shortened the sessions; and tested them with five youth actors. EMI messages were created to align with the MET and programmed to minimize repetition. Patients aged 18-25 using recreational cannabis ≥3 days/week were recruited from an urban medical practice. Participants received the intervention and responded to surveys on satisfaction and burden. At baseline, post-intervention, and two months, participants reported behavior change readiness/importance/confidence and cannabis use. EMI engagement was calculated as % days with ≥1 phone survey completed. RESULTS: Fourteen eligible patients enrolled; 79 % used cannabis daily/near-daily and 100 % reported use problems. All completed both MET sessions and responded to EMI surveys. All agreed/strongly agreed that they felt respected by, comfortable with, and trust for the counselor and that the activities and discussion were helpful; all rated the MET sessions as very good/excellent. Technical issues were infrequent and minor. Median EMI engagement was 100 % (≥1 report/day) in each week. Behavior change confidence was higher post-intervention and importance and confidence were higher at two months vs. baseline. By two months, 11 participants had started to change cannabis use; median percent days of use in the past 30 days declined by 27 % and average times of use per use day declined by 28 %. All rated intervention quality as good, very good, or excellent. CONCLUSIONS: Emerging adults were highly satisfied and engaged with a telehealth MET counseling-plus-mHealth EMI intervention for cannabis use and reported higher motivation to change cannabis use and less use post-intervention and at 2-month follow-up.
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Abuso de Marihuana , Telemedicina , Humanos , Proyectos Piloto , Masculino , Adulto Joven , Femenino , Adulto , Adolescente , Abuso de Marihuana/terapia , Consejo/métodos , Estudios de Factibilidad , Entrevista Motivacional/métodosRESUMEN
The COVID-19 pandemic highlighted Vaccine Hesitancy (VH) as an accelerating global phenomenon that must be addressed. According to the WHO, thirty to fifty percent of the world's population are VH. Motivational Interviewing (MI) is an evidence-based communication style demonstrated to significantly reduce VH. MI guides people toward change through the expression of empathy and by respecting an individual's autonomy. Healthcare providers (HCPs) are the primary implementors of vaccine policies and the most trusted advisors and influencers of vaccination intention at the individual patient level. Training HCPs in MI is one of the most effective strategies to overcome VH. Many countries are currently implementing HCP training programs and population-based MI interventions to improve vaccine uptake. MI conversations are 'the heart' of vaccine decision-making processes. Understanding individual patient-level drivers of hesitancy allows clinicians to efficiently provide tailored, accurate information that reinforces a person's own motivation and confidence in their own decision. This paper describes a 4-step practical framework designed to support HCPs in their dialogue with vaccine-hesitant patients. (1) Engaging to establish a trustful relationship and safety to freely express opinions, beliefs, and knowledge gaps; (2) Understanding what matters most to the individual; (3) Offering Information to co-build accurate knowledge in order to guide the individual toward vaccine intention (4) Clarifying and Accepting to validate an individual's decision-making autonomy. We believe that our pragmatic approach can contribute to greater acceptability of COVID-19 and other vaccines, and enable rapid deployment of practical MI skills across care systems.
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Vacunas contra la COVID-19 , COVID-19 , Personal de Salud , Motivación , Entrevista Motivacional , Vacilación a la Vacunación , Vacunación , Humanos , Entrevista Motivacional/métodos , Vacunas contra la COVID-19/administración & dosificación , COVID-19/prevención & control , Personal de Salud/psicología , Vacilación a la Vacunación/psicología , Vacunación/psicología , Consejo/métodos , Toma de Decisiones , SARS-CoV-2 , Conocimientos, Actitudes y Práctica en SaludRESUMEN
BACKGROUND: There are no clinical practice guidelines addressing the treatment of tobacco-cannabis co-use and a dearth of studies to inform treatment for co-use. This narrative review aims to (1) summarize promising intervention components used in published co-use treatment studies, (2) describe key gaps and emerging issues in co-use, and (3) provide recommendations and considerations in the development and evaluation of co-use interventions. METHODS: We conducted a literature search in June 2024 across several databases to update previous reviews on tobacco-cannabis co-use treatment. We found 9 published intervention studies that specifically addressed treatment for both substances. Data from these studies were manually extracted and summarized. RESULTS: Most of the 9 included studies (1) focused on acceptability and/or feasibility, (2) provided both psychosocial/behavioral and pharmacotherapy intervention components, (3) were conducted in adults, and (4) were delivered in-person, with some having digital asynchronous components, for a 5-to-12-week duration. The most common psychosocial/behavioral strategies used were Cognitive Behavioral Therapy, Motivational Interviewing, and Contingency Management; while the most common pharmacotherapy was Nicotine Replacement Therapy. There was no evidence of compensatory use of tobacco or cannabis when providing simultaneous treatment for both substances. CONCLUSIONS: The literature to date provides support for well-integrated multi-component interventions of psychosocial/behavioral and pharmacotherapy strategies for co-use treatment. This review reinforces an urgent need for treatments targeting tobacco and cannabis co-use. Future interventions should address key gaps, including co-use of vaporized products among youth and young adults, tailored interventions for priority populations, and digital applications to increase reach and advance health equity.
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Entrevista Motivacional , Humanos , Entrevista Motivacional/métodos , Terapia Cognitivo-Conductual/métodos , Dispositivos para Dejar de Fumar Tabaco , Abuso de Marihuana/terapiaRESUMEN
BACKGROUND: With the rise of computer science and artificial intelligence, analyzing large data sets promises enormous potential in gaining insights for developing and improving evidence-based health interventions. One such intervention is the counseling strategy motivational interviewing (MI), which has been found effective in improving a wide range of health-related behaviors. Despite the simplicity of its principles, MI can be a challenging skill to learn and requires expertise to apply effectively. OBJECTIVE: This study aims to investigate the performance of artificial intelligence models in classifying MI behavior and explore the feasibility of using these models in online helplines for mental health as an automated support tool for counselors in clinical practice. METHODS: We used a coded data set of 253 MI counseling chat sessions from the 113 Suicide Prevention helpline. With 23,982 messages coded with the MI Sequential Code for Observing Process Exchanges codebook, we trained and evaluated 4 machine learning models and 1 deep learning model to classify client- and counselor MI behavior based on language use. RESULTS: The deep learning model BERTje outperformed all machine learning models, accurately predicting counselor behavior (accuracy=0.72, area under the curve [AUC]=0.95, Cohen κ=0.69). It differentiated MI congruent and incongruent counselor behavior (AUC=0.92, κ=0.65) and evocative and nonevocative language (AUC=0.92, κ=0.66). For client behavior, the model achieved an accuracy of 0.70 (AUC=0.89, κ=0.55). The model's interpretable predictions discerned client change talk and sustain talk, counselor affirmations, and reflection types, facilitating valuable counselor feedback. CONCLUSIONS: The results of this study demonstrate that artificial intelligence techniques can accurately classify MI behavior, indicating their potential as a valuable tool for enhancing MI proficiency in online helplines for mental health. Provided that the data set size is sufficiently large with enough training samples for each behavioral code, these methods can be trained and applied to other domains and languages, offering a scalable and cost-effective way to evaluate MI adherence, accelerate behavioral coding, and provide therapists with personalized, quick, and objective feedback.
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Entrevista Motivacional , Prevención del Suicidio , Humanos , Entrevista Motivacional/métodos , Líneas Directas , Aprendizaje Automático , Inteligencia Artificial , Femenino , Masculino , Adulto , Consejo/métodosRESUMEN
BACKGROUND: Approximately 16.5% of U.S. young adults have a cannabis use disorder (CUD) and are at risk for negative outcomes. Treatment can reduce cannabis use, but young adults are less likely to seek help than older adults. Peer Network Counseling-txt (PNC-txt) is a brief, text-delivered, Motivational Interviewing-informed substance use intervention focusing on peer relations and activity spaces as mechanisms for behavioral change. PNC-txt has shown evidence of reducing tobacco and cannabis use with adolescents and young adults, but it has not been tested in the context of legal cannabis use. The current randomized controlled trial sought to expand the evidence regarding the context of PNC-txt effects, comparing one state in which cannabis is legal (Colorado) and one state in which it is not (Tennessee). We hypothesized that participants randomized to PNC-txt would show significant reductions in cannabis use compared to controls, with larger reductions for females and those in Colorado, and that peer relations and activity space would mediate effects. METHODS: One thousand, seventy eight 18-25 year olds (CO: 551; TN: 527) who met screening criteria for CUD and biologically-verified cannabis use were randomly assigned to PNC-txt or waitlist control condition. Every other day for 4 weeks, participants assigned to PNC-txt received pre-programmed text conversations, tailored via data from the baseline assessment. Self-report and biological indicators of cannabis use were measured at 1-, 3-, and 6-months. DISCUSSION: Data analysis is underway. Results will provide evidence regarding whether, and how, PNC-txt reduces cannabis use in young adults with CUD. TRIAL REGISTRATION: This trial was prospectively registered on September 28, 2020 with ClinicalTrials.gov (NCT04567394).
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Consejo , Abuso de Marihuana , Entrevista Motivacional , Grupo Paritario , Envío de Mensajes de Texto , Humanos , Masculino , Femenino , Adulto Joven , Abuso de Marihuana/terapia , Abuso de Marihuana/psicología , Adolescente , Entrevista Motivacional/métodos , Adulto , Consejo/métodos , Colorado , Factores SexualesRESUMEN
BACKGROUND: Mothers' intentions regarding the Human Papillomavirus (HPV) vaccination of their daughters are crucial, especially in societies that prioritize cultural and religious values. OBJECTIVES: This study aimed to encourage mothers to vaccinate their daughters against HPV by enhancing their perceptions of the vaccine's benefits, susceptibility, severity, and knowledge levels, while reducing their barriers through web-based interventions and Health Belief Model-based motivational interviews. METHODS: The study was designed as a pre-mid-post test randomized controlled experimental study. The sample included 63 mothers of female high school students (31 in the experimental group, 32 in the control group). Data were collected using a "Demographical and Descriptive Characteristics Information Form", "Health Belief Model Scale for Human Papillomavirus and Its Vaccination" and "Human Papillomavirus Knowledge Scale". Mothers in the experimental group received three HBM-based motivational interviews, web support, and follow-up. CLINICALTRIALS: gov code is NCT04992741. RESULTS: Following the interventions, the experimental group exhibited higher levels of knowledge, benefit, susceptibility, and severity perception of HPV vaccination, and lower perceptions of barriers compared to the control group. At the end of the study, 24 mothers from the experimental group and 5 mothers from the control group decided to vaccinate their daughters against HPV. CONCLUSIONS: Motivational interviews, along with web support and monitoring, significantly enhanced mothers' knowledge and beliefs. IMPLICATIONS FOR PRACTICES: This study provides evidence for the applicability of theory-based motivational interviewing in the acceptance of HPV vaccine by mothers. It enables the dissemination of HPV vaccination and encourages community health nurses to use theory-based motivational interviewing to recommend HPV vaccination.