Using topic coding to understand the nature of change language in a motivational intervention to reduce alcohol and sex risk behaviors in emergency department patients

Abstract

Objective To elucidate patient language that supports changing a health behavior (change talk) or sustaining the behavior (sustain talk). Methods We developed a novel coding system to characterize topics of patient speech in a motivational intervention targeting alcohol and HIV/sexual risk in 90 Emergency Department patients. We further coded patient language as change or sustain talk. Results For both alcohol and sex, discussions focusing on benefits of behavior change or change planning were most likely to involve change talk, and these topics comprised a large portion of all change talk. Greater discussion of barriers and facilitators of change also was associated with more change talk. For alcohol use, benefits of drinking behavior was the most common topic of sustain talk. For sex risk, benefits of sexual behavior were rarely discussed, and sustain talk centered more on patterns and contexts, negations of drawbacks, and drawbacks of sexual risk behavior change. Conclusions Topic coding provided unique insights into the content of patient change and sustain talk. Practice Implications Patients are most likely to voice change talk when conversation focuses on behavior change rather than ongoing behavior. Interventions addressing multiple health behaviors should address the unique motivations for maintaining specific risky behaviors.

A sequential analysis of motivational interviewing technical skills and client responses

“…For the present study, we developed additional therapist skill codes to extend and enhance the information provided by the MISC 2.5 (Houck, Moyers, Miller, Glynn, & Hallgren, 2010), some of which is analyzed and described elsewhere within the Generalized Behavioral Intervention Analysis System (GBIAS) (Kahler et al, 2016). Coding manuals are available at https://doi.org/10.7301/Z0Z60MKW.…”

Do what you say and say what you are going to do : A preliminary meta-analysis of client change and sustain talk subtypes in motivational interviewing

“…In other words, sustain talk statements, related to what Amrhein (2004) refers to as "preparatory" thinking, were associated with less change at follow up while sustain talk "action" statements were not. Negative commitments or reported steps can be quite rare in MI process studies (e.g., Apodaca et al, 2014;Kahler et al, 2016;Vader et al, 2010). As such, our results could relate to low power to detect these statements' effects.…”

“…In this meta-analysis, we examined the frequency of sustain talk and its subtypes, but we did not prioritize one portion of the session over another. A few process studies have highlighted the value of making a temporal distinction between client language that arises during engaging and focusing and talk that arises during MI planning (Amrhein et al, 2003;Kahler et al, 2016;Morgenstern et al, 2017). A question to consider in the future is whether greater sustain talk represents a prognostic patient factor (e.g., a defensive or reactant trait) occurring early in the session, a resistance marker that emerges later via the MI process (i.e., a relational state), or both?…”

The role of therapist MI skill and client change talk class membership predicting dual alcohol and sex risk outcomes

“…MISC coders received about 60 hr of training, including: an initial didactic session, individual and group practice with corrective feedback, and double coding of practice sessions followed by resolution of discrepancies (Kahler et al, ). All sessions were transcribed, pre‐parsed for therapist and client speech acts, and two additional passes were completed for MISC and topic variables.…”