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

背景：与将军相比，退伍军人遭受与香烟相关的疾病和死亡的比例更高 人口，但退伍军人经常支持低动力戒烟。无动机的客户语言分析 吸烟者可能会提供新的见解，让人们了解动机是如何随着不同的治疗而改变的。治疗的方法 没有动机的吸烟者包括动机访谈(MI)，旨在通过以下方式增强内在动机 解决矛盾心理；以及健康教育(HE)，提供脚本化的健康建议。MI研究表明 这增加了会话中的客户“改变谈话”(CT)，或反映对改变目标的承诺的语言 行为，相对于“持续谈话”(ST)，或反映计划继续目标行为的语言，是 与改善治疗结果相关。他可能包含反映学习的客户声明，或者 “学习谈话”(Listing Talk)，以回应健康信息，这可能会通过 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的语言 (RCT)由我们的合作调查员进行的MI和HE与无动机吸烟者的比较，包括1)a) 对255名无动机吸烟者进行的社区随机对照试验；和2)退伍军人健康管理局(VHA)的试点研究 85名患有精神疾病的资深吸烟者，其中一部分人报告戒烟动机较低。对客户的分析 对无动机吸烟者进行的这些研究中的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：鉴于退伍军人吸烟的高流行率， 确定与无动机吸烟者的积极结果相关的治疗技术具有重大意义 改善退伍军人健康的潜力。该项目涉及精神健康、初级保健等高铁研发的优先事项 实践，以及质量/安全。创新：这个混合方法项目是此类项目中第一个检查方面的项目 非动机吸烟者治疗效果预测指标的研究 VHA护理中大多数资深吸烟者的代表。具体目标：目标1是在音频中编码客户语言 记录了两个随机对照试验对无动机吸烟者的MI和HE会话，包括社区样本和 老兵样本。我们假设，在这两个数据集中，心肌梗死的CT比例将高于HE，并且 高血压病患者会比心肌梗塞患者更高。目的2探讨CT与ST的比例与CT和ST的关系 在社区样本中，LT与RT的比例以及3个月和6个月的治疗结果。我们假设 CT相对于ST的更高比例将与治疗结果正相关，无论是在 MI和HE；与RT相比，LT的比例较高将与结果呈正相关，两者在MI中都是如此 在同一疗程中，高CT和高LT将与改善结果相关 相对于单纯高CT或单纯ST段，与治疗组无关。我们还假设 CT比例对MI的疗效起中介作用，LT比例对HE的疗效起中介作用。 目标3是利用结果为资深吸烟者开发一份简短的手册，其中包括HE和MI。研究方法： 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会话。为了编写会议代码，我们将使用激励性面试技巧 代码2.5(MISC 2.5)，一种经过验证的MI客户端语言度量，用于编码CT和ST；以及LT编码扩展 我们团队开发的MISC 2.5系统，用于量化客户语言LT，或反映客户学习； 以及客户拒绝健康信息或拒绝谈话(RT)。我们将根据调查结果编写一份简短的手册 为VHA诊所中没有动力的资深吸烟者准备的。在整个项目中，我们将与一个顾问小组合作 资深利益相关者和VHA领导人，他们将就手册提供意见。实施/后续步骤： 该项目的最终目标是确定MI和HE潜在的治疗作用机制。 没有动机的吸烟者。研究结果将允许我们的团队申请资金来测试一项简短的干预措施，其中包括 在VHA临床环境中，来自HE和MI的有效技术适用于无动机的资深吸烟者。

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.