Thesis (M.S.)--Ohio University, November, 2009. / Release of full electronic text on OhioLINK has been delayed until December 1, 2011. Title from PDF t.p. Includes bibliographical references.

Eating disorders are defined by a complex interaction between emotional, cognitive and interpersonal challenges in addition to behaviours used to control weight or shape. One of the major challenges with the treatment of eating disorders is ambivalence, low motivation to engage in treatment, and a high treatment dropout rate. Motivational Interviewing is a therapeutic style that elicits intrinsic motivation from within the patient to drive behaviour change. The current study provides an evaluation of the effectiveness of the two pretreatment group motivation interventions delivered by the South Island Eating Disorder Service. Significant changes in motivational stage of change were observed in both the Motivation and Education Group and the pure Motivation Group. Significant improvements in patient readiness, confidence and importance to change as well as treatment attendance were identified in the pure Motivation Group. Recommendations for future treatment development are presented.

The efficacy of Motivational Interviewing (MI), like other evidence-based counselling interventions, relies on the skills of the practitioner. Therefore, it is imperative that such practitioners receive sufficient training in order to successfully implement the method. Hence, it is important to ensure a given training programme has been effective through the use of reliable and valid measures of knowledge and skill acquisition. The Motivational Interviewing Treatment Integrity code (MITI) is one such measure of MI skill attainment; however its use is labour intensive and requires the submission of in-session trainee audio recordings. Other measures of MI skill or knowledge also exist which may be more practical for evaluating training programmes. However, these measures are under researched and are therefore rarely utilised across the MI training literature. The present research is an investigation of the psychometric properties of the Motivational Interviewing Knowledge and Attitudes Test (MIKAT), a test of MI knowledge and attitudes, and the Video Assessment of Simulated Encounters–Revised (VASE-R), a test of MI skill attainment through the use of video to simulate encounters with clients. The measures were administered during a training programme for staff of Child Youth and Family services (CYFs) New Zealand. The results suggest that the MIKAT and VASE-R are sensitive to the effects of training. However, it appeared both measures require refinement and possibly restructuring to make them more consistent with the most recent MI developments.

Populations in developed and developing countries are becoming increasingly sedentary and the adverse health effects of relatively sedentary lifestyles, the so called lifestyle diseases, are now obvious. However, moderately vigorous physical activity is positively linked via a cause-and-effect relationship with a range of improved health outcomes. Broadly, current physical activity recommendations suggest that adults should achieve a total of at least 30 minutes a day of at least moderate intensity physical activity on five or more days of the week; however, estimates suggest that the majority of adults in the Western World do not meet these recommendations. Many of the factors involved in the initiation and long-term maintenance of physical activity are not fully understood. Considering the rapid pace of technological development and the general move away from labour-based economies, it does appear that the required level of physical activity necessary for optimal health needs to come from leisure-time activity– specifically, planned, regular, moderately vigorous exercise and/or sport. Unfortunately, many people experience great difficulty in engaging with and maintaining a physically active lifestyle and typically there is a rather large gap between what people know to be healthy and what they actually do. The general aim of this project was to design, implement and evaluate the clinical, social and behavioural effectiveness of a buddy-Motivational Interviewing intervention (buddy-MI) in assisting relatively sedentary adults to adopt and maintain regular physical activity for the purpose of improving their cardio-respiratory fitness, health, and quality of life. Specific aims of the intervention included formally involving social support (via the self-selected motivational-buddy) and strengthening individuals’ motivation for and movement toward their physical activity goals. The experimental intervention specifically aimed to extend the MI treatment effect by enhancing participants’ commitment to physical activity over time via intra-treatment social support (support provided within treatment sessions) as well as extra-treatment social support (day-to-day support) provided by the motivational-buddy. A fundamental was to deliver the intervention in a format that could realistically be implemented within typical primary care settings, workplaces, schools or other similar setting: to work towards healthier more active communities and to potentially reduce health system resource utilisation. Using a repeated-measures pragmatic parallel group randomised controlled trial (RCT) design, relatively sedentary adolescents and adults, in stable health, recruited from a university campus population were allocated to one of two interventions. In the experimental intervention, participants were supported by a self-selected motivational-buddy and they received 2-4 sessions of buddy-MI over a period of 12-months (participant determined schedule) as well as pro-active follow-up emails. The control intervention was standard care MI, and the same email follow-up as in the experimental group but without the additional support of a motivational-buddy. The main outcomes were self-reported physical activity, cardio-respiratory fitness and health related quality of life. These primary outcomes were measured at four time-points over the 12-months intervention and follow-up period and quantitative methods were used to analyse the data. Qualitative data were also analysed and presented in relation to the motivational-buddy component of the intervention. The study evaluated the feasibility and incremental effectiveness of motivational-buddy support compared to one-on-one MI in people who had expressed an interest in becoming more physically active. It used a novel intervention design incorporating self-selected motivational-buddies in an effort to mitigate the twin problems of poor adherence and behavioural regression that are commonly associated with physical activity promotion programmes. The intervention was found to have merit and the potential implications for the health-care system, and the wider community, are discussed.

The effectiveness of Motivational Enhancement Therapy (MET), a brief four session form of Motivational Interviewing (MI), provided by diabetes health practitioners at a hospital-based clinic, in improving diabetes outcome and self-management of Type 1 and Type 2 diabetes was evaluated using quasi-experimental designs (i.e., non-random control group and multiple baseline designs). Study 1 evaluated if MET provided by Diabetes Nurse Educators (DNEs) was effective in improving diabetes outcome (i.e., blood glucose and lipids) and diabetes self-management, and compared its effectiveness to the current standard treatment which comprised Patient Education (PE). Study 2 evaluated if the results of Study 1 could be generalised to Dietitians providing the intervention. Study 3 evaluated the effects of MI training and post-training supervised practice on practitioner and patient behaviour. Specific hypotheses (Studies 1-2) were that MI would lead to improved diabetes outcome through improved diabetes self-management, and would be more effective than PE. Further, training in MI plus supervised practice was predicted to lead to Nurse Educators behaving in ways consistent with MI and as a result the participants would exhibit less resistance and increased change talk than participants receiving PE (Study 3). The results suggest that MET was well received by the participants, and contributed to improved diabetes outcome (e.g., lowered blood glucose) and diabetes self-management (e.g., self-monitoring of blood glucose and dietary compliance), and may have been more effective than PE, although high variability made conclusions uncertain. Evidence of generalisation across participants, intervention staff, and outcomes is provided. Additionally, evidence is provided that with two days training plus supervised practice the DNE were able to practice MET to at least a beginning level of competency in MI and that as a result the participants behaved in ways consistent with MI theory (i.e., showed less resistance and increased change talk).

Ohälsosamma levnadsvanor är ett växande problem i dagens samhälle. Följdsjukdomar uppkommer som hade kunnat förebyggas. Motiverande samtal är en metod som används av distriktssköterskor idag, som handlar om att få patienten att skapa en förändring genom egen motivation. Distriktssköterskan ska genom reflektivt lyssnande återge patientens tankar och föra en dialog angående problemet. Problem är ofta långt gångna innan vård söks, vilket påvisar bristen av hälsoprevention. Syftet med studien är att beskriva distriktssköterskans upplevelse av att arbeta hälsofrämjande med motiverande samtal som metod. Studiens design är kvalitativ med induktiv ansats. Data samlades in genom att intervjua åtta distriktssköterskor. Materialet analyserades utifrån kvalitativ innehållsanalys. Det framkom två huvudkategorier och åtta underkategorier.   I den första huvudkategorin, som handlar om förutsättningar för motiverande samtal som metod, påvisas att det motiverande samtalet är en användbar metod vid förändring av levnadsvanor. Distriktssköterskorna upplevde att uppföljning var en viktig del i användningen av metoden. De upplevde även att det motiverande samtalet var tidskrävande eftersom resultat inte sågs direkt, det kunde ta månader till år. I den andra huvudkategorin, som handlar om holistiskt förhållningssätt i det hälsofrämjande mötet, påvisas vikten av att få patienten delaktig och att lyckas motivera till en förändring av ohälsosamma levnadsvanor, även i de fall patienten inte själv ännu är motiverad. Av distriktssköterskorna upplevdes det också som viktigt att patienten själv skulle komma fram till sina mål för att lyckas och att det inom vissa grupper i samhället ses som svårare att använda motiverande samtal. I diskussionen diskuteras det motiverande samtalets applicerbarhet, vikten av att prioritera metoden och att hela primärvårdens verksamhet arbetar efter samma mål.

Youth with disabilities experience significant vocational and social hardships. Self-determination, self-efficacy, and critical consciousness are important components of positive post-secondary outcomes for this population. The purpose of this study was to design, implement, and evaluate a motivational interviewing-based group career intervention (MEGI) that focused on increasing self-determination, self-efficacy, and critical consciousness among high school students with high incidence disabilities. A mixed methods research design was used to explore the relationship between the intervention and the main study variables. A total of 135 high school students and nine interventionists participated in this study. The results of a latent change score model indicated a positive and significant change in students' vocational skills self-efficacy, self-determination, and vocational outcome expectations. Thematic results of student focus group indicated that students experienced an increase in self-determination, awareness of systemic effects on their educational and vocational success, and uncertainty about the future. Additionally, thematic results of the interventionist focus group indicated an increase in students' self-understanding.

Type 1 diabetes (T1D) is one of the most common pediatric chronic illnesses. Glycemic control among patients with T1D often deteriorates during adolescence; yet little is known about the most effective way for providers to communicate with adolescents to prevent this decline. Given the importance of effective communication, examination of effective patient-provider communication strategies is needed. The current investigation used Motivational Interviewing (MI) as a framework to help characterize naturally-occurring adolescent patient-provider communication in medical encounters and examined the relations between provider communication and T1D self-management and control. Participants were five pediatric endocrine providers and 55 adolescents with T1D (49% female; 76% White; M age= 14.8 years, SD= 1.6). Mean T1D duration was 7.9 years (SD= 3.9) and mean baseline HbA1c was 8.58% (SD= 1.4). Adolescents and caregivers completed surveys related to diabetes self-management and psychosocial functioning at a routine endocrinology visit and again at one and three months post-baseline. Medical encounters were audio-recorded and coded. HbA1c was obtained via medical chart review at baseline, three, and six month appointments. Hierarchical multiple regressions revealed that, after controlling for prior MI training (providers) and adolescent baseline HbA1c, age, and race, use of MI non-adherent behavior (e.g., confronting, persuading) was associated with 1) poorer three month HbA1c, F(5,45)= 11.19, p < .001; R2 = .554 and 2) worse adolescent diabetes adherence, F(5, 46)= 9.86, p < .001; R2= .517. MI non-adherent behavior emerged as a significant predictor in each model, t(45)= 2.13,p = .038, β = .242 and t(46) = -2.39, p= .021, β= -.300, respectively. A mediation analysis determined that patient self-efficacy for diabetes self-management mediated the relation between the use of these MI non-adherent behaviors and lower diabetes adherence. In TalkT1me, providers’ overreliance on persuasion and confronting adolescents about the risks of non-adherence was paradoxically associated with poorer glycemic control and adherence. Certain communication techniques that are inconsistent with MI, like confronting or persuading, appear to have a negative impact on diabetes self-care and HbA1c. Results from this evaluation of naturally occurring communication can help guide targeted training efforts to enhance communication and improve diabetes self-care with these vulnerable patients.

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