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Mechanisms of Behavior Change in a Cultural Adaptation of Motivational Interviewing

动机访谈文化适应中行为改变的机制

基本信息

批准号：
10116231
负责人：
CHRISTINA S LEE
金额：
$ 40.62万
依托单位：
BOSTON UNIVERSITY (CHARLES RIVER CAMPUS)
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-03-01 至 2023-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10116231
关键词：
Acculturation Adult Alcohol consumption Alcoholic beverage heavy drinker Alcohols Anxiety Awareness Behavior Therapy Behavioral Mechanisms Client Code Complex Data Empathy Equation Ethnic group Evidence based intervention Evidence based treatment Group Processes Guidelines Health behavior Heavy Drinking Improve Access Intervention Investigation Knowledge Latino Link Literature Mediation Mediator of activation protein Mental Depression Meta-Analysis Methodology Modeling National Institute on Alcohol Abuse and Alcoholism Outcome Parents Patient Self-Report Population Process Randomized Controlled Trials Recommendation Research Research Design Sampling Science Series Services Source Strategic Planning Stress Structure Testing Therapeutic Training Treatment Efficacy Work active comparator active method alcohol abuse therapy alcohol response base behavior change behavioral outcome burden of illness causal model community setting evidence base follow-up health disparity health disparity populations improved improved outcome innovation motivational enhancement therapy novel pilot trial preservation primary outcome racial and ethnic skills social disadvantage theories trial comparing

项目摘要

Proposal Summary/Abstract Project Title: Mechanisms of Behavior Change in Culturally Adapted Motivational Interviewing The NIAAA Five Year Strategic Plan prioritizes health disparities research for socially disadvantaged Latinos to reduce the disproportionate burden of negative consequences related to alcohol use compared to other racial/ethnic groups (NIAAA, 2013/2016). Cultural adaptation of evidence-based treatments, such as motivational interviewing (MI), can improve access and overall response to alcohol treatment. However, research progress has been hindered by the few theoretically-guided tests of adaptation and limited knowledge about the active ingredients and mechanisms of behavior change that might discriminate an adapted, compared to non-adapted, intervention. The proposed study will fill this important gap by testing a series of theory-driven hypotheses regarding the within-session predictors of MI outcome and a novel mechanism of culturally adapted MI (CAMI) (self-exploration → decreases in perceived acculturation stress, reduced depression and anxiety → reduced heavy drinking and consequences). The proposed study codes and examines within-session, process data from a parent RCT (AAR01021136, Lee: PI) guided by adaptation theory initially tested in a small RCT (AAK23021136, Lee: PI) that showed promising effects in favor of CAMI (Lee et al., 2013). The ongoing parent CAMI trial compared single session MI to single session CAMI delivered to Latino heavy drinkers (N=301, 18-65 yrs old). The parent study design (e.g., assessment of multiple self-report mediators) permits examination of a causal model, while attending to key recommendations on examining mechanisms of change (Kazdin & Nock, 2003). Up-to-date statistical approaches will be used to examine the MI causal hypothesis, such as investigating change and sustain talk together as a proportion estimate (Magill et al., 2014). The parent study design, which used an active comparator (MI), permits between-condition tests of within-session ingredients and mechanisms, which is a level of contrast rare in MI theory and one of the first a- priori investigations of processes of change in an adaptation study. The first task in adaptation is to confirm that key active treatment ingredients and mechanisms are preserved, so study aims are first, to assess MI ingredients and mechanisms among Latino adults, second, to examine novel MI ingredients and mechanisms potentially relevant to both conditions, and third, to test the theory, ingredients, and mechanisms specific to the adaptation. Long term objectives. Findings will improve dissemination of MI to Latinos by providing empirically-based guidelines on therapist training and on critical MI intervention ingredients. It will also improve understanding of the stress-health behavior link observed among health disparities populations and how MI can be used to disrupt this association. The proposed study will be one of the first to contribute to the emerging science on mechanisms of behavior change with health disparities populations and will yield important recommendations on the science of adaptation and ways to improve MI dissemination to community settings.

提案摘要/摘要项目名称：文化适应性动机访谈中行为改变的机制 NIAAA 五年战略计划优先考虑针对社会弱势拉丁裔的健康差异研究与其他行为相比，减少与饮酒相关的负面后果的不成比例的负担种族/族裔群体（NIAAA，2013/2016）。循证治疗的文化适应，例如动机访谈（MI）可以改善酒精治疗的可及性和整体反应。然而，理论指导的适应测试很少和知识有限，阻碍了研究进展关于可能歧视适应者的行为改变的活性成分和机制，与非适应相比，干预。拟议的研究将通过测试一系列来填补这一重要空白关于 MI 结果的会话内预测因素的理论驱动假设以及一种新的机制文化适应 MI (CAMI)（自我探索→减少感知的文化适应压力，减少抑郁和焦虑 → 减少酗酒及其后果）。拟议的研究代码和在适应理论的指导下检查会话内、来自母体 RCT（AAR01021136，Lee：PI）的处理数据最初在小型 RCT（AAK23021136，Lee：PI）中进行测试，显示出有利于 CAMI 的良好效果（Lee 等人）等，2013）。正在进行的家长 CAMI 试验将单次 MI 与单次 CAMI 进行了比较拉丁裔酗酒者（N=301，18-65 岁）。家长研究设计（例如，评估多项自我报告调解员）允许检查因果模型，同时关注检查的关键建议变革机制（Kazdin & Nock，2003）。将使用最新的统计方法来检查 MI 因果假设，例如调查变化并维持谈话作为比例估计（Magill 等等，2014）。父研究设计使用主动比较器 (MI)，允许进行条件间测试会话内的成分和机制，这是 MI 理论中罕见的对比水平，也是第一个 - 适应研究中变化过程的先验调查。适应的首要任务是确认保留了关键的活性治疗成分和机制，因此研究目标首先是评估 MI 其次，研究拉丁裔成年人中新的 MI 成分和机制可能与这两种情况相关，第三，测试特定的理论、成分和机制适应。长期目标。研究结果将通过提供以下信息来改善 MI 向拉丁裔的传播：基于经验的治疗师培训和关键 MI 干预成分指南。它还将提高对健康差异人群中观察到的压力与健康行为之间联系的理解，如何使用 MI 来破坏这种关联。拟议的研究将是最早对这一问题做出贡献的研究之一关于行为改变与健康差异人群的机制的新兴科学将产生关于适应科学和改进 MI 传播的方法的重要建议社区设置。