Johanna E. Soet

Motivational interviewing in health promotion: it sounds like something is changing.

Motivational interviewing (MI), initially developed for addiction counseling, has increasingly been applied in public health, medical, and health promotion settings. This article provides an overview of MI, outlining its philosophic orientation and essential strategies. Major outcome studies are reviewed, nuances associated with the use of MI in health promotion and chronic disease prevention are described, and future directions are offered.

Using motivational interviewing to promote adherence to antiretroviral medications: a pilot study.

This report describes a pilot study of a nursing intervention to increase adherence to combination therapy. The intervention was based on motivational interviewing (MI). Participants completed a baseline assessment using the computer-administered self-interview with audio (ACASI) data collection method and then were randomly assigned to the MI intervention or control condition. Nurse counselors met with participants in the MI intervention group for three adherence sessions. Two months following baseline, participants completed a follow-up assessment. Mean scores on ratings of missed medications were lower for participants in the intervention group than those in the control group. Although there were no significant differences in the number of medications missed during the past 4 days, participants in the MI group reported being more likely to follow the medication regimen as prescribed by their health care provider. The pilot study provided useful information about the acceptability of ACASI and the adequacy of intervention procedures. The results of this pilot study show promise for the use of MI as an intervention to promote adherence to antiretroviral medications.

Using motivational interviewing to promote adherence to antiretroviral medications: A randomized controlled study

Abstract The primary aim of this study was to test an intervention to support antiretroviral medication adherence among primarily low-income men and women with HIV. The study was a randomized controlled trial (Get Busy Living) with participants assigned to treatment (Motivational Interviewing [MI]) and control groups. Participants were recruited from an HIV/AIDS clinic in Atlanta, Georgia, US. Of those referred to the study, 247 completed a baseline assessment and were enrolled with 125 randomized to the intervention group and 122 to the control group. Participants were patients beginning antiretroviral therapy or changing to a new drug regimen. The intervention consisted of five MI sessions delivered by registered nurses in individual counselling sessions. Participants were paid for each session attended. The intervention sought to build confidence, reduce ambivalence and increase motivation for ART medication-taking. Medication adherence was measured by the Medication Event Monitoring System (MEMS®) from the time of screening until the final follow-up conducted approximately 12 months following the baseline assessment. Participants in the intervention condition showed a trend towards having a higher mean percent of prescribed doses taken and a greater percent of doses taken on schedule when compared to the control group during the months following the intervention period. This effect was noted beginning at about the eighth month of the study period and was maintained until the final study month. Although the finding was weaker for overall percent of prescribed doses taken, the results for the percent of doses taken on schedule suggests that the MI intervention may be a useful approach for addressing specific aspects of medication adherence, such as adherrence to a specified dosing schedule.

A social cognitive-based model for condom use among college students.

BACKGROUND Social cognitive theory has been used extensively to explain health behaviors. Although the influence of one construct in this model-self-efficacy-has been well established, the role of other social cognitive constructs has not received as much attention in human immunodeficiency virus (HIV) prevention research. More complete understanding of how social cognitive constructs operate together to explain condom use behaviors would be useful in developing HIV and sexually transmitted disease (STD) prevention programs for college students. OBJECTIVE The primary aim of this study was to test a social cognitive-based model of condom use behaviors among college students. METHODS Data were collected from a sample of college students attending six different colleges and universities. Participants were 18 to 25 years of age, single, and sexually active. For the sample of 1,380 participants, the mean age was 20.6 years (SD = 1.76). Most participants reported having had vaginal intercourse (95.8%) and oral sex (86.5%); 16% reported anal sex. FINDINGS Self-efficacy was related directly to condom use behaviors and indirectly through its effect on outcome expectancies. As predicted, self-efficacy was related to anxiety, but anxiety was not related to condom use. Substance use during sexual encounters was related to outcome expectancies but not to condom use as predicted. CONCLUSIONS Overall, the findings lend support to a condom use model based on social cognitive theory and provide implications for HIV interventions. Interventions that focus on self-efficacy are more likely to reduce anxiety related to condom use, increase positive perceptions about condoms, and increase the likelihood of adopting condom use behaviors.

Mental Health Issues Facing a Diverse Sample of College Students: Results from the College Student Mental Health Survey

Over the past 5 years there has been increased attention given to mental health issues on college and university campuses across the country. However, few research efforts have been conducted to systematically investigate the mental health of college students. The College Student Mental Health Survey was undertaken as a first step towards gaining a better understanding of the broad range of mental health issues that face the college student population. This exploratory study describes the mental health history and current distress and coping of 939 college students from a large Midwestern public university, with an approximate enrollment of 40,000 students. Implications for research, policy, and practice are discussed.

THE EFFECTS OF ETHNICITY AND PERCEIVED POWER ON WOMEN'S SEXUAL BEHAVIOR

To aid development of programs to prevent HIV transmission in women, differences in sexual attitudes and behavior were examined among women who described themselves as dominant in their relationship with a male partner, sharing dominance equally with a male partner, or being dominated by a male partner. Ethnic differences were also examined among these three groups. Results indicated that perceived dominance was a significant predictor of womens personal empowerment (self-efficacy and outcome expectancies) with regard to sexual decisionmaking in their current relationship and safer sex behaviors. Ethnic differences were found between African American and White women in personal empowerment and safer sex behavior. Perceived dominance did not appear to affect African American and White women differently.

The Telephone as a Communication Medium for Health Education

The telephone is being widely used by the private sector as a communication medium for understanding and influencing consumer behavior. Coinciding with the growth of telephone use in the private sector is the expansion of telephone use in health care to include complex health promotion and disease prevention interventions aimed at initiating and maintaining health-related behavioral changes. While several studies have evaluated the impact of telephone interventions on a wide range of health behaviors, no published reports synthesizing current knowledge about using the telephone as a communication medium for health education were identified. In this article, the authors therefore (1) examine recent applications of telephone use in health education by describing three example interventions, (2) outline key features and alternatives in conceptualizing and designing health education using the telephone, (3) review advantages and disadvantages of using the telephone for health education, and (4) discuss implications for health education practice and research.

Detecting and explicating interactions in categorical data.

Detecting and explicating interactions in categorical data analyses using cross tabulation and the [chi]2 statistic can provide salient tests of hypotheses concerning the relationship between two variables measured at the nominal or ordinal levels. For example, researchers usually employ categorical analysis when they are interested in whether members of one group (e.g., males vs. females) differ in the proportion falling into two or more levels of a dependent variable (e.g., in favor of or opposed to sex education in public schools). In this case, the data can be expressed as a two-way table and hypotheses tested with the [chi]2 statistic. Interpretation of this simplest of two-way tables is straightforward. However, research questions are often more complex than this simple example both in the number of predictor variables and the number of levels of each variable. Researchers typically include other predictor variables (e.g., race, academic status, marital status) to gain a better understanding of more complex relationships among predictors and outcomes. In addition, researchers often employ measures that have more than two levels (e.g., income, race, treatment type, academic status), and they often choose to combine levels in one or more variables to simplify the analyses, meet assumptions, or clarify the results.

An evaluation of a self-generated identification code

We describe a self-generated coding form used in a study of HIV prevention practices of college students and provide information on the success rate of matching questionnaires over a 3-year period using the form. The data for this study were from a longitudinal study of HIV risk-reduction practices of college students. In order to match questionnaires over the 3-year study period while maintaining anonymity, participants were asked to complete a self-generated identification form at each data collection point. In the second year of the project, we were able to successfully match 74.3% of the questionnaires to those returned during the first year using 6 to 8 of the code elements on the form, and in the third year, we were able to match 73% of questionnaires to those returned in the second year. Participants for whom questionnaires matched were more likely than participants with unmatched questionnaires to be white students enrolled as underclassmen.

HIV Prevention Knowledge, Attitudes, and Sexual Practices of Asian College Students

Abstract While Asian Americans remain one of the ethnic groups least affected by AIDS, recent data suggests that this may be changing. The incidence of AIDS in the Asian community is increasing. The purpose of this study was to explore the knowledge, attitudes, and sexual practices of a sample of Asian college students. Data were collected from students enrolled at six colleges and universities in a southeastern metropolitan area (n = 2,044). For this analysis, respondents who reported that they were of Asian background and unmarried were included (n = 128). Twenty percent of the subsample (n = 26) indicated they had grown up outside the United States. Descriptive analyses were done by gender and country of early development (U.S. vs. foreign-reared). Results indicated that males were more sexually active, more likely to use condoms and had less positive attitudes toward abstinence than females. U.S.-reared students initiated intercourse at a younger age and had higher knowledge scores than foreign-reared...