Center for Translational Behavioral Science, Florida State University.
Division of Behavioral Sciences, Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine.
Health Psychol. 2021 Dec;40(12):920-927. doi: 10.1037/hea0001071. Epub 2021 Jul 29.
Interventions to promote evidence-based practices are particularly needed for paraprofessional staff working with minority youth with HIV who have higher rates of HIV infection but lower rates of linkage and retention in care compared to older adults. Utilizing the ORBIT model for behavioral intervention development, we defined and refined a behavioral intervention for providers, Tailored Motivational Interviewing (TMI), to improve provider competence in previous studies (Phase 1a and 1b). The current study focuses on ORBIT Phase 2a-proof of concept. We hypothesized that TMI would be acceptable and feasible and would show a signal of efficacy of improving and maintaining community health worker (CHW) MI competence scores using an innovative statistical method for small N proof-of-concept studies. Longitudinal data were collected from 19 CHWs at 16 youth HIV agencies. CHWs from 8 sites were assigned to the TMI group per the cofunders request. The remaining 8 sites were randomly assigned to TMI or services as usual. MI competence was assessed at baseline and up to 15 times over 2 years. Random coefficient models were utilized to examine time trajectories of competence scores and the impact of the intervention on competence trajectories. Semistructured interviews were conducted to determine barriers and facilitators of TMI. Competence scores in the TMI group significantly increased while the scores of the control group significantly decreased. Further analysis of the intervention group demonstrated that scores significantly increased during the first 3 months after initial workshop and was sustained through the end of the study. Qualitative findings revealed insufficient time and competing priorities as perceived barriers whereas integrating MI into routine agency practices and ongoing training might facilitate implementation. Following a successful proof-of-concept, the next step is a fully randomized pilot study of TMI relative to a control condition in preparation for a stepped-wedge cluster randomized full scale trial. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
干预措施尤其需要针对与少数族裔青少年艾滋病毒感染者合作的准专业人员,这些感染者的艾滋病毒感染率较高,但与老年人相比,他们的关联率和护理保留率较低。我们利用 ORBIT 行为干预发展模型,为提供者定义和完善了一种行为干预措施,即量身定制的动机访谈(TMI),以提高之前研究中提供者的能力(第 1a 和 1b 阶段)。本研究侧重于 ORBIT 第 2a 阶段——概念验证。我们假设 TMI 将是可以接受和可行的,并且将使用一种创新的小 N 概念验证研究统计方法,显示出改善和维持社区卫生工作者(CHW)MI 能力评分的疗效信号。从 16 个青少年艾滋病毒机构的 19 名 CHW 收集了纵向数据。根据共同资助者的要求,8 个地点的 CHW 被分配到 TMI 组。其余 8 个地点被随机分配到 TMI 或常规服务组。在基线和 2 年内最多进行 15 次评估 MI 能力。利用随机系数模型检查能力评分的时间轨迹和干预对能力轨迹的影响。进行半结构化访谈以确定 TMI 的障碍和促进因素。TMI 组的能力评分显著增加,而对照组的评分显著下降。对干预组的进一步分析表明,在初始研讨会后的头 3 个月内,评分显著增加,并持续到研究结束。定性研究结果表明,时间不足和优先事项冲突被视为障碍,而将 MI 纳入常规机构实践和持续培训可能有助于实施。在成功进行概念验证后,下一步是进行 TMI 相对于对照条件的完全随机试点研究,为分步楔形集群随机全面试验做准备。(PsycInfo 数据库记录(c)2022 APA,保留所有权利)。