Realist-informed review of motivational interviewing for adolescent health behaviors

Abstract

BackgroundClinical research investigating effective intervention strategies for adolescents to improve health behaviors has shifted to the application of motivational interviewing (MI). Evidence indicates that MI is an effective intervention for improving health behaviors as related to diet, exercise, and diabetes among adolescents. However, there is a lack of understanding about the mechanisms through which MI works and the contextual factors impacting MI effectiveness. The purpose of this review was to understand how, for whom, and under what circumstances MI works for adolescent health behavior change, which will inform future implementation of this intervention. To provide this in-depth understanding, a realist-informed systematic review was conducted in order to synthesize the evidence on the use of MI for health behaviors. Self-determination theory (SDT) was chosen as the candidate theory for testing in the present review.MethodsDatabases including PsycINFO, Healthstar, Cochrane, and PubMed were searched for articles published until March 2017. The search strategy included studies that examined or reviewed the effectiveness or efficacy of MI to change health behaviors among adolescent populations. The search identified 185 abstracts, of which 28 were included in the review. The literature was synthesized qualitatively (immersion/crystallization) and tested SDT as the candidate theory.ResultsBased on SDT, three mechanisms were found within reviewed studies, including competence, relatedness, and autonomy. The following contexts were found to impact mechanisms: school setting, clinician MI proficiency, parental involvement, and peer involvement.ConclusionsThis realist-informed systematic review provides advances in understanding the mechanisms involved in MI for adolescent health behavior change. Additionally, it provides important practical information as to which contexts create the conditions for these mechanisms to occur, leading to health behavior change. The results can inform future MI interventions for adolescent health behavior change. Future research should continue to test this realist theory and also examine mechanism variables not extensively documented in order to improve our understanding of MI in this population.

Efficacy of Motivational Interviewing to Improve Utilization of Mental Health Services Among Youths With Chronic Medical Conditions

“…60 Researchers have combined MI with limited case management in a collaborative care setting with varying success (eg, incorporating follow-up phone calls by social workers). 36,50 However, this approach requires additional resources and time from both caretakers and adolescents, a challenge reflected in the low rate of opting for a second appointment (25.5%).…”

“…Whereas we observed significantly better improvements only in anxiety scores with the MI approach, other research found that physician MI interventions also alleviated depression symptoms 32,34. Short MI seminars have been successful in teaching physicians basic MI skills,36,[47][48][49] but proficiency and long-term experience are associated with its success. MI delivered by a clinical psychologist with postgraduate MI-training improved treatment initiation and participation,31 but MI delivered by social workers was only partly effective in the recent STAT-ED intervention for adolescents with suicidal ideations 50.…”

Käyttäytymistieteelliset teoriat ja laadulliset menetelmät interventioiden tukena

“…Myös motivaatioon vaikuttavat sekä tietoiset prosessit että sosiaalinen ympäristö. On todettu, että elintapamuutosten onnistumista edesauttaa se, että ohjaajien vuorovaikutustyyli vahvistaa asiakkaiden autonomian tunnetta ja että muu tokseen saa tukea itselle tärkeiltä ihmisiltä (7). It semääräämisteorian (Self-Determination Theory, SDT) mukaan tällaiset asiat vahvistavat sisäistä motivaatiota, joka puolestaan varmistaa muu toksen ylläpitämistä pitkällä aikavälillä (8).…”

Resource mobilization combined with motivational interviewing to promote healthy behaviors and healthy weight in low-income families: An intervention feasibility study

“…22 MI inspires individuals to change behavior, but families must have the necessary resources to achieve their goals. 51,61,62 Needs may range from a bicycle to housing. In one lowincome pediatric practice, 52% of families had one or more unmet basic needs (i.e.…”