Evaluating the Effectiveness of Brief Motivational Interviewing As an Adjunct to Health Home Services

by Brittany Anne Tenbarge

Institution: University of Toledo
Department: Psychology
Degree: PhD
Year: 2014
Keywords: Clinical Psychology; Motivational Interviewing; Health Home; integrated healthcare; nutrition; physical activity; smoking cessation
Record ID: 2024965
Full text PDF: http://rave.ohiolink.edu/etdc/view?acc_num=toledo1415225884


Research indicates that individuals with severe and persistent mental illness (SPMI) experience higher rates of medical comorbidity and mortality than the general population (Colton & Manderscheid, 2006; Miller, Paschall, & Svendsen, 2006; Scott & Happell, 2011). These physical health disparities have not yet been addressed adequately by the healthcare system (Felker, Yazel, & Short, 1996). In the current study, a brief Motivational Interviewing (MI) intervention was evaluated as an adjunct to the Health Home model of integrated health care at a large community mental health center providing services to adults with severe and persistent mental illness in an urban area. MI is a therapeutic intervention with efficacy in promoting improved well-being and health-related behavior change, including behaviors contributing to poor health and increased morbidity for adults living with SPMI. Some preliminary evidence suggests MI can even be effective in brief, one session forms. A longitudinal (pre-post) design was utilized to assess the impact of Health Home and brief MI interventions on objective physical health outcomes (i.e., blood pressure, heart rate, weight, and BMI), as well as self-reported health-related behaviors (i.e., nutrition, physical activity, and smoking behaviors as measured by the Health-Related Behavior Questionnaire). Results indicated that participants were experiencing high rates of medical comorbidity (e.g., hypertension, obesity, and diabetes) and engaging in unhealthy lifestyle behaviors consistent with prior literature assessing adults living with SPMI in community settings and providing rationale for interventions aimed at improving wellness. Engagement in Health Home services (regardless of participation in MI) was associated with some positive outcomes (e.g., an increase in the average number of days per week that participants engaged in physical activity; moderate, significant reductions in both systolic and diastolic blood pressure) over a 3-month period. One brief MI session appeared to succeed in its intended purpose (i.e., assisting people in moving from a lower stage of change to a higher stage of change). Specifically, the majority of people who received brief MI experienced a slight increase in their desire to change (on a scale of 0-10) and almost half of the participants experienced an increase in their confidence that they could successfully change a health-related behavior (i.e., nutrition, physical activity, or smoking). Additionally, with regard to smoking, participants who received brief MI were more likely to report they had thought about quitting smoking than those receiving Health Home services only. Unfortunately, increased motivation for behavior change was not associated with an increase in attempts to change after one brief MI session. In general, it appears a longer course of MI intervention is needed to result in a clinically meaningful change in physical health and health-related behaviors above and beyond that of participants’ typical Health Home services. Future studies…