Adolescent obesity has increased exponentially over the past three decades in the United States. In response, behavioral interventions have been developed and implemented to address this epidemic; however, treatment adherence is often suboptimal. Motivational interviewing (MI) is a directive, person centered approach to reducing patient ambivalence about change, which has been shown to increase engagement in obesity interventions. The current study investigated the underlying process of MI by exploring two different, but related pathways that explain how change happens (e.g., the technical and relational hypotheses) in the context of a multidisciplinary obesity intervention with African American adolescent girls (N = 30). Results demonstrated that MI-consistent skills were associated with client “change talk,” or language consistent with their desire, ability, reasons, need, taking steps or commitment to change. Specifically, clinician reflection of client change language and support of client autonomy were especially important for increasing change language. Furthermore, client language related to change was associated with three-month treatment adherence, and increased fruit and vegetable intake. However, the clinician’s ability to embody the MI “spirit” was not related to either client language or three-month treatment adherence. Findings suggest that the technical aspect of MI helps explain this approach's effects on treatment adherence among African American girls with obesity.

INTRODUCTION: While research indicates that Motivational Interviewing (MI) is effective for reducing substance use, little is known about whether brief MI-based interventions reduce drug use in a primary care setting, or what processes impact outcomes. Mixed findings in MI process studies have led investigators to call for research exploring alternative process variables that may predict outcomes. The current study is a secondary data analysis using coded audio-recordings from a randomized controlled trial that tested the efficacy of two brief MI-based interventions as part of the `Assessing Screening Plus brief Intervention's Resulting Efficacy to stop drug use' (ASPIRE) trial. It was hypothesized that skill in affirming clients and enhancing self-efficacy (also assessed as a composite self-enhancement variable) would be associated with lower frequency of drug use at 6 weeks and 6 months after controlling for baseline drug use and indicators of general MI proficiency. METHODS: Audio-recordings from two intervention conditions [Enhanced Motivational Intervention (EMI; N=176) and Brief Negotiated Interview (BNI; N=174)] were coded with behavior counts and global interventionist skill ratings using an established coding system for MI and a study-specific coding manual. A series of negative binomial regression models were conducted that were stratified by intervention due to the different goals and characteristics of the two interventions. Secondary and tertiary analyses examined moderators including MI Spirit and patient baseline ratings of self-efficacy. RESULTS: There were no significant findings for the main effects models (Incidence Rate Ratio range .71-1.29). Only patient self-efficacy moderated the relationship between self-enhancement composite and 6 week outcome in the BNI condition; Self-enhancement composite was associated with lower frequency of drug use at 6 weeks in the BNI condition for those with low self-efficacy at baseline. Discussion: Overall, the results provided little support for the view that therapist skill in affirmation or enhancing self-efficacy was predictive of drug use outcomes in one-session interventions in primary care. The restricted range of interventionist skill ratings may account, in part, for these intervention process findings. Future work should explore the role of these interventionist variables on proximal indicators of change (i.e., intention) and drug use in MI-based interventions with demonstrated efficacy.

Bakgrunden beskrivs utifrån ett globalt och svenskt perspektiv hur levnadsvanor påverkar människors hälsa negativt. Den vanligaste ohälsosamma levnadsvanan är övervikt och den ökar globalt samtidigt kan övervikt leda till sjukdomar. Vidare beskrivs motiverande samtal (MI) och vårdande samtal som kan vara en del i behandlingen vid livsstilsförändringar. Problemformuleringen beskriver sjuksköterskans roll i arbetet med patienters livsstilförändringar. Syftet är att belysa patienters upplevelser av motiverande samtal vid livsstilsförändringar. Arbetet är en litteraturöversikt, metoden som används är beskriven av Friberg (2012, ss. 133-142). Vetenskapliga artiklar från databaserna PubMed och Cinahl har granskats och analyserats. Resultatet beskriver att patienters upplevelse av MI innebär en ökad kunskap, ökad motivation till förändring och ökad fysisk aktivitet. Vidare beskrivs relationens betydelse samt en ökad livskvalitet. Diskussionen består av en metoddiskussion där styrkor och svagheter i litteraturöversikten belyses. I den avslutande resultatdiskussionen diskuteras huvudfynden av resultatet, till exempel att patienter upplever att MI bidrar till en god vårdrelation. Avslutningsvis diskuteras slutsatser och förslag på vidare forskning. / Program: Sjuksköterskeutbildning

Distriktssköterskan ska bedriva hälsofrämjande arbete både på individ, grupp- och samhällsnivå. Hälsosamtalet kan vara en del av distriktssköterskans arbetsuppgift för att nå fram till patienten med hälsoinformation. Syftet med vår studie är att undersöka patientens erfarenheter av hälsosamtalet. Vi har använt oss av kvalitativ metod genom att intervjua sex patienter, som deltagit i planerade hälsosamtal på vårdcentral. Intervjuerna spelades in på band och texten skrevs ut ordagrant av författarna. Data bearbetades enligt kvalitativ innehållsanalys och genom det framkom då tre kategorier. Att få stöd till livsstilsförändringar, Att bli motiverad till att ta eget ansvar för sin hälsa, Att ha behov av ytterligare stöd och fyra underkategorier. Resultatet visar, att genom hälsosamtalet får patienterna en ökad insikt om att de behöver ändra levnadsvanor för att motverka ohälsa. Distriktssköterskans kompetens och stöd gör, att motivationen till att vilja förändra livsstil underlättas för patienterna. Förändringen är lättare att genomföra om distriktssköterskan ger patienterna en möjlighet att återkomma för uppföljning. Distriktssköterskan får möjlighet att förmedla kunskaper om levnadsvanor på ett pedagogiskt sätt genom hälsosamtalet. Vidare måste distriktssköterskan vara medveten om att utgå från patientens perspektiv vid ett hälsosamtal, för att lyckas motivera till en förändring av levnadsvanor. / Program: Specialistsjuksköterskeutbildning med inriktning mot distriktssköterska

En av de vanligaste folksjukdomarna i Sverige är astma. Det finns många vårdcentraler som har en astmamottagning med specialiserade sjuksköterskor och läkare. Distriktssköterskan har en stor betydelse genom att erbjuda undervisning och ge god omvårdnad för att patienten själv ska kunna hantera sin sjukdom. Distriktssköterskan arbetar med olika omvårdnadsstrategier för att behandla och hjälpa sina patienter. Vid astma är egenvård av största vikt för att uppnå en god symtomkontroll och för patientens möjlighet att uppleva hälsa. Syftet med studien var att belysa vilka omvårdnadsstrategier distriktssköterskan använder i behandlingen av astma. I denna studie har en kvalitativ ansats använts och tio sjuksköterskor som innehar funktionen astmasjuksköterska har intervjuats. Två av dessa sjuksköterskor saknade specialistutbildning till distriktssköterska. En intervjuguide användes med en inledande fråga där informanten ombads att beskriva ett möte med en astmapatient. Analys av data har skett med hjälp av kvalitativ innehållsanalys.I resultatet framkom att i de omvårdnadsstrategier som distriktssköterskan utför finns en tydlig strävan att inge trygghet och kunskap till patienten. Informanterna betonar vikten av att skapa en god relation till patienten för att kunna förmedla kunskap, ge stöd och rådgivning. Enligt föreliggande studie kan det finnas belägg för vidare forskning inom området bemötande samt stöd och rådgivning riktat till patienter med astma. Studien kan ge distriktssköterskan vidare möjligheter att bli medvetna och reflektera över vikten av att skapa god relation. / Program: Specialistsjuksköterskeutbildning med inriktning mot distriktssköterska

The purpose of this qualitative interpretive descriptive study was to better understand children’s perceptions of the use of motivational interviewing (MI) as a communication style for childhood obesity treatment. Childhood obesity in the United States has reached epidemic proportions and much research effort has been dedicated to reversing this trend. One approach that has demonstrated positive outcomes in the clinical setting is MI. Leading organizations in pediatric healthcare now recommend MI as a communication style to be used for childhood obesity-related behavior change. Although empiric studies have demonstrated improvement in outcomes when this communication style is used with patients and families, no study to date had looked at MI from the perspective of the child. Thorne’s (2008) framework for interpretive descriptive research was used for this study. Individual interviews with children ages 7 through 13 were conducted in an outpatient weight management clinic that utilizes MI as the primary communication style for facilitating behavior change. Qualitative data analysis was conducted utilizing Thorne’s recommendations for interpretive descriptive research. Five themes emerged from the data: 1) Empowerment, 2) Freedom to be Me, 3) Educating without “Educating”, 4) Unconditional Support, and 5) Blossoming. A conceptual model was developed from the research findings to help clinicians working with children in similar contexts glean a deeper understanding of the use of MI with children. Future research endeavors should focus on the implementation of this model in clinical practice to strengthen the conceptual links and determine applicability to practice.

The purpose of this study was to assess the impact of motivational interviewing (MI) counselor training in a public vocational rehabilitation (VR) setting. Data were collected from a total of 347 participants (67 counselors and 280 clients) in the experimental and comparison groups, during the pre-and-posttests. The counselors in the experimental group received a 4-hour standardized MI training and a 4-week follow up coaching sessions. Results of this study indicated that counselors in the experimental group demonstrated significant gains in their MI competence scores compared to the comparison group. The clients of the experimental group’s counselors significantly improved their engagement in VR services and working alliance with their counselors. Also, counselors’ education level and CRC status showed strong correlation with the posttest MI competence total scores. Finally, working alliance was found to be a significant predictor of client engagement. This study established the preparatory knowledge for the relationship between MI counselor training, client engagement, and counselor-client working alliance in a public rehabilitation setting. The results of this study contribute to the rehabilitation literature by providing evidence-based knowledge and tools designed to improve the quality of VR service outcomes, such as employment, for people with disabilities. With the findings of this research, there is evidence available to provide rehabilitation administrators to justify investing time and other resources into training rehabilitation counselors on the use of MI intervention. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

It is currently estimated that over one-third of children aged 6-11 years in the United States are overweight or obese with some of the highest rates documented in Southern Appalachia. Primary care providers are uniquely positioned to intervene, however, lack of time as well as training and confidence in using behavioral techniques have been cited as barriers. Recommended strategies include use of a multidisciplinary team approach, family-centered communication, behavioral strategies, and care delivery following the chronic care model, including enhancement of parent self-management. The purpose of this study was to develop and evaluate a parent-mediated approach utilizing physician’s brief motivational interviewing and parent group sessions to treat child overweight and obesity in the primary care setting in Southern Appalachia. The current study enrolled 67 children (5-11 years) with BMI≥85th percentile and a parent/primary caregiver from four primary care practices in Southern Appalachia. The two participating Pediatric practices and two Family Medicine practices were randomized to intervention or usual care control groups. Providers in the intervention group were trained to deliver two individual visits, using brief motivational interviewing and following the AAP 15-minutes obesity prevention protocol, and four group visits using the NIH We Can! Curriculum with parents over an 8-10 week period. Trained study staff also completed four phone calls using brief motivational interviewing with parents following each group visit. Child weight and height and parent surveys were collected for both intervention and control groups at baseline, three, and six months. Additionally, parents in the intervention group completed We Can! surveys at baseline and following the fourth group session. An analysis of covariance (ANCOVA) was performed to test for the effect of treatment on zBMI at three and six months post-intervention. We Can! survey results were analyzed using paired t-tests. Data on 53 (82%) and 46 (69%) of participants was available at 3 and 6 months, respectively. While the point estimate of the treatment effect was in the expected direction, the effect of treatment assignment did not have a statistically significant effect on the zBMI at either three or six months. However, significant (p This study provides preliminary data on the use of a combination of individual and group visits with parents to treat overweight and obesity in children in primary care.

Mental health counselors who counsel adolescents suffering from substance abuse and obesity issues have successfully used motivational interviewing with their clients; however there is little data that has explored motivational interviewing when it has been used to address academic concerns in schools. The purpose of this study was to explore the experiences of school counselors who have used motivational interviewing to improve student academic performance. This heuristic phenomenological qualitative study examined the perceptions and experiences of professional school counselors who had used motivational interviewing in their schools. Criterion sampling was used to recruit 9 middle and high schools counselors from across the United States. Interview data was analyzed using NVivo software and provisional coding, which revealed four specific themes: defining motivational interviewing in schools, explaining specific techniques, combining motivational interviewing with other theories, and training opportunities for school counselors. The themes that emerged from this study strengthen existing research and provide current and future school counselors with insight into the potential that motivational interviewing could bring to their school counseling programs.

Dual diagnosis clients continue to have low treatment completion rates. The purpose of the current study was to understand if motivational interviewing helped to increase completion rates for clients receiving cognitive behavioral therapy (CBT). Studying the problem was necessary for identifying an evidenced-based model for mental health counselors to help clients with dual diagnoses complete CBT treatment. There were no studies available for understanding the effectiveness of motivational interviewing as a tool for improving treatment completion rates for dual diagnoses clients in intensive outpatient programs. The research question examined if motivational interviewing was effective for improving treatment completion rates for the dual diagnosis population. A quantitative methodology with a quasi-experimental design used for this study and included a paired samples t test, a chi-square test, and a logistic regression analysis. The results showed a statistically significant association between receiving the motivational interviewing techniques and completing CBT. Clients who received motivational interviewing were 4 times more likely to complete CBT treatment compared to clients who did not receive the technique. Clients with increased self-efficacy levels were 2 times more likely to complete treatment, thus addressing the problem of dual diagnosis clients having low treatment completion rates. The overall results demonstrated that clients reduced substance use relapse and recidivism improved. Completing treatment helped to reduce crimes related to drug use; it also prepared substance users for return to society as productive citizens, which promoted positive social change.