Client Language Analysis in Veterans and Non-Veterans with Low Motivation to Quit Smoking: Identifying Mechanisms of Change

戒烟动机低的退伍军人和非退伍军人的客户语言分析：识别变化机制

• 批准号: 10313988
• 负责人: Ellen Herbst
• 金额: --
• 依托单位: VETERANS AFFAIRS MED CTR SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-10-01 至 2023-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10313988
• 关键词: Address; Affect; Behavior; Caring; Cessation of life; Cigarette; Client; Clinic; Clinical; Code; Communities; Community Health Education; Data; Data Set; Disease; Funding; General Population; Goals; Health; Health education; High Prevalence; Intervention; Language; Language Development; Lead; Learning; Link; Low income; Manuals; Measures; Mediating; Mediator of activation protein; Mental Health; Mental disorders; Methodology; Methods; Morbidity - disease rate; Motivation; Movement; National Cancer Institute; Outcome; Pathway interactions; Pharmaceutical Preparations; Pilot Projects; Population; Practice Guidelines; Primary Health Care; Public Health; Randomized; Randomized Controlled Trials; Reporting; Research; Research Personnel; Safety; Sampling; Smoke; Smoker; Smoking; Smoking Cessation Intervention; System; Techniques; Testing; Therapeutic; Treatment outcome; United States National Institutes of Health; Veterans; Veterans Health Administration; Work; behavior change; brief advice; brief intervention; cigarette smoke; effective intervention; improved; improved outcome; innovation; insight; intrinsic motivation; mortality; motivational enhancement therapy; response; skills; smoking cessation; smoking prevalence; treatment effect; treatment group; trial comparing

Background: Veterans disproportionately suffer cigarette-related disease and death relative to the general population, but Veterans often endorse low motivation to quit. Analysis of client language with unmotivated smokers may provide new insights into how motivation shifts in response to different therapies. Therapies for unmotivated smokers include motivational interviewing (MI), which aims to enhance intrinsic motivation by resolving ambivalence; and health education (HE), which delivers scripted health advice. MI research suggests that increased in-session client “change talk” (CT), or language reflecting commitment to change the target behavior, relative to “sustain talk” (ST), or language reflecting plans to continue the target behavior, is associated with improved treatment outcomes. HE may contain client statements reflecting learning, or “learning talk” (LT), in response to health information, which may lead to improved outcomes through a different therapeutic mechanism. We propose to analyze client language from two randomized controlled trials (RCTs) comparing MI to HE with unmotivated smokers conducted by our Co-Investigators, including 1) a community RCT with 255 unmotivated smokers; and 2) a Veterans Health Administration (VHA) pilot study with 85 Veteran smokers with mental illness, of which a subset reported low motivation to quit. Analysis of client language in MI and HE sessions from these studies with unmotivated smokers will provide insight into the mechanisms underlying MI and HE. Significance/Impact: Given the high prevalence of smoking in Veterans, identifying therapeutic techniques associated with positive outcomes in unmotivated smokers has great potential to improve Veteran health. This project addresses HSR&D priorities of mental health, primary care practice, and quality/safety. Innovation: This mixed methods project is the first of its kind to examine aspects of in-session client language as predictors of treatment outcomes in unmotivated smokers, a population representative of most Veteran smokers in VHA care. Specific Aims: Aim 1 is to code client language in audio recorded MI and HE sessions from two RCTs with unmotivated smokers, including a community sample and a Veteran sample. We hypothesize that in both datasets, proportion of CT will be higher in MI than HE and that LT will be higher in HE than in MI. Aim 2 is to examine the relationship between proportion of CT to ST and proportion of LT to RT and 3- and 6- month treatment outcomes in the community sample. We hypothesize that that a higher proportion of CT relative to ST will be positively associated with treatment outcomes, both in MI and HE; that a higher proportion of LT relative to RT will be positively associated with outcomes, both in MI and HE; and that both high CT and high LT in the same session will be associated with improved outcomes relative to either high CT alone or ST alone irrespective of treatment group. We also hypothesize that proportion of CT will mediate treatment effects in MI, and proportion of LT will mediate treatment effects in HE. Aim 3 is to use results to develop a brief manual for Veteran smokers incorporating HE and MI. Methodology: We will use mixed methods to code and analyze 102 MI and 102 HE sessions from the community RCT and 15 MI and 15 HE sessions from the VHA RCT. To code sessions, we will use the Motivational Interviewing Skill Code 2.5 (MISC 2.5), a validated MI client language measure, to code CT and ST; and a LT coding extension system of the MISC 2.5 developed by our team to quantify client language LT, or reflective of client learning; and client rejection of health information, or rejection talk (RT). We will use findings to develop a brief manual for unmotivated Veteran smokers in VHA clinics. Throughout the project, we will work with an advisory panel of Veteran stakeholders and VHA leaders, who will provide input on the manual. Implementation/Next Steps: The ultimate goal of the project is to identify therapeutic mechanisms of action underlying MI and HE for unmotivated smokers. Findings will allow our team to apply for funding to test a brief intervention incorporating effective techniques from both HE and MI for unmotivated veteran smokers in VHA clinical settings.

背景：相对于普通人，退伍军人不成比例地遭受与癌症相关的疾病和死亡。 人口，但退伍军人往往赞同低动机戒烟。无动机的客户语言分析 吸烟者可能会提供新的见解，以了解动机如何根据不同的治疗方法而变化。疗法 动机访谈（MI）旨在通过以下方式增强内在动机： 解决矛盾心理;健康教育（HE），提供脚本健康建议。MI研究表明 增加了会话中客户的“改变谈话”（CT），或反映改变目标的承诺的语言 行为，相对于“维持谈话”（ST），或反映计划继续目标行为的语言， 与改善治疗结果相关。HE可能包含反映学习的客户陈述，或 “学习谈话”（LT），以应对健康信息，这可能会导致改善的结果，通过 不同的治疗机制。我们建议从两个随机对照试验中分析客户语言 由我们的合作研究者在无动机吸烟者中进行的比较MI与HE的随机对照试验，包括1）a 社区随机对照试验，255名无动机吸烟者; 2）退伍军人健康管理局（VHA）试点研究， 85名患有精神疾病的老烟民，其中一部分人报告戒烟动机低。客户分析 在这些研究中，无动机吸烟者的MI和HE会话中的语言将提供对 MI和HE的潜在机制。意义/影响：鉴于退伍军人吸烟率很高， 确定与无动机吸烟者的积极结果相关的治疗技术， 改善退伍军人健康的潜力。该项目涉及HSR&D的精神健康，初级保健优先事项 实践和质量/安全。创新：这个混合方法项目是同类项目中第一个研究 在非动机性吸烟者中，会话中客户语言作为治疗结果的预测因子， 代表VHA护理中的大多数退伍军人吸烟者。具体目标：目标1是在音频中编码客户端语言 记录了来自两个随机对照试验的无动机吸烟者的MI和HE会话，包括社区样本和 经验丰富的人。我们假设在两个数据集中，MI中CT的比例高于HE， HE组LT高于MI组。目的2是检查CT与ST的比例与 LT与RT的比例以及社区样本中3个月和6个月的治疗结果。我们假设 CT相对于ST的较高比例将与治疗结果呈正相关， MI和HE; LT相对于RT的比例更高将与MI和HE的结局呈正相关 高CT和高LT在同一个疗程中将与改善的结果相关 相对于单独的高CT或单独的ST，不考虑治疗组。我们还假设， CT的比例将介导MI的治疗效果，LT的比例将介导HE的治疗效果。 目标3是使用结果来制定一个简短的手册，为退伍军人吸烟者纳入HE和MI。方法学： 我们将使用混合方法对来自社区RCT的102个MI和102个HE会话进行编码和分析， 来自VHA RCT的15次MI和15次HE治疗。要对会话进行编码，我们将使用动机性面试技巧 代码2.5（MISC 2.5），一种经验证的MI客户端语言测量，用于编码CT和ST;以及LT编码扩展 由我们的团队开发的MISC 2.5系统，用于量化客户语言LT或反映客户学习; 和客户拒绝健康信息，或拒绝谈话（RT）。我们将利用调查结果制定一份简短的手册 在VHA诊所为无动机的退伍军人吸烟者提供服务。在整个项目中，我们将与一个顾问小组合作， 经验丰富的利益相关者和VHA领导人，他们将为手册提供投入。实施/后续步骤： 该项目的最终目标是确定MI和HE的治疗作用机制， 无动机的吸烟者研究结果将允许我们的团队申请资金，以测试一个简短的干预， 在VHA临床环境中，HE和MI对无动机的资深吸烟者的有效技术。