Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA; Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.
PGSP-Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, CA, USA.
Prev Med. 2019 Sep;126:105738. doi: 10.1016/j.ypmed.2019.05.026. Epub 2019 May 30.
The alarming prevalence of adult obesity warrants consideration of treatments with broad reach; digital health interventions meet this need and have demonstrated efficacy for weight loss. One approach that can be delivered remotely is motivational interviewing - a counseling style that helps resolve ambivalence to change unhealthy behavior. This is the first review to systematically examine eHealth and telehealth interventions that incorporate motivational interviewing for weight loss. We searched four electronic databases (PubMed, Embase, PsycInfo, CINAHL) for publications from November 2009-May 2018. Included papers were weight loss RCTs conducted among adults with overweight or obesity that examined eHealth or telehealth interventions with motivational interviewing, compared to any type of treatment arm without it. Results were presented separately by comparison arm (control vs. active comparator). Sixteen papers (15 trials) were included. Twelve used telephone-based counseling to deliver motivational interviewing, two used email and phone, and one used online chats. When compared to a no-treatment control arm, the motivational interviewing arm was associated with greater weight loss on 6 of 11 occasions, but performed better than an active comparator on only 1 of 7 occasions. Retention and engagement were generally high, though few trials examined the relation with weight loss. No trial had high risk of bias, but five lacked power calculations and only two reported fidelity to motivational interviewing. Telephone-based interventions that incorporate motivational interviewing hold promise as effective obesity treatments. There is a dearth of evidence to support the use of motivational interviewing via eHealth, signaling a needed research area.
成人肥胖的惊人流行率需要考虑广泛覆盖的治疗方法；数字健康干预措施满足了这一需求，并已证明对减肥有效。一种可以远程提供的方法是动机访谈——一种帮助解决对改变不健康行为的矛盾心理的咨询方式。这是第一项系统审查电子健康和远程医疗干预措施中纳入动机访谈以减肥的综述。我们在 2009 年 11 月至 2018 年 5 月期间从四个电子数据库（PubMed、Embase、PsycInfo、CINAHL）中搜索了有关超重或肥胖成年人的减肥 RCT 出版物，这些研究考察了具有动机访谈的电子健康或远程医疗干预措施与任何不包含该方法的治疗方法相比的效果。结果分别按比较组（对照组与主动对照组）呈现。有 16 篇论文（15 项试验）被纳入。12 项研究使用基于电话的咨询来提供动机访谈，2 项研究使用电子邮件和电话，1 项研究使用在线聊天。与无治疗对照组相比，动机访谈组在 11 次中有 6 次与体重减轻相关，但在 7 次中有 1 次与积极对照组相比表现更好。保留率和参与率通常较高，但很少有试验检查与体重减轻的关系。没有试验具有高偏倚风险，但有 5 项试验缺乏功效计算，只有 2 项试验报告了动机访谈的保真度。纳入动机访谈的基于电话的干预措施有望成为有效的肥胖治疗方法。缺乏支持通过电子健康使用动机访谈的证据，表明这是一个需要研究的领域。
