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Getting from Here to There: Motivational Interviewing and Other Techniques to Promote Healthy Aging.
Lianov, L
Clinics in geriatric medicine. 2020;(4):719-732
Abstract
Successful health behavior change relies on the autonomy of the individual who is driven toward personally meaningful, positive goals. The medical practitioner and health care team can use several techniques to facilitate such change effectively, including motivational interviewing, cognitive behavioral restructuring, appreciative inquiry, and positive psychology techniques. Older adults can be supported to make change, and may have greater capacity to maintain those changes due to increased levels of conscientiousness. Positive psychology approaches may be effective in older adults, due to evidence that, as individuals age, they tend to prioritize activities that bring them satisfaction and emotional well-being.
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Integrated motivational interviewing and cognitive behaviour therapy for lifestyle mediators of overweight and obesity in community-dwelling adults: a systematic review and meta-analyses.
Barrett, S, Begg, S, O'Halloran, P, Kingsley, M
BMC public health. 2018;(1):1160
Abstract
BACKGROUND The aim of this study was to investigate whether integrated motivational interviewing and cognitive behaviour therapy leads to changes in lifestyle mediators of overweight and obesity in community-dwelling adults. METHOD Six electronic databases were systematically searched up to 04 October, 2017. Analyses were restricted to randomised controlled trials that examined the effect of integrated motivational interviewing and cognitive behaviour therapy on lifestyle mediators of overweight and obesity (physical activity, diet, body composition) in community-dwelling adults. Meta-analyses were conducted using change scores from baseline in outcome measures specific to the lifestyle mediators of overweight and obesity to determine standardized mean differences (SMD) and 95% confidence intervals (95% CI). The Grades of Recommendation, Assessment, Development and Evaluation approach was used to evaluate the quality of the evidence. RESULTS Ten randomised controlled trials involving 1949 participants were included. Results revealed moderate quality evidence that integrated motivational interviewing and cognitive behaviour therapy had a significant effect in increasing physical activity levels in community-dwelling adults (SMD: 0.18, 95% CI: 0.06 to 0.31, p < 0.05). The combined intervention resulted in a small, non-significant effect in body composition changes (SMD: -0.12, 95% CI: -0.24 to 0.01, p = 0.07). Insufficient evidence existed for outcome measures relating to dietary change. DISCUSSION The addition of integrated motivational interviewing and cognitive behaviour therapy to usual care can lead to modest improvements in physical activity and body composition for community-dwelling adults. The available evidence demonstrates that it is feasible to integrate MI with CBT and that this combined intervention has the potential to improve health-related outcomes. CONCLUSION This review details recommendations for future research including the adoption of uniform objective outcome measures and well-defined interventions with sufficient follow-up durations and assessments of treatment fidelity.
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Improving physical health of patients with severe mental disorders: a critical review of lifestyle psychosocial interventions.
De Rosa, C, Sampogna, G, Luciano, M, Del Vecchio, V, Pocai, B, Borriello, G, Giallonardo, V, Savorani, M, Pinna, F, Pompili, M, et al
Expert review of neurotherapeutics. 2017;(7):667-681
Abstract
People with severe mental disorders have a mortality rate that is more than two times higher than the general population, with at least a decade of potential years of life lost. People with mental disorders have a significantly higher risk of obesity, hyperglycemia and metabolic syndrome, which are related to modifiable risk factors, such as heavy smoking, poor physical activities, and inappropriate unhealthy diet, which can be improved through lifestyle changes. Areas covered: Lifestyle behaviours are amenable to change through the adoption of specific psychosocial interventions, and several approaches have been promoted. In the present review, the authors aim to: 1) critically analyze studies involving multimodal lifestyle interventions; 2) discuss the way forward to integrate these interventions in clinical routine care. Expert commentary: The psychoeducational approaches developed for the improvement of healthy lifestyle behaviours differ for several aspects: 1) the format (individual vs. group); 2) the setting (outpatient vs. inpatient vs. home-based); 3) the professional characteristics of the staff running the intervention (psychiatrists or nurses or dietitians or psychologists); 4) the active ingredients of the intervention (education only or inclusion of motivational interview or of problem solving); 5) the duration of treatment (ranging from 3 months to 2 years).
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Motivational interviewing by general practitioners for Type 2 diabetes patients: a systematic review.
Thepwongsa, I, Muthukumar, R, Kessomboon, P
Family practice. 2017;(4):376-383
Abstract
BACKGROUND Motivational interviewing (MI) is an effective tool to help clinicians with facilitating behavioural changes in many diseases and conditions. However, different forms of MI are required in different health care settings and for different clinicians. Although general practitioners (GPs) play a major role in Type 2 diabetes management, the effects of MI delivered by GPs intended to change the behaviours of their Type 2 diabetes patients and GP outcomes, defined as GP knowledge, satisfaction and practice behaviours, have not been systematically reviewed. METHODS An electronic search was conducted through Cochrane Library, Scopus, ProQuest, Wiley Online Library, Ovid MEDLINE, PubMed, CINAHL, MEDLINE Complete and Google Scholar from the earliest date of each database to 2017. Reference lists from each article obtained were reviewed. Measured changes in GP satisfaction, knowledge, and practice behaviours, and patient outcomes were recorded. RESULTS Eight out of 1882 studies met the criteria for inclusion. Six studies examined the effects of MI on Type 2 diabetes patient outcomes, only one of which examined its effects on GP outcomes. Two-thirds of the studies (4/6) found a significant improvement in at least one of the following patient outcomes: total cholesterol, low-density lipoproteins, fasting blood glucose, HbA1c, body mass index, blood pressure, waist circumference and physical activity. The effects of MI on GP outcomes yielded mixed results. CONCLUSIONS Few studies have examined evidence for the effectiveness of MI delivered by GPs to Type 2 diabetes patients. Evidence to support the effectiveness of MI on GP and patient outcomes is weak. Further quality studies are needed to examine the effects of MI on GP and patient outcomes.
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A systematic review of Motivational Interviewing interventions in cancer patients and survivors.
Spencer, JC, Wheeler, SB
Patient education and counseling. 2016;(7):1099-1105
Abstract
OBJECTIVE To explore the use of Motivational Interviewing (MI) interventions among cancer patients and survivors, and determine aspects of intervention design that are common across successful MI interventions for this population. METHODS We conducted a systematic review of studies addressing behavior change in cancer patients or survivors using Motivational Interviewing techniques. Studies were categorized into three groups based on behavioral outcome; lifestyle behaviors, psychosocial outcomes, and cancer-related symptom management. RESULTS We included 15 studies in our analysis. Studies addressed behaviors such as diet, exercise, smoking cessation, cancer-related stress, and fatigue management. Counseling sessions varied in frequency and method of delivery, although telephone-based interventions were common. Trained oncology nurses often delivered MI sessions, and the majority of interventions included quality assessment to verify fidelity of MI techniques. CONCLUSION Solid evidence exists for the efficacy of MI to address lifestyle behaviors as well as the psychosocial needs of cancer patients and survivors. More research is needed on the use of MI for self-management of cancer-related symptoms. PRACTICE IMPLICATIONS Motivational Interviewing is a promising technique for addressing many types of behavior change in cancer patients or survivors. Intervention design must be sensitive to cancer type, phase of care, and complexity of desired behavior.
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Motivational interviewing and outcomes in adults with type 2 diabetes: A systematic review.
Ekong, G, Kavookjian, J
Patient education and counseling. 2016;(6):944-52
Abstract
OBJECTIVES The management of type 2 diabetes (T2D) requires complex behavior changes and treatment regimens to achieve optimal outcomes. Interventions including motivational interviewing (MI) have been explored to help patients achieve behavior change and outcomes; this study aimed to explore evidence and gaps in the literature for MI interventions and outcomes in adults with T2D. METHODS A modified Cochrane method structured the search strategy among databases including MEDLINE, CINAHL, PsycINFO, and others. Inclusion criteria included randomized controlled trials that assessed the effects of MI on behavior changeoutcomes and resultant clinical outcomes in adults with T2D. RESULTS Of the initial 159 studies identified, 14 were eligible for retention. Behavior targets in the retained studies included dietary changes, physical activity, smoking cessation, and alcohol reduction. MI had significant impact on some dietary behaviors and on weight loss. MI intervention structures were heterogeneous across studies; fidelity assessment was infrequent. CONCLUSION The effects of MI interventions on outcomes in T2D showed promising results for dietary behaviors. Clinical change outcomes from MI-based interventions were most favorable for weight management in T2D. PRACTICE IMPLICATIONS Behavior-specific MI interventions may positively influence study outcomes. Assessment of MI intervention fidelity will enhance treatment integrity and claims for validity.
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Advances in Motivational Interviewing for Pediatric Obesity: Results of the Brief Motivational Interviewing to Reduce Body Mass Index Trial and Future Directions.
Resnicow, K, Harris, D, Wasserman, R, Schwartz, RP, Perez-Rosas, V, Mihalcea, R, Snetselaar, L
Pediatric clinics of North America. 2016;(3):539-62
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Abstract
Rates of childhood obesity in the United States remain at historic highs. The pediatric primary care office represents an important yet underused setting to intervene with families. One factor contributing to underuse of the primary care setting is lack of effective available interventions. One evidence-based method to help engage and motivate patients is motivational interviewing, a client-centered and goal-oriented style of counseling used extensively to increase autonomous motivation and modify health behaviors. This article summarizes the methods and results from a large trial implemented in primary care pediatric office and concludes with recommendations for improving the intervention and increasing its dissemination.
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Effective Patient-Provider Communication in Pediatric Obesity.
Carcone, AI, Jacques-Tiura, AJ, Brogan Hartlieb, KE, Albrecht, T, Martin, T
Pediatric clinics of North America. 2016;(3):525-38
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Abstract
Effective patient-provider communication is not a primary focus of medical school curricula. Motivational interviewing (MI) is a patient-centered, directive communication framework appropriate for in health care. Research on MI's causal mechanisms has established patient change talk as a mediator of behavior change. Current MI research focuses on identifying which provider communication skills are responsible for evoking change talk. MI recommends informing, asking, and listening. Research provides evidence that asking for and reflecting patient change talk are effective communication strategies, but cautions providers to inform judiciously. Supporting a patient's decision making autonomy is an important strategy to promote health behaviors.
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The primary prevention of cardiovascular disease: nurse practitioners using behaviour modification strategies.
Farrell, TC, Keeping-Burke, L
Canadian journal of cardiovascular nursing = Journal canadien en soins infirmiers cardio-vasculaires. 2014;(1):8-15
Abstract
Cardiovascular disease (CVD) places great financial strain on the health care system and dramatically affects individual quality of life. As primary health care providers, nurse practitioners (NPs) are ideally positioned to advise clients on risk factor and lifestyle modifications that ameliorate the impact of CVD. While the lifestyle targets for CVD prevention are established, the most effective means of achieving these goals remain uncertain. Behaviour modification strategies, including motivational interviewing (MI) and the transtheoretical model (TTM), have been suggested, but neither approach is established as being more efficacious than the other. In this paper, evidence on the effectiveness of the two approaches for modifying smoking, diet, and exercise behaviour are presented, and a recommendation for NP practice is made.
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Effectiveness of motivational interviewing to improve chronic condition self-management: what does the research show us?
Coyne, N, Correnti, D
Home healthcare nurse. 2014;(1):56-63
Abstract
Motivational interviewing (MI) as a strategy to promote behavior change has its roots in the addiction field. In recent years there is growing use of MI as an intervention to help patients with diet, physical activity, and other lifestyle changes. This counseling approach initially developed by clinical psychologists is a goal-oriented, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence (). MI is appealing because it is seen as a practical front-line intervention that is concordant with patient-centered care that is being called for in the health service environment.This column profiles four published research/synthesis articles describing experiences by different groups in implementing MI strategies. As you will read, results from trials evaluating MI on patient outcomes are mixed and there continues to be gaps in the evidence on how to best implement MI and on which patients will most likely benefit. Even with outstanding questions, MI shows promise in the very challenging area of promoting behavior change and warrants continued investigation. Interested readers are encouraged to read the original articles for more details.