Department of Psychology, Arizona State University, Tempe, AZ 85287-1104, USA.
Int J Behav Nutr Phys Act. 2012 Jun 8;9(1):69. doi: 10.1186/1479-5868-9-69.
Counselor behaviors that mediate the efficacy of motivational interviewing (MI) are not well understood, especially when applied to health behavior promotion. We hypothesized that client change talk mediates the relationship between counselor variables and subsequent client behavior change.
Purposeful sampling identified individuals from a prospective randomized worksite trial using an MI intervention to promote firefighters' healthy diet and regular exercise that increased dietary intake of fruits and vegetables (n = 21) or did not increase intake of fruits and vegetables (n = 22). MI interactions were coded using the Motivational Interviewing Skill Code (MISC 2.1) to categorize counselor and firefighter verbal utterances. Both Bayesian and frequentist mediation analyses were used to investigate whether client change talk mediated the relationship between counselor skills and behavior change.
Counselors' global spirit, empathy, and direction and MI-consistent behavioral counts (e.g., reflections, open questions, affirmations, emphasize control) significantly correlated with firefighters' total client change talk utterances (rs = 0.42, 0.40, 0.30, and 0.61, respectively), which correlated significantly with their fruit and vegetable intake increase (r = 0.33). Both Bayesian and frequentist mediation analyses demonstrated that findings were consistent with hypotheses, such that total client change talk mediated the relationship between counselor's skills--MI-consistent behaviors [Bayesian mediated effect: αβ = .06 (.03), 95% CI = .02, .12] and MI spirit [Bayesian mediated effect: αβ = .06 (.03), 95% CI = .01, .13]--and increased fruit and vegetable consumption.
Motivational interviewing is a resource- and time-intensive intervention, and is currently being applied in many arenas. Previous research has identified the importance of counselor behaviors and client change talk in the treatment of substance use disorders. Our results indicate that similar mechanisms may underlie the effects of MI for dietary change. These results inform MI training and application by identifying those processes critical for MI success in health promotion domains.
在健康行为促进中，调节动机性访谈（MI）功效的咨询行为尚不清楚，特别是在应用于健康行为促进时。我们假设客户的改变谈话在咨询师变量与随后的客户行为改变之间起中介作用。
采用有目的的抽样方法，从一项前瞻性随机现场试验中确定参与者，这些参与者使用 MI 干预措施来促进消防员的健康饮食和定期运动，从而增加水果和蔬菜的摄入量（n=21）或不增加水果和蔬菜的摄入量（n=22）。使用动机性访谈技能编码（MISC 2.1）对 MI 交互作用进行编码，以对咨询师和消防员的言语进行分类。采用贝叶斯和频率论中介分析来研究客户的改变谈话是否在咨询师技能与行为改变之间起中介作用。
咨询师的整体精神、同理心以及方向和与 MI 一致的行为计数（例如，反映、开放式问题、肯定、强调控制）与消防员的总客户改变谈话话语显著相关（rs=0.42、0.40、0.30 和 0.61），这些话语与他们的水果和蔬菜摄入量的增加显著相关（r=0.33）。贝叶斯和频率论中介分析均表明，结果与假设一致，即总客户的改变谈话中介了咨询师技能与 MI 一致的行为之间的关系[贝叶斯中介效应：αβ=0.06（0.03），95%CI=0.02，0.12]和 MI 精神[贝叶斯中介效应：αβ=0.06（0.03），95%CI=0.01，0.13]——并增加了水果和蔬菜的消费。
动机性访谈是一种资源密集型和时间密集型的干预措施，目前正在许多领域得到应用。先前的研究已经确定了咨询师行为和客户改变谈话在治疗物质使用障碍中的重要性。我们的结果表明，类似的机制可能是 MI 促进饮食改变的基础。这些结果通过确定 MI 在健康促进领域取得成功的关键过程，为 MI 培训和应用提供了信息。
