Motivational interviewing for older adults in primary care: A systematic review

Purath, Janet; Keck, Annmarie; Fitzgerald, Cynthia

doi:10.1016/j.gerinurse.2014.02.002

Cited by 43 publications

(32 citation statements)

References 16 publications

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“…During recent years, motivational interviewing (MI), a collaborative conversation style (Miller & Rollnick 2013), has been used a great deal in prevention and treatment of many different health behaviours and diseases. Much of the research on MI has not only shown its efficacy, especially in treating substance abuse but also in addressing other health behaviours such as diet, exercise, weight loss and chronic diseases (Lundahl et al 2013, Stanton & Grimshaw 2013, Purath et al 2014, Barnes & Ivezaj 2015, Moral et al 2015. Research on the mechanisms underlying MI is growing, especially in the area of substance abuse, but research on MI and disease prevention has also been called for (Pirlott et al 2012, Copeland et al 2015.…”

Section: Introductionmentioning

confidence: 99%

Primary care nurses' communication and its influence on patient talk during motivational interviewing

Östlund

Wadensten

Häggström

et al. 2016

Journal of Advanced Nursing

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Section: Introductionmentioning

confidence: 99%

Primary care nurses' communication and its influence on patient talk during motivational interviewing

Östlund

Wadensten

Häggström

et al. 2016

Journal of Advanced Nursing

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“…Therefore, the effects of BSM to promote healthy lifestyle change may be enhanced by using motivational interviewing (MI) – a patient-centered approach to strengthen bereaved elders' motivation and commitment to change. MI facilitates healthy lifestyle change by helping patients resolve ambivalence about lifestyle change in an empathetic and encouraging climate [24] , [25] , [26] .…”

mentioning

confidence: 99%

Design and rationale for a technology-based healthy lifestyle intervention in older adults grieving the loss of a spouse

Stahl

Emanuel

Albert

et al. 2017

Contemporary Clinical Trials Communications

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Introduction Experiencing the death of a spouse during late life is associated with an increased risk of developing debilitating mental health problems. Healthy lifestyle practices, such as regular exercise, healthy eating, and good sleep hygiene are promising strategies to influence the mental health and associated physical symptoms of late-life spousal bereavement. Objective This paper describes the design and rationale of an intervention development study addressing selective and indicated prevention of depression, anxiety, and/or complicated grief disorder(s) among adults 60 years and older who are grieving the recent loss (within 8 months) of a spouse or partner. Methods In Phase I, now complete, we developed and standardized behavioral self-monitoring of daily lifestyle choices via an electronic diary (BSM) and the combined BSM + motivational interviewing-based lifestyle coaching (BSM+MI) to be administered to participants grieving the loss of loved one. In Phase II, we have been implementing the interventions in a randomized controlled trial and addressing challenges related to recruitment. Randomization is to one of three cells: BSM, BSM+MI, or an enhanced usual care condition. Discussion Several challenges in implementing our lifestyle interventions to older widow(er)s who are at risk for common mental disorders have been identified. Direct outreach to hospice organizations is an effective way to identify older adults in the early months following spousal death. Results from study may advance the field of grief support and promote a healthy adaptation to widowhood.

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“…This might be related to a relative increase in clinician “advice talk” time in the intervention group which could have competed with time available for listening and encouraging patients to set their own goals, one of the practical techniques in MI. 11 Given the limited scope and time of our intervention and that helping patients set SMART goals may require the most time and skilled effort, it is reasonable to suggest that further adjustments in the dose and content of our intervention may enhance goal-setting conversations as well. These adjustments may include additional emphasis on patient empowerment for goal-setting through patient and clinician education and direct feedback to clinicians on selected visits observed by a professional trained in MI and goal-setting.…”

Section: Discussionmentioning

confidence: 99%

Improving Patient-Clinician Conversations During Annual Wellness Visits

et al. 2017

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Background In 2010, the Patient Protection and Affordable Care Act instituted dedicated reimbursement for Annual Wellness Visits (AWVs) in primary care, requiring the use of comprehensive health risk assessment (HRA) that covers specific health content. HRAs have been implemented and studied for decades in various settings, but little is known about the effect of introducing HRAs on the dynamics and content of patient-clinician conversations during AWVs and if the effective use of HRAs requires additional training and resources. Methods We used established technology to video-record 40 AWVs conducted by 5 faculty in an academic family medicine residency practice. A comprehensive HRA-Health Planner report was implemented in these practices over a 3-month baseline period without additional training or resources. Subsequently, three of the five clinicians received a brief, low-intensity intervention to use the HRA to support patient behavior change. Patients received a 5-minute orientation on the purpose of the enhanced AWV and advice on how to communicate their needs and preferences more effectively. Twenty-two pre- and post-intervention visit recordings were carefully matched on known covariates and were explored by several evaluators using Conversation Analysis techniques to describe the dynamics and content of conversations. Short exit interviews with patients and clinicians were evaluated by standard content analytic techniques. Results Six overarching themes emerged that described the dynamics of AWV conversations. Patients and clinicians sub-optimally utilized the HRA report and missed many opportunities for promoting behavior change. However, a low-intensity, multi-component intervention significantly decreased the proportion of clinician talk time per visit by 9% (p<0.001), while it increased the proportion of patient talk time by 7% (p<0.001), robustly increased the number and duration of “change talk” by 639% (p= 0.0007), increased the number of patient cut-ins by 237% (p= 0.04) and tended to increase the number and duration of clinician “advice talk” (p=0.065). The total number, duration, and proportions of conversational turn types, “goal setting talk”, “education talk”, and “prescriptive talk” did not change. The majority of patients and clinicians had a positive experience. Patients felt more informed, empowered, and motivated by the HRA-enhanced wellness visit. Clinicians emphasized that the HRA report helped them construct and follow a visit agenda more effectively and that it facilitated the convergence of the patients’ goals with evidence-based recommendations suggested by the HRA report. Conclusions Our study suggests that HRAs introduced without proper framing, education, and additional resources may not allow patients and clinicians to optimally leverage AWVs for health planning and improvement. A low-intensity, multi-component intervention may help patients and clinicians improve the quality of HRA-supported health conversations and realize the potential of AWVs.

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Motivational interviewing for older adults in primary care: A systematic review

Cited by 43 publications

References 16 publications

Primary care nurses' communication and its influence on patient talk during motivational interviewing

Primary care nurses' communication and its influence on patient talk during motivational interviewing

Design and rationale for a technology-based healthy lifestyle intervention in older adults grieving the loss of a spouse

Improving Patient-Clinician Conversations During Annual Wellness Visits

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