This thesis investigates the acceptability and efficacy of Functional Imagery Training (FIT), a motivational intervention for weight-management. FIT is based on Elaborated Intrusion Theory, delivered in the style of Motivational interviewing (MI), and designed to promote sustained behaviour change and address cravings. It trains the habitual use of affective, goal-directed mental imagery of personal incentives, using imagery to plan behaviours, anticipate obstacles, and mentally try out solutions from previous successes. Participants are taught to update their imagery from their experience, and to generalise their imagery skills to new goals. In study 1, focus groups explored problems and wishes in regards to weight-management, including reactions to Functional Imagery Training (FIT) as a possible intervention. The issue of waning motivation and the desire for motivational app support was expressed in all groups. Participants were positive about FIT. Study 2 was an uncontrolled pilot trial of FIT. Eleven out of 17 participants (65%) lost 5% body weight or more by three months. Participants continued to lose weight during an unsupported 12-month period and experienced mean weight loss of 6kg (SD= 5.7; d=1.06) and mean waistline reduction of 11.5 cm (SD= 7.4; d=1.56) at 15 months. Study 3 compared the impact of FIT with MI on motivation and self-efficacy, over the first month of a randomised controlled trial (RCT) for weight-loss. Structured elicitation and training in goal-related imagery, i.e., FIT, increased motivation and self-efficacy for weight-loss relative to MI. Study 4 was the RCT for weight-loss, comparing FIT and MI over an intervention-supported six-month period, followed by six months unsupported. The FIT group achieved clinically meaningful weight-loss at 6 months (M kg-loss=4.11) and continued weight-loss at 12 months (M kg-loss=6.44); the MI group stabilised by 12 months (M kg-loss=.67), after minimal weight loss at 6 months (M kg-loss=.74). Study 5 qualitatively explored experiences of MI and FIT RCT participants, upon completing the 6-month intervention phase. MI participants wished for continued therapist- support and feared relapse. FIT participants described a mind-set-change and were confident they could maintain changes and overcome challenges using imagery techniques. Given the demonstrated benefit of motivational imagery in weight-control, FIT should be considered and further tested as an intervention for health behaviour change.

Syfte Syftet med studien var att utforska distriktssköterskors användning av MI för livsstilsförändringar hos patienter med svårläkta bensår. Design Kvalitativ intervjustudie med en induktiv ansats. Metod Författarna intervjuade åtta distriktsjuksköterskor som arbetar på vårdcentral. Dessa distriktsjuksköterskor arbetade med patienter med bensår. Författarna använde sig av en kvalitativ design där data insamlades genom semistrukturerade intervjuer som spelades in på band och transkriberades. Resultat I studien framkom det att patienter som tog till sig råd om livsstilsförändringar upplevde distriktssköterskorna hade en högre livskvalité. Dock kunde distriktssköterskorna uppleva en lägre livskvalité hos patienter som hade mycket smärta av såren, trots att de tog till sig de råden om livsstilsförändringar. Distriktssköterskorna arbetade personcentrerat och använde sig av MI i sina samtal under besök, dock användes endast vissa delar och inte hela konceptet av MI. De delar man använde sig av var öppna frågor, bekräftelse och sammanfattning. Slutsats I studien framkommer det att det är av stor vikt att arbeta personcentrerat vid behandling av sår, samt att motivera patienten att vara delaktig i sin behandling för bästa resultat. Författarna tror att med mer utbildning i MI och att MI används som hjälpmedel för att motivera varje enskild individ för livsstilsförändringar ger en förbättrad möjlighet till att få patienten mer motiverad, delaktig i sin vård och därmed få en förbättrad livskvalité och förbättrad läkning av det svårläkta bensåret. / Purpose The purpose of the study was to explore district nurses' use of MI for lifestyle changes in patients with severe leg ulcers. Design Qualitative interview study with an inductive approach. Method The authors interviewed eight district nurses working at the health center. These district nurses worked with patients with leg ulcers. The authors used a qualitative design and data was gathered through semi structured interviews that were recorded on tape and transcribed. Results The study found that according to the interviewed nurses, patients who receive advice about lifestyle changes experience a higher quality of life. Patients with a lot of pain due to leg ulcers, experience a lower quality of life even after undertaking the advice of life style changes. District nurses worked with person-centred care and use MI in their conversations during patient appointments. However, only certain parts of the MI is used and not the entire concept. The parts used are open questions, confirmation and summary. Discussion The study found that it is of great importance to use person-centred care in the treatment of wounds, as well as to motivate the patient to be involved in his treatment for best results. The authors believe that increased education on the use of MI and actual increased use of MI provide a big opportunity to get the patients more motivated, involved in their own care and thereby an improved quality of life and improved healing of the severe leg wound.

Bakgrund: Att förändra livsstilen till det bättre kan ge stora hälsovinster både på individ- och samhällsnivå. Vid hälsofrämjande arbete är motiverande samtal en av de rekommenderade samtalsmetoderna. Distriktssköterskans huvuduppgifter är att förebygga ohälsa samt vägleda patienten till en god hälsa. Syfte: Syftet med studien var att belysa distriktssköterskans erfarenhet av att använda motiverande samtal till patienter som är i behov av en livsstilsförändring inom primärvården. Metod: Kvalitativ studie med induktiv ansats. Semistrukturerade individuella intervjuer genomfördes med nio distriktssköterskor. Materialet analyserades med hjälp av en innehållsanalys. Huvudresultat: Distriktssköterskorna upplevde att motiverande samtal var användbart till många olika patientgrupper som var i behov av en livsstilsförändring. Vidare menade deltagarna att motiverande samtal uppmuntrade till ett personcentrerat förhållningssätt samt ökade patientens motivation till en förändring. Rutiner, uppdatering i samtalsmetoden samt implementering i verksamheten ansågs vara viktiga delar för ytterligare användning av samtalsmetoden. Konklusion: Motiverande samtal är ett användbart verktyg hos distriktssköterskan inom primärvården i mötet med patienter som är i behov av någon typ av livsstilsförändring. Motiverande samtal kan användas i många olika sammanhang och till flera olika patientgrupper. Genom att använda denna samtalsmetod skapas goda förutsättningar till en livsstilsförändring. / Background: Changing the lifestyle for the better health condition can provide major health benefits both at the individual level and at the social level. In health promotion work, motivating interviewing is one of the recommended methods. The district nurse's main tasks are to prevent illness and guide the patient to a good health. Aim: The aim of the study was to highlight the district nurse's experience of using motivational interviewing for patients in need of a lifestyle change in primary care. Method: Qualitative study with inductive approach. Semi-structured individual interviews were conducted with nine district nurses. The material was analyzed using a content analysis. Results: District nurses found that motivational interviewing was useful to many different patient groups who are in need of a lifestyle change. Motivational interviewing encouraged a person-centered approach and increase patient motivation for a change. Routines, update in the method and implementation in primary care were considered important parts for further use of the method. Conclusion: Motivational interviewing is a useful instrument for the primary care nurse in the meeting with patients in need of some type of lifestyle change. Motivational interviewing can be used in many different contexts and to several different patient groups. Using this method creates good conditions for a lifestyle change.

The emerging health care culture of accountability for patient outcomes compounds problems for already overwhelmed clinicians struggling to fit everything entailed in complicated office visits into 15-minute appointments. Unprocessed frustrations tempt clinicians to use ineffective and outdated methods for trying to get their patients to comply or adhere to their care plans, undermining effective health care management. The intention of this project was to evaluate whether educating medical assistants in the health coaching method of motivational interviewing can improve the patient care approach while simultaneously assisting clinicians struggling with insufficient time. Several individual scheduling conflicts limited the target population into two primary care medical assistants and two auxiliary primary care office staff who voluntarily chose to learn the new approach. Guided by the adult learning theory, an educational lecture project was designed to capture the spirit of motivational interviewing through basic descriptions and strategies that will assist learners to focus on person-centered conversation skills, helping to balance both the needs of the patient and clinician. Following the education, participants filled out an anonymous post-lecture evaluation questionnaire to provide immediate feedback about learner understanding. Responses indicated the project met its stated objectives, and results showed the versatility of the motivational interviewing method which can be learned and effectively applied by health care workers from a wide range of professional backgrounds. Motivational interviewing is an innovative approach that utilizes therapeutic communication to promote behavior changes that lead to improved health of our communities and country.

Bakgrund - Sjuksköterskor och distriktssköterskor har en viktig funktion i det hälsofrämjande arbetet och därför är det viktigt att få veta och ta del av deras erfarenheter om hur de upplever att arbeta med att få patienter till att bli mer fysiskt aktiva. Syfte – Syftet var att beskriva sjuksköterskors och distriktssköterskors erfarenheter av att med stöd av FaR® och motiverande samtal motivera patienter att öka sin fysiska aktivitet. Metod - Studien genomfördes med en kvalitativ ansats. Semistrukturerade intervjuer som utgick från en frågeguide användes. Data analyserade med en manifest kvalitativ innehållsanalys. En sjuksköterska och sju distriktssköterskor ingår i studien. Resultat – Resultatet visas i fyra kategorier och femton underkategorier. Kategorin ”Professionellt förhållningssätt” berör hur viktigt det är att lyssna och bekräfta patienten, att inte ge upp och finnas som ett stöd samt vilka känslor sjuksköterskorna upplever när det går bra och mindre bra med att motivera patienter till att öka sin fysiska aktivitet. Kategorin ”Svårigheter i arbetet” lyfter fram att det är svårt att motivera fysisk aktivitet. Att patienter har olika förutsättningar och att det är viktigt att öka patientens medvetenhet om sin hälsosituation. Tar även upp vikten av patientens motivation. Kategorin ” Erfarenheter av att använda FaR®” lyfter fram hur FaR® används och hur deltagarna upplever FaR®. Tar även upp hur arbetet med FaR® upplevs av kollegor och på hälsocentralen samt att behov av uppföljning finns. Kategorin ”Erfarenheter av att använda MI” berör hur MI upplevs som verktyg och hur det används. Att det är svårt att använda MI och att behov av mer utbildning i MI finns. Slutsats – Sjuksköterskors och distriktssköterskors erfarenheter visar att det är svårt att motivera patienter till ett förändrat beteende och det upplevs som svårt att arbeta med motiverande samtal. Motiverande samtal som verktyg är bra men otillräckligt. Det är viktigt att utgå från patientens förutsättning och att arbetet påverkas av hur sjuksköterskor och distriktssköterskor upplever sin motivation. FaR® som verktyg rekommenderas att användas mer. / Background – Nurses´ and district nurses have an important role in health promotion and therefore it is important to know and learn about their experiences on how they feel will work to increase the patients to become more physically active. Aim - The aim was to describe nurses and district nurses' experiences with the support of FaR ® and motivational interviewing motivate patients to increase their physical activity. Method - The study was conducted with a qualitative approach. Semi-structured interviews based on an interview guide were conducted. Data analyzed with a manifest content analysis. One nurse and seven districts nurses were included in the study. Results – The result is shown in four categories and fifteen sub-categories. The category "professional approach" addresses how important it is to listen and acknowledge the patient, not to give up and be as a support and the emotions nurses feel when things are going well and to motivate patients to increase their physical activity. The category "Difficulties in the work" is that it is difficult to motivate physical activity. The fact that patients have different conditions and that it is important to increase patient awareness of their health situation. Also discusses the importance of patient motivation. The category "Experience of using FaR®" addresses how FaR ® is used and how the participants feel FaR ®. Also discusses how work FaR ® are perceived by colleagues and the health center and the need for follow-up there. The category "Experiences of using MI" discusses how MI is perceived as a tool and how it is used. That it is difficult to use the MI and the need for more training in MI's. Conclusion – Nurses´ and district nurses’ experiences shows that it is difficult to motivate behaviour change and difficult to work with MI. Motivational interviewing as a tool is good bu insufficient. It is important to start from the patient's condition and that the work is influenced by how nurses and district nurses perceive their motivation. FaR ® as a tool is needed more widely used.

Project (Ed.S.)--James Madison University, 2009. / Includes bibliographical references.

L’insuffisance cardiaque (IC), une maladie chronique caractérisée par un mauvais fonctionnement du muscle cardiaque, entraîne des symptômes comme l’essoufflement, l’œdème et la fatigue. L’IC nécessite l’adoption de comportements d’auto-soins pour prévenir les épisodes de décompensation. Le but de cette recherche est d’évaluer l’intervention infirmière motivationnelle selon les stades de changements (MSSC) sur les comportements d’auto-soins chez des patients IC. Afin de guider l’intervention MSSC, la théorie spécifique aux auto-soins chez les patients IC de Riegel et Dickson (2008) a été retenue ainsi que le modèle d’intervention de Bédard et al. (2006) combinant le modèle transthéorique (Prochaska & DiClemente, 1984) et l’entrevue motivationnelle (Miller & Rollnick, 2006). Il s’agit d’un devis expérimental randomisé (pré et post-test) avec groupe contrôle (N = 15/groupe). Les patients du groupe contrôle ont reçu les soins usuels et les patients du groupe intervention (GI) ont reçu l’intervention MSSC durant trois entretiens. Les mesures de résultats ont été collectées à un mois suite à la randomisation par une assistante de recherche aveugle à la randomisation. L’effet de l’intervention a été évalué par des analyses de covariance sur cinq mesures de résultats : la réalisation et la gestion (générale et spécifique à l’IC) des auto-soins, la confiance aux auto-soins (générale et spécifique à l’IC) et la conviction. L’acceptabilité et la faisabilité ont été évaluées. Les résultats indiquent un effet significatif sur la mesure de confiance à effectuer les auto-soins spécifiques à l’IC. La majorité des participants du GI ont progressé dans leurs stades de changement. Ces résultats soulignent le potentiel de cette approche pour favoriser l’adoption des auto-soins mais une étude à plus large échelle est proposée afin d’évaluer l’effet de cette approche dans un essai clinique randomisé. / Heart failure (HF) is characterized by the heart’s reduced capacity to pump, resulting in symptoms causing respiratory problems and reduced quality of life. HF patients are advised to adopt self-care behaviours to prevent frequent episodes of decompensation. While medication and behaviour change play a major role in maintaining physiological stability, patient adherence to self-care recommendations is not optimal. The goal of this pilot study was to evaluate a Motivational Intervention following the Stages of Change (MISC) on HF patients’ self-care behaviours. To guide the MISC, the situation-specific theory of heart failure self-care (Riegel & Dickson, 2008) was retained as well as Bédard et al. (2006) model of intervention, a combination of Motivational interviewing (MI) (Miller & Rollnick, 2006) and Transtheoretical model (TTM) (Prochaska & DiClemente, 1984). This was a randomized experimental pilot project (pre and post-test, with a control group) (n=15/group). Patients in the control group received usual care from the HF clinic while patients from the experimental group (EG) received 3 MISC interventions. Data were collected at one month post-randomization by a blinded research assistant. The effect of the intervention was assessed on five self-care outcomes using analysis of covariance models: self-care maintenance and management (general and specific to HF), confidence in self-care (general and specific to HF) and conviction. Acceptability and feasibility were assessed. Significant results were obtained regarding the confidence in performing self-care behaviours specific to HF. A majority of patient in the EG did progress in the stages of change. The results suggest that a MISC intervention has potential to improve self-care. A larger study is needed to evaluate the effects of the MISC intervention in a randomized controlled trial.

Background & objective Cognitive Behavioural Therapy (CBT) and Motivational Interviewing (MI) have been the treatment of choice for problem or pathological gambling in the field in Western countries, and their efficacy has been supported by a considerable empirical research. Alternative treatments are little known; and such treatments for minority ethnic populations have been scarce. This study adopted Kazdin‘s procedures for assessing the acceptability of treatments (Kazdin, 1980a, 1980b, 1981) to test alternative treatments of problem or pathological gambling as a part of the broadening of treatment choices. This thesis presented 2009 survey results from counselling service providers in New Zealand on the acceptability of alternative treatments to problem or pathological gambling. The thesis, therefore, reports the responses of counsellors to counselling vignette case examples, not the views of actual clients viewing counselling. Methods The survey pack was distributed to counselling service providers in New Zealand. The survey included descriptions of sixteen vignettes of case examples of counselling treatments. Categories of clients in the vignette case examples included two genders (male, female) and three ethnicities (Pakeha, Maori, and Asian). Four counselling treatment conditions were selected from Solution-Focused Brief Counselling (SFBC), SFBC+Multicultural Counselling (SFBC+MC), Cognitive-Behavioural Therapy (CBT), and Motivational Interviewing (MI). CBT and MI were only administered to Pakeha clients for the purpose of comparison of the alternatives. Two measurements were used. The first a modified Problem Gambling Treatment Evaluation Inventory (TEI) was used to measure the acceptability levels of the alternative treatments for problem or pathological gambling. The Cross-Cultural Counselling Inventory-Revised (CCCI-R) was used for measuring the perceived cross-cultural competency of counsellors depicted in the vignette case examples. Findings Counsellors‘ ratings of the vignette case examples revealed the following findings: Measurement 1: Problem Gambling Treatment Evaluation Inventory (TEI). Overall, 1) The survey results of TEI questionnaires showed significant main effects across the four treatment conditions and the three client ethnicities, and there was no difference according to client genders. 1.1) SFBC+MC and SFBC were slightly more acceptable than CBT, and much more acceptable than MI. 1.2) The TEI scores for Pakeha clients were much higher than for Maori clients, and the scores for the Asian clients were in between. 2) There was a significant interaction effect between the four treatments and the three client ethnicities. 2.1) For Maori clients: SFBC+MC was much more acceptable than SFBC; for Pakeha clients: SFBC+MC was the most acceptable, closely followed by SFBC, CBT, then MI; and for Asian clients: SFBC was more acceptable than SFBC+MC. 2.2) SFBC+MC was most acceptable to Maori clients across all treatments and ethnic groups. 2.3) The variation in acceptability ratings for SFBC was larger than for SFBC+MC in Maori and Asian clients, and less variable in Pakeha. 2.4) Maori clients had the largest mean variation between SFBC and SFBC+MC, and Pakeha clients had the smallest mean variation. Measurement 2: Cross-Cultural Counselling Inventory-Revised (CCCI-R). The survey results of the CCCI-R showed significant main effects across the four treatment conditions and the three ethnicities. 1) The counsellors depicted in the vignette case examples under the SFBC+MC treatment condition were rated with the highest mean competence score and least variability across all the treatments and the ethnicities, the MI treatment condition were rated with the lowest mean score, CBT and SFBC were in between. 2) The counsellors described in the vignette case examples were rated more culturally competent with Pakeha clients and Maori clients than with Asian clients in the vignette case examples, the rating levels for both Pakeha and Maori were similar. 3) The Maori client in the vignette case examples had the largest mean gap between SFBC and SFBC+MC, and Pakeha client in the vignette case examples had the smallest mean gap. Clinical implications The tests of the acceptability of alternative treatment for problem or pathological gambling could provide useful information about 1) whether the above alternatives would be recommended or selected by the counselling service providers in their clinical practice, 2) which treatment would be more/less preferred by which ethnic group, 3) whether it would work or be worth the efforts to introduce or promote the above alternatives to the counselling service providers, 4) what needs to be explored for increasing levels of the acceptability of alternative treatment to problem or pathological gambling, 5) adding training in the techniques to counsellors training programme and curricula. The limitation of this study was discussed and future research was suggested.

abstract: This action research dissertation study was undertaken to establish the foundation of a comprehensive evaluation component for the Turn-It-Around (TIA) workshop intervention program at Arizona State University (ASU), and was delivered in the form of a program development consultation. The study's intent was to enhance the ASU Counseling Service's departmental capacity to evaluate one of its important clinical services. The outcomes of this study included multiple assessments of TIA's evaluability and the fidelity of its implementation to its program design. The study products include a well-articulated program theory comprised of program goals, learning objectives, a detailed description of program activities, a logic model, and theoretical construct checklist documents articulating the behavioral science theory underlying the TIA intervention. In addition, instruments tailored to the Turn-It-Around intervention that are suitable for assessing program outcomes were developed and are implementation ready. TIA's clinical stakeholders were interviewed following the generation and delivery of the products and instruments mentioned above to determine whether they found the study's processes and products to be worthwhile and useful. In general, the clinicians reported that they were very satisfied with the benefits and outcomes of the program development consultation. As an action research dissertation, this study generated useful and usable collateral materials in the form of reports, documents, and models. These products are now at the disposal of TIA's institutional stakeholders for use in day-to-day business activities such as training new facilitators and liaisons, and giving presentations that describe the usefulness of TIA as an intervention. Beyond the documents generated to form a program evaluation infrastructure for Turn-It-Around, the processes involved in crafting the documents served to engage relevant stakeholders in a cycle of action research that enriched and solidified their understandings of TIA and furnished them with insight into their counterparts' thinking about the intervention and its potential to benefit the college students they are responsible for helping. Consistent with the intent of action research, the processes involved in accomplishing the objectives of this study surfaced new topics and questions that will be useful in subsequent cycles of program improvement.   / Dissertation/Thesis / Ed.D. Educational Leadership and Policy Studies 2012

Studiens syfte var att undersöka på vilka sätt socialsekreterare ser på sitt arbete med äldre personer med alkoholmissbruk. Målet med undersökningen var att få en fördjupad förståelse för hur socialsekreterares erfarenheter kan relatera till de insatser och arbetsmetoder vilket socialtjänsten erbjuder äldre personer med alkoholmissbruksproblematik. Metoden som tillämpades var en kvalitativ metod och vi valde att inhämta vårt empiriska material genom semistrukturerade intervjuer. Det var 12 respondenter som deltog i undersökningen, 10 socialsekreterare och två enhetschefer inom vuxenavdelningen på respektive socialtjänst. Med användning av tidigare forskning samt begreppen socialsekreterare, äldre personer med alkoholmissbruk, empowerment och samverkan kunde resultatet analyseras. Socialsekreterare arbetar inom olika enheter på socialtjänsten där vuxenenheten är den avdelning vi valt att fokusera på eftersom den omfattar äldre personer med alkoholmissbruk. I arbetet med klienten har de lagar de utgår ifrån och det är främst Socialtjänstlagen (SFS2001:453) och Lag (SFS1988:870) om vård av missbrukare i vissa fall. I ett allt mer åldrande samhälle möter socialsekreterare allt fler individer inom missbruksområdet vilket gör att dessa socialsekreterare behöver kunskap kring de äldres åldrande och livsvillkor. Studiens resultat visade på hur majoriteten av respondenterna betonade hur viktig eftervården var för klientens fortsatta nykterhet, vikten av motiverande samtal som arbetsmetod och en god relation till klienten för att kunna ge utrymme till klientens egen vilja till förändring samt betydelsen av en god samverkan i syfte att kunna ge klienten bästa möjliga hjälp. / The purpose of the study was to investigate the ways in which social welfare secretaries look at their work with elderly people with alcohol abuse. The aim of the survey was to gain a deeper understanding of how social welfare secretaries' experiences can relate to the efforts and working methods, which social services offer elderly people with alcohol abuse problems. The method we used was a qualitative method and we chose to collect our empirical material through semi-structured interviews. There were 12 respondents who participated in the survey, 10 social welfare secretaires and two branch managers in the adult department of the respective social services. Using previous research and the concepts of social welfare secretaries, elderly people with alcohol abuse, empowerment and collaboration, the results could be analyzed. Social welfare secretaries work in different social services units, where the adult unit is the department we have chosen to focus on as it includes elderly people with alcohol abuse. In the work with the client, the laws they are based on are in some cases the Social Services Act (SFS2001: 453) and the Care of abusers (special provisions act) (SFS1988: 870). In an increasingly aging society, social welfare secretaries meet more and more individuals in the area of abuse, which means that these social welfare secretaries need knowledge about the aging and living conditions of the elderly. The study's results showed how the majority of respondents emphasized the importance of aftercare for the client's continued sobriety, the importance of motivating conversations as a working method and a good relationship with the client in order to provide space for the client's own will for change as well as the importance of a good collaboration with the aim of to provide the client with the best possible help.