Mechanisms of Behavior Change in a Cultural Adaptation of Motivational Interviewing

建议书摘要/摘要 项目名称：文化适应动机访谈中的行为改变机制 NIAAA五年战略计划将社会弱势拉丁裔的健康差距研究放在优先位置 与其他方式相比，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机会和总体反应。然而， 少数理论指导的适应性测试和有限的知识阻碍了研究进展 关于行为改变的有效成分和机制可能会歧视适应的人， 与非适应、干预相比。拟议的研究将通过测试一系列 关于心梗结局的会议内预测因子的理论驱动的假说和一种新的机制 文化适应MI(CAMI)(自我探索性→)减少感知的文化适应压力，减少 抑郁和焦虑→减少了大量饮酒和后果)。建议的研究守则和 在适应理论的指导下，检查来自父RCT(AAR01021136，Lee：PI)的会话内过程数据 最初在小型RCT(AAK23021136，Lee：PI)中进行测试，显示出有利于CAMI(Lee Et)的有希望的效果 Al.，2013)。正在进行的家长CAMI试验比较了单会话MI和单会话CAMI交付到 拉美裔酗酒者(N=301，18-65岁)。家长研究设计(例如，多份自我报告的评估 调解人)允许检查因果模型，同时注意关于检查的关键建议 变化机制(Kazdin&Nock，2003)。将使用最新的统计方法来研究 我的因果假设，如调查变化和维持谈话一起作为比例估计(Magill et Al.，2014)。父母研究设计使用了有源比较器(MI)，允许条件间测试 会议内的成分和机制，这是MI理论中罕见的对比水平，也是最早的 适应研究中变化过程的先验调查。适应的第一个任务是确认 关键的有效治疗成分和机制被保存下来，因此研究目标首先是评估MI 拉丁裔成年人的成分和机制，第二，检查新的MI成分和机制 可能与这两种情况相关，第三，测试特定于 改编版。长期目标。研究结果将改善MI向拉丁裔的传播，方法是 治疗师培训和关键心肌梗死干预成分的经验指南。它还将 提高对在健康差异人群中观察到的压力-健康行为联系的理解 MI如何被用来破坏这种联系。拟议的研究将是首批有助于 关于健康差异人群行为变化机制的新兴科学，将产生 关于适应科学的重要建议和改善MI传播的方法 社区设置。

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.