Effectiveness of Interventions using Motivational Interviewing for dietary and physical activity modification in Adults: A Systematic Review.

Transcription

1 Effectiveness of Interventions using Motivational Interviewing for dietary and physical activity modification in Adults: A Systematic Review.. Reviewers Jenna L Hollis BND (Hons) APD 1 Lauren T Williams PhD, GDipHlthProm, GDipDiet, GDipSocSc, BSc(Hons), AdvAPD, AN 2 Clare E Collins PhD, Bsc, Dip Nutri&Diet, Dip CliEpi, FDAA 3 Philip J Morgan PhD, B Ed (Health and Physical Education)(Hons) PhD Candidate, School of Health Sciences, Faculty of Health, University of Newcastle. Contact: Jenna.Hollis@newcastle.edu.au 2. Professor in Nutrition and Dietetics, Faculty of Health, University of Canberra. Lauren.williams@canberra.edu.au 3. Professor in Nutrition and Dietetics, School of Health Sciences, Faculty of Health, University of Newcastle. Contact Clare.Collins@newcastle.edu.au 4.Associate Professor in Health and Physical Education, School of Education, Faculty of Education and Arts, University of Newcastle. Contact Philip.Morgan@newcastle.edu.au The Australian Centre for Evidence Based Nutrition and Dietetics (ACEBAND), School of Health Sciences, Faculty of Health, The University of Newcastle, New South Wales, Australia; A collaborating centre of the Joanna Briggs Institute 1

2 Review Objective The objective of this review is to synthesise the best available evidence on the effectiveness of interventions using motivational interviewing (MI) to modify dietary and physical activity behaviours. Background Health professionals frequently employ counselling during consultations to facilitate behaviour change. 1 Research evidence suggests that the application of validated behaviour change theories and models provide a good framework for health professionals to develop effective evidence based health counselling strategies. 1 Traditionally, healthcare professionals have been trained to promote behaviour change through the provision of advice in an attempt to persuade their patients to make lifestyle changes. 2 Many healthcare professionals are confronted with patients ambivalent to behaviour change and traditional advice giving is often counter-productive with the healthcare professional feeling that it is their responsibility to argue for the side of change and the patient taking the role of defending the status quo. 2 Consequently, there is a need for new evidence based counselling strategies to be applied to health behaviour change consultations to promote constructive communication and a supportive environment, encouraging the patient to take ownership for their behaviours and the potential solutions to their problem. Motivational Interviewing (MI) is a directive client centred style of counselling developed to facilitate behaviour change by assisting clients to enhance intrinsic motivation to change through exploring and resolving ambivalence to behaviour change. 3 The concept of MI was first described and published in The MI approach aims to be non-confrontational and applies a gentler approach which is less likely to be met with conflict and resistance. 3 Centred on concepts of a guiding style of communication, using reflective listening balanced with a more traditional direct approach to health care, motivational interviewing aims to achieve patient autonomy, evoke a sense of collaboration between the patient and health professional and strengthen the commitment to behaviour change. 3 To assist in enhancing behaviour change, MI applies four basic principles: express empathy, develop discrepancies between actual and desired behaviour, roll with resistance and support self efficacy. 3 Originally adopted as a counselling style used with problem drinkers, more recently MI and adaptations of MI have been applied to a variety of other health behaviours including smoking, substance abuse, HIV risk reduction and nutrition and physical activity. 3 The available literature suggests that MI has the potential to improve the quality of health, nutrition and physical activity counselling. 5-7 A systematic review conducted by Rubak and colleagues in 2005 examined the application of MI to a broad range of health behaviour problems and found that MI carried out in a research setting outperformed that of traditional advice in 74% of RCT s examined. 8 More recently, Armstrong and colleagues conducted a systematic literature review and meta-analysis to investigate the effectiveness of MI in reducing body mass in overweight or obese adults with 11 studies included in the meta-analysis. MI was found to enhance weight loss in overweight and obese participants with the standardised mean difference for the effect of MI on the reduction in body mass reported as kg. 9 Brug and colleagues aimed to examine if basic MI training for dietitians improved their counselling abilities and consequently the patient s diet and health parameters. 10 They found that MI trained dietitians were more empathetic, reflected more often during the consultation and were more willing to let their patients speak for the majority of the time. This led to reduced saturated fat intakes in MI patients. The Women s Health Initiative study similarly showed the participants receiving the MI intervention significantly reduced their dietary fat intake when compared to the standard care group. 11 Conversely, Heinrich and colleagues found their MI based counselling strategy for diabetes care to be ineffective in changing weight, fruit and vegetable consumption and biochemical markers. 12 Webber and colleagues, who aimed to determine the effectiveness of MI when added to an existing online behavioural weight loss program, found that while both minimal intervention and enhanced intervention groups lost weight, there was no difference in weight outcomes between the groups. 13 In an RCT examining physical activity, Harland and colleagues aimed to examine the effectiveness of MI in encouraging exercise among mid age adults. Although relying on self reported data, the study found the intensive MI intervention to be most effective in promoting the adoption of physical activity at 12 weeks but this change was not sustained over the long term at 12 months. 14 2

3 The primary aim of the systematic review is to: Examine the effectiveness of dietary and physical activity modification in interventions employing MI to achieve behaviour change The secondary aims of the systematic review are to: Explore sex differences in dietary and physical activity modification to determine if there is a difference in MI effectiveness according to sex Determine the components in the training, development and delivery of MI interventions which may enhance its success. This systematic review will provide insight into potential ways to improve health outcomes in both the public health and clinical setting. A preliminary search of the literature through the Joanna Briggs Institute, Cochrane and PubMED databases found no recent systematic reviews either published or underway which aimed to examine the effectiveness of MI in dietary and physical activity modification. Previous systematic reviews, both published and underway, focus on overweight and obesity treatment examining weight outcomes only but do not consider MI studies whose primary aim is to achieve dietary or physical activity behaviour 9, 15 change. Other systematic reviews have studied all health behaviours combined including addiction, alcohol abuse, smoking cessation, and weight loss as well as diet and physical activity modification. 6, 8, 16 Furthermore, previous systematic reviews have not excluded studies that have not evaluated MI integrity therefore these studies may not have upheld the spirit of MI. 9 Recently published systematic literature reviews have also combined data of both men and women in the review thus were unable to determine if there is a difference in MI effect by sex. 8, 9 Therefore this review will differ from previous systematic reviews as it includes a broader set of aims by including studies aiming to achieve dietary and physical activity modification, will separate the results of included studies that do and do not report effectiveness of MI stratified by sex. monitoring or evaluation of MI and will explore the Inclusion criteria Types of Participants This review will consider studies that include adults, aged 18 years and older. The review will report data separately for: 1. women only interventions (or where data has been reported separately for women) 2. men only interventions (or where data has been reported separately for men) 3. interventions which do not separate results by gender Types of interventions This review will consider quantitative studies that investigate the effectiveness of MI intervention and interventions employing components of MI on dietary and physical activity behaviour change. Studies must separate subjects into at least 1 group receiving the MI based intervention and one group receiving an attention control.. The intervention may either use MI as the sole intervention strategy or as an intervention component. The review will be divided into studies examining: 3

4 1. Dietary modification 2. Physical activity modification Types of outcomes This review will consider studies that include the following outcome measures: Primary outcomes: - Dietary: E.g. Energy intake, intake of core food groups, macronutrient composition of the diet, diet quality or diet index. - Activity: E.g. Physical activity or sedentary behaviours: energy expenditure, steps taken per day, time spent participating in physical activity, sitting time. Types of studies The review will consider Randomised Controlled Trials (RCT s). However in the absence of RCT s, other experimental research designs including Non-Randomised Controlled Trials or pre-post studies will be considered for inclusion. This will enable the identification of current best available evidence in regards to dietary and physical activity modification using motivational interviewing. Exclusion Criteria - Studies where participants are under the age of 18 years - Studies where participants are pregnant, breastfeeding or have a history of eating disorders - Studies investigating addictive behaviours (e.g. substance abuse) or clinically diagnosed psychotic states ( e.g. schizophrenia or bipolar disorder) - Studies which do not provide detail on how MI was incorporated into the study - Observational studies - Studies not published in English Search Strategy This review will include a search of both published and unpublished literature, written in English from 1980 to July A three step search strategy will be used when undertaking this review. An initial limited search of Medline and CINAHL using initial key words will be undertaken with the aim of identifying all possible key words from the text words contained in the title and abstract of the retrieved literature. A second extensive search using all key words identified and terms will then be carried out across all included databases. Thirdly, the reference list of all identified literature will be searched for additional studies not previous identified during the first or second search strategy. The databases to be searched include: CINAHL, The Central Cochrane database, Medline, EMBASE, Web of Science, Scopus, Informit Health Collection, PSCYHextra and PsycINFO. 4

5 Initial key words to be used during search step one include: treatment, prevention, women, female, men, male, motivational interviewing, counselling, diet, nutrition, food, reducing diet, diet quality, diet index, healthy eating, physical activity, fitness, exercise, RCT and intervention. All studies identified during the database search will be retrieved and examined to ensure relevance and that they meet the inclusion criteria using the title, abstract and description/mesh heading by two independent reviewers. If the two independent reviewers disagree on whether a study should be included, a third independent reviewer will be consulted until a consensus has been reached. Assessment of Methodological Quality The standardised critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistical Assessment and Review Instrument (JBI-MAStARI) (Appendix I) will be used by the two independent reviewers to ensure methodological quality of all papers retrieved before inclusion in the review. Any disagreements arising over the inclusion of the papers will be resolved with a discussion or by the third reviewer. Data collection Data will be extracted from the retrieved papers using the instrument developed from the JBI- MAStARI standardised data extraction tool (Appendix II). The data extracted will provide details on: - Study methods: length of intervention, length of follow-up, data collection points, inclusion criteria and method of randomisation - Setting: description of the setting - Participants: number of participants, gender, age and retention rates - Intervention: description of each of the interventions in the study - Comparators: description of each of the comparators used in each study - Outcomes of significance to the review question dietary and physical activity behaviours - Limitations of the study - Author conclusions Data synthesis Where possible, quantitative papers will be pooled into a meta analysis using the (JBI-MAStARI). Odds ratios for categorical data and weighted mean differences for continuous data (including their 95% confidence intervals) will be calculated. Standard Chi-square will be used to assess heterogeneity of the studies. All results will be entered twice to minimise human error. 5

6 Conflicts of interest None to be declared. Acknowledgements This systematic literature review will form part of the theses work for RHD candidate Jenna Hollis from the University of Newcastle, Australia. 6

7 References 1 Spahn JM, Reeves RS, Keim KS, et al. State of the evidence regarding behavior change theories and strategies in nutrition counseling to facilitate health and food behavior change. J Am Diet Assoc. 2010; 110: Rollnick S, Kinnersley P, Stott N. Methods of helping patients with behaviour change. BMJ. 1993; 307: Miller WRR, S. Motivational Interviewing: Preparing people for change. 2nd ed edn. New York: The Guilford Press, Miller WR. Motivational Interviewing with Problem Drinkers. Behavioural and Cognitive Psychotherapy. 1983; 11: Britt E, Hudson SM, Blampied NM. Motivational interviewing in health settings: a review. Patient Educ Couns. 2004; 53: Dunn C, Deroo L, Rivara FP. The use of brief interventions adapted from motivational interviewing across behavioral domains: a systematic review. Addiction. 2001; 96: VanWormer JJ, Boucher JL. Motivational interviewing and diet modification: a review of the evidence. Diabetes Educ. 2004; 30: 404-6, 08-10, 14-6 passim. 8 Rubak S, Sandbaek A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract. 2005; 55: Armstrong MJ, Mottershead TA, Ronksley PE, Sigal RJ, Campbell TS, Hemmelgarn BR. Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Rev Brug J, Spikmans F, Aartsen C, Breedveld B, Bes R, Fereira I. Training dietitians in basic motivational interviewing skills results in changes in their counseling style and in lower saturated fat intakes in their patients. J Nutr Educ Behav. 2007; 39: Bowen D, Ehret C, Pedersen M, et al. Results of an adjunct dietary intervention program in the Women's Health Initiative. J Am Diet Assoc. 2002; 102: Heinrich E, Candel MJ, Schaper NC, de Vries NK. Effect evaluation of a Motivational Interviewing based counselling strategy in diabetes care. Diabetes Res Clin Pract. 2010; 90: Webber KH, Tate DF, Michael Bowling J. A randomized comparison of two motivationally enhanced Internet behavioral weight loss programs. Behav Res Ther. 2008; 46: Harland J, White M, Drinkwater C, Chinn D, Farr L, Howel D. The Newcastle exercise project: a randomised controlled trial of methods to promote physical activity in primary care. BMJ. 1999; 319: DiRosa L. Motivation Interviewing to Treat Overweight/Obesity: A meta-analysis of relevant research. USA: Wilmington University, Hettema J, Steele J, Miller WR. Motivational interviewing. Annu Rev Clin Psychol. 2005; 1:

8 Appendix I: JBI Critical Appraisal Checklist for Experimental Studies Reviewer Date Author Year Record Number Yes No Unclear 1. Was the assignment to treatment groups truly random? 2. Were participants blinded to treatment allocation? 3. Was allocation to treatment groups concealed from the allocator? 4. Were the outcomes of people who withdrew described and included in the analysis? 5. Were those assessing outcomes blind to the treatment allocation? 6. Were the control and treatment groups comparable at entry? 7. Were groups treated identically other than for the named interventions 8

9 8. Were outcomes measured in the same way for all groups? 9. Were outcomes measured in a reliable way? 10. Was appropriate statistical analysis used? Overall appraisal: Include Exclude Seek further info. Comments (Including reasons for exclusion) 9

10 Appendix II: Data Extraction Tool JBI Data Extraction Form for Experimental/Observational Studies Reviewer Date Author Year Journal Record Number Study Method RCT Quasi-RCT Longitudinal Retrospective Observational Other Participants Setting Population Sample size Intervention 1 Intervention 2 Intervention 3 Interventions Intervention 1 Intervention 2 Intervention 3 10

11 Clinical outcome measures Outcome Description Scale/measure Study results Dichotomous data Outcome Intervention ( ) number / total number Intervention ( ) number / total number 11

12 Outcome Intervention ( ) number / total number Intervention ( ) number / total number Authors conclusions Comments 12