A brief motivational intervention to improve dietary adherence in adolescents

Abstract

Motivational interviewing offers health care professionals a potentially effective strategy for increasing a patient's readiness to change health behaviors. Recently, elements of motivational interviewing and the stages of change model have been simplified and adapted for use with patients in brief clinical encounters. This paper describes in detail a brief motivational intervention model to improve and renew dietary adherence with adolescents in the Dietary Intervention Study in Children (DISC). DISC is a randomized, multi-center clinical trial assessing the efficacy and safety of lowering dietary fat to decrease low-density lipoprotein cholesterol in high-risk children. In the first 3 years of follow-up covering ages 8-13, intervention participants (n = 334) were exposed to a family-based group intervention approach to change dietary choices. To address adherence and retention obstacles as participants moved into adolescence (age 13-17), an individual-level motivational intervention was implemented. The DISC motivational intervention integrates several intervention models: stages of change, motivational interviewing, brief negotiation and behavioral self-management. A preliminary test of the intervention model suggests that it was acceptable to the participants, popular with interventionists and appeared to be an age-appropriate shift from a family-based intervention model.

Recommendations for Prevention of Childhood Obesity

“…239,240 In the past decade, there has been considerable interest from public health, medical, and dietetic practitioners in adapting MI to address various chronic disease behaviors. [240][241][242][243][244][245][246][247][248][249][250][251] Although MI has been used to modify diet and physical activity behaviors in adults, the evidence base for obesity prevention and treatment in children is just beginning to emerge. 252 In the current absence of health care-based interventions for childhood obesity prevention, using MI is an interim step clinicians can take that has some basis in evidence.…”

Motivational Interviewing: Improving Patient Education

“…The process begins with precontemplation, in which the family is not ready to change behavior; it then moves toward contemplation, in which the family is aware a problem exists but is ambivalent about the need for change; from there, the family members move into preparation and action, in which changes are made. Miller (1983) and elaborated upon by Miller and Rollnick (1991), is consistent with the stages of change and offers a practical, brief counseling method for helping families increase their motivation or readiness to change (Berg-Smith et al, 1999). The main goals of MI are to assist the family in working through its ambivalence about behavior change; assessing the importance of change, their confidence in making change, and readiness for change; and planning for change if they are ready (Resnicow et al, 2002;Rollnick et al, 1999).…”

“…Specifically, MI has been shown beneficial in controlling alcohol, heroin, marijuana, tobacco, and opiate addictions (Berg-Smith et al, 1999;Sindelar, Abrantes, Hart, Lewander, & Spirito, 2004). In addition, tests of the effectiveness of MI in controlling nonaddictive health behaviors also have been promising, including studies evaluating its effectiveness with decreasing high-risk behaviors in HIV patients, treatment adherence in diabetics, medication regimens, pain treatment, and eating disorders (Berg-Smith et al ; Sindelar et al).…”

Efeitos da entrevista motivacional em adolescentes infratores

“…Em relação à maconha, Stephens et al (2000) avaliaram duas sessões de EM com adolescentes, e também encontraram aumento nos índices de abstinência da mesma, com diminuição de sintomas de dependência, diminuição do uso de outras drogas ilícitas e de problemas relacionados ao seu uso, demonstrando que a EM facilita o processo de mudança no consumo de drogas e outras substâncias. Em um estudo semelhante realizado com a EM, por Berg-Simth et al (1999), para aumentar a adesão à dieta alimentar, foi avaliado o consumo de calorias diárias. Na reavaliação, houve redução significativa na quantidade de calorias ingeridas, indicando, assim como neste estudo, uma diminuição do consumo de substância foco da EM.…”

“…A EM tem se mostrado aplicável e efetiva (Dunn, Deroo & Rivara, 2001;Miller et al, 2003) em diversos comportamentos e na mudança dos estágios motivacionais (Heather, Rollnick, Bell & Richmond, 1995), na aderência ao processo terapêutico (Daley & Zuckoff, 1998;Lincourt, Kuettel & Bombardier, 2002), na adesão a dietas (Berg-Smith et al, 1999), na redução do uso de álcool (Borsari & Carey, 2000;Monti et al, 1999;Oliveira, 2001;Project Match Research Group, 1997), na redução do uso de maconha (Stephens, Roffman & Curtin, 2000;Stephens, Roffman, Fearer, Williams & Picciano, 2004), na redução do uso de cocaína (Donavan, Rosegren, Downey, Cox & Sloan, 2001), na redução do uso de anfetaminas (Baker, Boggs & Lewin, 2001), na cessação do uso de tabaco (Brown et al, 2003;Butler et al, 1999;Colby, 1998;Rodriguez, 2003;WHO 1996) e em pacientes com diabetes (Burke et al, 2002;Channon, Smith & Gregory, 2003). Comparada com o não-tratamento e com o uso de placebo, a EM foi superior em comportamentos envolvendo álcool, drogas, dietas e exercícios (Burke et al, 2003).…”