Mechanisms of motivational interviewing in health promotion: a Bayesian mediation analysis
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RESEARCH
Open Access
Mechanisms of motivational interviewing in health promotion: a Bayesian mediation analysis Angela G Pirlott1*, Yasemin Kisbu-Sakarya1, Carol A DeFrancesco2, Diane L Elliot2 and David P MacKinnon1
Abstract Background: Counselor behaviors that mediate the efficacy of motivational interviewing (MI) are not well understood, especially when applied to health behavior promotion. We hypothesized that client change talk mediates the relationship between counselor variables and subsequent client behavior change. Methods: Purposeful sampling identified individuals from a prospective randomized worksite trial using an MI intervention to promote firefighters’ healthy diet and regular exercise that increased dietary intake of fruits and vegetables (n = 21) or did not increase intake of fruits and vegetables (n = 22). MI interactions were coded using the Motivational Interviewing Skill Code (MISC 2.1) to categorize counselor and firefighter verbal utterances. Both Bayesian and frequentist mediation analyses were used to investigate whether client change talk mediated the relationship between counselor skills and behavior change. Results: Counselors’ global spirit, empathy, and direction and MI-consistent behavioral counts (e.g., reflections, open questions, affirmations, emphasize control) significantly correlated with firefighters’ total client change talk utterances (rs = 0.42, 0.40, 0.30, and 0.61, respectively), which correlated significantly with their fruit and vegetable intake increase (r = 0.33). Both Bayesian and frequentist mediation analyses demonstrated that findings were consistent with hypotheses, such that total client change talk mediated the relationship between counselor’s skills—MI-consistent behaviors [Bayesian mediated effect: αβ = .06 (.03), 95% CI = .02, .12] and MI spirit [Bayesian mediated effect: αβ = .06 (.03), 95% CI = .01, .13]—and increased fruit and vegetable consumption. Conclusion: Motivational interviewing is a resource- and time-intensive intervention, and is currently being applied in many arenas. Previous research has identified the importance of counselor behaviors and client change talk in the treatment of substance use disorders. Our results indicate that similar mechanisms may underlie the effects of MI for dietary change. These results inform MI training and application by identifying those processes critical for MI success in health promotion domains. Keywords: Motivational interviewing, Dietary change, Occupational health, Firefighters, Bayesian mediation
Background The firefighter stereotype likely elicits an image of a strong hero rescuing individuals from burning buildings. Yet firefighters’ health profiles mirror that of other workers and include an unhealthy diet, a lack of regular physical activity, and being overweight/obese [1]. In addition, occupational hazards increase firefighters’ risk for cancer, heart disease, and musculoskeletal injuries [2-6]. Therefore, firefighters potentially benefit from health promotion programs;
* Correspondence: Angela.P
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