Provider Communication Behaviors that Predict Motivation to Change in Black Adolescents with Obesity

Abstract

Objective The goal of this research was to identify communication behaviors used by weight loss counselors that mostly strongly predicted Black adolescents’ motivational statements. Three types of motivational statements were of interest: change talk (CT; statements describing their own desires, abilities, reasons, and need for adhering to weight loss recommendations), commitment language (CML; statements about their intentions or plans for adhering), and counter change talk (CCT; amotivational statements against change and commitment). Method Thirty-seven Black adolescents with obesity received a single Motivational Interviewing session targeting weight-related behaviors. The video-recorded, transcribed sessions were coded using the MY-SCOPE generating a sequential chain of communication. Data were then subjected to sequential analysis to determine causal relationships between counselor and adolescent communication. Results Asking open-ended questions to elicit adolescent CT and emphasizing adolescents’ autonomy most often led to CT. Open-ended questions to elicit CML, reflecting adolescent CML, and emphasizing autonomy most often led to CML. In contrast, open-ended questions to elicit CCT, reflecting CCT, reflecting ambivalence, and neutral open-ended questions about the target behavior led to CCT. Conclusion This study provides clinicians with insight into the most effective way to communicate with Black adolescents with obesity about weight loss. Specifically, reflective statements and open questions focusing on their own desires, abilities, reasons, need and commitment to weight loss recommendations are more likely to increase motivational statements whereas other types of reflections and questions may be counterproductive. Finally, because adolescents have a strong need for autonomous decision-making, emphasizing their autonomy may be particularly effective in evoking motivational statements.

Comparing thin slices of verbal communication behavior of varying number and duration

“…This research is a secondary analysis of data collected as part of a study examining patient-counselor communication during Motivational Interviewing (MI) weight loss sessions with African American adolescents [23]. The goals of the parent study were to (1) develop an observational code scheme to characterize verbal communication behaviors and (2) identify specific counselor verbalizations effective at eliciting patient expressions of intrinsic motivation (i.e., change talk and commitment language) [1].…”

“…The goals of the parent study were to (1) develop an observational code scheme to characterize verbal communication behaviors and (2) identify specific counselor verbalizations effective at eliciting patient expressions of intrinsic motivation (i.e., change talk and commitment language) [1]. We provide a brief description of the parent study below; a detailed description, including methods, the development of the code scheme (Minority Youth - Sequential Coding for Observing Process Exchanges (MY-SCOPE)), and findings, has been reported elsewhere [23]. …”

“…In the parent study, families participated in one MI [25, 26] session targeting the nutritional and physical activity behavior changes necessary to promote and sustain weight loss [23]. We planned for sessions between the adolescent and MI counselor to last 20 minutes; the actual duration was closer to 30 (M = 29:21, SD = 8:21, Minimum = 15:34, Maximum = 45:47).…”

“…A primary goal of the parent study was to develop a coding scheme to characterize the verbal communication behavior counselors use during MI sessions and the resulting patient verbal communication [23]. With the MY-SCOPE, counselor verbal utterances were coded as “MI-consistent” (e.g., reflections, open-ended questions, statements emphasizing the patient’s autonomy in decision-making) or “MI-inconsistent” (e.g., reflections of amotivational patient communication).…”

Overweight adolescents and asthma: Revealing motivations and challenges with adolescent-provider communication

“…This study further illustrates the benefits of seeking and incorporating adolescents' motivations in health behavior change. Provider recommendations boost motivation to tackle weight management [10,27,33,34], and linking overweight-related asthma symptoms could further enhance weight management among adolescents' with asthma. Interventions that assess and bring together adolescents' values and perspectives, patient-centered approaches of providers, and parent/guardian participation will likely amplify weight-related behavior changes that benefit asthma control in overweight teens [18,19,35].…”