Within the context of poorer patient outcomes and rising healthcare costs, we need to better understand why many patients do not engage fully with their treatment plan. Movement away from talking about "compliance" towards "adherence" and "concordance" is evidence of a recognition that this is a two-way process. Whilst healthcare professionals expect patients to engage in treatment, equally, patients have expectations (whether positive or negative) of their treatment and their need for engagement. There is a need for an effective method that can specifically target those interventions that will provide the most benefit to individual patients and which, crucially, is easy and inexpensive to administer in everyday practice and widely applicable. Rubin's Four Tendencies model identifies a patient's "response to outer and inner expectations" as a key factor in adherence. The model therefore provides an opportunity to test such a targeted, patient-specific strategy and we present a call to action for research in this area.

/pdf/can-treatment-adherence-be-improved-by-using-rubin-s-four-27vyzafcy7.pdf

Can Treatment Adherence Be Improved by Using Rubin's Four Tendencies Framework to Understand a Patient's Response to Expectations

Background Motivational Interviewing is a well-known, scientifically tested method of counselling clients developed by Miller and Rollnick and viewed as a useful intervention strategy in the treatment of lifestyle problems and disease.

Aim To evaluate the effectiveness of motivational interviewing in different areas of disease and to identify factors shaping outcomes.

Design of study A systematic review and meta-analysis of randomised controlled trials using motivational interviewing as the intervention.

Method After selection criteria a systematic literature search in 16 databases produced 72 randomised controlled trials the first of which was published in 1991. A quality assessment was made with a validated scale. A meta-analysis was performed as a generic inverse variance meta-analysis.

Results Meta-analysis showed a significant effect (95% confidence interval) for motivational interviewing for combined effect estimates for body mass index, total blood cholesterol, systolic blood pressure, blood alcohol concentration and standard ethanol content, while combined effect estimates for cigarettes per day and for HbA1c were not significant. Motivational interviewing had a significant and clinically relevant effect in approximately three out of four studies, with an equal effect on physiological (72%) and psychological (75%) diseases. Psychologists and physicians obtained an effect in approximately 80% of the studies, while other healthcare providers obtained an effect in 46% of the studies. When using motivational interviewing in brief encounters of 15 minutes, 64% of the studies showed an effect. More than one encounter with the patient ensures the effectiveness of motivational interviewing.

Conclusion Motivational interviewing in a scientific setting outperforms traditional advice giving in the treatment of a broad range of behavioural problems and diseases. Large-scale studies are now needed to prove that motivational interviewing can be implemented into daily clinical work in primary and secondary health care.

Motivational interviewing: a systematic review and meta-analysis

A meta-analysis was conducted on controlled clinical trials investigating adaptations of motivational interviewing (AMIs), a promising approach to treating problem behaviors. AMIs were equivalent to other active treatments and yielded moderate effects (from .25 to .57) compared with no treatment and/or placebo for problems involving alcohol, drugs, and diet and exercise. Results did not support the efficacy of AMIs for smoking or HIV-risk behaviors. AMIs showed clinical impact, with 51% improvement rates, a 56% reduction in client drinking, and moderate effect sizes on social impact measures (d=0.47). Potential moderators (comparative dose, AMI format, and problem area) were identified using both homogeneity analyses and exploratory multiple regression. Results are compared with other review results and suggestions for future research are offered.

/pdf/the-efficacy-of-motivational-interviewing-a-meta-analysis-of-2hycrwhc30.pdf

The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials.

In 1996, a Federal law required the U.S. Attorney General to provide Congress with an independent review of the Many crime prevention programs work. Others don’t. Most programs have not yet been evaluated with enough scientific evidence to draw conclusions. Enough evidence is available, however, to create provisional lists of what works, what doesn’t, and what’s promising. Those lists will grow more quickly if the Nation invests more resources in scientific evaluations to hold all crime prevention programs accountable for their results. Issues and Findings

Preventing Crime: What Works, What Doesn't, What's Promising

The Evaluating Methods for Motivational Enhancement Education trial evaluated methods for learning motivational interviewing (MI). Licensed substance abuse professionals (N = 140) were randomized to 5 training conditions: (a) clinical workshop only; (b) workshop plus practice feedback; (c) workshop plus individual coaching sessions; (d) workshop, feedback, and coaching; or (e) a waiting list control group of self-guided training. Audiotaped practice samples were analyzed at baseline, posttraining, and 4, 8, and 12 months later. Relative to controls, the 4 trained groups showed larger gains in proficiency. Coaching and/or feedback also increased posttraining proficiency. After delayed training, the waiting list group showed modest gains in proficiency. Posttraining proficiency was generally well maintained throughout follow-up. Clinician self-reports of MI skillfulness were unrelated to proficiency levels in observed practice.

https://psycnet.apa.org/journals/ccp/72/6/1050.pdf

A randomized trial of methods to help clinicians learn motivational interviewing.

During the 1980s Motivational Interviewing emerged as one of the memes of the addictions field. This occurred despite the lack of scientific evidence supporting its utility. In this paper findings of a controlled trial of a brief motivational intervention with illicit drug users (n = 122) attending a methadone clinic are reported. Clients who met the study's inclusion criteria were randomly allocated to either a motivational (experimental, n = 57) or educational (control, n = 65) procedure. Over the 6-month follow-up period the motivational subjects demonstrated a greater, immediate, commitment to abstention, reported more positive expected outcomes for abstention, reported fewer opiate-related problems, were initially more contemplative of change, complied with the methadone programme longer and relapsed less quickly than the control group. There was, however, no difference in terms of the severity of reported opiate dependence and the control group fared better on reported self-efficacy. It was concluded that motivational interventions of the type investigated are useful adjuncts to methadone programmes.

The impact of a brief motivational intervention with opiate users attending a methadone programme.

This article describes the psychometric characteristics of two major assessment instruments used in a World Health Organization (WHO) clinical trial: (a) Alcohol Timeline Followback (TLFB, which as...

Cross-cultural evaluation of two drinking assessment instruments: alcohol timeline followback and inventory of drinking situations.

Aims. The aim of the study was to investigate factors hypothesized to inuence the relapse process, with a focus on the role of self-ef® cacy, alcohol dependence and cognitive functioning. Design. The study was conducted in the context of a controlled trial of a relapse prevention programme. Subjects were assessed prior to treatment, at immediate conclusion of treatment and at 6- and 12-month follow-up. Setting. The study was conducted in an Alcohol Treatment Unit (ATU) in Scotland. Participants: Subjects were 60 male problem drinkers who were patients at the ATU. They were heavy drinkers, with corresponding high levels of alcohol dependence and alcohol-related harm. Measurements. The independent variables were post- treatment self-ef® cacy, alcohol dependence, cognitive functioning, level of depression and alcohol consumption prior to admission to treatment. The dependent variables were post-treatment drinking behaviour and functioning and time to lapse and relapse. Findings. Although the methodology does not allow identi® cation of causality, support was found for the hypothesis that post-treatment self-ef® cacy was an intervening variable between treatment and outcome. Higher post-treatment self-ef® cacy predicted better outcome at 6-month follow-up and was associated with a reduced risk of lapse and relapse over the 12-month follow-up. Poorer cognitive functioning was signi® cantly associated with being categorized as a problem drinker at 6-month follow-up and with higher risk of a lapse over the 12-month follow-up. Level of alcohol dependence did not predict outcome. Conclusions. It was concluded that post-treatment self-ef® cacy rating is a predictor of treatment outcome and time to lapse and relapse and that cognitive functioning is a predictor of treatment outcome and time to lapse. The process of relapse It has been observed that in the treatment of alcohol dependence, high relapse rates are the norm, not the exception (e.g. Litman, 1980). However, only a limited amount of information exists about the process of relapse and much

The process of relapse in severely dependent male problem drinkers.

A sample of 44 women and 50 men attending an alcohol treatment facility were assessed on a range of demographic, social and psychological measures in order to determine whether women and men relapse for different reasons. Clients were monitored for a 3 month period after the initial intake interview whereupon follow-up interviews were conducted. The data were analysed by the use of survival analysis techniques. The results indicated that there were different predictors of relapse across the three levels of post treatment alcohol use investigated. Gender differences were present at two of these levels. The implications of these differences are discussed.

Women with alcohol problems: do they relapse for reasons different to their male counterparts?

https://onlinelibrary.wiley.com/doi/pdf/10.1080/09595239500185341

Harm reduction means what I choose it to mean.

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Bill Saunders

Author Tools

Chat about Author