A CONTENT ANALYSIS OF BRIEF INTERVENTION SESSIONS FOR HEALTH PROMOTION AND REDUCTION OF ALCOHOL CONSUMPTION IN COLLEGE STUDENTS

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Slide # Title & Content
1 A CONTENT ANALYSIS OF BRIEF
INTERVENTION SESSIONS FOR HEALTH
PROMOTION AND REDUCTION OF ALCOHOL
CONSUMPTION IN COLLEGE STUDENTS

Elizabeth M. Rash PhD, ARNP, FNP-C

James Schauss M.D., Michael Diechen, M.D., Michael Dunn PhD,
Mary Lou Sole PhD, Laura Riddle LFMT, Natalie Mullett, M.Ed.

University of Central Florida
Orlando, Florida

Study funded by grants from Sigma Theta Tau (Theta Epsilon Chapter), Florida Nurses Foundation, and AANP Foundation. Large study funded by NIAAA (U18 xxx)

(image: University of Central Florida logo)
2 Background

  • High rate of negative alcohol behaviors among college students (NIAAA, 2002).
  • Brief interventions using Motivational Interviewing (MI) successfully reduce negative behaviors (Miller & Rollnick, 2002).
  • Limited analyses of fidelity with MI principles (Miller & Rollnick).
3 MI Principles (Miller and Rollnick)

  • Client Centered
  • Collaborative
    • Dancing vs. wrestling
    • Rolling with Resistance
    • Empathy
    • Developing discrepancy
      • Values vs. behaviors
4 Background

  • NIAAA funded study of college students with evidence of negative alcohol behaviors
  • Control Grp. received routine care
  • Expt. Grp. received 2 brief intervention sessions with health care providers trained in MI using NIAAA BASICS
    (Fleming, Cotter & Talboy, 1997).
5 Purpose

  • Determine if the brief intervention sessions demonstrated fidelity with motivational interviewing principles
6 Methodology

  • Content analysis of randomly selected brief intervention session audio-taped transcripts using the Motivational Interviewing Skill Code (MISC) (Miller, 2000) & participant and provider session feedback forms

The MISC offers good to excellent intra-class correlations and inter-rater reliability on global ratings (Moyer, Martin, Catley, Harris, Ahluwalia, 2003).
7 MISC

  • 1st Pass: global rating
    — spirit
  • 2nd Pass: behavior counts
    — principles
  • 3rd Pass: computation of talk time
    — client centered
  • Summary scoring
    — MI proficiency
    • Not proficient (0-1.9)   Proficient (2-2.9 )   Expert (3+)
8 Data Analysis

Provider
(n=sessions) 		Proficiency
(range) 		Talk Time
(range)
W (n=7) 1.24 (1-1.7) 60% (35-75%)
X (n=12) 1.23 (1-1.7) 67% (59-80%)
Y (n=2) 1.05 (1-1.1) 70% (61-78%)
Z (n=3) 1.4 (1-1.9) 46% (28-65%)
Total (n1=24)
(n2=10) 		1.241 (1.26)2 62% (28-80%)

Rater1 Rater2 Inter-rater reliability
9 Discussion

  • Less talk time correlates with greater proficiency (albeit still not proficient).
  • Feedback forms reveal positive student perceptions & providers felt they were consistent with MI principles.
  • Comparisons (Wilcoxon Signed Ranks Test) of available pre- & 3 mos. post (1-mos. average) BAC (p=0.394) & pre- & 3 mos. post (1-mos. average) peak BAC (p=0.478) demonstrated no significant differences among experimental group. Subset too small to generalize to entire study.
  • Design produced artificial setting (consider blinding providers?)
10 Recommendations & Future Research

  • Reassess MI training protocols and needs
  • Reassess design
  • Determine influence of unintended extraneous variables
  • Re-analyze using criteria for a Behavior Change Counseling model
11 References

  • Moyer, T., Martin, T., Catley, D., Harris, K. J., & Ahluwalia, J. S. (2003). Assessing the integrity of motivational interviewing interventions: Reliability of the motivational interviewing skills code. Behavioral and Cognitive Psychotherapy 31, (2), 177-184.
  • National Institute on Alcohol Abuse and Alcoholism. (2002). A call to action: Challenging the culture of drinking at U.S. Colleges. NIH Pub. No. 02-5010. Bethesda, M.D.: NIAAA.
  • Miller, W. R. (2000). Motivational Interviewing Skill Code (MISC): Coders Manual. University of New Mexico
  • Miller, W. R. & Rollnick, S. (2002). Motivational interviewing (2nd ed.). New York: The Guilford Press.
  • National Institute on Alcohol Abuse and Alcoholism. (2002). A call to action: Challenging the culture of drinking at U.S. Colleges. NIH Pub. No. 02-5010. Bethesda, M.D.: NIAAA.

Thank you to Rater2 Ruchi Gandhi Shah BSN, FNP resident

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