Tailored Motivational Interviewing (TMI): Translating Basic Science in Skills Acquisition into a Behavioral Intervention to Improve Community Health Worker Motivational Interviewing Competence for Youth Living with HIV
Tailored Motivational Interviewing (TMI): Translating Basic Science in Skills Acquisition into a Behavioral Intervention to Improve Community Health Worker Motivational Interviewing Competence for Youth Living with HIV
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DOI：
10.1037/hea0001071
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发表时间：
2021-07-29
影响因子：
4.2
通讯作者：
Fortenberry, J. Dennis
中科院分区：
文献类型：
--
作者：
Naar, Sylvie;Pennar, Amy L.;Fortenberry, J. Dennis
目的：为感染艾滋病毒的少数族裔青年工作的准专业工作人员尤其需要采取干预措施，以促进循证做法。与老年人相比，这些人的艾滋病毒感染率较高，但关联和保留率较低。在先前的研究(阶段1a和1b)中，我们利用用于行为干预开发的Orbit模型，定义并细化了针对提供者的行为干预--定制动机访谈(TMI)，以提高提供者的能力。目前的研究重点是轨道阶段2a--概念验证。我们假设TMI将是可接受和可行的，并将显示出改善和维持社区卫生工作者(CHW)MI能力分数的有效性的信号，使用一种创新的统计方法进行小N概念验证研究。方法：对16家青年HIV机构的19名社区卫生服务人员进行纵向调查。根据协助者的要求，来自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或照常提供服务。MI能力在基线时进行评估，在两年内最多评估15次。采用随机系数模型考察胜任特征得分的时间轨迹以及干预对胜任特征的影响。进行了半结构化访谈，以确定TMI的障碍和促进者。结果：TMI组的能力得分显著升高，而对照组的得分显著降低。对干预组的进一步分析表明，在最初研讨会后的前3个月，得分显著增加，并持续到研究结束。定性结果显示，时间不足和优先事项相互竞争是公认的障碍，而将管理信息纳入机构的常规做法和正在进行的培训可能有助于执行。结论：在成功的概念验证之后，下一步是对TMI与对照条件进行完全随机的先导性研究，为阶梯式楔形群随机全规模试验做准备。
Objective: 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. Method: 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. Results: 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. Conclusions: 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.