Mechanisms of Behavior Change in a Cultural Adaptation of Motivational Interviewing

提案摘要/摘要 项目名称：文化适应动机面试中的行为变化机制 NIAAA五年战略计划优先考虑社会弱势拉丁美洲人的健康差异研究， 减少与酒精使用有关的负面后果的不成比例的负担， 种族/民族群体（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获得和整体反应。然而，在这方面， 研究进展一直受到少数理论指导的适应性测试和有限知识的阻碍 关于行为改变的活性成分和机制，可能会区分一个适应， 与非适应性干预相比。拟议的研究将通过测试一系列 关于MI结局的会话内预测因子的理论驱动的假设和 文化适应性MI（CAMI）（自我探索→减少感知的文化适应压力，减少 抑郁和焦虑→减少酗酒和后果）。拟定的研究代码和 在适应理论的指导下，检查来自父RCT（AAR 01021136，Lee：PI）的会话内过程数据 最初在小型RCT（AAK 23021136，Lee：PI）中进行了测试，其显示出有利于CAMI的有希望的效果（Lee et 例如，2013年）。正在进行的母CAMI试验比较了单次治疗MI和单次治疗CAMI， 拉丁裔重度饮酒者（N=301，18-65岁）。母研究设计（例如，多重自我报告评估 调解员）允许检查因果模型，同时注意检查的关键建议 变化机制（Kazdin & Nock，2003）。最新的统计方法将用于审查 MI因果假设，如调查变化和维持谈话一起作为比例估计（马吉尔等 例如，2014）。使用活性对照药物（MI）的母研究设计允许进行以下条件间检验： 会话内成分和机制，这是MI理论中罕见的对比水平，也是第一个 在适应性研究中对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，因此研究目的首先是评估MI 第二，研究新的MI成分和机制 可能与这两种情况有关，第三，测试理论，成分，和特定的机制， 适应。长期目标。研究结果将通过提供以下方式改善MI向拉丁美洲人的传播 关于治疗师培训和关键MI干预成分的基于实践的指南。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， 如何利用MI来破坏这种关联。拟议的研究将是第一批有助于 新兴的科学机制的行为变化与健康差距的人口，并将产生 关于适应科学的重要建议和改进管理信息传播的方法， 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.