Urogenital chlamydia infection, caused by the bacterium Chlamydia trachomatis (CT), is the most common sexually transmitted bacterial infection in Sweden. In 2008 it was estimated by WHO that there were 105.7 million new cases of CT worldwide, an increase by 4.2 million cases (4.1%) compared to 2005. If untreated, CT infections can progress to serious reproductive health problems, especially in women. These complications include subfertility/infertility, ectopic pregnancy and chronic pain. The CT infection is often asymptomatic and reliable diagnostic methods and contact tracing are important tools for identifying infected individuals. CT infection is classified in the Swedish Communicable Diseases Act as a serious disease; consequently, written reporting and contact tracing are compulsory. Previous or ongoing CT infection is not uncommon in infertile couples, especially in women with tubal factor infertility (TFI). We have tested 244 infertile couples for CT antibodies, and CT IgG positive couples were tested for CT DNA in urine. The prevalence of CT antibodies was higher in infertile men and women, and ongoing CT infection was common. Our results support a role of CT in infertility and underscore the importance of prevention of CT infection. Contact tracing was studied during using questionnaires. A total of 544 questionnaires was sent to tracers in a Swedish county and 534 (98%) were completed. Centralized contact tracing performed by experienced tracers is effective; on average 65% of sexual contacts found by contact tracing are CT-infected. Our data show that it is worthwhile to extend the tracing period beyond 6 months as 30% of reported sexual contacts between months 7-12 were CT-infected. Contact tracing may be performed face-to-face at the clinic or by telephone. Because of the severe consequences of CT infection there is a need for useful methods for both primary and secondary prevention of CT and other sexually transmitted infections (STIs). An important sub-population for CT/STI-prevention is the “core group”, i.e. a subpopulation with high incidence of STIs combined with risky sexual behaviours. This subpopulation contributes particularly to the spread of STIs in the population. Therefore, we have developed and evaluated a brief standardised but flexible manual-based single-session intervention based on motivational interviewing (MI) for the reduction of high risk sexual behaviour. Women (n=105) and men (n=119) at high risk of contracting CT infection were randomly eighter offered brief MI counselling or standard care. Our findings support the effectiveness of brief MI-based counselling in reducing high-risk sexual behaviour and incident CT infection in women (p<0.01) but not in men. Our results suggest that gender aspects need to be considered and that men and women should be treated differently for achieving maximal risk-reduction. Whereas it might be sufficient to include information and motivation when performing risk-reducing counselling on women, counsellors may also add other components, such as behavioural skills and booster sessions, when counselling is performed on men. / Klamydiainfektion orsakas av Chlamydia trachomatis och är den vanligaste sexuellt överförda bakterieinfektionen. WHO har uppskattat att det år 2008 var 105,7 miljoner nya fall av klamydia i världen, en ökning med 4,2 miljoner fall (4,1 %) jämfört med år 2005. Klamydiainfektion är ett folkhälsoproblem och klassificeras i den svenska smittskyddslagen som en allmänfarlig sjukdom varför det är obligatoriskt att smittspåra och göra en skriftlig anmälan till smittskyddsläkaren och Smittskyddsinstitutet. Klamydiainfektionen ger oftast inga symtom och tillförlitliga diagnostiska metoder och smittspårning är viktiga ”redskap” för att hitta smittade personer. Om klamydiainfektionen inte behandlas kan den leda till allvarliga hälsoproblem, speciellt hos kvinnor. Bland komplikationer efter klamydiainfektion ingår ofrivillig barnlöshet, utomkvedshavandeskap och kronisk buksmärta. Tecken på tidigare eller pågående klamydiainfektion är vanliga hos ofrivilligt barnlösa par, speciellt hos kvinnor med skadade äggledare som orsak till barnlösheten. Våra resultat ger stöd för betydelsen av klamydia vid ofrivillig barnlöshet och understryker vikten av förebyggande åtgärder mot klamydia samt klamydiaprovtagning av både män och kvinnor vid utredning av ofrivillig barnlöshet. Centraliserad klamydiasmittspårning utförd av erfarna smittspårare är effektiv och i genomsnitt är 65 % av spårade sexuella kontakter klamydiasmittade. Våra data visar att det lönar sig att förlänga smittspårningsperioden från 6 till 12 månader eftersom betydligt fler klamydiasmittade kontakter då hittas. Den så kallade ”Västerbottensmodellen” med en smittspårningsperiod på 12 månader rekommenderas nu av Socialstyrelsen. Kontaktspårning kan utföras antingen på mottagningen eller per telefon. På grund av risk för allvarliga konsekvenser av klamydia finns det behov av metoder för att förebygga klamydiasmitta. En viktig grupp för prevention är den så kallade ”kärngruppen", alltså de personer som har en hög förekomst av klamydia och andra sexuellt överförda infektioner i kombination med sexuellt riskbeteende. Denna grupp bidrar särskilt till spridningen av sexuellt överförda infektioner bland befolkningen. Därför har vi utvecklat och utvärderat en kort samtalsmetod som bygger på metoden motiverande samtal (MI, motivational interviewing) för att minska sexuellt risktagande. Våra fynd visar att kort MI-baserad rådgivning för att minska sexuellt riskbeteende och klamydiainfektion fungerar bra på kvinnor men inte lika bra på män. Resultaten tyder på att genusaspekter måste beaktas och att kvinnor och män ska behandlas på olika sätt för att uppnå maximal riskminskning. Det kan vara tillräckligt att fokusera på information och motivation vid rådgivning av kvinnor men för rådgivning av män kan man behöva komplettera med beteendemässiga färdigheter och/eller upprepad MI-baserad rådgivning för att nå god effekt.

Bakgrund: Livsstilsrelaterad ohälsa är ett stort samhällsproblem både i Sverige och i övriga världen. Sjukvården står inför en stor utmaning att komma till rätta med de sjukdomar och det lidande som orsakas av en ohälsosam livsstil. Sjuksköterskor har en viktig roll i mötet och behandlingen av patienter som lider av livsstilsrelaterad ohälsa. Motiverande samtal är en klinisk praktiserad och erkänd metod för att hjälpa människor att ändra sitt beteende.   Syfte: Att belysa sjuksköterskans användning och erfarenhet av motiverande samtal i praktiken med patienter som är i behov av livsstilsförändring.    Metod: Metoden som använts är litteraturöversikt. Tio vetenskapliga artiklar har granskats och använts för att besvara syftet.   Resultat: I resultatet framkom två huvudteman. Det första temat, hur MI används, beskriver vikten av utbildning och hur utbildning i MI står i relation till det kliniska användandet samt i vilken utsträckning MI-metoden används. Det andra temat, erfarenheter, beskriver sjuksköterskors erfarenheter av att arbeta med MI.   Diskussion: Diskussionen fördes utifrån Rosemarie Rizzo Parses teori om Human becoming och relevant litteratur.

Thesis (Ph. D.)--University of Canterbury, 2008. / Typescript (photocopy). Includes bibliographical references (leaves 263-313). Also available via the World Wide Web.

abstract: Correctional officers are increasingly being trained in evidence-based practices and the willingness of officers to implement what they have learned is crucial for organizational reform. Most of the literature in this area has examined officer attitudes about rehabilitation and punitiveness. Left out are additional characteristics, such as self-control, that may affect an officer’s receptivity to learn and implement new techniques. The present study examines officer receptiveness to motivational interviewing using 280 surveys administered to correctional officers tasked with both delivering and supervising program delivery to inmates within the Arizona Department of Corrections. Three broad questions are asked: 1) Are officer attitudes about punishment associated with receptivity toward implementing rehabilitative techniques? 2) Are officer levels of self-control associated with receptivity toward implementing rehabilitative techniques? and 3) Is the association between officer attitudes toward punishment and receptivity toward implementing rehabilitation techniques moderated by officer self-control? The results suggest that punitiveness and self-control both have statistically significant direct effects on correctional officer receptivity to training and that self-control does not moderate the relationship between punitiveness and receptivity to training. However, these findings could be due to limitations in the present study’s sampling and statistical methods. Policy implications and future research are discussed. / Dissertation/Thesis / Masters Thesis Criminology and Criminal Justice 2018

Pediatric obesity is a major public health epidemic with serious physical and psychological consequences. Difficulty engaging families in treatment is a significant obstacle in addressing pediatric obesity, especially among underserved populations. Motivational interviewing (MI) is a collaborative, person-centered communication style that has been shown to reduce attrition, increase attendance, and improve patient treatment adherence; however, little is known about the process of MI and how it improves treatment engagement. This study examined clinician and parent language in a pre-treatment MI session that increased initial engagement in a parent- focused pediatric obesity intervention (N= 81). Results showed that increased parent change talk, and preparatory language in particular, was positively related to the likelihood of initial attendance at baseline. Additionally, certain types of MI consistent clinician strategies were positively associated with parent change talk. Complex positive reflections were correlated with preparatory language and overall change talk, suggesting this might be a particularly important MI skill. Findings have implications for better understanding the process of MI and mechanisms through which MI can improve treatment engagement.

Magister Curationis - MCur / Background: Motivational interviewing is an approach that relates to a person’s hopes and aspirations. It is individual-focused to enhance intrinsic motivation to change. Over a decade, motivational interviewing has been shown to help achieve positive client outcome regarding substance use at various health settings in high income countries. In the Western Cape, clinical evidence suggests there is increase in number of children born with abnormalities related to prenatal exposure to substance. Anecdotal evidence suggests that the current support system in place for women who have children that are suffering from the effect of prenatal substance exposure seems not to be helping. As agents of change some NGOs in Western Cape are working towards decreasing substance use among pregnant women. Problem statement: The NGOs involve groups of individuals in Cape Town who render their service voluntarily to help pregnant women who have problem of substance use. They help motivate and support pregnant women to live a healthy lifestyle. It is however uncertain if personnel in these NGOs have knowledge of motivational interviewing. Aim: In the absence of the above information, this study is therefore aimed to explore NGO personnel’s knowledge on the use of motivational interviewing in addressing substance use among pregnant women in Western Cape. Method: A quantitative approach using a descriptive design with a non-probability all-inclusive sampling was used. A total of 45 participants were drawn from NGO shelters and day centres working with pregnant women who use substance in the Southern sub-urban district of Cape Town metropolis. Structured questionnaires were given to the participants for data collection and the response rate was 53% (n=24). Data was analysed using descriptive statistics. Results: The results of the study showed that the general performance of the participants on knowledge of motivational interviewing was poor. The score of most participants (i.e. mode) fell within 31 – 40%. Hence, the distribution of the scores was skewed toward the failed side. The percentages of males and females that passed were very low and the values were very close. Hence, gender was found not to influence the performance of the participants in this study. Lack of training in motivational interviewing was found to be responsible for lack of knowledge of the concept. There was no correlation between years of experience and age of participants on performance in the evaluation. The knowledge of participants on characteristics of substance user and the dynamic client-therapist’s interaction was very shallow. Participants who agreed to myths regarding substance users were most likely to exhibit actions that were not consistent with principles of motivational interviewing during their interactions with clients. The participants did not have adequate knowledge of the five basic principles of motivational interviewing. The conclusion of the study was that there was need to train NGO personnel in the concepts of motivational interviewing.

Background: In Canada, only 15% of adults meet the physical activity guidelines (Colley et al., 2011). As regular physical activity has been demonstrated to substantially improve physical and mental health (Naci & Ioannidis, 2013; Schuch et al., 2016), a wealth of physical activity promoting interventions have been developed and evaluated (Kahn et al., 2002; Prince et al., 2014). Physical Activity Counselling (PAC) is one of these and has been shown effective in increasing physical activity motivation and behaviour (Fortier et al., 2011). However, the active ingredients of PAC have never been reported in detail, thus limiting our potential for understanding its effectiveness and to allow for its replication. Recently, taxonomies have been published for characterizing behaviour change techniques (BCTs) and Motivational Interviewing (MI) techniques in interventions (Hardcastle et al., 2017; Michie et al., 2013). Due to its novelty, no studies to date have used the MI technique taxonomy to report interventions. Purpose: To investigate the behaviour change techniques (BCTs) and Motivational Interviewing (MI) techniques applied in PAC sessions delivered by student-counsellors. Methods: PAC 1 and PAC 2 sessions delivered by 11 student-counsellors were double coded for identification of BCTs and MI techniques, for a total of 22 video recorded sessions. Two trained coders rated the presence of BCTs and MI techniques using the Behaviour Change Technique Taxonomy v1 (BCTTv1) and the table of MI techniques. Inter coder agreement was assessed using Cohen’s kappa and the prevalence- and bias-adjusted kappa (PABAK) statistic. Results: Overall, 29 BCTs (on 93) and 27 MI techniques (on 38) were reliably coded across the sampled PAC sessions (Cohen’s k =.81, PABAK=.91). Popular BCTs included 3.1 Social support (unspecified), 1.1 Goal setting (behaviour), 1.4 Action planning, whereas OARS skills (i.e., open-ended questions, affirmations, reflective and summary statements) and 24. Emphasize autonomy were the predominating MI techniques. On average, 5.7 BCTs and 9.5 MI techniques were recorded per session. Conclusions: Findings of this study provide a first detailed report of a PAC intervention and have important implications for PAC training and replication. Future research in this area specifically looking at the quality of application of the techniques and the influence of use and quality on physical activity behaviour over time is recommended.

Abstract: Purpose: Effective interventions are needed to help adolescents with T1D develop independent self-management skills to prevent commonly observed deterioration of disease self-management resulting in poor health outcomes. Using a prospective RCT design, we assessed the impact of a nurse-led education program based on motivational interviewing (MI) in youth with Type 1 diabetes (T1D). Design and methods: After parental consent and youth assent, we prospectively randomized 66 adolescents 13-18 years old with T1D to either usual care (every 3 months visit with pediatric endocrinologist) or usual care supplemented by 2 in-person and 4 follow-up phone calls with a nurse educator in a pediatric endocrinology clinic of the University Hospital Farhat Hached, Sousse, Tunisia. We used MI sessions to support youth general and disease specific self-management skills. Outcomes were change, between baseline and 6 months, in TRAQ (a validated measure of youth self-management) scores and HbA1c values. Results: Mean TRAQ scores (based on a 5-point Likert scale) increased by 1.44 points (s.d. = 0.56) in the Intervention Group versus 0.26 points (s.d.= 0.34) in the control group (p < 0.001). The mean HbA1C value decreased in the intervention group by 0.95 units versus a decrease of 0.12 units in the control group (p=0.047). Conclusion: We found that a brief, nurse-led MI-based educational intervention, integrated into specialty pediatric care, resulted in a significant improvement in both self-reported self-management skills and in HbA1c values. Trial registration: Registered in ClinicalTrials.gov Identifier: NCT04798937

Indiana University-Purdue University Indianapolis (IUPUI) / Health care reform emphasizes prevention of chronic disease through the reduction of modifiable risk factors as a way to reduce health care costs, morbidity, and mortality. Motivational interviewing (MI) is an effective method of health behavior counseling. It has been used successfully applied in health related behavior change and self- management of chronic disease. The knowledge, skills, and attitude of MI are acquired through learning as other techniques used in the health professions. Nurse practitioner faculty need guidance on how to design instruction in MI that incorporates competencies and utilizes innovative strategies. Prescriptive instructional design theory utilizes knowledge from educational research to establish the steps in the design process. The purpose of this research was to apply prescriptive instructional theory to the design of effective, efficient, and engaging instruction in MI resulting in beginning proficiency in the NP students. A formative design was used for this study. The First Principles of Instruction served as the prescriptive design theory used in the design of instruction in MI. Data sources included the researcher’s design journal, observation during interaction with the instance, demographics of authentic users, authentic user reaction, and knowledge testing. Four cycles of design-redesign were completed. Results of the study point to improvements in the First Principles of Instruction. The instruction was effective, based on the improved scores from pretest to posttest on the Helpful Response Questionnaire. The improved scores also indicated an increase in knowledge of MI. Efficiency was not improved from pretest to posttest. The definition of efficiency as less time to completion of the task did not apply to MI communication skills. The First Principles of Instruction were useful in the design of the techniques of MI. However, there is little guidance for the affective component of MI such as empathy. The prescriptions of the First Principles of Instruction were useful in designing the instruction in MI. NP students indicated in post instruction interviews that engagement in the instruction was related to the relevance of the subject matter to practice and interactive exercises.

AbstractCharlotta Moritz och Hanne Kirsten 2016 Motiverande samtal i skolan (School based Motivational interviewing). Specialpedagogprogrammet, Lärande och samhälle – Skolutveckling och ledarskap, Malmö högskola.Den svenska skolan idag lider brist på motivationskapital. Det leder till att elevernas resultat sjunker och lärarnas sjukskrivningar ökar. Skoldebatten har en tendens att inta problemfokus istället för att finna lösningar. Det är därför viktigt att skolutveckling handlar om att försöka hitta, eller utveckla och anpassa, sätt att möta de problem som finns i skolvardagen.Vi vill undersöka om samtalsmetoden MI kan vara ett användbart redskap för specialpedagoger när de möter behovet av motivation hos pedagoger och elever i skolan. Vidare vill vi problematisera kring arbetets empiri med hjälp av motivationsteori kompetensutvecklingsteori och KASAM. Detta för att, med vetenskapligt förhållningssätt, kunna bidra med underlag för överväganden kring MI i en skolkontext.Arbetet har tre huvudsakliga frågeställningar:•Vilka erfarenheter har de intervjuade specialpedagogerna av metoden MI?•Har MI bidragit till kompetensutveckling hos specialpedagogerna?•Finns skillnader mellan specialpedagogernas uppfattning av MI och upphovsmännens definition av metoden, och vad gör det i så fall med användbarheten i en skolkontext?Arbetets upplägg är induktivt. Kvalitativa intervjuer utgör empirin. Tre specialpedagoger intervjuades i ett inledningsskede, därefter intervjuades en utbildare av metoden MI. Noggranna jämförelser mellan empiri och forskning ligger till grund för resultaten. Som analysverktyg i arbetet används dels Dreyfus och Dreyfus ”Skill Acquisition” modell dels motivationsteorier: Rogers ”Client Centered Therapy”, Deci och Ryans ”Self Determination Theory”, och Banduras ”Self-efficacy Theory".Resultaten visar på breda möjligheter för användandet av MI i skolan. Resultaten visar också att skolans praktiska aspekter gör att möjligheterna kan begränsas.Kompetensutvecklingen inom MI har bidragit till en upplevd förstärkning av relations-kompetensen hos specialpedagogerna. Den tekniska delen av MI-kompetensen hos informanterna förblir, i vårt arbete, till viss del otydlig.MI som metod och förhållningssätt rimmar väl med KASAM vilket kan sägas vara en del av kärnan i specialpedagogens yrkesutövande. De specialpedagogiska implikationerna blir följaktligen att ta ställning till om den egna verksamheten har, eller kan skapa, förutsättningar som gör att MI kan leda till positiva resultat.Elevers och lärares motivation i svensk skola är ett relativt outforskat område. Kontextbunden forskning inom både motivation och MI är därför angeläget.Nyckelord: Motivation, Motivational Interviewing, samtal, relationskompetens, kompetensutveckling.