Symposium 22 Tuesday Sept. 25th 9.00 am–10.30 am; Room: Lecture Hall 2
Understanding and defining motivational interviewing and its adaptions mechanisms using content analyses: Chairpersons: Lesch OM (Austria), Daeppen JB (Switzerland)
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Abstract |
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Presentation S22-1
Communication during brief intervention intention to change and outcome
Daeppen J-B, Bertholet N, Gmel, G, Gaume J (Switzerland)
Objectives. To explore the relationship between patient's intention to change regarding future alcohol consumption following brief alcohol intervention (BAI) and changes in alcohol consumption 12-months later and the communication characteristics between patient and counselor during BAI.
Methods. Data from 367 patients (experimental arm) of a pragmatic randomized controlled trial were used to assess the effectiveness of BAI among hazardous drinkers attending an Emergency Department (Lausanne University Hospital, Lausanne, Switzerland). Alcohol outcome measures at baseline and 12 months follow-up included usual number of drinks per week, monthly frequency of heavy episodic drinking (5 or more standard drinks for men; 4 or more for women), and the Alcohol Use Disorders Identification Test (AUDIT) score. In addition, the communication characteristics between patient and counselor were analyzed via tape recordings using the Motivational Interviewing Skill Code (MISC) from 97 participants Patient readiness and importance to change on a 10-point Likert scale (readiness/importance to change ruler) was asked during BAI, and patient intention to change alcohol consumption (yes/no) was asked at the last step. Differences in alcohol outcome at follow-up between the 367 patients who did or did not have an intention to change consumption at baseline were compared, as were differences between these two groups in communication characteristics for the 97 who completed tape recordings
Results. Patients with an intention to decrease alcohol consumption reduced alcohol use and related problems more often, and reported higher levels of importance and readiness to change than did their counterparts. Analyses of MISC-coded data showed a significantly higher use of MI-consistent skills among those with a moderation intention, but no group differences on the 8 other counselor communication skills measures were found. Analyses of patient speech during the intervention indicated that those with an intention to change their alcohol consumption significantly more often self-explored personal ambivalence towards alcohol, expressed more intensely their ability, commitment, desire, need and reason to change their alcohol use than did those in the no decrease group.
Conclusions. The intention expressed by hazardous drinkers when concluding BAI is associated with both patient change talk during BAI and drinking outcome 12 months later, but is mainly independent of counselor communication skills. This intention may be an important clinical indicator of which hazardous drinkers are most likely to improve after BAI.
Presentation S22-2
Exploring primary health care nurses' training and counselling experiences
Soederlund LL, Nilsen P, Kristensson M (Sweden)
This paper explores the training and counselling experiences of 20 nurses, aiming to identify key elements in the process of learning and applying MI counselling skills with adherence to protocols.
The nurses were recruited from 10 primary health care units in oestergoetland, Sweden. The study was carried out after the nurses had been practicing MI counselling in daily clinical work for about a year. Data were collected by means of semi-structured interviews, based on an interview guide, which contained questions on factors that past research has identified as important for effective training and practicing of MI. The interviews revealed several key factors for successfully learning and applying MI. Extensive training and close integration of training and practice were seen as crucial aspects to effective learning of MI skills. A barrier to satisfactory learning the MI counselling skills was the difficulty of adjusting to the new way of thinking required when practicing this technique since it contrasted with the authoritarian expert approach that the nurses were used to. Another difficulty was achieving effective communication with patients who were unwilling to accept responsibility for their own health.
Effective learning and applying of MI skills with adherence to protocols is fraught with many problems, requiring a considerable amount of time and effort for practice as well as the adoption of a new frame of mind with regard to the health care providers' relationships with the patients.
Presentation S22-3
Does readiness to change predict alcohol consumption in medical inpatients with unhealthy alcohol use?
Bertholet N, Cheng DM, Palfai T, Samet J-H, Saitz R (USA)
Aims. We studied whether readiness predicts alcohol consumption 3 months later in medical inpatients with unhealthy alcohol use.
Methods. Patients who participated in a randomized trial of brief intervention were assessed at baseline and 3 months later on alcohol consumption and with the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). We used two factors for analyses: 1-‘Perception of Problem (PP)’, and 2-‘Taking Action (TA)’. Poisson regression analyses were used to model the number of drinks per day at 3 months based on quartiles of each factor. Each model was controlled for baseline drinking and randomization group.
Results. The 267 participants drank a mean (SD) 6.9 (9.0) drinks/day (70%: men; 78%: alcohol dependence; mean age: 45). Baseline median SOCRATES score (Q25, Q75) were PP 39 (28, 44) and TA 22 (18, 26). Those in the 3rd quartile of PP consumed more drinks per day at 3 months [incidence rate ratios (IRR) (95%CI) for 2nd, 3rd, and highest vs lowest quartile: 1.54 (0.79, 2.98), 1.94 (1.02, 3.68), 1.64 (0.86, 3.14)]. Those in the highest quartile of TA drank about half as much at 3 months compared to those in the lowest quartile [IRR 0.42 (0.23, 0.78)]; no significant associations were observed for the 2nd [0.94 (0.58, 1.52)] or 3rd quartiles [1.06 (0.66, 1.71)].
Conclusions. Predictive value of readiness at 3 months differs according to the measure used. A measure that reflects volition or commitment to change appears to predict less drinking. Supporting self-efficacy may be particularly useful for medical inpatients with unhealthy alcohol use.
Presentation S22-4
Counselor behaviours and patient language during brief motivational interventions for at-risk alcohol consumption: A sequential analysis of speech
Gaume J, Gmel G, Daeppen J-B (Switzerland)
Aims. Patient language oriented toward change (change talk) during motivational interviewing (MI) sessions has been described as a predictor of effective change. Recent research showed that counselor behaviors consistent with MI theory were more likely to be followed by self-motivational statements of patients during MI sessions. But less is known how counselor reacts on patient behavior during the talk and whether e.g. the motivation of patient for change also influences counselor behaviors in a feedback slope. The purpose of this study was to investigate the articulation between counselor behaviors and patient language during brief motivational interventions (BMI) addressing at-risk alcohol consumption.
Methods. Two raters independently coded 97 tape-recorded BMI using the Motivational interviewing skill code (MISC), version 2.0. We summarized MISC variables in 3 counselor behaviors and 3 kinds of patient language and computed transition frequencies and odds ratios using sequential analysis software.
Results. 11,219 transitions between patients and counselors utterances were observed. Counselor MI-consistent behaviors were significantly more likely to be followed by patient change talk (OR = 2.58, 95% CI = 2.41–2.77) and were the only counselor behaviors to do so. MI-inconsistent behaviors were significantly more likely to be followed by neutral statements (OR = 2.86, 95% CI = 2.19–3.72).
Conclusions. Counselor behaviors consistent with MI theory significantly led to patient change talk during BMI for at-risk alcohol consumption. This supports the usefulness of MI consistent behaviors and spirit during brief interventions targeting change enhancement.
Presentation S22-5
Do we really know where we are? The public health impact of brief interventions
Gmel G (Switzerland)
Aims. There exist xyz meta-analytical reviews. The technique of brief interventions is one of the cheapest treatments and thus even cost-efficient. These are the average claims that someone might receive today when asking for research grants of brief intervention studies, everything seems to be known. The presentation argues that this is not true.
Methods. Narrative literature review.
Results. First, substantial evidence for efficacy of BIs has been shown for primary care settings only. There is an absence of evidence (not evidence of absence) for its efficacy in others settings such as in emergency departments or school settings. Second, that a treatment is efficacious in randomized controlled trials with well motivated (or paid) GPs does not mean that it is effective (and thus not cost-effective). A large scale implementation of BIs in a health care system is far from being reality and thus any public health impact of BIs is far from being proven. Thirdly, though efficacy has been shown for alcohol and tobacco use, more research is needed on other substances such as cannabis, and on interventions more reflecting the reality of young at-risk users which is not a reality of a single substance problem but multiple substance misuse. Fourth, little is known for whom BI works best. Are these the well motivated, ready to change, the abusers, hazardous users, young, men, etc.?
Conclusions. There is no need for more research on efficacy of BI in primary care. But there is an urgent need for demonstrating the public health impact of BI in real life settings.